Doctor's Note

Here’s a direct link to my kidney video: Treating Kidney Failure Through Diet. And my discussion of plant versus animal iron sources: Risk Associated With Iron Supplements.

Another toxic addition to alter the color of meat is arsenic-containing drugs fed directly to chickens. See my video Arsenic in Chicken. Carbon monoxide is used to keep red meat red, anthoxanthins keep salmon pink (Artificial Coloring in Fish) and titanium dioxide is used to whiten processed foods (Titanium Dioxide & Inflammatory Bowel Disease). It’s amazing the risks the food industry will take to alter food cosmetically (Artificial Food Colors and ADHD).

There are other harmful additives in soda as well (Is Sodium Benzoate Harmful? and Diet Soda and Preterm Birth).

What else is in poultry purge (chicken “juice”)? Find out (if you dare!) in my next video, Phosphate Additives in Chicken.

For more context, check out my associated blog post: What Do Meat Purge and Cola Have in Common?

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  • Adrien

    Crazy story once again. I’m happy to be vegan sometimes. I got some questions in mind: Do we have dietary need for phosphate ? The bones aren’t made of calcium and phosphate bonded together ? and it doesn’t get inside the ATP molecule too ? Are we at risk of high phosphate intake if we use creatine supplement with a whole plant based diet ? Sometimes I’m confused, phosphate, phosphorous, phosphoric acide.. It looks like iron, needed but not too much. It’s seems that once again, plants offer the best choice.

    • Darryl

      The U.S. IoM’s report on its dietary phosphorus recommendations has some answers. For both adult men and women, the estimated average requirement is 580 mg, achieved in the lowest percentile of consumption. Meanwhile, median intake for men is roughly 1550 mg, and for women, 1000 mg.

      Phosphorus is so ubiquitous in various foods that near total starvation is required to produce dietary phosphorus deficiency

      As the report notes, phosphorus uptake is poorly regulated, and in those with poor kidney function that can’t rapidly excrete the excess, supersaturated calcium phosphate can precipitate out of solution (like rock candy) causing soft-tissue calcification and further kidney damage. Since that report, we’ve learned that serum phosphate in the high-normal range increases vascular calcification (a complex process where some vascular smooth muscle cells start acting like bone cells), that high levels are achieved in healthy subjects after high phosphate meals, and high phosphate directly impairs endothelial function.

      Also, scoop!.

    • Dan

      Adrien, intestinal phosphate loading actually reduces calcium absorption by complexing with calcium in the gut and inactivating it so that the calcium cannot get absorbed. Thus despite the fact that our skeletal predominant article is calcium hydroxyapatite (which has phosphate in it), we do ourselves a disservice by taking in too much phosphate in the diet. This is one of the reasons that colas literally leach our skeleton of calcium (another is that they are highly acidic).

      • Adrien

        Thanks for the hint on phosphate and calcium absorption/balance. But, on the subject of leaching calcium from our bones (due to an acidic environnement) that theory had been revised. And it seems that acidity damage more our muscles than our bones. That being said, I don’t drink soda and has been since a while and I think my diet is slightly alkali. Thanks to my favorite doctor, I discovered the amazing “flower power” hibiscus tea ;)

        More hints on my other questions, anybody ?

        • Dan

          Adrien, I did not realize that the theory on how soda pop damages bones by being acidic has been revised. Certainly soda will rot your teeth enamel, in part due to hyperacidity.

          Also, with respect to your other questions (ADP + P = ATP), I would make a conjecture that as long as you are not hypophosphatemic, bioenergetics will not be compromised. It is very difficult to become hypophosphatemic through diet alone. Certain tumors of the gastrointestinal tract can leach large amounts of phosphate which can cause hypophosphatemia and all the problems therein (e.g. muscle breakdown).

          I hope someone else can answer your question about creatine, as I really don’t know. I am not aware of any evidence linking creatine supplements with hyperphosphatemia.

    • Steve

      @disqus_7EbxqJ0UaN:disqus I’m happy to be vegan all the damn time :-)

      • Mark

        DAMN RIGHT!!!

