Hidden Phosphorus at Breakfast: Part 2

Article Outline

• Impact on CKD Patients
• Keeping Abreast of the Nutrition Content of Breakfast Foods
• Phosphorus and Potassium Content of Breakfast Cereals and Cereal Bars
• Manufacturer Information
• References

SINCE 2002, breakfast food manufacturers have faced many new challenges. The popularity of low-carbohydrate diets, the increasing consumer demands for “grab and go” foods, and the release of the updated 2005 US Department of Agriculture's (USDA) Dietary Guidelines for Americans have all influenced changes within the industry.¹, ², ³

The 2005 USDA Dietary Guidelines for Americans have had the greatest impact. New to this set of guidelines are the USDA's recommendations to increase consumption of whole grains to a level that is “at least half of the recommended grain servings” and to increase potassium-rich foods in the diet.³ General Mills (Minneapolis, MN) was the first breakfast food company to make changes to meet these new standards by reformulating their products to 100% whole grain.

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Impact on CKD Patients 

Whole grains are higher in phosphorus and potassium than refined grains. Both the chronic kidney disease (CKD) patient and the renal dietitian will be impacted as manufacturers make changes to meet consumer needs and governmental standards. For the CKD patient, food choices may become further restricted, or the patient may need to take more phosphate binders to accommodate the increase in phosphorus load. For the renal dietitian, time will be spent educating the patient on the changes the food industry has made, finding acceptable alternative food choices to replace the new higher-phosphorus breakfast foods, and adjusting patient meal plans or phosphate binders. Both patients and dietitians alike will face the challenge of keeping abreast of ongoing formulation changes made by food manufacturers.

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Keeping Abreast of the Nutrition Content of Breakfast Foods 

Regular monitoring of in-store food nutrition labels is the best way to keep abreast of the nutritional content of breakfast foods. In researching this article, the investigators found problems obtaining accurate analyses from widely used resources available to dietitians and patients. In some instances, we found as many as three different analyses for the same product, none resembling the other! In trying to clarify these discrepancies, we found limitations to nutrition analysis resources generally used by the public and the professional.

Breakfast foods manufacturers change formulations throughout the year, but are only required to report nutritional content of their products to the USDA once per year (Linda Lamahr, US Department of Agriculture, personal communication, January 28, 2005). As a result, nutrition analyses found in the USDA National Food Database and nutrition analysis programs that use the USDA for their databases may be obsolete.

Nutrition fact labels listed on a company's website are not always accurate. On visiting a website of a product believed to be low in phosphorus, we found a picture of the product's nutrition label that listed the phosphorus content as 0% daily value. However, in a different area of the website, which provided a detailed description of the product, the phosphorus content was reported to be 230 mg per serving! When questioned, the company responded that they were not required by law to list the phosphorus content of their product. However, they did acknowledge the error and planned to correct it (White Wave, E-mail communication, January 12, 2005).

Customer service representatives are limited in the information provided on the company's website or the nutrition label. To receive a detailed nutrition analysis, consumers must make a special request that may not be granted because of the company's proprietary information policy. For this article, the investigators contacted the media relations department of each company for nutrition analysis and permission to publish the company information.

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Phosphorus and Potassium Content of Breakfast Cereals and Cereal Bars 

Table 1 lists the phosphorus and potassium content of most breakfast cereals and cereal bars found in the United States. This information was obtained directly from manufacturers in March 2005. For product comparison, data were adjusted to reflect the National Renal Diet serving sizes.

