Exploring the Potential Relationship Between Phytate Ingestion, Urinary Phytate Excretion, and Renal Stone Risk in a Unique Human Model: No Hard Evidence in Support of Phytate as a Stone Inhibitor.

OBJECTIVE: Dietary phytate (IP6) enjoys a reputation as an inhibitor of calcium renal stone formation, although there are very few human studies to support this notion. In South Africa, urolithiasis occurs in the white (W) but is rare in the black (B) population. We undertook this unique human model to further investigate the IP6 theory. METHODS: Healthy W and B males completed baseline food-frequency recall questionnaires. Dietary intake of IP6 was restricted for 18 days. An IP6 dietary supplement was ingested on days 15-18. Twenty-four-hour urinary phytate and other urinary components were determined. Relative supersaturations of calcium salts were calculated. The urinary metastable limit (MSL) of calcium oxalate (CaOx) and its crystallisation kinetics were determined experimentally. RESULTS: Habitual dietary intake of IP6 and its urinary excretion were significantly higher in B than in W (1650 ± 202 vs. 640 ± 134 mg/d, P = .0002 and 1.13 ± 0.12 vs. 0.75 ± 0.13 µM, P <.05, respectively). In B, urinary phytate decreased significantly after 15 days of IP6 restriction, but in W, its excretion remained constant. After supplementation, urinary IP6 increased significantly in both groups reaching levels commensurate with the baseline value in B. No significant differences occurred in B in any of the routine urinary risk factors throughout the trial. However, in W, urinary citrate excretion increased on day 18 relative to day 0. There were no significant intragroup or intergroup changes in relative supersaturation, metastable limit, or crystallization kinetics. CONCLUSIONS: Despite notable differences in the renal handling of ingested IP6, there were no changes in any of the well-established urinary risk factors for calcium renal stone formation in either of our uniquely different test groups. We conclude that, in the absence of hard evidence, claims that IP6 is a stone inhibitor remain unproven.

Urinary phytate concentration and risk of fracture determined by the FRAX index in a group of postmenopausal women

Background/aim: This study was designed to evaluate the relationship between urinary phytate concentration and risk of fracture at 10 years, determined by using the FRAX model, in women who had undergone menopause within 5 years of the time of enrollment. Materials and methods: Of the 212 postmenopausal women evaluated, 69 were excluded because they had urinary phytate concentrations between 0.51 and 0.99 mg/L. Of the remaining 143 women, 91 had low (≤0.50 mg/L) and 52 had high (≥1.0 mg/L) urinary phytate concentrations. The 10-year risk of fracture was calculated by using the FRAX model. Results: The risks of major osteoporotic fracture and hip fracture were higher in women with low urinary phytate levels (P < 0.001 in both cases). Evaluation of the risk of hip fracture in women with and without risk factors for osteoporosis (e.g., tobacco, alcohol, and drug consumption) and according to urinary phytate concentrations indicated that, among women with no risk factors, those with low and high urinary phytate levels had a range of risks of 0%­0.6% and 0%­0.3%, respectively (P = 0.098). Moreover, among women with at least one risk factor, those with low and high urinary phytate had a range of risks of 0.1%­0.8% and 0.1%­0.4%, respectively (P = 0.002). Similar results were observed when the risks of major osteoporotic fracture were analyzed. Conclusion: These results indicate the relationship of phytate with the risks of major osteoporotic fracture and hip fracture, with these differences being more marked in women with risk factors for osteoporosis. From this study follows the importance of the consumption of phytate-rich products (nuts, legumes, whole cereals) to protect against the risk of fracture in 10 years, mainly in women with risk factors for osteoporosis.

Protective Effect of Myo-Inositol Hexaphosphate (Phytate) on Abdominal Aortic Calcification in Patients With Chronic Kidney Disease.

