Food Additives, IBD, Crohn’s and Colitis — What’s the Connection?

SCD and food additives, what is the link

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Food additives have become an almost inescapable part of the modern diet — and modern diets have been linked to the development of Inflammatory Bowel Disease (IBD). What role do food additives play in the rising incidence of Crohn’s and Ulcerative Colitis? Should patients or the public avoid them?

Read on to find out the answers to these questions, as well as more information about food additives and new treatments for Crohn’s disease, IBD, and colitis.

A Brief History on Food Additives + Diseases

Factors that influence the microbiome

Did you know that Crohn’s disease research indicates that diet is significantly linked to the development of the disease? Diet has also been found to be an effective therapy option for some pediatric patients living with Crohn’s disease, through a liquid formula diet known as exclusive enteral nutrition (EEN). 

Research on diet and IBD is ongoing regarding various elimination or exclusion diets. A common theme between these diets is the elimination of processed foods. Researchers are beginning to look at the impacts of various food additives on the intestine, but thus far mostly in animal models.

The Evolution of IBD & the Western Diet 

Food preserving has been around for decades, but processing has evolved over time. It’s a main part of the “Western Diet.” Processed foods contain chemically modified ingredients and pick up potential threats during production that may disrupt gut health and/or lead to  intestinal inflammation. 

There are other factors as well to the Western Diet that may impact inflammation, but we will specifically focus on food additives in this article.

Processed food has increasingly become part of the “Western lifestyle,” and exposure to foods common in the Western diet is associated with the increased risk of developing Crohn’s disease around the globe (1,2). These foods are processed extensively, and are often filled with preservatives and ingredients such as added sugars and fats that offer a poor nutrient profile to consumers. 

One specific ingredient in processed foods that is thought to cause intestinal damage is food additives (3). Growing evidence supports the idea that additives in the Western diet are linked to increases in disease, making IBD a global disease.

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What Are Food Additives?

Food additives are generally (and legally) defined as substances that are added to foods, but that are not naturally a component of the food itself. This results indirectly or directly in the food being altered (4). 

Additives are not inherently “evil.” In fact, many products have vitamins added back into their product that are removed initially during the production process.

Why Use Food Additives? Aren’t They Safe If They Are in Our Food?

Food additives serve a variety of purposes in production. For example, they promote anti-caking, brighten the appearance of food, leaven, thicken, and stabilize foods. 

However, some of these same additives have been shown in studies to cause gut inflammation and alterations in animals. Human studies with the same set up are rare to find due to the ethical considerations of testing the additives in question. 

Specific food additives have been shown to have potentially harmful effects, including (3,5):

  • increased in intestinal permeability (commonly known as “leaky gut”)
  • erosion of the mucous layer which acts as a barrier to protect the intestine
  • colitis (inflammation) in genetically predisposed mice
  • hyperactivity in children

Research on Crohn’s disease in children shows that young patients frequently consume various food additives that are associated with inflammation in their intestines and threats to their overall gut health. 

To make matters worse, many foods contain more than one additive, compounding the negative effects, especially when consumed long-term (3). Food additives sneak into our food supply daily through condiments, pre-cut deli meats, packaged products, etc. 

One has to be a very savvy shopper and label reader to know what to look for. I say this as a dietitian who does research in this area. Label reading is not straightforward, and we do not know for certain at this time which food additives pose deleterious effects and which are less harmful.

So, what can you do to protect yourself from potentially harmful food additives? How do you know what to look for when shopping for your favorite products? Read on to find out.

These Additives Are Generally Recognized as Safe (GRAS)… But Are They, Really?

Did you know that the Environmental Working Group has a roster of 80,000 foods in their Food Scores database, and that “natural flavor” is part of more than a quarter of those foods? I don’t know about you, but I see the term artificial flavors on nearly every other pre-packaged food I come across. 

Statistically, they actually appear in one out of every seven food labels. Some food additives that are considered “safe” have not been thoroughly studied, such as Carboxymethylcellulose (CMC), but are given “Generally Recognized as Safe” (GRAS) status. This means that they exist in our food supply even though experts aren’t certain of their effects on the human body.  

This poses a serious concern, especially for those who have uncommon allergies and sensitivities or for those who are on avoidance diets, such as the Specific Carbohydrate Diet (6).

Legal guidelines and other regulations became law in the United States with the Food Additives Amendment (1958) and the Color Additives Amendment (1960), part of the Federal Food, Drug and Cosmetic Act of 1938.

Substances that are GRAS gain this recognition one of two ways:

  1. Based on experience from common use prior to 1958 (the year the additive amendment was added into law) – meaning they were accepted as safe as they were already in the food supply prior to 1958.
  2. Based on scientific testing and procedures.

