Emulsifiers and Type 2 Diabetes

Diabetes (blood sugar)

Diabetes is a group of metabolic diseases (disorders in the metabolism of nutrients) in which blood sugar levels rise over time. This disease is caused by a defect in the production or function of insulin (a hormone that helps regulate blood sugar levels), and it primarily occurs in adults and older individuals. However, it is increasingly being seen in children and adolescents due to rising obesity levels, lack of physical activity, and energy-dense diets. Its symptoms usually include excessive thirst, frequent urination, weight loss, fatigue, blurred vision, recurrent infections, slow-healing wounds (wounds that take longer than usual to heal), and skin changes.

Global statistics on diabetes mortality

According to the World Health Organization (WHO) and the International Diabetes Federation (IDF), 537 million adults (1 in 10 people) were living with diabetes as of 2021, based on the latest comprehensive data. This number is expected to increase to 643 million by 2030 and 783 million by 2045. Nearly one in two adults (44%) with diabetes remains undiagnosed (around 240 million), most of whom have Type 2 diabetes. Diabetes caused 6.7 million deaths in 2021. More than half a billion people worldwide are living with diabetes, and this number is expected to double over the next 30 years (to 1.3 billion people globally). The most recent and comprehensive calculations in 2023 indicate that the global prevalence of diabetes is 1.6%, making it one of the top 10 causes of death and disability worldwide. In North Africa and the Middle East, the prevalence of diabetes is around 9.3%, and it is projected to reach 16.8% by 2050. In Latin America and the Caribbean, it is expected to rise to 11.3%. Diabetes is especially prominent in individuals aged 65 and older in every country. The highest rate for individuals between 75 and 79 years old is 24.4%. Studies have shown that North Africa and the Middle East have the highest rate in this age group at 39.4%, while Central Europe, Eastern Europe, and Central Asia have the lowest rate at 19.8%. Nearly all of these global cases (96%) are Type 2 diabetes. The rapid growth of diabetes is not only alarming but also presents a challenge for every healthcare system worldwide.

Connection between Type 2 diabetes and ultra-processed foods consumption

Among various unhealthy diets, ultra-processed foods are considered a major risk factor for Type 2 diabetes. Today, due to modern lifestyles, people are increasingly turning to ultra-processed foods. These foods are widely produced using industrial processes and contain food additives. They typically have high amounts of sugar, simple carbohydrates, and salt. These sugars are rapidly absorbed into the bloodstream, causing a rapid rise in blood sugar and consequently increasing the need for insulin. Many ultra-processed foods contain unhealthy fats such as trans fats (formed through the process of hydrogenation, where hydrogen is added to liquid vegetable oils to create solid or semi-solid oils) and saturated fats (fats that are solid at room temperature), which can increase insulin resistance and disrupt blood sugar regulation. Furthermore, ultra-processed foods lack sufficient nutrients like fiber, vitamins, and minerals. These foods can also increase inflammation in the body, which may disrupt the metabolism of sugar and fat. When inflammation is high, the body cannot efficiently use sugar and fat, which increases the risk of Type 2 diabetes. Studies have shown that the link between Type 2 diabetes and ultra-processed foods is not only due to high levels of sugar, salt, and unhealthy fats in these foods, but also that artificial additives like flavorings, added colors, artificial sweeteners, emulsifiers, and other similar compounds may play a role. Therefore, understanding the role and characteristics of emulsifiers, one of the common additives in ultra-processed foods, is of great importance in analyzing this issue.

Emulsifiers

Emulsifiers are substances that help combine two liquids that cannot mix uniformly (such as water and oil), creating stable emulsions like mayonnaise and ice cream. Emulsifiers are used in almost every type of ultra-processed food, from bakery products to confectionery and ice cream. Some of the most commonly used food emulsifiers include monoglycerides of fatty acids (E471) (used in a variety of foods like bread, cakes, pasta, frozen desserts such as ice cream, icing, peanut butter, and more), tripotassium phosphate (E340) (often used in cereals, cheese, beverages, etc.), and guar gum (E412) (used in products such as sauces, ice cream, bread, protein drinks, canned foods, etc.).

Connection between emulsifiers and type 2 diabetes

Long-term exposure to emulsifiers has been linked to an increased risk of developing Type 2 diabetes. Emulsifiers can impact the gut microbiota, the microorganisms that naturally live in the gut, causing chronic inflammation (long-term inflammation) in the intestine, which in turn exacerbates metabolic disorders (disorder in metabolism). This process leads to insulin resistance and the onset of Type 2 diabetes. The percentage increase in the risk of Type 2 diabetes due to common emulsifiers includes the following:

1- Carrageenan (E407), for every 100 mg increase in daily intake, the risk of Type 2 diabetes increases by 4%.

2- Tripotassium phosphate (E340), for every 500 mg increase in daily intake, the risk of Type 2 diabetes increases by 15%.

3- Esters of mono- and di-acetyl tartaric acid mono- and diglycerides of fatty acids (E472e), for every 100 mg increase in daily intake, the risk of Type 2 diabetes increases by 4%.

4- Sodium citrate (E331), for every 500 mg increase in daily intake, the risk of Type 2 diabetes increases by 4%.

5- Guar gum (E412), for every 500 mg increase in daily intake, the risk of Type 2 diabetes increases by 11%.

6- Acacia gum (E414), for every 1000 mg increase in daily intake, the risk of Type 2 diabetes increases by 3%.

7- Xanthan gum (E415), for every 500 mg increase in daily intake, the risk of Type 2 diabetes increases by 8%.

Strategies to reduce emulsifier consumption related to type 2 diabetes

1- Since many foods containing emulsifiers and associated with Type 2 diabetes are ultra-processed products such as packaged breads, industrial cakes and cookies, ice cream and frozen desserts, sweetened beverages (such as sodas and industrial fruit juices), sauces, canned foods, etc., the higher the weight of ultra-processed foods in the diet (higher consumption), the more likely it is to cause an increase in blood sugar levels and a decrease in the body’s ability to control it. In contrast, reducing the intake of ultra-processed foods can help improve health.

2- Try to include fresh and natural foods in your diet and focus on whole foods such as fresh fruits, vegetables, lean proteins, and whole grains (with bran and germ). These foods are naturally free from emulsifiers, and consuming them more often is associated with better blood sugar control.

3- Prepare foods at home, as this allows you to control what goes into your food and reduce the likelihood of consuming emulsifiers.