by Ron Brown, Ph.D., author of The Body Fat Guide
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one of the most common acid-forming minerals consumed in our diet. Phosphorus
is an essential nutrient in many metabolic activities, but excessive amounts of
dietary phosphorus causes phosphate toxicity that is harmful to health (Razzaque,
2011). A low-phosphorus diet
is clinically effective in helping patients manage chronic kidney disease (Barsotti &
Cupisti, 2005). Could dietary phosphorus restriction also help prevent other chronic diseases that are associated with
phosphate toxicity, like osteoporosis, cardiovascular
disease, and tumor formation? The first part of this
article cites peer-reviewed research literature that examines the association between excess dietary phosphorus, tumor growth or tumorigenesis, and bone
loss. The second part presents a practical strategy to reduce excessive levels of dietary phosphorus
a raw vegan diet.
Today's cooked-starch Neolithic diet and less conventional flesh-based Paleolithic diet may be considered survival diets for our human species that originated and developed through biological natural selection during historical periods of climate change, continental drift, population migration, hunting, food gathering, and agricultural development. As modern transportation continues to provide a greater diversity of fresh imported plant-based foods to consumers, it is becoming much easier to consume a balanced raw vegan diet that is hypothesized to be closer to our original species-specific optimal diet, based on inter-species comparisons with human anatomical structure and complementary physiological function. If this hypothesis is correct, than the diet described in this article may have broad applications to restore and maintain optimal health in a wide variety of physical and mental conditions.
Phosphorus, Tumors, & Bone Loss
Many carcinogenic substances are associated with tumors and cancer. However, Dr. T. Colin Campbell (2009) pointed out that these substances only initiate the first stage of cancer development through cell mutation—the next stages involving promotion and progression of cancer seem to be much more dependent on other lifestyle factors, including diet. In other words, as Dr. Campbell demonstrated in his laboratory experiments, whether or not a carcinogen is promoted and progresses into cancer is largely a matter of nutrition.
High intake of dietary phosphorus has been found to stimulate tumor growth (Camalier et al., 2010; Jin et al., 2009). Phosphorus intake that was twice the Institute of Medicine's Recommended Dietary Allowance of 700 mg/day was associated with "greater risk of overall prostate cancer and lethal and high-grade cancers" (Wilson, Ma, & Giovannucci, 2011). Cancer growth and regression in lab animals was associated with dietary intake of casein, a phospho-protein in cow milk (Campbell & Campbell, 2006). Cancer cells accumulate twice as much phosphorus as normal cells (Elser et al., 2007; Rasmussen & Steinberg, 2012), and cancer patients have been observed to retain and store phosphorus in tumors (Fenninger et al., 1953). As tumors are forced apart (lyse) during conventional medical therapy they release high amounts of their accumulated phosphorus and other substances back into the blood stream, causing a toxic condition known as tumor lysis syndrome.
These facts support the hypothesis that tumor growth occurs as the body removes and stores excess phosphorus out of circulation when serum levels of phosphorus remain elevated (hyperphosphatemia). In other words, rather than generating useless tissue, tumorigenesis may be a type of phosphorus homeostatic mechanism or rebalancing action taken by the body to maintain internal stability under severe and chronic conditions, somewhat similar to the homeostatic effect of an acute inflammatory response to injury (Calder et al., 2009). In fact, tumorigenesis has been shown to be regulated by the inflammatory response through the release of cytokines (Zaki, Lamkanfi, & Kanneganti, 2011). Gradual changes occur in tissue structure (dysplasia) during chronic inflammation which eventually form tumor cells.
Describing his opinion of the "protective nature" of tumor formation, Shelton wrote in Orthopathy that "it prolongs life in the face of causes, which, except for the tumor-formation, would produce death much earlier." In other words, if hyperphosphatemia is not reduced by homeostatic responses such as tumor formation, death would soon result. Researchers have verified that the immune system in mice actively protects tumor cells, blocking effector T-cells (TEFFS) from destroying tumor cells when tumors begin to form (Darrasse-Jeze et al., 2009). Chemotherapy, which often uses phosphorus-based toxins like cyclophosphamide (mustard gas), was found to actually promote "tumor cell survival and disease progression" (Sun et al, 2012). These findings provide strong evidence that the body does not treat tumor cells as foreign substances, but values tumor cells' protective homeostatic function while actively supplying them with growth-promoting proteins (Goldstein et al., 2012). This phosphate homeostasis hypothesis could lead to a paradigm shift in understanding the cause and treatment of tumorigenesis and cancer in humans.