Although these substances do require documented evidence of safety, they don’t get pre-market approval from the FDA before ending up as ingredients on the grocery aisle shelves (4). This impacts the food we eat in a few different ways:

  • Additives that have been commonly used prior to 1958, such as sugar or baking soda, may be GRAS, but can still have negative effects as an additive if not consumed as recommended. For example, sugar can be considered a “safe” ingredient, yet consuming chronically high levels of sugar has significant effects on overall health and can lead to disease.
  • Potentially dangerous substances can end up in products without approval from the FDA.

As consumers, knowledge is power when it comes to understanding where to find and how to evaluate the evidence of safety, scientific testing, and procedures in regards to food safety.

“The last half-century has witnessed a steady increase in consumption of food additives, many of which have not been carefully tested as they were given GRAS status at the time government entities charged with regulating food safety were created and/or expanded.” (7)

 

Which Additives Could Be Harmful?

Healthy dietary patterns & healthy microbiomes (8)

I would also note that a healthy microbiome is impacted by our environment and consumption of beneficial pre-and probiotics in addition to an overall healthy dietary pattern. 

 

Below is a table highlighting a few out of the 80,000 food additives frequently seen on food labels that are of interest in the scientific literature. As mentioned above, most additives are not researched. Therefore, it can be difficult to make a health conclusion at this point.

Table 2 (3,4, 6-17)

Get your free download of the “Common Additives” PDF

Another helpful resource, if you are interested in learning more, is the GRAS Database (13, 14). Just remember: GRAS status doesn’t mean an additive is safe, it just means it hasn’t been proven universally harmful yet. The database can be helpful in determining if an additive that looks like gibberish is GRAS or not.

How Many Additives Are in Our Food Supply – Without Research on Health Implications?

Of the tens of thousands of additives existing in the food supply, the Environmental Working Group (EWG) believes at least 10,000 of them are causes of concern. Although a regulatory system exists, GRAS is a voluntary notification process, which means that companies that are not complying with safety standards can withdraw their requests. 

The GRAS process can sometimes act as a giant loophole. The designation can occur without notifying the FDA, relying instead on “expert panels” carefully curated by the companies themselves to promote their product in the best possible light. Safety studies and information can be withheld altogether, and oftentimes consumers don’t have access to information about their food or any way to identify the additives they are eating beyond vague words like “natural flavors” or “proprietary blend” (6).

A recent study on animals showed that mice prone to inflammation given dietary emulsifiers (a class of food additive) developed colitis (inflammation of the intestines), and even those who weren’t prone to inflammation developed poor intestinal health (7). 

Animals are different from humans, but these studies still beg the question: how safe are additives for human consumption, and why aren’t they more thoroughly tested for negative effects before going to market?

Images from Reference 7 listed below. Colons of mice drinking standard water, water containing CMC, and water containing P80 (shown from left to right). Intestines of the mice given CMC and P80 show intestinal alterations compared to the mice drinking water that was absent of additives.

 

What About “Natural” Additives?

Everything in the human body is made of chemicals. Our bodies have built-in systems that alert us to imbalances, but certain chemicals in excessive amounts can expose our body to damage from which full recovery is not possible. 

Vitamins C and E are “natural” chemicals used in our food supply but so is ricin, a poison, found naturally in castor beans. Natural does not always equal safe. The World Health Organization (WHO) said it best (4):

“All chemicals are toxic to man if large enough doses are administered. Even innocuous substances, when given in excessive doses, may induce untoward effects!”

A good rule of thumb when approaching additives is to be cautious but not fearful (4). Thinking clearly and making wise decisions regarding your food can help you make healthier choices when it comes to additives. You can read more about understanding product labeling and making informed choices as a consumer in Organic, Grass Fed, and Free Range: Label Deciphering and Take Home Resources (Part 3 of 3).

The Dose Makes the Poison

In general, artificial ingredients tend to be hallmarks of food items that are more highly processed. Toxicity is dose dependent, meaning the amount of exposure you receive to additives is a key factor.

Use Food as an Additive for Your Health

As always, more diet research is needed, specifically on food additives and the role they may play in gut health, Crohn’s disease treatment, inflammation, IDB constipation symptoms, and more. 

However, there are common themes between a Westernized diet, food additives (specifically synthetic ones), and the need for improved processes to protect consumers. Humans are very different from animals, but we share commonalities.

Individuals with IBD, or those on diets for Crohn’s disease, may consider removing all processed foods and/or food additives to manage their symptoms. If this is not possible, I would strongly encourage patients to minimize exposure to processed foods as much as able, working to incorporate whole foods and homemade meals. I would also encourage those without a known autoimmune disease to do likewise.

While cooking does take more time, it is the only way to ensure wholesome meals for your family and to decrease your exposure to food additives. The more “from scratch” you can manage, the better. 

Your health and the health of your family is worth it. Avoiding additives becomes an easy habit when you are able to focus on the long-term health benefits with a goal of minimizing potentially harmful exposures.

