In Reply: As Dr Lopes and Ms Lopes point out, restricting dietary phosphorus intake may be associated with unacceptable declines in protein intake. This may occur because many foods that are naturally high in phosphorus, such as meats, dairy products, beans, and nuts, are also important protein sources. However, the widespread use of phosphorus-containing food additives, especially in low-protein products such as baked goods and beverages, has weakened the link between phosphorus and protein intake. Therefore, avoiding baked goods and beverages that contain phosphorus additives should have little effect on protein intake.
Sehgal AR, Sullivan C, Sayre SS. Reducing Serum Phosphorus Concentration in Patients With End-Stage Renal Disease—Reply. JAMA. 2009;301(23):2443-2444. doi:10.1001/jama.2009.846