Table 1. Phosphorus and Potassium Content of Breakfast Cereals and Cereal Bars

Cereal Name	Serving size	Phosphorus (mg)	Potassium (mg)
Ready-to-eat cereals
Kellogg Special K–Low Carb Lifestyle	3/4 c	200	320
Malt-O-Meal Honey Graham Squares	3/4 c	200	50
General Mills Shrek	3/4 c	188	23
Quaker Squares	3/4 c	155	158
Kellogg Complete Wheat Bran Flakes	3/4 c	150	170
Kellogg Cracklin' Oat Bran	3/4 c	150	220
Kellogg Smart Start–Healthy Heart	3/4 c	150	228
Malt-O-Meal Balance Bran Flakes	3/4 c	150	170
Quaker Squares Cinnamon	3/4 c	147	158
Quaker Life	3/4 c	133	90
Quaker Oatmeal–Honey Nut Heaven	3/4 c	122	135
Quaker Oatmeal–Brown Sugar Bliss	3/4 c	116	120
Quaker Cinnamon Life	3/4 c	115	80
General Mills Multibran Chex	3/4 c	113	165
General Mills Oatmeal Crisp Almond	3/4 c	113	135
General Mills Wheat Chex	3/4 c	113	143
Kellogg Smart Start–Soy Protein	3/4 c	113	308
Malt-O-Meal Frosted Mini-Spooners	3/4 c	113	120
Kashi Heart to Heart	3/4 c	100	120
Kellogg Complete Oat Bran Flakes	3/4 c	100	120
Kellogg Just Right Fruit and Nut	3/4 c	100	140
Quaker Toasted Oats	3/4 c	87	64
Cascadian Farms Hearty Morning	3/4 c	80	200
Cascadian Farms Multigrain Squares	3/4 c	80	115
Cascadian Farms Wheat Crunch	3/4 c	80	75
General Mills Basic 4	3/4 c	75	100
General Mills Berry Burst Cheerios Strawberry	3/4 c	75	75
General Mills Berry Burst Cheerios Strawberry Banana	3/4 c	75	75
General Mills Berry Burst Cheerios Triple Berry	3/4 c	75	68
General Mills Cheerios	3/4 c	75	150
General Mills Honey Nut Cheerios	3/4 c	75	94
General Mills Multigrain Cheerios	3/4 c	75	64
General Mills Oatmeal Crisp Raisin	3/4 c	75	135
General Mills Total Raisin Bran	3/4 c	75	232
General Mills Wheaties	3/4 c	75	79
Kellogg Cruncheroos	3/4 c	75	68
Malt-O-Meal Honey and Nut Toast Os	3/4 c	75	71
Malt-O-Meal Scooter's	3/4 c	75	60
Quaker Marshmallow Safari	3/4 c	75	55
Quaker Honey Nut Oats	3/4 c	70	55
General Mills Oatmeal Crisp Apple Cinnamon	3/4 c	67	128
Cascadian Farms Honey Nut Os	3/4 c	60	53
Cascadian Farms Purely Os	3/4 c	60	75
General Mills Apple Cinnamon Cheerios	3/4 c	60	60
General Mills Brown Sugar and Oat Total	3/4 c	60	60
General Mills French Toast Crunch	3/4 c	60	40
General Mills Honey Nut Clusters	3/4 c	60	101
General Mills Reese's Puffs	3/4 c	60	65
Kellogg Smart Start–Antioxidant	3/4 c	60	68
Malt-O-Meal Apple Cinnamon Toasty Os	3/4 c	60	55
Malt-O-Meal Blueberry Muffin Tops	3/4 c	60	45
Malt-O-Meal Toasted Cinnamon Twists	3/4 c	60	45
Quaker Honey Grahams	3/4 c	59	65
Cap'n Crunch Peanut Butter	3/4 c	52	60
Cap'n Crunch Regular	3/4 c	46	55
Quaker Frosted Oats	3/4 c	46	34
Cascadian Farms Clifford Crunch	3/4 c	45	64
General Mills Frosted Cheerios	3/4 c	45	41
General Mills Team Cheerios	3/4 c	45	53
Kellogg Special K	3/4 c	45	45
Cap'n Crunch Crunchberries	3/4 c	44	55
Quaker Cinnamon Crunch	3/4 c	43	45
Cap'n Crunch Ooops Choco Donut	3/4 c	41	50
Quaker Cocoa Blast	3/4 c	41	45
Quaker Frutangy Os	3/4 c	41	45
Cap'n Crunch Neutron Berries	3/4 c	40	49
General Mills Berry Berry Kix	3/4 c	40	40
General Mills Cinnamon Toast Crunch	3/4 c	40	45
General Mills Golden Grahams	3/4 c	40	50
General Mills Peanut Butter Toast Crunch	3/4 c	40	70
General Mills Red Cinnamon Toast Crunch	3/4 c	40	55
Kellogg Honey Smacks	3/4 c	40	40
Malt-O-Meal Golden Puffs	3/4 c	40	35
Quaker Fruity Ocean Adventure	3/4 c	38	41
Quaker King Vitamin	3/4 c	37	40
Quaker Crunchy Corn Bran	3/4 c	35	60
Quaker Apple Zaps	3/4 c	34	38
Quaker Quisp	3/4 c	32	26
Quaker Sweet Crunch	3/4 c	31	26
