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Mass-produced desserts and other common foods contain additives that may increase the risk of type 2 diabetes. Image credit: Monty Rakusen/Getty Images.
  • About 530 million adults around the world have diabetes, with type 2 diabetes accounting for 98% of cases.
  • Certain lifestyle choices, such as following an unhealthy diet and eating ultra-processed foods, can increase a person’s risk for this condition.
  • French researchers have now identified seven food additive emulsifiers found in ultra-processed foods that are associated with an increased risk of developing type 2 diabetes.

Researchers estimate that about 530 million adults globally live with diabetes, with 98% of those diagnoses being type 2 diabetes.

Certain lifestyle choices, such as being sedentary, following an unhealthy diet, and having overweight or obesity can increase a person’s risk of developing type 2 diabetes.

Previous research also shows that moderate intake of ultra-processed foods — which generally contain large amounts of sugar, fat, salt, and food additives — can heighten a person’s risk for the condition.

Now, a new study from researchers at the National Research Institute for Agriculture, Food and Environment (INRAE) and the National Institute of Health and Medical Research (INSERM) in France has found that consuming seven specific food additive emulsifiers found in ultra-processed foods may be associated with an increased risk of developing type 2 diabetes.

The study was recently published in the journal The Lancet Diabetes & Endocrinology.

According to Bernard Srour, PhD, junior professor at INRAE and co-lead author of this study, emulsifiers are among the most commonly used additives in processed foods.

Speaking to Medical News Today, he explained where these food additives are typically found:

“They are often added to processed and packaged foods, such as certain industrial cakes, biscuits, and desserts, as well as ice creams, chocolate bars, breads, margarines, and ready meals, to improve their appearance, taste, and texture and lengthen shelf life, and to be able to mix aqueous substances — water-based — with oil-based substances.”

For this study, Srour and his team analyzed medical data from more than 104,000 French citizens who participated in the NutriNet-Santé web-cohort study between 2009 and 2023.

Over 14 years, study participants provided at least 2 days of dietary records every 6 months. Foods consumed were matched against databases to identify the presence and amount of food additives.

After an average follow-up of 7 years, the scientists identified seven food additive emulsifiers associated with an increased risk for type 2 diabetes.

These are:

  1. tripotassium phosphate (E340) — 15% increased risk per increment of 500 milligrams (mg )per day
  2. guar gum (E412) — 11% increased risk per increment of 500 mg per day
  3. xanthan gum (E415) — 8% increased risk per increment of 500 mg per day
  4. mono- and diacetyltartaric acid esters of mono- and diglycerides of fatty acids (E472e) — 4% increased risk per increment of 100 mg per day
  5. sodium citrate (E331) — 4% increased risk per increment of 500 mg per day
  6. carrageenans (total carrageenans and E407) — 3% increased risk per increment of 100 mg per day
  7. gum arabic (E414) — 3% increased risk per increment of 1,000 mg per day.

But the most unexpected finding was that these additives came up amongst the ingredients in some foods and beverages that people often think of as healthy.

“Surprisingly, some of the emulsifiers were present in some foods that are marketed as ‘healthy’ foods such, as plant-based light margarines, some types of bread, plant-based milks, flavored yogurts, and therefore, even participants with more favorable dietary behaviors can be exposed to these substances,” Srour told us.

Mathilde Touvier, PhD, research director at INSERM, coordinator of the NutriNet-Santé cohort, and co-lead author of this study, told MNT the research team decided to study the potential impact of food additive emulsifiers on type 2 diabetes risk as a small number of experimental studies — in vitro, animal, and short-term randomized controlled trials — suggested adverse effects of some emulsifiers such as gut microbiota dysbiosis, inflammation, and metabolic perturbations.

“Two cohort studies from our group showed associations between exposure to various food additive emulsifiers and an increased risk of cardiovascular disease and cancer,” Touvier continued.

“No such investigation has, to the best of our knowledge, yet been conducted to assess the risk of type 2 diabetes. We have therefore decided to look into these associations in the NutriNet-Santé cohort, as we have detailed and repeated dietary data — including commercial brands of consumed foods — coupled with a long follow-up,” she told us.

In the future, Touvier said, the team will investigate the potential underlying mechanisms behind this association, as these are currently unclear.

“We will be looking at variations in certain blood markers and the gut microbiota linked to the consumption of these additives, to better understand the underlying mechanisms,” she told us. “We will also look at the health impact of additive mixtures and their potential ‘cocktail effects’.”

After reviewing this study, Monique Richard, MS, RDN, LDN, a registered dietitian nutritionist and owner of Nutrition-In-Sight, told MNT that these findings bring forth an interesting “causation” hypothesis through an observational methodology lens.

“It is well established however that diabetes is a very complex disease often attributed to multiple factors — i.e. genetics, lifestyle, excess of energy-dense foods — that may elevate risk or influence disease manifestation,” Richard explained.

“Certainly, the potential pathways of affecting inflammation, interrupting detoxification and gastrointestinal health are plausible contributions that could increase type 2 diabetes risk,” she hypothesized.

MNT also spoke with Pouya Shafipour, MD, a board-certified family and obesity medicine physician at Providence Saint John’s Health Center in Santa Monica, CA, not involved in this research, who commented he was not surprised by the study’s findings.

“We know that additives are a big contributing factor to obesity,” Shafipour continued. “It’s not a surprise as that increases fatty liver, and generally weight gain and insulin resistance. It was a good step because now it encourages hopefully more government regulation and also for patients to eat more real, wholesome foods.”

For those looking to consume less food additive emulsifiers, Shafipour said it is as easy as focusing on eating real whole foods.

“Even a lot of diet supplements, protein bars, protein shakes, anything that pretty much comes with a wrapper, something that’s dried, they have to add […] different preservatives to be able to preserve and make it last longer,” he explained.

“So the more natural sources we eat in terms of food and supplements, the better. Eating more fruits rather than fruit bars, fruit juices, [and] sodas. Instead of protein bars, more natural sources of protein like cheese, meats, or plant-based protein.”

– Pouya Shafipour, MD

Richard encouraged everyone to read the ingredients list along with the nutrition facts panels to understand the composition and nutrient profile of the food they are choosing.

“Monitoring the frequency and amount of those packaged types of food — i.e. chocolate or candy, snack foods, baked goods, pre-packaged meals — is also very important while increasing foods that naturally are free from these additional ingredients such as fruits, vegetables, healthy fats, whole grains and lean protein as often as possible,” she advised.

And “meeting with a registered dietitian nutritionist to further understand how to interpret the ingredients list and possible consequences, as well as understand [individualized advice] for specific dietary recommendations” is also crucial, said Richard.