Extra work for the kidneys
The body absorbs the phosphate added to processed food more easily than the phosphorus that occurs naturally in whole foods. The kidneys have to filter out the extra. In people with chronic kidney disease they cannot keep up, so phosphate builds up in the blood, which is linked to heart problems and faster decline. Even in healthy adults, a steady high intake adds to the kidneys' workload over time.
European reviewers set a shared daily limit of 40mg of phosphorus per kg of body weight for all phosphate additives (E338 to E341, E343, E450 to E452), and said this limit does not protect people with moderate to severe kidney disease.
2019Regulator reviewEFSA Panel on Food Additives and Flavourings (FAF), EFSA Journal
The body absorbs about 80 to 100% of the phosphate from additives, against about 40 to 60% of the phosphorus in whole foods. So added phosphate raises blood phosphate more for each milligram eaten.
2013ObservationalCalvo & Uribarri, American Journal of Kidney Diseases
High blood phosphate was linked to more deaths from heart disease in people with kidney disease, and in the general population in some long-term studies.
2007ObservationalDhingra et al., Archives of Internal Medicine
Linked to type 2 diabetes in a large French study
The NutriNet-Santé study asked more than 100,000 French adults to record everything they ate, then followed their health for about 7 years. People who ate more potassium phosphates were more likely to develop type 2 diabetes. This shows a link, not proof that E340 causes diabetes, and the researchers called for more research.
Among 104,139 French adults followed for an average of 6.8 years, each extra 500mg of potassium phosphates eaten a day was linked to a 15% higher risk of type 2 diabetes.
2024Observational study in peopleSalame et al., The Lancet Diabetes & Endocrinology, NutriNet-Santé cohort
Bones need phosphorus and calcium in balance
Phosphorus and calcium work as a pair in the body. Eating a lot of phosphorus compared with calcium, year after year, can push up the hormone that controls calcium and cut how much calcium is absorbed, which may affect bone strength over a long time. In healthy adults on a varied diet the effect is thought to be small, but it shows up in studies of large groups.
European reviewers noted that the balance of calcium and phosphorus matters for bones, and that too much phosphate compared with calcium can harm bone density.
2019Regulator reviewEFSA Panel on Food Additives and Flavourings (FAF), EFSA Journal
In a trial where people ate more phosphorus with the same calcium, the hormone that controls calcium rose and signs of new bone forming fell, pointing to a harmful effect on bone.
2009Randomised trial in peopleKemi et al., Nutrition Journal
It adds up across a processed diet
Added phosphates are concentrated in ultra-processed food. People who eat a lot of processed meat, instant products and processed cheese can take in several times more phosphorus than whole foods alone would give them. UK labels do not show phosphorus, so there is no easy way to track how much you are getting.
Studies of Western diets estimate that additives may supply 10 to 50% of daily phosphorus in people who eat a lot of processed food.
2013ObservationalLeon et al., Journal of Renal Nutrition