OBJECTIVE: The aim of this study was to evaluate the relationship between physiological levels of myo-inositol hexaphosphate (phytate) and cardiovascular (CV) calcification in patients with chronic kidney disease (CKD). DESIGN AND METHODS: This was a prospective cross-sectional study conducted from December 2012 to June 2013. SUBJECTS: Sixty-nine consecutive patients with CKD who were not undergoing renal replacement therapy. INTERVENTION: All subjects were given lateral lumbar X-rays to quantify abdominal aortic calcification (AAC). Clinical laboratory analyses and phytate food frequency questionnaires were also performed. MAIN OUTCOME MEASURE: Phytate urinary excretion, estimated phytate consumption (based on food frequency questionnaire) and AAC score. Patients were divided into two groups based on median abdominal aortic calcification (AAC) score: no/mild AAC (AAC ≤ 6, n = 35) and moderate/severe AAC (AAC > 6, n = 34). RESULTS: Patients with no/mild AAC were younger, had lower pulse pressure, greater dietary intake of phytate, greater urinary phytate and the prevalence of prior CV disease was significantly lower compared to patients with moderate/severe AAC. Among the top 10 phytate-rich foods, lentil consumption was significantly greater in patients with no/mild AAC than in those with moderate/severe AAC. Multivariate logistic regression analysis indicated that age, prior CV disease, urinary phytate (or lentil consumption) were independently associated to AAC. CONCLUSION: Our results suggest that adequate consumption of phytate can prevent AAC in patients with CKD. Further prospective studies must be performed to elucidate the benefits of a phytate-rich diet and the associated risk of phosphorus bioavailability in these patients.

Conundrum of IP6.

Here are comments on the recent paper on the determination of inositol hexaphosphate (IP6) in human plasma and on its efficacy.

There is no 'Conundrum' of InsP6.

Indirect assays have claimed to quantify phytate (InsP6) levels in human biofluids, but these have been based on the initial assumption that InsP6 is there, an assumption that our more direct assays disprove. We have shown that InsP6 does not and cannot (because of the presence of an active InsP6 phosphatase in serum) exist in mammalian serum or urine. Therefore, any physiological effects of dietary InsP6 can only be due either to its actions in the gut as a polyvalent cation chelator, or to inositol generated by its dephosphorylation by gut microflora.

Relationship between Urinary Level of Phytate and Valvular Calcification in an Elderly Population: A Cross-Sectional Study.

Pathological calcification generally consists of the formation of solid deposits of hydroxyapatite (calcium phosphate) in soft tissues. Supersaturation is the thermodynamic driving force for crystallization, so it is believed that higher blood levels of calcium and phosphate increase the risk of cardiovascular calcification. However several factors can promote or inhibit the natural process of pathological calcification. This cross-sectional study evaluated the relationship between physiological levels of urinary phytate and heart valve calcification in a population of elderly out subjects. A population of 188 elderly subjects (mean age: 68 years) was studied. Valve calcification was measured by echocardiography. Phytate determination was performed from a urine sample and data on blood chemistry, end-systolic volume, concomitant diseases, cardiovascular risk factors, medication usage and food were obtained. The study population was classified in three tertiles according to level of urinary phytate: low (<0.610 µM), intermediate (0.61-1.21 µM), and high (>1.21 µM). Subjects with higher levels of urinary phytate had less mitral annulus calcification and were less likely to have diabetes and hypercholesterolemia. In the multivariate analysis, age, serum phosphorous, leukocytes total count and urinary phytate excretion appeared as independent factors predictive of presence of mitral annulus calcification. There was an inverse correlation between urinary phytate content and mitral annulus calcification in our population of elderly out subjects. These results suggest that consumption of phytate-rich foods may help to prevent cardiovascular calcification evolution.

A novel method for the purification of inositol phosphates from biological samples reveals that no phytate is present in human plasma or urine.

Inositol phosphates are a large and diverse family of signalling molecules. While genetic studies have discovered important functions for them, the biochemistry behind these roles is often not fully characterized. A key obstacle in inositol phosphate research in mammalian cells has been the lack of straightforward techniques for their purification and analysis. Here we describe the ability of titanium dioxide (TiO2) beads to bind inositol phosphates. This discovery allowed the development of a new purification protocol that, coupled with gel analysis, permitted easy identification and quantification of InsP6 (phytate), its pyrophosphate derivatives InsP7 and InsP8, and the nucleotides ATP and GTP from cell or tissue extracts. Using this approach, InsP6, InsP7 and InsP8 were visualized in Dictyostelium extracts and a variety of mammalian cell lines and tissues, and the effects of metabolic perturbation on these were explored. TiO2 bead purification also enabled us to quantify InsP6 in human plasma and urine, which led to two distinct but related observations. Firstly, there is an active InsP6 phosphatase in human plasma, and secondly, InsP6 is undetectable in either fluid. These observations seriously question reports that InsP6 is present in human biofluids and the advisability of using InsP6 as a dietary supplement.

