Phosphorus in the Modern Food Supply: Underestimation of Exposure

Modern food processing techniques, while improving many desirable aspects of processed foods, have introduced unforeseen risk factors linked to renal, bone, and cardiovascular disease in people with chronic kidney disease (CKD). This chapter examines in depth one of these widely used processing tools, the addition of phosphate additives during processing to provide a number of different needed functions that improve processed foods in a variety of ways. We contend that the popularity, convenience, and continued demand for processed foods containing one or more phosphate additive is increasing their presence in the market place. This change in the modern food supply limits food choices and provides no means of identifying foods with added phosphates. Consequently, this adversely impacts the 20 million Americans with CKD who need to limit their phosphorus intake in order to avoid the hormonal repercussions of a disordered mineral balance. Phosphate additive use also contributes to the phosphorus intake of the general healthy population, which currently exceeds nutrient needs for the majority of adults and disrupts the delicate balance between calcium and phosphorus intake. In this chapter, we offer compelling evidence of the need for mandatory labeling of total phosphorus content on the Nutrition Facts Panel of processed foods, which would capture both naturally present and added phosphorus content. Such mandatory labeling would enable CKD patients and regulatory scientists to accurately measure phosphorus exposure and determine true potential individual and population health risks.