Bone loss is another phosphorus homeostatic mechanism that regulates hyperphosphatemia. Calcium is removed (resorbed) from bone to neutralize excess serum phosphorus, which eventually leads to osteoporosis. The association of osteoporosis with cancer implies that phosphate homeostasis may contribute to the etiology of both diseases. For example, men with greater bone mineral density were found to have a reduced risk for prostate cancer (Farhat et al., 2009), although women with greater bone mineral density had increased risk for breast cancer likely due to confounding hormonal factors (American Cancer Society, 2012). The National Institutes of Health (2012) reported that breast cancer may stimulate bone loss, although it may be that bone loss and breast cancer are both initially stimulated by hyperphosphatemia. Cancer risk increased 25% among osteoporosis patients the first year after hospitalization (Ji, Sundquist, & Sundquist, 2012 ), and bone is the most common site for metastasis in breast cancer (Pennery, 2005), suggesting that metastasis and bone pathology may both be caused by phosphate homeostasis. Note that serum levels of phosphorus alone are not a good indicator of phosphorus homeostatic mechanisms.
Fibroblast growth factor-23 (FGF-23) is a protein that prevents the kidneys from reabsorbing filtered phosphorus back into the blood, thereby mitigating or preventing hyperphosphatemia. Elevated levels of FGF-23 have been associated with increased risk for bone fractures in elderly men (Mirza et al., 2011) and with increased risk for colorectal tumors (Jacobs et al., 2011). FGF-23 levels are also elevated in late-stage ovarian cancer patients and in patients with tumor-induced osteomalacia (Berndt, Schiavi, & Kumar, 2005). Dietary phosphorus restriction lowered FGF-23 levels in healthy subjects and in patients with chronic kidney disease (Sigrist et al., 2012). Would a phosphorus restricted diet have the same effect in cancer patients?
Cancer is also associated with obesity, probably partially because obesity-related kidney disease impairs kidney filtration causing "phosphate toxicity" (Ohnishi, Kato, & Razzaque, 2011). Fasting or calorie restriction improves kidney filtration (Bemieh et al., 2010 ), thus helping to reduce phosphate toxicity. As calorie intake is reduced, the body may also gradually breakdown tumors and other cellular deposits through autolysis, or self-digestion (Shelton, 1978). Shelton claimed that in autolysis "accumulations of superfluous tissues are overhauled and analyzed...the refuse is thoroughly and permanently removed." Cancer cell self-digestion is recognized in chemotherapy and is called autophagy (Marx, 2006).
Tumor lysis syndrome is avoided during fasting or calorie restriction as the body slowly and persistently self-digests the tumor and eliminates or reuses its contents—an amount Shelton estimated as "a few grams a day" (1978). Recent research verified that fasting breaks down tumor cells without harming normal cells in a process called differential stress resistance (Lee et al., 2012). Laviano and Fanelli (2012) explained: "In the absence of nutrients, normal cells switch their metabolism toward maintenance pathways, whereas tumor cells are unable to activate this protective response." Furthermore, tumor cells may actually assist in providing "maintenance pathways" to normal cells by breaking down into reusable substances. For example, as the fasting body continues to need about one gram of phosphorus a day to maintain vital tissue, it is likely that a portion of phosphorus released from tumor cells is reused to nourish other cells. In this way, as Shelton claimed, less vital tissue nourishes vital tissue.
Calorie restriction and fasting in mice have been shown to reduce tumorigenesis (Moore et al., 2012 ) and "weaken" cancer, producing results superior to chemotherapy (Lee et al., 2012). Camalier et al. (2010) suggested "reducing dietary phosphate as a novel target for chemoprevention" (cancer prevention). Physical activity also reduces cancer risk by affecting hormones, the immune system, and energy balance (American Cancer Society, 2007). Hursting (2012) wrote, "...the mechanisms underlying the energy balance-cancer link will facilitate the development of novel prevention and treatment strategies."
As the world struggles to find a cancer cure, the above findings support the hypothesis for a novel two-step cancer treatment & prevention intervention:
Raw Vegan Dietary Phosphorus Restriction
Strategies for dietary phosphorus restriction used in chronic kidney disease patients include eliminating inorganic phosphorus from food additives and selecting grain sources with lower phosphate bioavailability (Gutierrez & Myles, 2010). Limitations of such strategies include lack of food additive knowledge, and reduced bioavailability of essential nutrients from grain consumption (Gutierrez & Myles, 2010). A raw vegan diet has potential as an efficacious dietary phosphorus restriction strategy to meet the needs of kidney patients and anyone interested in preventing kidney disease with associated bone disorders (osteodystrophy), vascular problems (calcification), and tumorigenesis. For more information on dietary phosphorus and bone disorders, see: How Dairy Products Cause Osteoporosis. For information on phosphorus and cardiovascular disease, see: Unplug Your Stove to Unplug Your Arteries.
