99.7% of people who got Diabetes had been regularly consuming food emulsifiers - May 2024

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Food additive emulsifiers and the risk of type 2 diabetes: analysis of data from the NutriNet-Santé prospective cohort study

Lancet - Diabetes| VOLUME 12, ISSUE 5, P339-349, MAY 2024 https://doi.org/10.1016/S2213-8587(24)00086-X
Clara Salame, PhD, Guillaume Javaux, MSc, Laury Sellem, PhD, Emilie Viennois, PhD, Fabien Szabo de Edelenyi, PhD, Cédric Agaësse, RD

Background
Experimental studies have suggested potential detrimental effects of emulsifiers on gut microbiota, inflammation, and metabolic perturbations. We aimed to investigate the associations between exposures to food additive emulsifiers and the risk of type 2 diabetes in a large prospective cohort of French adults.
Methods
We analysed data from 104 139 adults enrolled in the French NutriNet-Santé prospective cohort study from May 1, 2009, to April 26, 2023; 82 456 (79·2%) were female and the mean age was 42·7 years (SD 14·5). Dietary intakes were assessed with three 24 h dietary records collected over three non-consecutive days, every 6 months. Exposure to additive emulsifiers was evaluated through multiple food composition databases and ad-hoc laboratory assays. Associations between cumulative time-dependent exposures to food additive emulsifiers and the risk of type 2 diabetes were characterised with multivariable proportional hazards Cox models adjusted for known risk factors. The NutriNet-Santé study is registered at ClinicalTrials.gov (NCT03335644).
Findings
Of 104 139 participants, 1056 were diagnosed with type 2 diabetes during follow-up (mean follow-up duration 6·8 years [SD 3·7]). Intakes of the following emulsifiers were associated with an increased risk of type 2 diabetes: total carrageenans (hazard ratio[ [HR] 1·03 [95% CI 1·01–1·05] per increment of 100 mg per day, p<0·0001), carrageenans gum (E407; HR 1·03 [1·01–1·05] per increment of 100 mg per day, p<0·0001), tripotassium phosphate (E340; HR 1·15 [1·02–1·31] per increment of 500 mg per day, p=0·023), acetyl tartaric acid esters of monoglycerides and diglycerides of fatty acids (E472e; HR 1·04 [1·00–1·08] per increment of 100 mg per day, p=0·042), sodium citrate (E331; HR 1·04 [1·01–1·07] per increment of 500 mg per day, p=0·0080), guar gum (E412; HR 1·11 [1·06–1·17] per increment of 500 mg per day, p<0·0001), gum arabic (E414; HR 1·03 [1·01–1·05] per increment of 1000 mg per day, p=0·013), and xanthan gum (E415, HR 1·08 [1·02–1·14] per increment of 500 mg per day, p=0·013).
Interpretation
We found direct associations between the risk of type 2 diabetes and exposures to various food additive emulsifiers widely used in industrial foods, in a large prospective cohort of French adults. Further research is needed to prompt re-evaluation of regulations governing the use of additive emulsifiers in the food industry for better consumer protection.

Research in context

Evidence before this study
We did a comprehensive literature search of PubMed from database inception to Sept 25, 2023, for studies published in English and French focusing on the potential effects of food additive emulsifiers on type 2 diabetes. The search terms were “(diabetes or type 2 diabetes or diabetes mellitus)” AND “(food additive emulsifiers or emulsifiers)”. A small number of experimental studies (in vitro, animal, and short-term randomised controlled trials) suggested adverse effects of some emulsifiers such as

• gut microbiota dysbiosis,
• inflammation, and
• metabolic perturbations.
  • (all 3 of which are fought by vitamin D)

Two cohort studies from our group showed associations between exposure to various food additive emulsifiers and
an increased risk of

• cardiovascular disease and
• cancer.

