The amount of phosphate-containing food additives in the US has substantially increased over the past several decades.^1-3 This is due to the increase in the production of ultra-processed foods, a high percentage of which contain phosphate additives⁴; phosphate food additives serving a wide variety of functions (such as leavening agents, stabilizers, thickeners, emulsifiers, acidifiers, flavoring agents, anticaking agents, dough strengtheners, antimicrobials, and color enhancers⁴); and a lack of Food and Drug Administration (FDA) regulation of the majority of phosphate-containing additives due to their “Generally Recognized as Safe” (GRAS) status.⁴  

Over 50,000 unique food products, representing over 85% of all food products sold in the US, contain one or more phosphate additives.⁵ These additives include 28 inorganic phosphate salts⁴ (e.g., phosphoric acid, sodium phosphate, potassium phosphate, and sodium polyphosphate), as well as over a dozen organic phosphate additives, which lack the “phos” identifier, such as lecithin (which is phosphatidylcholine and contains as much as 2,000 mg phosphorus per 100 g⁶) and modified food starch (e.g., acetylated distarch phosphate and monostarch phosphate^1,7) and contribute approximately 12% to 50% to daily phosphorus intake.^2,7,8  

A diet based on foods containing phosphate additives can have up to 1,000 mg more phosphorus than a diet composed of minimally processed foods.^2,9 The increase in highly absorbable phosphate additives to our food supply is cause for concern not only for the 35.5 million Americans with chronic kidney disease (CKD)¹⁰ who have limited capacity to excrete excess phosphorus and suffer many health consequences, including cardiovascular and bone diseases and increased mortality⁵ as a result but for the general population as well. A growing body of evidence demonstrates associations between typical daily phosphorus intakes (which are about twice the Recommended Dietary Allowance [RDA])¹¹ and increased risks for all-cause and cardiovascular mortality; several diseases (e.g., cardiovascular diseases, type 2 diabetes, and certain cancers); and biomarkers for bone, cardiovascular and kidney diseases in the general population.^5,12-15 The FDA does not mandate that the amount of phosphorus—either in total or from phosphate additives—be included on the Nutrition Facts Panel (NFP) of the food label,¹⁶ disadvantaging Americans who wish to make fully informed choices regarding their intake of phosphate additives.

The aim of this article is to raise awareness of the possible adverse health effects of these ubiquitous phosphate additives among the general population and offer strategies to decrease intake.