General Mills Cookie Crisp	3/4 c	30	30
General Mills Lucky Charms	3/4 c	30	38
Kellogg Product 19	3/4 c	30	38
General Mills Kix	3/4 c	28	23
General Mills Kaboom	3/4 c	24	24
General Mills Rice Chex	3/4 c	24	30
Kellogg Rice Krispies	3/4 c	24	24
General Mills Total Corn Flakes	3/4 c	23	28
General Mills Frosted Chex	3/4 c	20	30
General Mills Honey Nut Chex	3/4 c	20	35
Kellogg Cinnamon Crunch Crispix	3/4 c	20	35
Kellogg Cocoa Krispies	3/4 c	20	50
Kellogg Rice Krispies Treats Cereal	3/4 c	20	26
Malt-O-Meal Cocoa Dyno-Bites	3/4 c	20	40
Quaker Cocoa Bronto Blasts	3/4 c	17	15
Quaker Fruity Bronto Blasts	3/4 c	17	15
Quaker Sweet Puffs	3/4 c	16	49
General Mills BooBerry	3/4 c	15	26
General Mills Cocoa Puffs	3/4 c	15	45
General Mills Corn Chex	3/4 c	15	34
General Mills Count Chocula	3/4 c	15	53
General Mills Country Corn Flakes	3/4 c	15	38
General Mills Frankenberry	3/4 c	15	26
General Mills Red Cocoa Puffs	3/4 c	15	53
General Mills Red Trix	3/4 c	15	26
General Mills Trix	3/4 c	15	26
Kellogg Froot Loops	3/4 c	15	26
Malt-O-Meal Apple Zings	3/4 c	15	26
Malt-O-Meal Honey Buzzers	3/4 c	15	26
Malt-O-Meal Tootie Fruities	3/4 c	15	26
Quaker Honey Crisp Corn Flakes	3/4 c	14	25
Quaker Frosted Flakes	3/4 c	13	25
Malt-O-Meal Crispy Rice	3/4 c	12	24
Quaker Honey Dipps	3/4 c	11	42
Quaker Rice Crisps	3/4 c	0	19
High-fiber cereals
Kellogg All-Bran Original	1/3 c	233	233
Kellogg All-Bran Bran Buds	1/3 c	150	300
Kellogg Frosted Mini-Wheats Bite Size	24 biscuits	150	200
Kellogg Frosted Mini-Wheats Bite Size–Maple and Brown Sugar	24 biscuits	150	180
Kellogg Frosted Mini-Wheats Bite Size–Vanilla Crème	24 biscuits	150	170
Kellogg Frosted Mini-Wheats–Original	5 biscuits	150	170
Kellogg All-Bran With Extra Fiber	1/3 c	133	180
Quaker 100% Natural Granola Oats and Honey	1/3 c	105	174
Quaker 100% Natural Granola With Raisins	1/3 c	101	167
General Mills Fiber One	1/3 c	100	120
Cascadian Farms Cinnamon Raisin Granola	1/3 c	75	80
Cascadian Farms Oat and Honey Granola	1/3 c	75	70
Quaker Shredded Wheat	1 biscuit	75	74
General Mills Raisin Nut Bran	1/3 c	67	87
Kashi GoLean	1/3 c	67	160
Kellogg Low-fat Granola Without Raisins	1/3 c	67	80
Kellogg Mini-Wheats With Raisin	1/3 c	67	111
Kellogg Mini-Wheats With Strawberry	1/3 c	67	73
Kellogg Raisin Bran	1/3 c	67	120
Malt-O-Meal Raisin Bran	1/3 c	67	120
Quaker 100% Natural Granola–Low Fat	1/3 c	65	95
Quaker Frosted Shredded Wheat	1/3 c	61	77
Cascadian Farms Raisin Bran	1/3 c	50	90
Kellogg Low-Fat Granola with Raisins	1/3 c	50	90
Kellogg Mueslix	1/3 c	50	120
Kellogg Shredded Wheat Miniatures	1/3 c	50	80
General Mills Whole Grain Total	1/3 c	35	40
Kashi Good Friends	1/3 c	34	87
Kellogg Raisin Bran Crunch	1/3 c	33	70
General Mills Raisin Bran	1/3 c	25	68
Puffed cereals
Quaker Crispy Corn Puffs	1 c	99	85
Kashi Puffed Seven Whole Grains and Sesame	1 c	80	80
Malt-O-Meal Puffed Wheat	1 c	40	80
Malt-O-Meal Puffed Rice	1 c	20	20
Popeye Puffed Rice	1 c	17	15
Popeye Puffed Wheat	1 c	16	44
Hot cereals
Quaker Quick Oats With Salt	1/2 c	192	150
Quaker Old-Fashioned Oats	1/2 c	183	143
Quaker Quick Oats	1/2 c	183	143
Quaker Oatmeal Nutrition for Women–Golden Brown Sugar	1 packet	154	146
Malt-O-Meal Oatmeal Cinnamon and Spice	1 packet	150	142
Malt-O-Meal Oatmeal Maple and Brown Sugar	1 packet	150	148
Malt-O-Meal Oatmeal Regular	1 packet	150	140
Quaker Oatmeal Nutrition for Women–Vanilla Cinnamon	1 packet	143	117
Quaker Oatmeal Supreme Cinnamon Pecan	1 packet	141	133
Quaker Oatmeal Cinnamon Spice	1 packet	138	115
