Food reformulation is commonly used as a strategy to produce foods for improved health; for example, replacing sugar with aspartame, and salt (NaCl) with KCl may help to reduce the incidence of obesity and heart disease. However, such reformulations will also change the intrinsic physicochemical properties of the food, which may in turn support the growth of foodborne pathogens and ultimately increase the incidence of foodborne disease. Thus, we need a better understanding of the microbiological food safety issues associated with product reformulation. Herein we review the most recent advances in our understanding of how microbial pathogens adapt to changes in the food composition, and how this information may ultimately be used for the design of effective pathogen control measures.