    • beccadoggie10

      We do have a dietary need for phosphorus. Our bones contain phosphorous. But what we need and what we are getting from industrial and agrochemical companies are two different stories.

  • Dan

    That’s an amazing video. Yes phosphate is a really hot topic right now in kidney circles. Interestingly, calcimetics which bind up and inactivate phosphate do not appear to lower mortality in kidney disease patients (e.g. BEACON and ANCHOR trials). This has led some to believe that phosphate is an epiphenomenon (not causally related to death and cardiovascular events in kidney disease patients); however, these agents may have significant off-target toxicity (like the HDL-raising drugs) that obviate any phosphate-lowering benefit.

    The injection industry is also fascinating. I did not realize that chickens are dunked in a bath of basically pus-water to boost up their weight; in fact, up to 30% of the weight of the chicken that people are buying in the grocery store consists of this added pus-filled water. Why pus? Because of the factory farm system being so hard on animals; read it in “Eating Animals” by Jonathan Safran-Foer. Fascinating!

    Who wants to eat injected anything? I agree with Adrien that videos like this only confirm my decision to go vegan. I thank you, Dr Greger, for continuing to produce them.

  • Plantstrongdoc M.D.

    And hence the responsible governments in US, Canada and Europe will ban the use of phosphate additives to protect the consumer………..won’t they ?

    • Myomoto Nori Sato

      Not unless there is money to be made out of it…

      • Adrien

        Indeed, have you notice that there is war against cancer, but not against homelessness ? No money can be made out of poor people, but a lot of diseased and scared people.

        • Plantstrongdoc M.D.

          And the war on cancer has been going on for 40 years with limited results (I mean we are not winning), probably because of wrong approach – attack (toxic treatment) instead of defence (prevention). Reason: A lot of money in treatment, no money in prevention.

          • b00mer

            Re: the war on cancer — I thought this was a really good article. Definitely changed my perspective. Even when the mainstream powers that be talk “prevention” what they’re typically describing is actually treatment/tests, or fear-mongering, without any real guidance on real preventative measures (i.e. vegetables).

            “Our Feel-Good War on Breast Cancer”

            I’d like to note I have never had breast cancer or even had any close loved ones have it, and I’m not personally trying to discourage the self-tests or mammograms; I just think this article raises some good questions for discussion.

          • Dan

            Actually mammography is pretty controversial. Even here in Canada we over-screen with it. The group that sets the guidelines for clinical practice has just told doctors to substantially back off and start at a later age. There is not a lot of high quality evidence that mammography saves lives or prevents advanced cancer. The head of the Cochrane Nordic Centre in Denmark is adamantly against breast cancer as he feels that the balance of benefits and harms is highly weighted towards harms (false positives, unnecessary biopsies, unnecessary anxiety, radiation-associated tumors). I am not in the field so I do not keep “abreast” of the recommendations as closely as I would need to if I was in oncology or family medicine, but it seems many cancer screening practices have lately been turned against – e.g. PSA testing and mammography, just to name two. Of course the oncologists, urologists and surgeons are up in arms against these recommendations as this represents a direct threat to their bottom line. A woman is much more likely to die from cardiovascular disease than breast cancer, but most worry far more about breast ca than they do their vascular health, which can be definitely influenced through diet.

          • Plantstrongdoc M.D.

            Screening is not prevention, but early detection, and that can be problematic as Dan points out. The 5 year survival is longer with early detection, not necessarily because of treatment, but because you were diagnosed at an earlier stage of disease.

          • I recommend all women who are considering getting a mammogram read the Cochrane Leaflet on Screening Mammography and discuss with their physicians…
            I believe all physicians/nurse practitioners/physician assistants who are involved with breast cancer screening read Peter Gotzsche’s book. See Dr. McDougall’s May 2012 for more information on this book which goes through all the studies.

          • Thea

            b00mer: That NY Times article is SO good and comes at such a good time for me given a family conversation I am having. Thank you for posting it here.