Quaker Oatmeal Take Heart Golden Maple	1 packet	137	363
Quaker Oatmeal Double Raisin Danish	1 packet	136	190
Quaker Oatmeal Maple Brown Sugar	1 packet	136	114
Quaker Oatmeal Honey Nut	1 packet	134	115
Quaker Oatmeal Cinnamon Roll	1 packet	133	111
Quaker Oatmeal Take Heart Blueberry	1 packet	133	357
Quaker Oatmeal Nutrition for Women–Apple Cinnamon	1 packet	132	136
Quaker Oatmeal Supreme Banana Walnut	1 packet	132	144
Quaker Oatmeal Dinosaur Eggs	1 packet	131	109
Quaker Oatmeal Lower Sugar Maple Brown	1 packet	131	111
Quaker Oatmeal Supreme Apple Raisin	1 packet	130	168
Quaker Oatmeal French Toast	1 packet	129	107
Quaker Oatmeal Breakfast Blast Chocolate Chip	1 packet	128	118
Quaker Oatmeal Banana Bread	1 packet	126	116
Quaker Oatmeal Regular	1 packet	126	104
Quaker Oatmeal Breakfast Blast Cinnamon Toast	1 packet	123	102
Quaker Oatmeal Breakfast Blast S'Mores	1 packet	123	107
Quaker Oatmeal Raisin, Date, Walnut	1 packet	120	157
Quaker Oatmeal Raisin Spice	1 packet	115	155
Quaker Oatmeal Bananas and Cream	1 packet	114	102
Quaker Oatmeal Apple Crisp	1 packet	111	111
Quaker Oatmeal Lower Sugar Apple Cinnamon	1 packet	111	120
Quaker Oatmeal Blueberries and Cream	1 packet	100	92
Quaker Oatmeal Peaches and Cream	1 packet	100	102
Quaker Oatmeal Strawberry and Cream	1 packet	99	101
Quaker Oatmeal Apple Cinnamon	1 packet	96	110
Quaker Oatmeal Express Cups Cinnamon Roll	1/2 c	85	70
Quaker Oatmeal Express Cups Golden Brown Sugar	1/2 c	85	70
Quaker Oatmeal Express Cups Baked Apple	1/2 c	78	82
Breakfast bars
Milk 'n Cereal Bar Cinnamon Toast Crunch	1 bar	150	115
Milk 'n Cereal Bar Cocoa Puffs	1 bar	150	120
Milk 'n Cereal Bar Honey Nut Cheerios	1 bar	150	115
Milk 'n Cereal Bar Peanut Butter Toast Crunch	1 bar	150	120
Milk 'n Cereal Bar Trix	1 bar	150	100
Quaker Breakfast Squares Oatmeal Raisin	1 bar	120	162
Quaker Breakfast Squares Banana Bread	1 bar	114	132
Quaker Breakfast Squares Brown Sugar Cinnamon	1 bar	106	122
Quaker Breakfast Squares Baked Apple	1 bar	102	134
Chewy Trail Mix Bar Apple Cinnamon	1 bar	75	85
Chewy Trail Mix Bar Fruit 'N Nut	1 bar	75	95
Nature Valley Crunchy Granola Bar Banana Nut	1 bar	65	70
Nature Valley Crunchy Granola Bar Peanut Butter	1 bar	65	75
Chewy Trail Mix Bar Mixed Berry	1 bar	65	65
Nature Valley Crunchy Granola Bar Apple Crisp	1 bar	60	60
Nature Valley Crunchy Granola Bar Cinnamon	1 bar	60	65
Nature Valley Crunchy Granola Bar Maple Brown Sugar	1 bar	60	60
Nature Valley Crunchy Granola Bar Oats N' Honey	1 bar	60	63

NOTE. Nutrition analysis reflects data received in March 2005. Listed values may change. Please consult products' nutrition fact labels.

Note that Post/Nabisco cereals are not included in this list because Kraft, the parent company, did not give permission to publish the data.

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Manufacturer Information 

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References 

1. Duxbury D . Measuring and labeling carbohydrates . Food Technol . 2004;58:72–73
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2. The International Dairy Deli Bakery Association. What's in Store Report. The International Dairy Deli Bakery Association, Madison, WI, 1998
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3. US Department of Agriculture (Dietary Guidelines for Americans, 2005) . Washington, DC: US Government Printing Office; 2005;
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