Characterization of deposits in patients with calcific tendinopathy of the supraspinatus. Role of phytate and osteopontin.

Calcific tendinopathy of the tendons of the rotator cuff is common in adults. These calcifications tend to be reabsorbed after a period of acute pain. This study evaluated the morphologic characteristics of calcific deposits and the participation of phytate and osteopontin (OPN) in their development. Calcific deposits were removed from 21 patients with calcific tendinopathy by ultrasound-guided needle puncture under local anesthesia. The removed deposits were evaluated by scanning electron microscopy, X-ray diffraction and Fourier transform infrared spectroscopy. The amounts of calcium and phosphorus in the deposits were semi-quantitatively determined by energy dispersive X-ray analysis. Phytate was determined in 2 h urine samples, and OPN was extracted from a pool of deposits. The calcific deposits consisted of amorphous and poorly crystalline carbonated hydroxyapatite containing molecular water and organic matter. OPN was associated with the hydroxyapatite deposits. Phytate concentrations were significantly lower in the urine of patients with calcific tendinopathy than in healthy controls. The deficit in crystallization inhibitors such as phytate, and the presence of regulators such as OPN, may play important roles in the development of calcific tendinopathy.

Urinary phytate (Myo-inositol hexaphosphate) in healthy school children and risk of nephrolithiasis.

OBJECTIVE: Although the incidence of urolithiasis is lower in children than in adults, the number of children with urolithiasis is increasing. Phytate, a naturally occurring compound present in legumes, nuts, and whole meals, has antilithiasic activity. The aim of this study was to assess, for the first time, the urinary levels of phytate in children and to correlate these levels with other urinary parameters related to crystallization risk and to general dietary habits. DESIGN AND METHODS: This was a cohort study conducted from April 2012 to March 2013 in the Laboratory of Investigation in Renal Lithiasis and at Son Espases Universitary Hospital in Palma de Majorca, Spain. SUBJECTS: Subjects included 165 healthy schoolchildren aged 5 to 12 years. INTERVENTION: All subjects followed their habitual diet. Information on the main dietary habits of the study subjects was obtained by asking each child's parents to fill out a dietary questionnaire. MAIN OUTCOME MEASURE: Phytate and citrate concentration and excretion were measured in 2 urine samples (a spot sample and a 12-hour overnight sample) for each child. Furthermore, common urinary biochemical indicators of stone risk were measured in each sample. RESULTS: The urinary phytate concentrations were low in this child population because of low consumption of dietary phytate. The urinary concentrations of phytate and citrate were low in 27.5% of these children. CONCLUSION: Because both substances are important inhibitors of crystallization, these finding suggests that these children are at risk of crystallization. Moreover, their diets consisted of foods rich in animal protein, with insufficient consumption of vegetables, legumes, and fruits.

Protective effect of myo-inositol hexaphosphate (phytate) on bone mass loss in postmenopausal women.

INTRODUCTION: The objective of this paper was to evaluate the relationship between urinary concentrations of InsP6, bone mass loss and risk fracture in postmenopausal women. MATERIALS AND METHODS: A total of 157 postmenopausal women were included in the study: 70 had low (≤0.76 µM), 42 intermediate (0.76-1.42 µM) and 45 high (≥1.42 µM) urinary phytate concentrations. Densitometry values for neck were measured at enrollment and after 12 months (lumbar spine and femoral neck), and 10-year risk fracture was calculated using the tool FRAX(®). RESULTS: Individuals with low InsP6 levels had significantly greater bone mass loss in the lumbar spine (3.08 ± 0.65 % vs. 0.43 ± 0.55 %) than did those with high phytate levels. Moreover, a significantly greater percentage of women with low than with high InsP6 levels showed more than 2 % of bone mass loss in the lumbar spine (55.6 vs. 20.7 %). The 10-year fracture probability was also significantly higher in the low-phytate group compared to the high-phytate group, both in hip (0.37 ± 0.06 % vs 0.18 ± 0.04 %) and major osteoporotic fracture (2.45 ± 0.24 % vs 1.83 ± 0.11 %). DISCUSSION: It can be concluded that high urinary phytate concentrations are correlated with reduced bone mass loss in lumbar spine over 12 months and with reduced 10-year probability of hip and major osteoporotic fracture, indicating that increased phytate consumption can prevent development of osteoporosis.

