Recent French research indicates that certain food emulsifiers may increase the risk of type 2 diabetes, underscoring the need for further studies to confirm these findings and potentially revise food additive regulations.

Ultra-Processed Foods and Health Risks

In Europe and North America, adults get between 30% and 60% of their caloric intake from ultra-processed foods. A growing body of epidemiological research indicates that higher consumption of these foods is associated with increased risks of diabetes and other metabolic diseases.

Emulsifiers are among the most commonly used additives, added to processed and packaged foods such as industrial cakes, biscuits, yogurts, ice cream, chocolate, industrial bread, margarine, and ready-to-eat or ready-to-heat meals. They improve the appearance, taste, and texture of products and extend their shelf life. These emulsifiers include mono- and diglycerides of fatty acids, carrageenans, modified starches, lecithins, phosphates, celluloses, gums, and pectins.

Innovative Research from France

For the first time worldwide, a team of French researchers studied the relationship between dietary intake of emulsifiers and the risk of developing type 2 diabetes in a large general population study. The study analyzed data from 104,139 adults in France (average age 43 years; 79% women) who participated in the NutriNet-Santé web-cohort study between 2009 and 2023.

Participants completed at least two days of dietary records, collecting detailed information on all foods and drinks consumed and their commercial brands. These dietary records were repeated every six months for 14 years and were matched against databases to identify the presence and amount of food additives (including emulsifiers) in the products consumed. Laboratory assays provided quantitative data, allowing measurement of chronic exposure to these emulsifiers over time. During the follow-up, participants reported the development of diabetes (1,056 diagnosed cases), and reports were validated using a multi-source strategy (including data on diabetes medication use). Several well-known risk factors for diabetes, including age, sex, weight (BMI), educational level, family history, smoking, alcohol, and levels of physical activity, as well as the overall nutritional quality of the diet (including sugar intake), were taken into account in the analysis.

Study Findings and Implications

After an average follow-up of seven years, researchers observed that chronic exposure to the following emulsifiers was associated with an increased risk of type 2 diabetes:

• Carrageenans (total carrageenans and E407; 3% increased risk per increment of 100 mg per day)
• Tripotassium phosphate (E340; 15% increased risk per increment of 500 mg per day)
• Mono- and diacetyl tartaric acid esters of mono- and diglycerides of fatty acids (E472e; 4% increased risk per increment of 100 mg per day)
• Sodium citrate (E331; 4% increased risk per increment of 500 mg per day)
• Guar gum (E412; 11% increased risk per increment of 500 mg per day)
• Gum arabic (E414; 3% increased risk per increment of 1000 mg per day)
• Xanthan gum (E415; 8% increased risk per increment of 500 mg per day)

This study constitutes an initial exploration of these relationships, and further investigations are needed to establish causal links. The researchers mentioned several limitations of their study, such as the predominance of women in the sample, a higher level of education than the general population, and generally more health-promoting behaviors among the NutriNet-Santé study participants. Therefore, caution is needed when extrapolating the conclusions to the entire French population.

The study is nevertheless based on a large sample size, and the researchers accounted for a large number of factors that could have led to confounding bias. They also used unique, detailed data on exposure to food additives, down to the commercial brand name of the industrial products consumed. Additionally, the results remain consistent through various sensitivity analyses, reinforcing their reliability.

Mathilde Touvier, Research Director at Inserm, and Bernard Srour, Junior Professor at INRAE, the lead authors of the study, explain: “These findings are issued from a single observational study for the moment and cannot be used on their own to establish a causal relationship. They need to be replicated in other epidemiological studies worldwide and supplemented with toxicological and interventional experimental studies to further inform the mechanisms linking these food additive emulsifiers and the onset of type 2 diabetes. However, our results represent key elements to enrich the debate on re-evaluating the regulations around the use of additives in the food industry to better protect consumers.”

Among the next steps, the research team will analyze variations in certain blood markers and gut microbiota linked to the consumption of these additives to better understand the underlying mechanisms. They will also study the health impact of additive mixtures and potential “cocktail effects.” They will collaborate with toxicologists to test the impact of these exposures in in vitro and in vivo experiments to gather more arguments in favor of a causal link.

Reference:

“Food additive emulsifiers and the risk of type 2 diabetes: analysis of data from the NutriNet-Santé prospective cohort study” by Clara Salame, Guillaume Javaux, Laury Sellem, Emilie Viennois, Fabien Szabo de Edelenyi, Cédric Agaësse, Alexandre De Sa, Inge Huybrechts, Fabrice Pierre, Xavier Coumoul, Chantal Julia, Emmanuelle Kesse-Guyot, Benjamin Allès, Léopold K Fezeu, Serge Hercberg, Mélanie Deschasaux-Tanguy, Emmanuel Cosson, Sopio Tatulashvili, Benoit Chassaing, Bernard Srour and Mathilde Touvier, May 2024, The Lancet Diabetes & Endocrinology. DOI: 10.1016/S2213-8587(24)00086-X