drawing by marguerita
As much as I try to come to a logical understanding, for someone who always loved and still loves food, I am in a real tough spot.
Now more than ever i crave for all the ingredients, spices, fruits, vegetables,and different ways of cooking food, I am forced to calculate,to forget about and just imagine how green is my valley.
So I read and study every possible way of finding how to negotiate this deal with Life and Death.
Below, a text about phosphorus. Ain't that great: I even glow in the Dark. Ha!!!!!!
To get a better understanding of phosphate binders, let's talk about what roles phosphorus and calcium play in your body. Phosphorus and calcium are two minerals that are vital for keeping your body in good health. In particular, they help to maintain strong, healthy bones and teeth. They are also important for the cells in your body to store and use energy efficiently. These minerals play important roles in nerve function as well.
Normally, your body maintains a delicate balance between the levels of phosphorus and calcium. The amount of calcium and phosphorus (in the form of phosphate) in your blood is tightly regulated in various ways. One of these ways is by controlling the amount of phosphate that is absorbed from your food and excreted by your kidneys. Another important way to control phosphate and calcium levels is through a hormone called parathyroid hormone (PTH).
When your kidneys fail, they are no longer able to get rid of excess phosphate from your body. Kidney failure also results in excess PTH production, which further disrupts the balance between calcium and phosphate in your blood. As a result, excess phosphate starts to build up in your blood.
If you don't control your phosphate levels, you may be at risk for developing complications like heart disease, bone damage and other diseases. High phosphate levels can also contribute to vitamin D deficiency. This may require treatment with vitamin D supplements, which can make your body absorb more calcium from your food or medications.
Luckily, as a dialysis patient, you have three ways to help control phosphorus levels in your blood through diet, dialysis and phosphate binders:
Diet: Cutting back on phosphorus-rich food such as dairy products, nuts and beans help lower your phosphorus blood levels. However, it's important to have a balanced, nutritious diet, so it's difficult to control your phosphate levels by relying only on your renal diet.
Dialysis: Following your regular dialysis treatments will help remove some of the excess phosphorus from your body. But dialysis and diet alone may not be enough to control phosphorus levels.
Phosphate binders: Phosphate binders help to pass excess phosphate out of your body in your stool, reducing the amount of phosphate that gets into your blood. These medicines "bind" the phosphate in your digestive tract by combining with it to form a compound that isn't absorbed into your blood. You normally take phosphate binders with every meal to help protect you from absorbing too much phosphate from your food and drink. When you take phosphate binders as prescribed, and follow your renal diet, you can take back control of your phosphate levels. You must also make sure to get your full dialysis treatment.
It is very important to control phosphate levels when you have kidney disease. Doing so can help reduce the risk of a variety of complications. It's also important to control your calcium levels, especially when your phosphate levels are high. Most of your calcium intake is from food (dairy products), calcium containing phosphate binders and dialysis solutions. Your doctor can help you balance your calcium by adjusting your prescriptions for calcium-containing phosphate binders, calcium and vitamin D supplements or by prescribing a calcium-free phosphate binder.
When you take in too much calcium, you can develop an excess calcium load. Because your body tightly controls blood calcium levels, the excess calcium may "spill over" into other tissues, even though calcium levels in your blood remain normal. When excess calcium and excess phosphate are present, they can combine to form bony deposits in your tissues and organs. This process is called metastatic calcification. These bony deposits can cause severe pain, itchy skin, red eyes and other symptoms. These deposits can occur in your lungs, causing pain and difficulty in breathing. When these bony deposits occur in your heart and blood vessels, this is called cardiac calcification. The consequences of cardiac calcification are severe heart damage and even death may follow.
There are three common types of phosphate binders:
1. Aluminum-based phosphate binders were the first type of phosphate binders to be used. They are very effective at controlling phosphorus. The most common binder of this type is aluminum hydroxide. However, aluminum has toxic effects that cause bone disease and damage the nervous system. For this reason, aluminum-based phosphate binders are not often used much anymore.
2. Calcium-based phosphate binders are effective but don't bind phosphorus as well as aluminum. Common types of calcium-based binders include calcium acetate and calcium carbonate. These binders can also serve as calcium supplements if your calcium is low. However, if you are taking vitamin D supplements, you may already have high calcium levels, and these types of phosphate binders may provide more calcium than you should safely have (i.e., excess calcium load). This can increase the risk of metastatic calcification and the complications described below.
3. Aluminum-free, calcium-free phosphate binders are newer binders that are effective at controlling phosphorus. Because they do not contain aluminum or calcium, they do not cause problems with excess aluminum or calcium load.
You can now see why it's important to control your phosphorus and calcium levels. With the help of your healthcare team, find out your target calcium and phosphorus levels. By following your renal diet, dialyzing regularly, and taking your prescribed phosphate binders, you can control your phosphorus and calcium levels. This will help you feel better, stay healthier and avoid some of the complications of kidney disease.
Keith Norris, MD is Professor and Executive Vice Chair of Medicine, Department of Internal Medicine, Charles R. Drew University of Medicine and Science and the University of California, Los Angeles (UCLA). He serves on the AAKP Board of Directors and the AAKP Medical Advisory Board and is an AAKP Life Member.