          • b00mer

            You’re welcome Thea, I’m glad you found it helpful. :) I can remember back to learning about self breast exams in middle school – being taught to “fear our breasts” as the article describes as pre-teens. But of course no one ever taught us about broccoli, tea, mushrooms, soy, etc, any of the real proactive and empowering preventative measures we could take. It’s a shame about how much money gets funneled into perpetual fund-raising rather than research by the big advocacy groups, and yet at the same time there is *so much* that women can do to help themselves with the research and knowledge that we have so far. If only that knowledge was being presented in the mainstream media rather than the message that we’re all helpless victims.

          • Thea

            I resonate with everything you just wrote!!

            I feel a lot more empowered now about my own health. All aspects of it, including avoiding breast cancer. Too bad this info isn’t more widely shared. Ah well, one person at a time…

    • Dan

      Industry – agribusiness and junk food manufacturers like Coca Cola – would stop any effort to ban the use of phosphate additives to protect the consumer, as they will not want to lose market share (e.g. by turning their product ‘black’ or stopping purge). On the other hand, no one is speaking up to government to protect our ‘nutritional health rights’. It is classic ‘David vs Goliath’ and we are all David (those of us who are even in the ‘know’). The only solution that I can see is to stop consuming phosphate-rich sources like meatstuffs and cola, as well as junk food with processed, unpronounceable ingredients.

      • Plantstrongdoc M.D.

        The best is to eat food with only one ingredient – broccoli contains broccoli!

        • beccadoggie10

          As long as broccoli is grown by the original organic method, and preferably by individuals rather than mass producing farmers.

          • Plantstrongdoc M.D.

            Well, yes.

      • beccadoggie10

        I agree. But, how are we going to avoid GMO’s which resist more Roundup, when our government seems to now be owned by Monsanto and the Obama Administration is weakening regulations on organic agriculture by undermining the Rule of the Law –allowing synthetic ingredients on a regular basis and misnamed inert ingredients in pesticides to be used on organic agriculture? Even when avoid meat and colas, we will still get more phosphorous from Roundup sprayed agriculture. When cannot grow all our own food in the city and in small city lots!

  • Mark

    Oh my God…
    The ways we are…

  • VegAtHeart

    Thanks Darryl for your interesting post.

    I am wondering about the connection between two recent articles that you cited and the upper limit on phosphorus intake provided by the 1997 IOM report pg. 187, which was 4g per day for adults – way above the median intakes.

    Unless I am mistaken,

    1- The Juno paper seems to focus on human aortic smooth muscle cell (HSMC) cultured in media containing phosphate levels comparable to those seen in hyperphosphatemic individuals (>1.4 mmol/L). If this is only a simulation of blood conditions, I don’t know if it really challenges the IOM’s numbers, which concern intake of phosphorus.

    2. The Shuto paper seems to focus on flow-mediated dilation of the brachial artery before and 2 hrs after meals containing 400 mg or 1200 mg of phosphorus. Not only does this dose of phosphorus seem quite high for a given meal even by American standards, but the effects being described are only acute endothelial effects – right?, so I am not sure this challenges the IOM’s numbers if they are based on likelihood of developing hyperphosphatemia.

    Maybe I have misunderstood something…what are your thoughts?

    • Darryl

      1200 mg phosphorous is a lot in one meal (though 5% of young men consume twice as much daily). On the other hand, its also the amount in 5 oz of Velveeta (all the processed cheeses are high). In 8 of 11 young (25 year old) men, the high P meal raised phosphate to > 1.5 mM, which appears to be into the range of direct adverse effects on endothelium (elevated reactive oxygen species, diminished flow mediated dilation, increased calcification) seen in vitro in the two papers. Older people tend to have lower phosphate diets (less cheese nachos?), but they also have slower hormonal signalling and lesser kidney function – perhaps their postprandial peaks would be higher.

      The lead source for this video offers a potential indirect mechanism for harm to bones. Excess serum phosphorus is regulated by bone cells releasing hormone FGF23 to increase urinary excretion. FGF23 also suppresses cacitriol (active vitamin-D) synthesis, leading to elevated parathyroid hormone release and secondary hyperparathyroidism. I’ve no idea whether a high phosphorous diet, in the absence of kidney disease, would require enough urinary regulation via FGF23 to cause bone weakness.