No such investigation has, to the best of our knowledge, yet been conducted to assess the risk of type 2 diabetes.
Added value of this study
The present study is the first to quantitatively assess exposure to food additive emulsifiers in a large-scale cohort (n=104 139), thereby providing novel insights into the association of emulsifiers with the risk of type 2 diabetes. Sparse details on the specific industrial food products consumed were available in previous epidemiological studies worldwide, but the variation in additive composition is huge for two different brands of the same food item (eg, a chocolate biscuit can contain zero to eight different additives). Thus, we evaluated the occurrence and dose of exposures to food additive emulsifiers by linking detailed dietary records from the NutriNet-Santé cohort (including commercial names and brands of industrial foods and beverages) to multiple food composition databases, ad-hoc laboratory assays, and dynamic matching to account for reformulations of industrial food items over time. We observed that higher intakes of seven individual emulsifiers (European codes: E407, E340, E472e, E331, E412, E414, and E415) and one emulsifier group (total carrageenans) were associated with an increased risk of type 2 diabetes.
Implications of all the available evidence
These findings could have important public health implications given the ubiquitous nature of these food additives used in thousands of widely consumed ultra-processed products ingested daily by millions of children and adults globally. Although additional long-term observational epidemiological studies as well as short-term interventions (for ethical reasons) are needed to confirm these findings, they align with those of previous in-vitro and in-vivo experiments suggesting adverse effects of several emulsifiers. Altogether, the available evidence supports a re-evaluation of regulations governing the use of food additive emulsifiers by the food industry for a better consumer protection. Indeed, current acceptable daily intakes (ADIs) were set up on the basis of classical cytotoxicity and genotoxicity criteria but neither included clinical epidemiological data on hard endpoints (which are missing so far) nor the latest experimental research (eg, on microbiota dysbiosis). As we advance our understanding of the potential role of additives in the development of diabetes, several public health authorities already recommend minimising the consumption of ultra-processed foods in order to lower exposure to controversial so-called cosmetic food additives.
However, to the best of our knowledge, no epidemiological study has quantified dietary exposures to a wide range of food additive emulsifiers and investigated their associations with the risk of type 2 diabetes. This research gap can be explained by the sparse details of specific industrial food products consumed in previous epidemiological studies. Emulsifier composition indeed varies greatly from one industrial product to another, for the same type of food. A chocolate biscuit, for example, could contain zero to eight different emulsifiers, depending on the brand. The NutriNet-Santé cohort has the potential to advance knowledge in this field, since it has collected extensive brand-specific dietary data through validated repeated 24 h dietary records since 2009. Therefore, in this study, we aimed to investigate the association between emulsifier exposure and type 2 diabetes risk in the NutriNet-Santé prospective cohort study.
 Download the PDF from VitaminDWiki

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Asked Perplexity AI May 2024

Do food emulsifiers increase the risk of diabetes?

Based on the search results provided, there is evidence suggesting that consumption of certain food emulsifier additives may be associated with an increased risk of developing type 2 diabetes. The key findings are:
A large prospective cohort study of over 100,000 French adults from the NutriNet-Santé study found that higher intakes of the following emulsifiers were associated with an increased risk of type 2 diabetes:

• Carrageenans (3% increased risk per 100 mg/day increment)
• Tripotassium phosphate (15% increased risk per 500 mg/day)
• Mono- and diacetyltartaric acid esters (4% increased risk per 100 mg/day)
• Sodium citrate (4% increased risk per 500 mg/day)
• Guar gum (11% increased risk per 500 mg/day)
• Gum arabic (3% increased risk per 1000 mg/day)
• Xanthan gum (8% increased risk per 500 mg/day)

These findings from a large epidemiological study add to previous experimental evidence from cell, animal and human studies suggesting that certain emulsifiers may disrupt the gut microbiota, increase inflammation, and lead to metabolic disturbances like insulin resistance, potentially increasing diabetes risk.
However, it's important to note that this is an observational study, so it cannot prove causation. The authors acknowledge the need for further research to establish causal links and understand the underlying mechanisms . Replication in other epidemiological studies is also needed to strengthen the evidence.
In summary, while not conclusive, this study provides initial epidemiological data indicating that chronic consumption of certain food emulsifier additives may be associated with a higher risk of developing type 2 diabetes, likely mediated through effects on the gut microbiome and metabolic processes. But more research is still needed.
Click here for 20 references

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How do emulsifiers affect gut health?