A simple and rapid colorimetric method for determination of phytate in urine.

Phytate is a natural product present in urine and biological fluids that is associated with health benefits, such as the prevention of calcium renal stone formation. The available methods for phytate analysis in urine all require elaborate instrumentation and cannot be routinely applied in clinical laboratories. Here, we describe a simple procedure for urinary phytate determination, employing colorimetric detection. Our method requires purification and preconcentration of phytate via solid-phase extraction prior to colorimetric detection employing Fe(III)-thiocyanate. The working linear range of the assay is 0-5 µM phytate. The limit of detection is 0.055 µM. The relative standard deviation obtained upon assay of samples containing 2 µM phytate was 3.5 %. Several urine samples were analyzed using an alternative method based on the detection of phosphorus; the results of the two assays were comparable. Our novel method of phytate analysis in human urine is simple, rapid (3 h for 10 samples), accurate, precise, reliable, and highly sensitive. The assay can be run in most analytical laboratories and does not require sophisticated instrumentation.

Synchronous fluorescence determination of phytic acid in foodstuffs and urine based on replacement reaction.

INTRODUCTION: Phytic acid is a ubiquitous and abundant natural component in many plant seeds, fruits and vegetables. Its biological and pharmaceutical functions are still controversial. The examination on the level of phytic acid in foodstuffs and urine can provide valuable information for its dietary intake and metabolism. OBJECTIVE: To develop a sensitive and reliable synchronous fluorescence protocol for determination of phytic acid in selected foodstuffs and human urine. METHODOLOGY: Phytic acid efficiently catches Cu²+ ion in previously prepared Cu(II) -2,2'-bipyridine complex in aqueous solution, releasing the fluorescent 2,2'-bipyridine molecule and recovering synchronous fluorescence. The recovered fluorescence is proportional to the added phytic acid, by which the levels of phytic acid in the selected foodstuffs and human urine are quantified. RESULTS: A calibration curve with a regression equation of I(f) = 37.745 + 39.245c (R² > 0.9988) showed good linearity over the range 0.18-17.50 mg/L phytic acid. The relative standard deviation at 95% confidence degree was less than 2.04% (n = 5), indicating that the procedures are reproducible. The detection and quantification limit of phytic acid were estimated to be 0.12 and 0.18 mg/L, respectively. By the proposed method, phytic acid in the selected foodstuffs and urine was determined to be 3.25-16.76 and 0.43-1.21 mg/L with recoveries of 96.8%-105.6% and 95.1%-104.2%, respectively. The results are in good agreement with those obtained by the reported HPLC technique. CONCLUSION: The developed method is sensitive, reliable and economical, which permits its practical application in quantitative analyses of trace phytic acid in foodstuffs and urine.

Phytate levels and bone parameters: a retrospective pilot clinical trial.

This study evaluated the relationship between phytate urinary levels and bone characteristics in a large population of postmenopausal women. The study population consisted of 180 postmenopausal women who participated in a descriptive cross-sectional study. A urine sample was collected from each subject to determine phytate levels and the volunteers were divided into two groups according to phytate urinary concentration (i.e., low and high levels). Bone mineral density was determined in the lumbar spine and femoral neck of groups with low and high phytate urinary levels. Urinary levels of phytate were linked to dietary phytate consumption. Hence, bone mineral density values were significantly higher in the lumbar spines and femoral necks of women who consumed high levels of phytate than in women with low urinary phytate concentrations. Higher urinary levels of phytate correlated with higher bone mineral density in the lumbar spine and femoral necks of postmenopausal women. This finding demonstrates the potential use of phytate in the treatment of bone related diseases, as it uses a mechanism of action similar to some bisphosphonates.

Effects of Mediterranean diets with low and high proportions of phytate-rich foods on the urinary phytate excretion.