References

  1. Molodecky NA, Soon IS, Rabi DM, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142(1):46-e30. doi:10.1053/j.gastro.2011.10.001
  2. Hou JK, Abraham B, El-Serag H. Dietary intake and risk of developing inflammatory bowel disease: a systematic review of the literature. Am J Gastroenterol. 2011;106(4):563-573. doi:10.1038/ajg.2011.44
  3. Lee D, Swan CK, Suskind D, et al. Children with Crohn’s Disease Frequently Consume Select Food Additives. Dig Dis Sci. 2018;63(10):2722-2728. doi:10.1007/s10620-018-5145-x
  4. Steele F. NDFS 250 Powerpoints, Spring 2015. Brigham Young University. BYU Academic Publishing. ISBN: 978-0-7003-7869-2.
  5. Marion-Letellier R, Amamou A, Savoye G, Ghosh S. Inflammatory Bowel Diseases and Food Additives: To Add Fuel on the Flames!. Nutrients. 2019;11(5):1111. Published 2019 May 18. doi:10.3390/nu11051111
  6. Environmental Working Group. EWG’s Dirty Dozen Guide to Food Additives. EWG. 2014. Accessed at https://www.ewg.org/research/ewg-s-dirty-dozen-guide-food-additives.
  7. Chassaing B, Koren O, Goodrich JK, et al. Dietary emulsifiers impact the mouse gut microbiota promoting colitis and metabolic syndrome [published correction appears in Nature. 2016 Aug 11;536(7615):238]. Nature. 2015;519(7541):92-96. doi:10.1038/nature14232
  8. Partridge D, Lloyd KA, Rhodes JM, Walker AW, Johnstone AM, Campbell BJ. Food additives: Assessing the impact of exposure to permitted emulsifiers on bowel and metabolic health – introducing the FADiets study. Nutr Bull. 2019;44(4):329-349. doi:10.1111/nbu.12408
  9. Feferman L, Bhattacharyya S, Oates E, et al. Carrageenan-Free Diet Shows Improved Glucose Tolerance and Insulin Signaling in Prediabetes: A Randomized, Pilot Clinical Trial. J Diabetes Res. 2020;2020:8267980. Published 2020 Apr 21. doi:10.1155/2020/8267980
  10. EFSA Panel on Food Additives and Nutrient Sources added to Food (ANS), Younes M, Aggett P, et al. Re-evaluation of carrageenan (E 407) and processed Eucheuma seaweed (E 407a) as food additives. EFSA J. 2018;16(4):e05238. Published 2018 Apr 26. doi:10.2903/j.efsa.2018.5238
  11. Laudisi F, Di Fusco D, Dinallo V, et al. The Food Additive Maltodextrin Promotes Endoplasmic Reticulum Stress-Driven Mucus Depletion and Exacerbates Intestinal Inflammation. Cell Mol Gastroenterol Hepatol. 2019;7(2):457-473. doi:10.1016/j.jcmgh.2018.09.002
  12. Nickerson KP, Chanin R, McDonald C. Deregulation of intestinal anti-microbial defense by the dietary additive, maltodextrin. Gut Microbes. 2015;6(1):78-83. doi:10.1080/19490976.2015.1005477
  13. Statovci D, Aguilera M, MacSharry J, Melgar S. The Impact of Western Diet and Nutrients on the Microbiota and Immune Response at Mucosal Interfaces. Front Immunol. 2017;8:838. Published 2017 Jul 28. doi:10.3389/fimmu.2017.00838
  14. Romagnolo DF, Selmin OI. Mediterranean Diet and Prevention of Chronic Diseases. Nutr Today. 2017;52(5):208-222. doi:10.1097/NT.0000000000000228
  15. Nimbal. Food Table. Legal/Illegal Food List. 2020. Accessed at https://www.nimbal.org/legalillegal-food-list.
  16. Nimbal. Around the Site, Food Table. 2020 Accessed at https://www.nimbal.org/search/scd.
  17. Levine A, Rhodes JM, Lindsay JO, Abreu MT, Kamm MA, Gibson PR, Gasche C, Silverberg MS, Mahadevan U, Boneh RS, Wine E, Damas OM, Syme G, Trakman GL, Yao CK, Stockhamer S, Hammami MB, Garces LC, Rogler G, Koutroubakis IE, Ananthakrishnan AN, McKeever L, Lewis JD. Dietary Guidance From the International Organization for the Study of Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol. 2020 May;18(6):1381-1392. doi: 10.1016/j.cgh.2020.01.046. Epub 2020 Feb 15. PMID: 32068150.

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Hi! I'm Kim Braly, RD, a clinical researcher and IBD Nutrition Consultant. I specialize in cutting-edge dietary therapies for inflammatory bowel disease that have been shown in multicenter trials to decrease inflammation, alleviate IBD symptoms and induce remission. I'm passionate about offering this effective new option to patients and their families with my 3D-Dietary™ Approach for IBD and helping to usher in a new era of IBD treatment through mentoring and research trial consultation. Let's see what diet can do for you.

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