Vegetarian and vegan diets “are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases” (Craig & Mangels, 2009, p. 1266). Writing in Orthopathy, Shelton mentions that, "Cancers are found almost wholly among meat eating animals and only rarely among vegetarian and fruitarian animals." And, "Among races of men, cancer incidence is highest among the meat eating peoples, lowest among vegetarian peoples." Vegan diets tend to be lower in bioavailable phosphorus and may be useful in disease prevention (McCarty, 2003). Vegetarian protein lowered serum phosphorus levels in chronic kidney disease patients more effectively than meat protein (Moe et al., 2011). Most phosphorus consumed in the Western diet comes from dairy, meat, fish, fowl, and grain products (Calvo & Park, 1996). Vegan diets are used to proscribe animal-based foods including flesh from mammal, fish, and fowl, eggs, and dairy products, thus reducing dietary phosphorus intake significantly.
Testifying before a hearing by the United States Senate (1946) on the Gerson Diet for cancer treatment, Dr. Miley, Medical Director of Gotham Hospital, New York City stated, "The diet consists chiefly of large amount of fresh fruit and fresh vegetables and does not allow any meat, milk, alcohol, canned or bottled foods." The Gerson Diet, according to Dr. Miley, normalizes blood serum ratios of sodium, potassium, and phosphorus, thereby correcting "abnormal chemistry of the whole body." Dr. Miley said, "Cancer is primarily a disease of abnormal body chemistry."
As well as eliminating animal-based foods, a raw vegan diet also eliminates cooked plant-based foods such as grain, corn, legumes, and starchy tubers like potatoes which contribute significant amounts of dietary phosphorus per calorie, especially in the large amounts they are usually consumed. For example, 3500 calories of potatoes has 2891 mg phosphorus compared to only 773 mg phosphorus in 3500 calories of low-phosphorus fruit. Ross Horne (1988), who worked closely with Nathan Pritikin, described how patients who followed Pritikin's cooked-grain and starch-based vegan diet developed cancer and arthritis. Dr. Ruth Cilento said, "When later reviewing the results of my cancer patients' different dietary programs, I realized that none of the patients on the strict Pritikin Program were recovering." Breast cancer recurrence was also found to increase as female survivors increased their starch intake (Emond, Patterson, & Pierce, 2011).
A raw vegan diet that consists predominately of uncooked, low-phosphorus plant-based foods may be used as an effective dietary phosphorus restriction strategy while providing essential nutrients and energy. A phosphorus restricted raw vegan diet also has potential to increase patient compliance through the diet’s convenience, palatability, and satiety. A diet of natural, unprocessed plant-based foods also eliminates phosphate food additives, and, if organic foods are used, reduces intake of organophosphate pesticides that have been related to Attention-Deficit/Hyperactivity Disorder, ADHD (Bouchard et al., 2010). A phosphorus restricted diet has been found effective in reducing symptoms of ADHD (Hafner, 2001).
Raw vegan diets that include generous quantities of high-protein and high-phosphorus nuts and seeds are not effective for dietary phosphorus restriction. Used in limited amounts, coconuts and macadamia nuts are examples of low-phosphorus nuts that supply needed concentrated sources of energy and protein in a raw vegan phosphorus restricted diet. Coconuts and macadamia nuts are particularly low in phosphorus in comparison with other foods when measured by calorie. Table 1 shows that phosphorus in macadamia nuts measured by calorie is over 10 times lower than in no-fat cow milk. Macadamia nuts are more than three times lower in phosphorus per calorie than whole wheat bread or potatoes and four times lower than corn.
Adapted from USDA National Nutrient Database for Standard Reference. Retrieved from http://www.nal.usda.gov/fnic/foodcomp/search/
Protein in coconut has been found to exceed meat, milk, and eggs in promoting tissue growth (Johns, Finks, & Paul, 1919). An advantage of supplying protein in raw nuts is that none of the amino acid content of the protein has been destroyed (deaminated) as occurs in cooked food. Therefore, the body requires less protein from coconuts and other natural raw foods to meet growth and maintenance needs.