BACKGROUND: Important health benefits have been reported recently to phytate intake. This includes the prevention of pathological calcifications such as renal calculi, dental calculi and cardiovascular calcification, due its action as crystallization inhibitor of calcium salts, and as preventive of cancer. AIM OF STUDY: The aim of this study was to establish a relation between the intake of phytate, through consumption of typical components of the Mediterranean diet (including nuts), and its excretion in urine. METHODS: This study recruited participants from subjects included in a larger trial (PREDIMED) of food habits, that were assigned to one of two diet groups: (1) the Mediterranean diet with low proportion of phytate-rich food group, where participants were asked to maintain their usual diet; and (2) the Mediterranean diet with high proportion of phytate-rich food group, where participants were asked to increase phytate-rich foods in their diet. Phytate intake was assessed on the basis of a food frequency questionnaire. Urinary phytate excretion was determined in 2-h urine samples. RESULTS: The overall phytate consumption of the Mediterranean diet with high proportion of phytate-rich food group (672 +/- 50 mg) was significantly higher than the Mediterranean diet with low proportion of phytate-rich food group (422 +/- 34 mg), representing a 59% difference. Urinary phytate excretion was also significantly higher (54%) in the Mediterranean diet with high proportion of phytate-rich food group (1,016 +/- 70 microg/L) than the Mediterranean diet with low proportion of phytate-rich food group (659 +/- 45 microg/L). CONCLUSIONS: Mediterranean diets high in whole cereals, legumes and nuts compared to Mediterranean diets low in these phytate-rich foods increase the urinary phytate excretion in humans.

Minimum handling method for the analysis of phosphorous inhibitors of urolithiasis (pyrophosphate and phytic acid) in urine by SPE-ICP techniques.

Pyrophosphate (PPi) and phytic acid (IP6) are natural phosphorous compounds with growing interest in the biomedical field due to their ability as potential inhibitors of urolithiasis among others. Existing methodologies for their evaluation show inconveniences mainly associated with sample treatment, matrix interferences and lack of resolution. The objective of the present work is the validation of a new method to determine both inhibitors in urine samples selectively and its application to the diagnosis of lithiasic patients. After urine purification by an off-line anion exchange solid phase extraction (SPE), based in an appropriate acidic elution gradient, the phosphorous compounds were analyzed by (31)P measurements by inductively coupled plasma mass spectrometry (ICP-MS) in the purified urine extracts. Linear range and limit of detection obtained were adequate for the analysis of the physiological amounts of the compounds in urine. The method was successfully applied to human urine samples, resulting in adequate accuracy and precision and allowing for the analysis of phosphorus inhibitors of urolithiasis in urine. The method simplicity and high sample throughput leads to a clear alternative to current determinations of the mentioned species in urine. Moreover, PPi and IP6 concentrations found in patients suffering from oxalocalcic urolithiasic were significantly lower than those for healthy controls, supporting the fact that the risk for oxalocalcic urolithiasis increases when urinary phosphorus inhibitors decrease. Thus, speciation of phosphorus inhibitors of urolithiasis in urine of stone formers can be performed, which is of unquestionable value in diagnostic, treatment and monitoring of urolithiasis.

Fluorimetric determination of phytic acid in urine based on replacement reaction.

A sensitive fluorimetric method for determination of phytic acid in human urine samples was described. The method was based on a fluorimetric replacement reaction, in which the added phytic acid replaced the Cu2+ ion from Cu2+-gelatin complex, liberating the fluorescent gelatin molecule. The fluorescence of the solution was accordingly recovered proportionally to the amount of the foreign phytic acid. The excitation wavelength was 273.5 nm and the characteristic emission wavelength was 305.0 nm, respectively. The calibration graph was obtained by plotting the recovered fluorescent intensity at maximum 305.0 nm against the added standard phytic acid, and was divided into two sections. One section was linear over the range of 0.40-2.40 mg L(-1) with a linear regression equation of I(f) = -0.895+15.146c (R2 > 0.9993), and the other over the range of 2.40-9.20 mg L(-1) with a linear regression equation of I(f) = -29.526+26.113c (R2 > 0.9996), respectively. The relative standard deviation (R.S.D.) at 95% confidence degree for a 2.0 mg L(-1) of standard phytic acid within 1 month was less than 1.26% (n = 5), indicating the procedure is reproducible. The detection and the quantification limits of phytic acid were estimated to be 0.23 and 0.40 mg L(-1), respectively. The proposed method was applied to the determination of phytic acid in urine samples and the found concentrations of phytic acid in urine were in the range of 0.49-0.75 mg L(-1) with recoveries of 96.2-108.8%. Comparison of the obtained results with the reported HPLC was performed, indicating the proposed method was reliable.

