Low-phosphate diet for adults on futibatinib : University College London Hospitals NHS Foundation Trust

This page explains which foods to eat and which to avoid when taking a medicine called futibatinib.

If you have any questions about the low-phosphate diet or futibatinib, speak to your healthcare team.

Phosphate, also called phosphorous, is a mineral found in many foods. It helps your body make energy, supports muscles and nerves, and keeps your bones healthy.

Futibatinib, the medicine you are taking to treat your cancer, can cause phosphate levels in your body to rise. High phosphate can initially lead to symptoms like red eyes and itchy skin. Over time, it may weaken your bones, cause joint pain and damage blood vessels.

A low phosphate diet helps to keep your phosphate levels normal and protects your health.

Phosphate is found in almost all foods. It mainly comes from:

Animal proteins and plant foods (‘organic’ phosphate)
Food additives (‘inorganic’ phosphate).

Organic phosphate:

Found in animal proteins, such as meat, fish, dairy and eggs.
Found in plant foods, such as cereal grains, seeds, nuts and pulses (beans or lentils).
Found in alcoholic drinks, such as wine and beer. This is due to how they are made and potential additives, which may not always be listed on labels. Non-alcoholic drinks, such as non-alcoholic beer, or drinks low in alcohol also contain phosphate.

Inorganic phosphate:

Found in food additives, which are included in many foods and can add a lot of phosphate to your diet. Check food labels for these additives: E338-343, E450-458 and E540-545.

In the tables on pages 4 – 13 we’ve included foods to choose, limit and avoid in each food group.

Breads/Flours/Cereals/Potatoes/Rice/Grains
Starchy foods provide energy, B-vitamins and some fibre which helps with digestion. They are often low in phosphate but phosphate may be added in the manufacturing process. Information about phosphate-containing additives is included in the section ‘Which foods contain phosphate?’
Foods to choose	Foods to limit
Plain flour Cornflour White and wholemeal bread Pitta bread Croissant Cream crackers Water biscuits Cassava, yam, sweet potato (boiled) Potatoes (boiled, baked, mashed, roasted) Rice noodles White rice White pasta Cornflakes Rice Krispies® Special K® Honey Monster Puffs® Porridge oats Shredded Wheat® Weetabix®	Baking powder Self-raising flour Soya flour Rye flour Naan and chapatti Rye bread, rye crispbreads and wheat crispbreads Oat cakes Rice cakes Crumpets Bagels Couscous Pearl barley Wheat and egg noodles Frozen potato products (chips, potato waffles and potato croquettes) Instant noodles All-Bran®, bran flakes, muesli, Fruit’n Fibre®, Ready brek®/instant oats
Additional tips
Boiling removes minerals from food. Boiling potatoes and throwing away the water can reduce the phosphate content. You can then mash or roast or bake them to finish cooking.

Dairy
Dairy foods provide protein, vitamins and minerals, in particular calcium, iodine and vitamin B12. But they are also high in phosphate.
Foods to choose (follow standard portion size recommendations as included on the food label)	Foods to limit (aim for one portion per day only)
Cream cheese Crème fraîche Cream (double or single) and soured cream	Up to 300ml (half a pint) cow’s or fortified soya milk per day Up to 550ml (one pint) oat or rice milk per day 30g (one small matchbox size) hard cheese (cheddar, edam, wensleydale or red leicester) 15g parmesan 150ml custard 200g (half a tin) milk-based pudding 1 pot (125 – 150g) yoghurt 120g cottage cheese, ricotta, mascarpone 50g brie, feta, mozzarella, stilton
Foods to avoid
Cheese spreads (Dairylea®, Primula®) Processed cheese Condensed milk Evaporated milk Milk-based sauces Cheese sauces Coconut milk/cream Instant pasta Ready meals, such as macaroni cheese, lasagne, quiche or pizza
Additional tips
Use two measures of double cream to one measure of water as a milk alternative (for tea, coffee and cereal). Grate hard cheeses to make them go further and opt for mature cheeses to give stronger flavour.

Fruits and vegetables
Fruits and vegetables are naturally low in phosphate and you can eat them freely on a low-phosphate diet. They are an important source of vitamins, minerals and fibre, and you should aim to have a minimum of five portions of fruits and vegetables per day. One portion is 80g of fresh, frozen or tinned fruit or vegetables. For example, a small handful of berries or grapes; one small apple, orange or banana; three heaped tablespoons of cooked vegetables; or one small bowl of salad. One portion of dried fruit is 30g. For example, a small handful of raisins, dried apricots, sultanas, or currants. Beans and pulses can also count as one portion (80g) of fruits and vegetables per day. For example, three heaped tablespoons of chickpeas, lentils, black-eye beans or turtle beans.

Fruits and vegetables

Fruits and vegetables are naturally low in phosphate and you can eat them freely on a low-phosphate diet. They are an important source of vitamins, minerals and fibre, and you should aim to have a minimum of five portions of fruits and vegetables per day.

One portion is 80g of fresh, frozen or tinned fruit or vegetables. For example, a small handful of berries or grapes; one small apple, orange or banana; three heaped tablespoons of cooked vegetables; or one small bowl of salad.
One portion of dried fruit is 30g. For example, a small handful of raisins, dried apricots, sultanas, or currants.
Beans and pulses can also count as one portion (80g) of fruits and vegetables per day. For example, three heaped tablespoons of chickpeas, lentils, black-eye beans or turtle beans.