Concerns about saturated fat and overall fat levels in coconuts and other nuts as a cause of dyslipidemia and chronic disease have been refuted by numerous investigators (Assunção, Ferreira, dos Santos, Cabral, & Florêncio, 2009; Griel et al., 2008; Prior, Davidson, Salmond, & Czochanska, 1981; Sabaté, Oda, & Ros, 2010). Also, "About 40 per cent of the calories in a typical American diet are derived from fats, which is almost equal to the calories derived from carbohydrates. Therefore, the use of fats by the body for energy is as important as the use of carbohydrates is" (Guyton & Hall, 2006, p.842).
Coconuts and macadamia nuts are higher in phosphorus when measured by weight than by calories (see Table 1) and should be used in strictly controlled amounts to maintain low absolute dietary phosphorus levels. Nut milks made by blending coconut or macadamia nuts with water are versatile replacements for dairy products and can be used in soups, dressings, toppings, smoothies, and dips.
Avocados are another example of a low-phosphorus plant-based food that can be used to supply a concentrated energy source in a raw vegan phosphorus restricted diet (see Table 1). Dates and other dried fruit also have low amounts of phosphorus measured by calories (see Table 1) and are a rich dietary source of energy and nutrients (Vinson, Zubik, Bose, Samman, & Proch, 2005). Coincidently, dates, coconuts, coconut water, and edible young buds, shoots, leaves, and heart-of-palm all grown on tropical palm trees probably provided an original source of fruit, nuts, and vegetables for our species.
Oils processed from nuts, seeds, and other foods lack phosphorus, which probably explains why diets high in fat and oil, such as ketogenic diets, have been associated with tumor inhibition (Freedland et al., 2008). Nevertheless, oils are not whole foods, and they should be used sparingly, if at all. Providing a concentrated source of calories along with some of the fat-soluble vitamins, oils lack many other vitamins and minerals—they are mostly empty-calorie foods.
The balance of the phosphorus restricted raw vegan diet should consist of an abundance of fresh whole foods like raw fruit and vegetables, particularly raw dark leafy greens with high calcium-phosphorus ratios such as collards, kale, radish leaves, and bok choy. Greens may be made more palatable blended in a green smoothie with sweet fruit (Boutenko, 2009). Smaller amounts of other raw nuts and seeds like almonds, walnuts, filberts, etc. may also be added to the diet. No sodium in the form of sodium chloride (table salt) should be consumed, neither added on to food nor as an ingredient processed into the food. Spices and condiments should be avoided. No vitamin or mineral supplements are recommended, and only purified or distilled water should be consumed. Patients should keep a spreadsheet of their daily nutrient intake to ensure compliance with phosphorus restriction while maintaining an overall nutrient balance on a raw vegan diet. See Diet Analyzer.
Fruits, nuts, and vegetables lowest in phosphorus per calorie are:
Adapted from USDA National Nutrient Database for Standard Reference. Retrieved January 18, 2013 from http://www.nal.usda.gov/fnic/foodcomp/search/
A sample menu includes blended soups, salads, and smoothies made with:
According to the USDA nutrient database, this menu supplies 2,143 calories, 6% protein, 47% fat, 47% carbohydrates, 1128 mg calcium, and 753 mg phosphorus with a calcium-phosphorus weight ratio of 1.5:1. Calories and carbohydrates may be increased in this menu by including more foods lowest in phosphorus per calorie. Research suggests a calcium-phosphorus ratio between 1.6:1 and 1.8:1 is optimal for growth and development in infants (Mize et al., 1995), and a 1.5:1 ratio is found in human bone (Huttenen, 2007). Note that some foods with high calcium-phosphorus ratios like oranges and kale also have fairly high absolute amounts of phosphorus, so you need to watch the amount of these foods in your diet as your overall calorie intake increases.
Healthy people may find it easier to satisfy growth and energy requirements by eating more overall calories from the above menu, allowing a slightly greater phosphorus intake: 12.6 mg phosphorus/kg bodyweight or about 800-1000 mg phosphorus per day. For example, 3,300 calories of food from the above menu supplies 51 grams of protein, 1275 mg calcium, and 984 mg phosphorus—significantly less phosphorus than the average person eats on a high phosphorus diet of 1200-1800 mg or more!
In conclusion, this article presented peer-reviewed evidence supporting the hypothesis that dietary phosphate restriction commonly used in managing chronic kidney disease may be effective in managing other chronic diseases like tumorigenesis and bone disease, and that a properly balanced raw vegan diet may be used for phosphorus restriction. Future research in medical nutrition therapy should test the clinical results based on this hypothesis.
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