Phytate acts as an inhibitor in formation of renal calculi.

The aim of this study was to assess the inhibitory action of phytate in formation of renal calculi. Hypertension (induced by nicotine) combined with hypercalcemia (induced by D vitamin) was used to induce calcification in renal tissue in male Wistar rats that were fed a purified phytate free diet. Phytate non-treated rats developed significant calcium deposits in kidneys and papillae, as well as in kidney tubules and vessels, whereas calcium deposits were absent in control and phytate treated rats. Fragments of hydroxyapatite (HAP) calculi exhibited the capacity to induce the growth of calcium salts on their surfaces. Presence of 1.5 mg/L of phytate in the synthetic urine inhibited the formation of calcium oxalate monohydrate on HAP renal calculi in normocalciuric conditions. The findings show that the action of phytate as a crystallization inhibitor takes place both in the intrapapillary tissue and urine.

Absorption of myo-inositol hexakisphosphate (InsP6) through the skin in humans.

In this paper, we present a pilot study of the absorption of myo-inositol hexakisphosphate (InsP6) through the skin in humans. We found that, after topical treatment with a 4% InsP6 rich gel, InsP6 urinary excretion increased 54% compared to the control situation (participants submitted to an InsP6-poor diet for 15 days, n = 6), clearly demonstrating that InsP6 is absorbed through the skin of humans. These results demonstrate the topical application as a suitable administration route of InsP6 in humans.

Influence of concomitant food intake on the excretion of orally administered myo-inositol hexaphosphate in humans.

myo-Inositol hexaphosphate (InsP6) widely occurs in plant seeds. At present, some important benefits of InsP6 for human health have been described. The purpose of this study was to find the best condition for the optimum absorption of orally administered InsP6, evaluated by InsP6 urinary excretion. The influence of different stomach conditions (empty, empty with an alkalinizing agent, and full stomach) on the effects of oral administration of InsP6 and its urinary excretion was investigated in six healthy subjects on an InsP6-poor diet, given 400 mg of calcium/magnesium salt of InsP6 as a single dose. The basal urinary excretion of InsP6 on an InsP6-poor diet (50.91 +/- 15.09 microg) was significantly lower than that found when an InsP6-normal diet was consumed (100.09 +/- 26.42 microg) (P < .05). No differences were observed in the areas under the curve of accumulated excretion at 8 hours among the three different stomach conditions studied, suggesting that the overall InsP6 absorption took place independently of the stomach state (full or fasted) and indicating that the InsP6 absorption also takes place during the intestinal transit. Thus, if InsP6 supplements of vegetal origin are consumed to maintain the optimum InsP6 levels needed for a healthy status, these supplements can be consumed either during or between meals with the same efficacy.

Intracellular and extracellular myo-inositol hexakisphosphate (InsP6), from rats to humans.

The presence of myo-inositol hexakisphosphate (InsP6) in biological fluids (blood, urine, saliva, interstitial fluid) of mammalians has been clearly demonstrated. The existence of intracellular InsP6 in mammalian cells has also been established. Further, significant extracellular and intracellular functions of this molecule have been found. The relationship between InsP6 ingestion and the InsP6 distribution in various tissues of mammalians is discussed. It was found that the majority of the extracellular InsP6 found in organs, tissues and biological fluids of mammalians has a dietary origin and is not a consequence of endogenous synthesis, whereas the intracellular InsP6 probably originates in the cell. Little absorption of dietary InsP6 takes place during intestinal transit and depletion of extracellular InsP6 occurs at high rates when InsP6-poor diets are consumed. From these results, it can be deduced that health benefits linked to extracellular InsP6 must be related to dietary InsP6.