True tumoral calcinosis is a genetic disorder that causes crystalline deposits of calcium and phosphorus near joints. Your body reabsorbs excess phosphorus instead of excreting it and then uses this excess to form the abnormal deposits. There are other conditions that resemble this and are sometimes referred to by the same name. A special diet is sometimes used in treating tumoral calcinosis. It is not a balanced diet and should never be used except under close medical supervision.
Genetics
Tumoral calcinosis is an hereditary metabolic disorder. It is most commonly a recessive disorder. Both parents must be carriers of the defective gene in order for this condition to appear in their children. Tumoral calcinosis is found more often in people of African descent. It is considered a rare disease. A non-genetic, acquired form of the disease can occur with conditions that cause severely increased levels of phosphorus.
Identification
Since many bone-like deposits appear similar on x-rays, and many conditions can cause a high phosphorus level, the diagnosis of tumoral calcinosis is made by a combination of these tests, age at onset and family history. The condition usually begins in childhood and is a lifelong disease process. "Harrison's Principles of Internal Medicine" explains that the masses are usually painless in themselves, but nerve damage from pressure and injury and infection from the deposits breaking through the skin are major complications of tumoral calcinosis.
Purpose of Diet
The treatment by diet is intended to lower the phosphorus level in the body. In children, it is important to be sure they are getting what they need for developing bones. A registered dietitian can help. Calcium phosphate is found in milk and dairy products, so these foods should be very limited and may need to be avoided altogether when the phosphorus level is too high. The University of Michigan recommends only ½ cup of milk, ice cream, pudding or yogurt a day. Cheese should be limited to 1 oz. of regular cheese or ¼ cup of cottage cheese twice a week.
The "Phos" Word
Beverages are a little easier. Cola and some similar drinks must be avoided, but many sweet sodas and fruit drinks are allowed. You do need to be careful with mineral waters, as many of these are high in phosphorus. MayoClinic.com gives this useful advice for label reading: "Look for any ingredient that contains "phos" in the term." Phosphorus-restricted diets are complicated by phosphorus being bound to other chemicals. Any product with a "calcium added" label should be checked as the calcium may be calcium phosphate. MayoClinic.com emphasizes that while many foods have phosphorus added and there may be a similar product without it. You can look for these to find foods you enjoy and that are safe for you.
Grains and Proteins
Whole grain products, so good for most people, are not included on a phosphorus-restricted diet. White bread and a few cereals are allowed. Bran is avoided, as is wild rice. White rice is allowed. All grain products that contain chocolate or nuts, such as flavored cereals, are not permitted. Nuts are not on the diet, nor is liver. Most other protein foods are allowed, but egg yolks and peanut butter are only to be used in limited amounts twice a week.
Other Considerations
Many fruits and vegetables are allowed, but some beans and legumes are not. Prunes and dates are the forbidden fruits. Peas and corn are limited. This diet is one of careful substitution and your doctor and dietitian can help with printed information to make your choices easier and your food more enjoyable. Your phosphorus restrictions may differ from these depending on your age and test results. The diet may be adjusted when the lab results change. Medications may be used to help rid your body of the excess phosphorus.
References
- Online Mendelian Inheritance in Man: Tumoral Calcinosis
- "RadioGraphics"; Tumoral Calcinosis: Pearls, Polemics, and Alternative Possibilities; Kathryn M. Olsen, MD and Felix S. Chew, MD; May 2006
- "Harrison's Principles of Internal Medicine"; Anthony S. Fauci, Eugene Braunwald, Dennis L. Kasper, Stephen L. Hauser, Dan L. Longo, J. Larry Jameson, Joseph Loscalzo; 2008.
- University of Michigan Hospitals and Health Centers: Phosphorus Restricted Diet
- MayoClinic.com: Low Phosphorus Diet
