A growing body of research suggests that common food additives are associated with the development or exacerbation of inflammatory bowel disease.
BCCHR’s Ask an Expert Series
We asked an expert about food additives and risk of inflammatory bowel disease in children.
The incidence of inflammatory bowel disease (IBD) is on the rise in Canada, where more than 7,000 children have been diagnosed with the condition and around 650 children are newly diagnosed each year. The age group with the most rapidly rising incidence of IBD is children under five.
People with IBD have a lower quality of life and increased risk of certain types of cancer compared to the general population. While IBD treatments lead to remission for some patients, treatment effectiveness is low for others. Some research demonstrates that dietary interventions can help in the management of IBD.
We spoke with Dr. Genelle Lunken about IBD and IBD-related risks associated with consuming food additives.
What is inflammatory bowel disease and what causes it?
Inflammatory bowel disease includes disorders that involve inflammation and ulceration of the gastrointestinal tract. The main forms of IBD are Crohn’s disease (CD) and ulcerative colitis (UC). Symptoms of IBD include diarrhea, fatigue, fever, weight loss, and stomach pain.
Over time, other areas of the body besides the digestive tract can become involved. Some people develop arthritis, skin disease, mouth sores, eye problems, kidney stones, gallstones, and other complications.
The causes of IBD appear to be a combination of inherited susceptibility and environmental exposures. Diet is one important environmental factor that we know directly impacts the gut microbiota — the collection of microorganisms in the human intestinal tract.
Past research has linked diets high in red and processed meats with an increased risk of developing IBD. The Mediterranean diet (high in plant-based foods and healthy fats) and diets high in probiotics, prebiotics, and fibres have been shown to have protective effects.
Why has there been such a steady rise of IBD prevalence around the world, particularly in “highly developed” countries like the United States and Canada?
Many experts suspect that the increased prevalence of IBD has to do with our diets, specifically the increased consumption of processed foods. Processed foods often contain food additives that are used to improve taste, maintain texture and freshness, increase shelf life, or alter the appearance or colour of food products.
A growing body of research indicates that several food additives may be associated with the onset and progression of IBD, especially in those who are genetically susceptible. Common food additives include colourants or dyes such as Red 40 and Yellow 6, sugar substitutes such as aspartame and sucralose, and emulsifiers such as sunflower lecithin and carrageenan.
Some research has even shown that maternal consumption of carboxymethyl cellulose or cellulose gum, a common emulsifier that keeps ingredients “mixed” together, may lead to dysbiosis in their offspring.
Dysbiosis is defined as an imbalance of the intestinal microbiome, characterized by an overall reduction in bacterial diversity, decreased numbers of beneficial bacteria, and increased numbers of harmful or pathogenic bacteria. Dysbiosis is associated with loss of protective intestinal mucus layer, increased gut barrier permeability (sometimes called leaky gut) and inflammation, and plays a key role in the development and progression of IBD.
In light of intestinal microbiome-related risks associated with food additives, what would you advise pediatric patients with IBD or those with susceptibility to IBD?
Although several recent studies have demonstrated that many food additives may negatively impact the gut microbiome, most of this research has been done using mouse models. Therefore, it’s difficult to draw definitive conclusions at this time. More large-scale research is needed that replicates in humans what has been discovered in mouse models.
However, if a pediatric IBD patient is consuming high amounts of processed foods that contain food additives, then it might be useful to consider reducing these foods in the diet. Specifically, consider cutting out foods that contain:
- titanium dioxide
- carboxymethyl cellulose
- polysorbate 80
- acesulfame potassium
What food additive-related research are you planning?
In collaboration with a group from the University of Toronto, we are planning to develop several food files that can be used to assess the artificial sweetener and emulsifier intake of patients with IBD. We aim to determine whether intakes of these food additives are associated with treatment response and modulation of the gut microbiome.
Currently in Canada, there are no dietary assessment tools that can accurately evaluate food additive intakes. Therefore, we hope that the development of these novel food files will help us better understand the impact food additives have on the development and progression of IBD.