  • Bloom

    This is very good for learning

  • beccadoggie10

    Wow! Now I better understand why I have osteoporosis.

    How long as this practice been going on –injection in meat? And with soft drinks, has it gone on as long as the 1950’s, when soft drinks became really popular? Or, earlier?

    I’ve read that “Many fertilizers contain a high proportion of phosphorus and are
    manufactured from concentrated phosphoric acids. Worldwide demand for
    fertilizers has greatly increased in recent years as their importance to
    agriculture and farming has grown.”

    Isn’t Roundup, trademark, glyphosate made with an abundant amount of phosphorus? With genetically engineered crops and some so-called biologic *recombinant DNA” genetically engineered pharmaceuticals that are alleged to build bone also using phosphorous (which I refused to take for other reasons), no wonder so many Americans have diseases and ailments which Europeans do not have.

    This research has really opened my eyes further.

    Thanks Dr. Greger!!!!

    • Darryl

      Phosphorous in fertilizer (including organic ones) is a required plant nutrient that is part of organically bound plant DNA, RNA, ATP, cell membranes phospholipids, and in plant seeds, phytic acid. The concern in this video is the inorganic phosphate salts used as preservatives, acidifying agents, acidity buffers, and emulsifying agents. Unlike organically bound phosphates, these are quickly absorbed in the gut, leading to postprandial serum spikes.

      The EU has approved many inorganic phosphates for food use: eg. (E 339), potassium phosphate (E 340), calcium phosphate (E 341), salts of orthophosphoric acid diphosphate (E 450), triphosphate (E 451), and polyphosphate (E 452) for their food system, and I haven’t come across evidence their intakes are substantially different from American ones.

  • beccadoggie10

    Just curious. Are Phosphate Additives added to certified organic chicken/turkey as well?

    Not that I am planning to eat any meat again

  • Darryl

    Add cancer to the list:

    Jin, Hua, et al. “High dietary inorganic phosphate increases lung tumorigenesis and alters Akt signaling.” American journal of respiratory and critical care medicine 179.1 (2009): 59.

  • Ernest Mayberry

    You responded to a post of mine about tricalcium phosphate additive in almond milk. You came up with a calculated amount, which I believe was on the order of 150 mg.

    Just wanted to give you a nutrition label comparison I found on almond milks, one using calcium carbonate and the other tricalcium phosphate. The former was 2% of RDA for phosphorous and the later was 4% or RDA (per 8 oz.) Now my internet search on RDA came up with 700 mg for adults, a little different than you mention. Anyway, 2% is only 14 mg. It appears to me that the tricalcium phosphate is only adding 14 mg, which really is a trivial amount.

  • Ruby

    You’re a font. Love this. I’m here all day skipping about. . . .what an amazing site. What work was done here, gathering, assessing, relaying. I’m astounded and humbled, and grateful Dr G.

    • Thea

      Ruby: Glad you were able to find the site. Welcome aboard.

  • Karen

    at location 2:39 in the video, I see beer at the far right with 100% absorption. However there was no mention of beer so I am wondering if beer is particularly dangerous?

  • Kate Scott

    Does this mean that the calcium phosphate that is added to commercial soymilk is doing more harm than good for those of us with osteopenia/osteoporosis consuming soymilk to help boost the calcium in our diet? There does not seem to be any other kind of calcium used in the soymilks available to me locally.

    • Darryl

      Most non-dairy milks use chalk (calcium carbonate), with no phosphate, others use calcium phosphate (which I prefer as it doesn’t add a chalky taste to soups). My understanding is the levels are fairly modest in most, however, a non-dairy productserving with 50% of the calcium AI (500 mg) in the form of calcium phosphate would provide 257 mg inorganic phosphate. Those with normal kidney function can handle this amount without issue, but when levels approach 1200 mg P in a single meal, even healthy young kidneys are challenged. My concern is less with non-dairy milks, than with processed cheeses, as 1200 mg inorganic phosphorus is the amount in just 5 oz of Velveeta (where its used as an emulsifier.).

      • Kate Scott

        OK, so it is both total amount, and amount at one time, that is at issue. Very helpful – many thanks.