Are emulsifiers harming your patients' health?
Source: MDLinx /image: -/Author: Alpana Mohta, MD, DNB, FEADV, FIADVL, IFAAD | Fact-checked by Barbara Bekiesz
Key Takeaways
There is a possible connection between food emulsifiers, cardiovascular diseases, gut inflammation, and adverse reactions to food, such as allergies or intolerances.
Emulsifiers like MDG, cellulose, trisodium phosphate, carrageenan, and cellulose are associated with coronary heart disease and cerebrovascular events. Polysorbate 80 and carrageenan also trigger gut inflammation and disrupt the composition of gut bacteria responsible for malignancies, metabolic disorders, and inflammatory bowel disease.
HCPs can advise patients to avoid additives whenever possible by grocery shopping mindfully, focusing on a diet rich in whole foods and fiber, and preparing meals at home.
A significant portion of dietary energy intake in any Western diet comes from ultra-processed foods (UPF). These edibles are heavily processed products containing unusual food additives and infrequently used ingredients.[1]
The prevalence of emulsifiers
Research from the NutriNet-Santé cohort has established a direct connection between the high consumption of UPF rich in food additives and increased risks of cardiovascular disease (CVD). Studies have also found higher incidence rates of obesity, diabetes mellitus, and malignancies with the consumption of UPF.[2]
Emulsifiers are particularly popular additives in the food industry, especially for products with high-fat content. They are prized for their capacity to dissolve and thicken, improving texture and extending shelf life.[3] Other common food additives include preservatives, artificial sweeteners, and dyes.[4]
The NutriNet-Santé data highlights the prominence of emulsifiers among the top-10 food additives that adults consume. The study authors also note that over 54% of edibles worldwide contain at least one emulsifier.
The problematic GRAS
In the US, the safety of food additives, including emulsifiers, is regulated by the FDA, per the Federal Food, Drug, and Cosmetic Act.
GRAS—aka, “generally regarded as safe”—is a term used by the FDA to label food substances recognized as safe by experts, allowing them to be used in food without formal FDA approval.
Unlike regulated food additives, GRAS substances don't undergo FDA review and have no specific usage limits.[5]
Among the 450 items on the GRAS list are the following emulsifiers and additives: lecithins, mono- and diglycerides (MDG), monosodium phosphate derivatives of mono- and diglycerides, diacetyl tartaric ester of monoglycerides (DATEM), maltodextrin, carboxy-methyl-cellulose (CMC), carrageenan, and polysorbate 80 (p80).
Cardiovascular risks
Researchers for the NutriNet-Santé cohort study recently reported their results regarding the risk of cardiovascular events in subjects consuming food containing emulsifiers. The most commonly consumed emulsifiers were starches, diphosphates, sodium bicarbonate, MDG, and pectins.
Over a follow-up period spanning more than 7 years, there were 1,995 occurrences of CVD, 1,044 for coronary heart disease, and 974 for cerebrovascular disease. Cellulose was linked with higher risk of CVD and coronary heart disease. MDG was associated with a higher risk of CVD and cerebrovascular disease, while trisodium phosphate was linked with coronary heart disease.
Carrageenan, one of the most widely studied food emulsifiers, can also affect both the gut and the heart. Carrageenan-induced colitis may reduce the population of the cardioprotective gut microbiome Akkermansia muciniphila.
Risk of gut inflammation
Carrageenan can also trigger intestinal inflammation and ulcers in both laboratory and animal models. Other widely used agents like CMC and p80, as noted by researchers writing in Frontiers in Nutrition, tend to disrupt the microbiota composition, leading to continuous low-grade inflammation and metabolic disorders.[6]
As reported by the NutriNet-Santé investigators, excessive consumption of CMC has also been associated with an elevated colon cancer risk.
The investigators also cited a recent brief intervention study in which humans were administered a notably high dose—15 g/day of CMC— over an 11-day period. This resulted in the escalation of gut inflammation markers and a decline in gut microbiota diversity.
The Frontiers in Nutrition authors note that emulsifiers have the potential to alter the behavior of intestinal cells. A 2023 in-vitro study found that emulsifiers accelerate intestinal inflammation and trigger the release of inflammatory cytokines, particularly interleukin-6 (IL-6) and CCL2.
Emulsifiers' detergent-like qualities alter the protective mucosal layers in the intestines, facilitating the passage of bacteria through the epithelial barriers. Any interference with the interaction between mucus and bacteria can foster gut inflammation and immune responses.
Altered gut microbiota is linked to chronic inflammatory conditions, including obesity, inflammatory bowel disease (IBD), and metabolic syndrome.
Practical tips for healthier choices
As an HCP, you play a critical role in guiding your patients toward healthier dietary choices. Given the potential risks associated with these additives, here is some guidance to share with your patients.
Shop mindfully at grocery stores. Pick your edibles from the outer aisles of the grocery store, where fresh produce, lean meats, and dairy products are usually located. Take a moment to read the ingredient labels on packaged foods before buying them.
Watch out for terms like "emulsifiers," "additives," and "preservatives" on food labels. Foods with fewer additives are generally a better choice. For example, opt for plain yogurt instead of flavored variants.
Make it a priority to eat whole, unprocessed foods and a high-fiber diet. Fresh vegetables, fruits, whole grains, and lean proteins are packed with nutrients and free from artificial additives. For instance, pick fresh apples over apple-flavored snacks.
Minimize the consumption of heavily processed snacks like chips, crackers, and cookies. Instead, snack on natural foods like mixed nuts or fresh carrot sticks.
Prepare meals at home whenever possible. This allows greater control over the ingredients in the food and helps avoid hidden additives.
What this means for you
Consumers should not bear the entire responsibility for making healthier food decisions, particularly when it pertains to establishing a foundation for better long-term health in children. As an HCP, you are uniquely positioned to promote the consumption of whole grains and fresh fruits and vegetables for your patients. Educate them about the health benefits of reducing consumption of ultra-processed food, sugar, sodium, and saturated fatty acids.