The kidneys have to clear it
The body absorbs phosphate additives far more easily than the phosphorus in whole foods. Studies of large groups have linked high phosphate intake to faster worsening of chronic kidney disease and to raised blood phosphate. In 2019 European reviewers consulted kidney specialists, who confirmed the daily limit does not protect people with moderate to severe kidney disease, because their kidneys cannot clear the extra.
Reviewers set a shared daily limit for phosphates (E338 to E341, E450 to E452) of 40mg of phosphorus per kg of body weight, and said plainly it does not apply to people with moderate to severe kidney disease.
2019Regulator reviewEFSA Panel on Food Additives and Nutrient Sources added to Food (ANS), EFSA Journal 2019, volume 17, 5674
Kidney specialists consulted by the reviewers confirmed that high phosphate additive intake matters clinically for people with chronic kidney disease, because additive phosphate is absorbed almost completely, unlike phosphorus bound to protein in food.
2019Regulator reviewEFSA Supporting Publications EN-1624, outcome of nephrology expert consultation on phosphate food additives
Linked to coronary heart disease in a large French study
The NutriNet-Santé study asked 95,442 French adults with no history of heart disease to record everything they ate, then followed their health for about 7 years. People with a high intake of trisodium phosphate (E339) had more coronary heart disease. This shows a link, not proof that E339 causes it, and the researchers called for the finding to be repeated.
Among 95,442 French adults followed for a median of 7.4 years, high intake of trisodium phosphate (E339) was linked to a higher risk of coronary heart disease.
2023Observational study in peopleSellem et al., BMJ, NutriNet-Santé cohort
High blood phosphate and the heart
Large studies have linked higher blood phosphate to more heart disease, including in people without kidney disease. These are links, not proof, and in population data it is hard to separate phosphate additives from phosphorus in whole foods.
In a large US community study of people free of heart and kidney disease, higher blood phosphate was linked to more heart disease over the following years.
2007ObservationalDhingra et al., Archives of Internal Medicine
Additive phosphate hits the blood harder
The phosphorus in meat, fish, nuts and pulses is attached to protein, and the body absorbs roughly 40 to 60% of it. The phosphate salts used as additives are absorbed at about 80 to 100%. So each gram of additive phosphate raises blood phosphate more, which matters most for people whose kidneys struggle to clear it.
Phosphate additives are absorbed at roughly 80 to 100%, against roughly 40 to 60% for phosphorus from protein-rich whole foods, so they raise blood phosphate more for the amount eaten.
2013EstablishedCalvo and Uribarri, American Journal of Kidney Diseases
The heaviest eaters can reach the limit from additives alone
Phosphate additives are in so many processed foods that someone eating a heavily processed diet can take in a lot. European reviewers found the heaviest eaters in some age groups get close to, or reach, the daily limit from additives alone, before the phosphorus naturally in their food is counted.
The heaviest eaters of phosphate additives (top 5%), particularly teenagers, could approach or pass the shared daily limit from additives alone, before phosphorus from ordinary food is added.
2019Regulator reviewEFSA Panel on Food Additives and Nutrient Sources added to Food (ANS), EFSA Journal 2019, volume 17, 5674