Dietary phosphate toxicity: an emerging global health concern
Erem, S., Razzaque, M.S.
Phosphate is a common ingredient in many healthy foods but, it is also present in foods containing additives and preservatives. When found in foods, phosphate is absorbed in the intestines and filtered from the blood by the kidneys. Generally, any excess is excreted in the urine. In renal pathologies, however, such as chronic kidney disease, a reduced renal ability to excrete phosphate can result in excess accumulation in the body. This accumulation can be a catalyst for widespread damage to the cellular components, bones, and cardiovascular structures. This in turn can reduce mortality. Because of an incomplete understanding of the mechanism for phosphate homeostasis, and the multiple organ systems that can modulate it, treatment strategies designed to minimize phosphate burden are limited. The Recommended Dietary Allowance (RDA) for phosphorous is around 700 mg/day for adults, but the majority of healthy adult individuals consume far more phosphate (almost double) than the RDA. Studies suggest that low-income populations are particularly at risk for dietary phosphate overload because of the higher amounts of phosphate found in inexpensive, processed foods. Education in nutrition, as well as access to inexpensive healthy food options, may reduce risks for excess consumption as well as a wide range of disorders, ranging from cardiovascular diseases to kidney diseases to tumor formation. Pre-clinical and clinical studies suggest that dietary phosphate overload has toxic and prolonged adverse health effects. Improved regulations for reporting of phosphate concentrations on food labels are necessary so that people can make more informed choices about their diets and phosphate consumption. This is especially the case given the lack of treatments available to mitigate the short and long-term effects of dietary phosphate overload-related toxicity. Phosphate toxicity is quickly becoming a global health concern. Without measures in place to reduce dietary phosphate intake, the conditions associated with phosphate toxicity will likely to cause untold damage to the wellbeing of individuals around the world.
Decreased bone mass and an increased risk of bone fractures become more common with age. This condition is often associated with osteoporosis and is caused by an imbalance of bone resorption and new bone formation. Lifestyle factors that affect the risk of osteoporosis include alcohol, diet, hormones, physical activity, and smoking. Calcium and vitamin D are particularly important for the age-related loss of bone density and skeletal muscle mass, but other minerals, such as magnesium, also have an important role. Here, we summarize how optimal magnesium and vitamin D balance improve health outcomes in the elderly, the role of magnesium and vitamin D on bone formation, and the implications of widespread deficiency of these factors in the United States and worldwide, particularly in the elderly population.
Chapter 24. The crosstalk between phosphate, FGF23 and klotho in the regulation of tissue homeostasis in health and disease.
Fibroblast Growth Factor 23 describes how FGF23 was initially identified as a bone-derived factor targeting the kidney. As such, sections in this comprehensive book cover exciting research that shows that different FGF23 effects require distinct signaling receptors and mediators that differ among target tissues, cover FGF23 initially identified as a bone-derived factor targeting the kidney, look at FGF23 as a regulator of phosphate metabolism and beyond, and cover research on novel concepts of FGF receptor signaling. Additional sections cover biochemistry, pharmacology and nephrology, making this book an ideal reference source on FGF23.
We all know that too much exposure to UV radiation from the sun can cause skin cancer. It is equally well known that the production of Vitamin D as a result of sunlight exposure has many benefits, not the least of which is its positive impact on bone health and conditions such as rickets, osteoporosis, and osteomalacia, to name a few. What is not well known is the benefits of sunlight exposure beyond Vitamin D production. Our review suggests that sunlight exposure, independent of vitamin D, has positive/moderating effects on colorectal cancer, diabetes, hypertension, immune-mediated inflammatory diseases, multiple sclerosis, and obesity. Covid-19 and its relationship to sunlight exposure and vitamin D are also reviewed.