Emulsifiers, commonly used in processed foods to improve texture and extend shelf life, have been increasingly scrutinized for their potential impact on gut health. The evidence from various studies suggests that certain emulsifiers can negatively affect the gut microbiome, leading to inflammation and potentially contributing to metabolic and intestinal diseases.
Impact on Gut Microbiome

1. Disruption of Gut Microbiota:
   • Emulsifiers like carboxymethylcellulose (CMC) and polysorbate 80 (P80) have been shown to significantly alter the composition of gut bacteria. These changes often result in a decrease in beneficial bacteria and an increase in pro-inflammatory bacteria.
   • Studies using artificial gut models and animal experiments have demonstrated that these emulsifiers can reduce the diversity of gut microbiota and promote the growth of harmful bacteria that can cross the gut lining, leading to inflammation.
2. Intestinal Inflammation:
   • Emulsifiers can disrupt the protective mucus layer of the gut, making it more permeable and allowing bacteria to invade the gut lining. This can trigger an inflammatory response, which has been linked to conditions such as inflammatory bowel disease (IBD) and metabolic syndrome.
   • In vitro studies have shown that emulsifiers can increase the production of inflammatory cytokines like IL-6 in gut cells, further supporting their role in promoting gut inflammation.
3. Metabolic and Chronic Diseases:
   • There is emerging evidence that emulsifiers may contribute to the development of metabolic diseases such as obesity and type 2 diabetes. This is thought to be mediated through their impact on gut microbiota and the resulting low-grade inflammation.
   • Epidemiological studies have suggested a correlation between high intake of certain emulsifiers and an increased risk of metabolic syndrome and other chronic diseases.

Specific Emulsifiers of Concern

1. Carboxymethylcellulose (CMC) and Polysorbate 80 (P80):
   • These emulsifiers have been consistently identified as having the most detrimental effects on gut health. They are associated with significant alterations in gut microbiota composition, increased intestinal permeability, and heightened inflammatory responses.
2. Carrageenan:
   • Carrageenan has been linked to gut inflammation and has been shown to exacerbate conditions like IBD in animal models. Its use in infant formulas has been restricted in some regions due to concerns about its safety.
3. Other Emulsifiers:
   • While not all emulsifiers have the same impact, some, like lecithin, appear to have minimal or no adverse effects on the gut microbiome. However, the overall impact of many emulsifiers remains under-researched, and more studies are needed to fully understand their effects.

Recommendations

• Dietary Choices:
  • Reducing the intake of processed foods that contain harmful emulsifiers can help maintain a healthy gut microbiome. Opting for whole foods and checking ingredient labels for emulsifiers like CMC and P80 can be beneficial.
  • Some emulsifiers, such as gum arabic, may have prebiotic effects and could potentially benefit gut health, but more research is needed to confirm these effects.

Further Research:

• There is a need for more human studies to confirm the findings from animal and in vitro studies. Understanding the long-term effects of emulsifier consumption and identifying safe alternatives are crucial steps forward.

In conclusion, while emulsifiers play a crucial role in the food industry, their potential impact on gut health cannot be overlooked. Certain emulsifiers, particularly CMC and P80, have been shown to disrupt gut microbiota and promote inflammation, which may contribute to various chronic diseases. Reducing the intake of processed foods and opting for emulsifier-free or minimally processed options can help mitigate these risks.

