Food emulsifiers up CVD risk, research advises caution

Consuming foods with emulsifiers may increase the risk of cardiovascular disease (CVD) as shown in a large prospective cohort study.

Although the researchers could not single out themselves the specific additive that causes the most harm, they pointed out that their findings should have widespread policy implications given that food additives are used ubiquitously in ultra-processed food products.

Emulsifiers are food additives used in prepackaged and processed foods, including mayonnaise, margarine, meats, ice cream, salad dressings, chocolate, peanut butter, shelf-stable frostings, cookies, crackers, creamy sauces, breads, and baked products. Natural emulsifiers like hydrocolloids, for example, guar gum, gellan gum, and carrageenan, keep the consistency, texture, smoothness, and flavour of packaged foods and extend their shelf-life.

“If confirmed in epidemiological and experimental research, [the findings] could lead to a modification in the regulation of emulsifier use by the food industry, through food policies requiring a modification of the acceptable daily intake of some emulsifiers, or even restricting the use of others, for better citizen protection,” said co-authors Dr Mathilde Touvier and Bernard Srour, both from Sorbonne Paris Nord University, France.

The long and short of it

The results support the notion that the longer the shelf life of a product, the shorter it can cut your life, commented Dr Andrew Freeman from the National Jewish Health in Denver, Colorado, US, who was not part of the study.

“We should do our best to eat unprocessed, whole, untouched foods as much as possible,” he said. “However, this message does not resonate to most of us. Clinicians can promote these findings in their interactions with patients starting now.”

Researchers quantified intakes of emulsifiers among 95,442 adults without CVD. Mean age was 43.1 years, 79 percent were women. All were  enrolled in the French NutriNet-Santé study between 2009 and 2021 and had  completed at least three 24-hour dietary records during the first 2 years of follow-up. [BMJ 2023;382:e076058]

Almost 100 percent of the participants consumed foods with emulsifiers, the most common being  modified starches, sodium bicarbonate, pectins, and diphosphates. Processed fruit and vegetables, cakes and biscuits, and dairy products contained the most food additive emulsifiers.

Using multivariable proportional hazard Cox models, the researchers assessed the associations between emulsifier intake and risks of CVD, coronary heart disease (CHD), and cerebrovascular disease.

Triad of harm looming large

After a median follow-up of 7.4 years, there were 1,995 incident CVD events, including 1,044 CHD, and 974 cerebrovascular events.

Higher intake of celluloses was associated with higher risks of CVD (hazard ratio [HR], 1.05)  and CHD (HR, 1.07), so were intake of carboxymethylcellulose (1.03 and 1.04, respectively).

The same was true for higher intakes of monoglycerides and diglycerides of fatty acids which were associated with higher risks of all outcomes. Among these emulsifiers,  lactic ester of monoglycerides and diglycerides of fatty acids were associated with  higher risks of CVD (HR, 1.06) and cerebrovascular disease (HR, 1.11). Citric acid ester of monoglycerides and diglycerides of fatty acids were associated with higher risks of CVD (HR, 1.04) and CHD (HR, 1.06), whereas higher intake of trisodium phosphate was associated with an increased risk of CHD (HR, 1.06).

Changing lifestyle the answer

The authors said the results will contribute to the re-evaluation of regulations around food additive usage in the food industry to protect consumers.

Meantime, limiting consumption of ultra-processed foods is a good precautionary advice to reduce exposure to emulsifiers.

“Clinicians need to pay attention. Nutrition is an incredibly powerful therapeutic intervention that is not taught in most medical schools,” said Freeman. “Most people have no clue how to apply them, and as a result, we continue to throw very expensive, lifelong drugs at people when changing lifestyle is really the answer.”