This week (10-16 June) marks Diabetes Week 2024. This is a week to, as Diabetes UK puts it, “make some noise, raise awareness and shout about the things that matter to people with diabetes.” With that in mind, we’re looking at a recent study, analysing the potential link between emulsifiers, a common food additive, and type 2 diabetes.
What is type 2 diabetes?
Formally called ‘non-insulin dependent’, type two diabetes affects how the body uses sugar (glucose) for energy and stops it from using insulin properly. This can lead to high levels of blood sugar if not treated. In time, type two diabetes can cause serious damage to the body, in particular to the nerves and blood vessels. This type of diabetes was previously seen only in adults, but it is now also occurring increasingly frequently in children.
Over 33 million people in the EU suffer from diabetes. According to International Diabetes Federation (IDF) data, the absolute number of diabetics in the EU will rise from approximately 33 million in 2010 to 38 million in 2030.
Number of diabetes sufferers increasing
The number of people living with type 2 diabetes has been steadily rising over the past four decades, with the National Library of Medicine declaring it a “major public health problem that is approaching epidemic proportions globally.”
Though family history, ethnicity and age are all cited as being contributing factors towards the risk of developing type 2 diabetes, it is diet which is the most influential.
“An unhealthy diet is one of the major risk factors for a range of chronic diseases, including cardiovascular diseases, cancer, diabetes and other conditions linked to obesity,” said a spokesperson for the World Health Organization (WHO).
Do emulsifiers increase the risk of developing type 2 diabetes?
Published in The Lancet Diabetes and Endocrinology, a recent study carried out by researchers in France, indicates that certain food emulsifiers may increase the risk of developing type 2 diabetes.
Emulsifiers are among the most commonly used additives in foods produced globally and are often added to processed and packaged foods such as certain factory-produced breads, cakes, biscuits, and desserts, as well as yogurts, ice creams, chocolate bars, margarines, and ready-to-eat meals.
Why are emulsifiers added to some food products?
Emulsifiers are food additives used to help combine two substances, which would otherwise separate when mixed together. An example of this would be oil and water.
As a result, the emulsifier creates a stable, homogenous, and smooth emulsion. This improves the appearance, taste, and texture of a food product. It’s also helps to lengthen its shelf life.
Examples of emulsifiers include modified starches, lecithins, phosphates, gums, and pectins.
As with all food additives, emulsifiers were evaluated by food safety and health agencies when they were introduced. However, these evaluations were based on the scientific evidence available at the time and so could now be challenged. As a result of this, emulsifiers are now being analysed by scientists, based on the latest scientific evidence and understanding.
With this latest research, emulsifiers have been found to potentially disrupt the gut microbiota and increase the risk of inflammation and metabolic disruption, potentially leading to insulin resistance and the development of diabetes.
How was the study conducted?
The research team sought to specifically study and understand the relationship between the dietary intake of emulsifiers, and the risk of developing type 2 diabetes, in a study of the general population, from 2009 to 2023.
The results of the NutriNet-Santé web-cohort study are based on the analysis of data from 104,139 adults in France, with an average age 43.
Participants completed at least two days of dietary records, prior to the commencement of the study, providing detailed information on all foods and drinks consumed and their commercial brands (in the case of industrial products). These dietary records were then repeated every six months for 14 years and were matched against databases in order to identify the presence and amount of food additives, including emulsifiers, in the products consumed. Laboratory assays were also performed in order to provide quantitative data. This allowed a measurement of chronic exposure to these emulsifiers over time.
Additional risk factors for developing diabetes, such as 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.
During follow-up analysis, 1056 participants were confirmed to have been diagnosed with type 2 diabetes.
The researchers found that chronic exposure to the following emulsifiers was associated with an increased risk of developing type 2 diabetes:
- Carrageenans
- Tripotassium phosphate
- Mono- and diacetyltartaric acid esters of mono- and diglycerides of fatty acids
- Sodium citrate
- Guar gum
- Gum arabic
- Xanthan gum
However, the research team have highlighted that this study constitutes an initial exploration of these relationships, and further investigations are now needed to establish causal links. They also noted several limitations of their study, including the predominance of women in the sample (79.2%) and a high level of education amongst the participants, which could influence diet quality.
“These findings are issued from a single observational study for the moment and cannot be used on their own to establish a causal relationship,” say lead authors of the study, Mathilde Touvier and Bernard Srour. “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, in order to better protect consumers.”
Source: Food additive emulsifiers and the risk of type 2 diabetes: analysis of data from the NutriNet-Santé prospective cohort study
Published online: May 2024
DOI: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(24)00086-X/fulltext
Authors: Clara Salame, PhD, Guillaume Javaux, MSc, Laury Sellem, PhD, Emilie Viennois, PhD, Fabien Szabo de Edelenyi, PhD Cédric Agaësse, RD et al.