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VitaminDWiki – Overview Diabetes and vitamin D contains

• Diabetes is 5X more frequent far from the equator
• Children getting 2,000 IU of vitamin D are 8X less likely to get Type 1 diabetes
• Obese people get less sun / Vitamin D - and also vitamin D gets lost in fat
• Sedentary people get less sun / Vitamin D
• Worldwide Diabetes increase has been concurrent with vitamin D decrease and air conditioning
• Elderly get 4X less vitamin D from the same amount of sun
      Elderly also spend less time outdoors and have more clothes on
• All items in category Diabetes and Vitamin D 547 items: both Type 1 and Type 2

Vitamin D appears to both prevent and treat diabetes

• Appears that >2,000 IU will Prevent
• Appears that >4,000 IU will Treat , but not cure
• 90% less T2 Diabetes in the group having lots of Vitamin D
• Appears that Magnesium helps both Prevention and Treatment
• Many diabetics would be better treated if Gut-Friendly Vitamin D were used

Number of articles in both categories of Diabetes and:

• Dark Skin 24;   Intervention 56;   Meta-analysis 38;   Obesity 36;  Pregnancy 44;   T1 (child) 39;  Omega-3 11;  Vitamin D Receptor 24;  Genetics 13;  Magnesium 29    Click here to see details

Some Diabetes studies

• Take Vitamin D to prevent prediabetes from progressing into diabetes – American Diabetic Association – 2024
• 99.7% of people who got Diabetes had been regularly consuming food emulsifiers - May 2024
• Type 2 Diabetes treated by Vitamin D (often 50,000 IU weekly) – meta-analysis July 2023
• Diabetic inflammation synergistically decreased by Vitamin D and exercise – RCT June 2022
• Incidence of Type-2 Diabetes increased 3X in 30 years (by the way, Vitamin D helps) – July 2022
• Vitamin d treats Type II Diabetes in many ways (14 article review) - Sept 2021
• T2 Diabetes 30 percent more likely if poor Vitamin D Receptor – meta-analysis of 47 studies – July 2021

50 ng of Vitamin D fights Diabetes

• Saudi study defines normal Vitamin D level to be 50 to 70 ng (diabetes, etc.) - June 2020
• Diabetes 5X less likely if more than 50 ng of Vitamin D – April 2018

T1 Diabetes

• T1 Diabetes 3X lower risk if high vitamin D (over 40 ng) – Meta-analysis Nov 2020
• Type 1 Diabetes is prevented and treated by Vitamin D – review of 16 studies – Sept 2019
• Type 1 Diabetes prevention with Vitamin D and Omega-3 – Symposium April 2019

Pre-Diabetes

• 4X reduction in prediabetes progressing to T2D if more than 50 ng of vitamin D – RCT March 2023
• Prediabetes reduced by weekly 60,000 IU of Vitamin D – RCT Jan 2021
• Prediabetes 1.5 X more likely to go away if take Vitamin D – meta-analysis July 2020

Diabetes, Metabolic Syndrome and Magnesium - many studies
Diabetic Epidemic

• Step back to 1994. Suppose an epidemic struck the United States, causing blindness, kidney failure, and leg amputations in steadily increasing numbers.
  Suppose that in less than a decade's time, the epidemic had victimized one out of every eight people
  That epidemic is real, and its name is diabetes, now the nation's sixth leading cause of death.
  Chart from the web (2018?)
  

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VitaminDWiki – Ultra-processed foods associated with worse health and lower Vitamin D - several studies

Table of Contents as of May 2024
Ultra-processed food and adverse health outcomes – BMJ meta-analysis Jan 2024
The Perils of Ultra-processed foods (article and book) - July 2023
Amazon Books include:
VitaminDWiki - Ultra-processed food consumption: 2X increased risk of vitamin D deficiency – Dec 2023
Ultra-processed foods increase the risk of metabolic syndromes - Jan 2024
Increased Ultra-processed foods increase risks of Cancer and CVD by 9% - Lancet Dec 2023
Ultra-processed foods can be as addictive as cocaine or smoking - Feb 2024
Perplexity AI on ultra-processed foods - March 2024

• Definition of ultra-processed foods
• Describe UP foods in as few words as possible
• How do ultra-processed foods affect gut health?