Protein – meat and fish
Protein is important for building and maintaining muscles. Since protein foods contain phosphate, it’s important to stick to the following portion sizes: 90 – 120g cooked meat (about the size of your palm, three slices of meat, or one average chop) One fish fillet (about the size of your palm).
Foods to choose (aim for one serving per day)	Foods to limit (aim for one serving per week)
Beef (no preservatives) and veal Lamb Pork Chicken Trout Tuna Cod Hake Sole Scallops	Sausages Offal (kidneys, liver, heart, sweetbreads) Turkey Ham Pâté Haddock Mackerel Prawns Herring Salmon/Trout Squid
Foods to avoid
Crab Fish paste and roe Mussels Oysters Pilchards Sardines Scampi Sea bass Whitebait

Protein – eggs, beans, pulses, lentils, nuts and seed
A portion of beans, dried soya mince, tofu or lentils can replace a portion of meat or fish without containing too much phosphate
Foods to choose (up to two or three servings per day) one serving = 80g or three heaped tablespoons	Foods to limit
Egg white (can be eaten freely with no restrictions) Chickpeas Red lentils, green lentils, Puy lentils, mung beans, urid beans, black-eyed beans, yellow split peas Peanut butter Tofu	Eggs - you can eat up to 4 whole eggs or egg yolks per week
Foods to avoid
Beans in sauce where there may be additives (see page 4), such as baked beans Nuts and seeds

Fats and oils
Fats provide us with lots of energy in relatively small quantities. They are low in phosphate and can be included freely on a low phosphate diet. Monounsaturated and polyunsaturated fats are better for heart health than saturated fats.
Monounsaturated fats: olive oil, olive oil-based spreads, rapeseed oil Polyunsaturated fats: sunflower oil and spreads, corn oil, vegetable oil Saturated fats: butter, cream, lard, coconut oil, palm oil, ghee

Cakes, biscuits, snacks, desserts
Many baked goods contain phosphate due to ingredients like eggs, self-raising flour, milk and baking powder). They may also have phosphate-containing additives.
Foods to choose	Foods to limit
Breadsticks Corn snacks (Wotsits®, Skips®) Potato crisps Popcorn Prawn crackers Sugar, sweets and jellies, fruit gums, mints Jam, marmalade, honey, lemon curd Marshmallows, Turkish delight Cream cakes, Jaffa Cakes® Doughnuts, jam tarts Shortbreads, ginger, rich tea or digestive biscuits Fresh fruit crumble Fresh fruit salad, tinned fruit Meringue/Pavlova Sorbet	Bombay mix Nuts and seeds Twiglets®, pretzels and tortilla chips Chocolate Liquorice, fudge Sponge cakes, muffins, fruit cake, rock cakes, scones Chocolate biscuits, flapjack, oat-based biscuits Teacakes Scotch pancakes, waffles, cereal bars, pancakes Trifle, mousse, cheesecake, crème caramel Bread and butter pudding, sponge pudding
Additional tips
Use cream or crème fraîche with desserts instead of custard or ice cream.

Drinks
Most drinks are low in phosphate but there are some you should avoid due to additives. Information about phosphate-containing additives is included in the section ‘Which foods contain phosphate?’
Drinks to choose	Drinks to avoid
Water Coffee, tea (make sure any milk added is within your allowance) Lemonade, Fanta®, Tizer®, Red Bull® Oxo Squash or cordial Cider, sherry, spirits	Bovril® Cola (Coca-Cola®, Pepsi®, Dr Pepper®) Malted milk drinks (Horlicks®, Ovaltine®) Hot chocolate Latté, cappuccino, milky tea/ coffee Lager, stout, ale, bitter, wine Non-alcoholic wine and beer

Miscellaneous
This group includes flavourings and condiments.
Foods to choose	Foods to limit
Spices, herbs, pepper, stock cubes Mustard, ketchup, mayonnaise, Brown Sauce, sweet chilli sauce, salad cream Vinegar	Bovril® Marmite®

If needed, your doctor may prescribe a medicine called a phosphate binder to take with your low-phosphate diet. Phosphate binders help to lower phosphate levels in your blood by absorbing some of the phosphate from the food in your stomach. Your pharmacist will tell you how to take them.

If you are losing weight or struggling with your appetite, the can help you to get the nutrients you need.

Eat little and often

Aim for three small meals and three high-energy, high-protein and low-phosphate snacks per day.

Use the ‘Foods to choose’ lists on this page for snack ideas.

Fortifying foods

Simple additions to meals can greatly increase their calorie content without increasing the amount of food you eat. Use full-fat products rather than low-fat.

For potatoes (boiled or mashed) and vegetables:
- 1 tablespoon of butter (110 Kcal)
- 2 tablespoons of double cream (140 Kcal)
- 1 tablespoon of olive oil (135 Kcal)
- 50g cream cheese (140 Kcal, 2g protein)
For salads and sandwiches:
- 2 tablespoons of olive oil (270 Kcal)
- 2 tablespoons of full-fat salad dressing (160 Kcal)
- 2 tablespoons of mayonnaise (200 Kcal)
- 50g cream cheese (140 Kcal, 2g protein)
For porridge, breakfast cereals, fresh fruits and desserts:
- 1 tablespoon of jam, honey or sugar (60 Kcal)
- 1 portion (30g) of dried fruit (100 Kcal)
- 2 tablespoons of double cream (140 Kcal) or full-fat crème fraîche (90 Kcal)