Food Additives and IBD
Its important to note that, at the moment, the evidence we have with regards to food additives is mainly in animal studies with only a handful of small human trials. Whilst animal trials can provide interesting information and inform direction of further research in humans, we cannot take animal trial findings as gospel as sometimes the findings in humans differ as we are different species.
The good news is there is a human trial being carried out in the UK at the moment called the ADDapt diet trial that is investigating the effects of a diet low in certain food additives compared to a normal UK diet on Crohn’s Disease, which will be able to give us a better idea of how food additives can impact humans with IBD and better inform dietary guidance.
The impact of food additives is a very interesting area of research in diet in IBD and an important topic considering the wide use of food additives in food production and manufacturing today.
What are food additives?
Food additives are substances added to food to maintain or improve its safety, freshness, taste, texture, or appearance(1).
The additives that we are most likely to come across on food labels are:
antioxidants – these stop food becoming rancid or changing colour by reducing the chance of fats combining with oxygen
colours
emulsifiers, stabilisers, gelling agents and thickeners – these help to mix or thicken ingredients
preservatives – used to keep food safer for longer
sweeteners – including intense sweeteners like stevia and aspartame which are many times sweeter than sugar(2).
What does the research show so far about food additives and IBD?
The following paragraphs will cover the main groups of food additives and what the animal and human research has shown so far.
Maltodextrin and Artificial Sweeteners
Maltodextrin is a hydrolysed starch that is commonly used as a thickener for foods. Splenda, an artificial sweetener, is comprised of 1% sucralose and 99% maltodextrin as a filler.
In animal studies, consumption of maltodextrin and artificial sweeteners have been shown to increase inflammatory markers and alter the balance of bacteria in the gut.
It is notable that maltodextrin is found in many nutritional supplements, including some used for exclusive enteral nutrition, which has been demonstrated to be an effective therapy. So, although there is theoretical and animal model data to support avoidance of maltodextrin among patients consuming a whole-food diet, these data or recommendations should not dissuade the use of exclusive enteral nutrition in appropriate situations (3).
Emulsifiers and Thickeners
Manufacturers add emulsifiers to processed foods to improve food texture and quality. Commonly used emulsifiers are lecithin, carboxymethylcellulose, carrageenan, and polysorbate-80 (P80).
P80 and carboxymethylcellulose have been studied in animal models of IBD and have been shown to increase intestinal permeability, reduce mucus thickness and impact inflammation in the intestine.
Interestingly, there has been a human trial looking at carrageenan and ulcerative colitis. This was a very small trial (only 12 people) where participants were instructed to eat a carrageenan-free diet then some were supplemented with foodgrade carrageenan (5 participants) and others placebo capsules (7 participants) although they didn’t know which one they were receiving (blinded trial). Participants were followed until they relapsed or up to 12 months. Three people in the carrageenan group had flare-ups of their UC and none in the placebo (3).
Nanoparticles
Nanoparticles, such as titanium dioxide (TiO2) and aluminum silicates (AlSi), are used as food additives to colour, coat, or preserve food. TiO2 is a white powder, used as a pigment in some confectionery, white sauces, dressings, non-dairy creamers, and toothpaste. AlSi is sometimes added to salt and other powdered foods to prevent clumping.
There have been two human dietary intervention trials looking at TiO2 in active Crohn’s Disease. Again, these were only small trials - one showed a positive impact of an TiO2/AlSi-restricted diet in achieving remission in Crohn’s Disease but the other did not show any impact, both carried out over a 4-month period (3).
Take Home
It is very early days in the research but there does seem to be some interesting research emerging showing there may be some impacts of food additives to our gut health and IBD.
In 2020 the International Organisation for the Study of IBD published a paper for dietary guidance for patients with IBD based on the best current evidence there is at the moment to provide expert opinion regarding specific dietary components, food groups and food additives that may be prudent to increase or decrease in the diet of patients with inflammatory bowel diseases to control and prevent relapse of inflammatory bowel diseases.
Although they admit the evidence is low, they concluded that it may be prudent to reduce intake of maltodextrin-containing foods, artificial sweeteners, carrageenan, carboxymethylcellulose, polysorbate-80 and processed foods containing titanium dioxide and sulfites (3).
I have written a free e-book to help you find a way forward for your everyday life with Inflammatory Bowel Disease. Whether you are right at the beginning of your journey with IBD or have been living with your condition for years and feel like you have tried almost everything, there are things you can do everyday, beyond the medication you are taking, to help you take back control.
Disclaimer: All content found on the nalmclinic.com website, including: text, video, or other formats have been created for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor, consultant or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
We are all wonderfully unique and what works for one person may not work for another so please seek help and advice before changing your diet to work out the right way forward for you.
References
World Health Organisation (WHO) (2018) Food Additives. Available at: https://www.who.int/news-room/fact-sheets/detail/food-additives (Accessed: 08 March 2021).
Food Standards Agency (2019) Food Additives. Available at: https://www.food.gov.uk/safety-hygiene/food-additives (Accessed: 08 March 2021).
Levine, A., Rhodes, J. M., Lindsay, J. O., Abreu, M. T., Kamm, M. A., Gibson, P. R., … Lewis, J. D. (2020). Dietary Guidance for Patients with Inflammatory Bowel Disease from the International Organization for the Study of Inflammatory Bowel Disease. Clinical Gastroenterology and Hepatology. doi:10.1016/j.cgh.2020.01.046