High Intake of Various E Numbered Emulsifiers and CVD Risk

According to a study published in The BMJ, a high intake of certain emulsifiers (part of the “E numbers” group of food additives), which are extensively employed in industrially processed foods to improve texture and lengthen shelf-life, is related with an increased risk of cardiovascular disease (CVD).

Given the prevalence of these food additives in thousands of frequently consumed ultra-processed food products, the researchers believe their findings have significant public health consequences.

Emulsifiers are frequently used to improve the appearance, taste, texture, and shelf life of processed and packaged foods such as pastries, cakes, ice cream, desserts, chocolate, bread, margarine, and ready meals. They consist of celluloses, fatty acid mono- and diglycerides, modified starches, lecithins, carrageenans (produced from red seaweed and used to thicken meals), phosphates, gums, and pectins.
Although the safety of emulsifiers, like that of all food additives, is frequently examined based on existing scientific evidence, some new research suggests that emulsifiers can alter gut bacteria and cause inflammation, potentially increasing vulnerability to cardiovascular diseases.

Researchers in France set out to investigate the links between emulsifier exposure and the risk of cardiovascular illness, including coronary heart disease and cerebrovascular disease—conditions that impact blood flow and blood arteries in the heart and brain.

Their findings are based on 95,442 French people with no history of heart disease who participated in the NutriNet-Santé cohort study between 2009 and 2021 (average age 43 years; 79% women).

Participants completed at least three (and up to 21) 24-hour online dietary records over the first two years of follow-up. Each food and beverage item ingested was then brand-matched against three databases to determine the presence and dose of any food additive. Quantitative data was also obtained through laboratory examinations.

Participants were also asked to report any serious CVD event, such as a heart attack or stroke, which an expert committee approved after evaluating their medical records.

The French national death register was also used to record CVD-related deaths, and several well-known risk factors for heart disease were considered, including age, gender, weight (BMI), educational level, family history, smoking status, physical activity levels, and diet quality (e.g., sugar, salt, energy, and alcohol intakes).

greater consumption of total celluloses (E460-E468), cellulose (E460), and carboxymethylcellulose (E466) was found to be positively linked with greater risks of CVD, notably coronary heart disease, after an average of 7 years of follow-up.

Higher intakes of monoglycerides and diglycerides of fatty acids (E471 and E472) were linked to increased risks of all outcomes evaluated. Among these emulsifiers, lactic ester of monoglycerides and diglycerides of fatty acids (E472b) was linked to an increased risk of CVD and cerebrovascular diseases, while citric acid ester of monoglycerides and diglycerides of fatty acids (E472c) was linked to an increased risk of CVD and coronary heart disease.

Trisodium phosphate (E339) consumption was likewise linked to an elevated risk of coronary heart disease.

There was no evidence of a link between the other emulsifiers tested and any of the cardiovascular outcomes.

Because this is a single observational study, no reason can be determined, and the researchers note certain study limitations. For example, the NutriNet-Santé study participants’ high proportion of women, higher educational level, and generally more health conscious behaviors as compared to the general French population may restrict the generalizability of the results.

Despite this, the study sample was big, and the researchers were able to account for a wide range of potentially important factors by utilizing unique precise brand-specific data on food additives. Furthermore, the results remained consistent following additional testing, indicating that they are resilient.

The authors stress that these results need replication in other large scale studies, but say they could “contribute to the re-evaluation of regulations around food additive usage in the food industry to protect consumers.”

“Meanwhile, several public health authorities recommend limiting the consumption of ultra-processed foods as a way of limiting exposure to non-essential controversial food additives,” they add.

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