E numbers in food increase risk of heart attack and strokes study says

Common E numbers found in ultra-processed foods such as pastries, ready meals and chocolate increase risk of heart attacks and strokes, study suggests

  • E numbers are emulsifiers used to thicken and preserve a wide variety of foods
  • READ MORE: Diets high in red meat, salt and alcohol to blame for rise in cancer 

A high intake of certain agents used in ultra-processed food (UPF) has been linked to an increased risk of heart attacks, angina and strokes, according to a new study.

French researchers said their findings, published in The BMJ, could be used to help re-evaluate regulations in the food industry ‘to protect consumers’.

They explored the health implications of certain emulsifiers, which are used to preserve and add texture to packaged foods such as cakes, ice cream, bread, margarine and ready meals.

Some scientists have already suggested the agents can impact gut bacteria and increase inflammation, potentially adding to a risk of heart problems.

The team looked at a cohort of 95,442 French adults with no history of heart disease, who were taking part in a study between 2009 and 2021.

E numbers are used to signify a product contains emulsifiers which are used to preserve and add texture to a wide variety of packaged foods such as cakes, ice cream, bread, margarine and ready meals

The average age of participants was 43 and 79 per cent were women.

Each person was asked to complete between three and 21 24-hour food diaries over a two-year period. 

Each item recorded in the diary was then matched to a brand so the researchers could pinpoint both presence and quantity of additives.

Participants were also asked to report any major cardiovascular event such as a heart attack or stroke to the researchers over the course of the study. 

Deaths linked to cardiovascular disease were recorded using the French national death register, taking into account other risk factors such as age, weight, family history and smoking status.

What foods are E numbers found in? 

E number: E460

What does it do: used to improve the texture of food

What food can it be found in: wraps, pasta, meat-free alternatives

E number: carboxymethylcellulose, also known as E466

What does it do: used as a thickener

What food can it be found in: protein drinks, syrups, sauces

E number: E339

What does it do: acidity regulator

What food can they be found in: instant noodles, baked goods, ready meals

E number: E472c

What does it do: binding agent

What food can it be found in: frozen desserts, pâtés, baked goods

E number: E472b

What does it do: emulsifier

What food can it be found in: desserts, pasta sauces, baked goods

After an average follow-up period of seven years, a higher intake of celluloses E460 to E468, which are used to improve the texture of food as well as thicken it, were linked to a higher risk of cardiovascular disease and coronary heart disease.

Similar links were established with acidity regulator E339 and binding agent E472c.

The emulsifier E472b, which is used as an airing agent in pastries and cakes, was associated with a risk of cardiovascular disease and cerebrovascular disease, which includes strokes and aneurysms.

But the team added there was ‘no evidence of an association between the other studied emulsifiers and any of the cardiovascular outcomes’.

They also acknowledged the single observational study can’t ‘establish cause’ but stressed the findings should be replicated in other large-scale studies and could ‘contribute to the re-evaluation of regulations around food additive usage in the food industry to protect consumers.’

Tracy Parker, heart health dietitian at the British Heart Foundation (BHF), said this type of study ‘can only show an association’ between a high intake of certain emulsifiers and cardiovascular disease.

She added: ‘We need more research to properly understand the link between UPF and heart disease.

‘While it would be hard to avoid UPF entirely in our diets, cutting down on food like cakes and biscuits and cooking more from scratch are already things we know can help improve our diets and, in doing so, lower our cardiovascular disease risk.

‘It is also essential to create an environment that supports this, by implementing delayed policies that are already on the table to restrict the advertising and promotion of often highly processed foods which are high in fat, sugar and salt.’

Dr Gavin Stewart, senior lecturer in evidence synthesis at Newcastle University, said that while the ‘study demonstrates a potential effect’ there is a need for ‘cautious interpretation’.

‘The strength of evidence from a single observational study is inherently low because of uncertainty about confounders and causal relationships.

‘Further studies and evidence synthesis are required to reduce this uncertainty.’

Professor Kevin Whelan, an expert in dietetics at King’s College London said emulsifiers were commonly used in the UK and other countries but weren’t always easily identifiable on packaging.

Nutritionists split food into three groups based on the amount of processing they have gone through. Minimally processed foods, like apples, are usually exactly how they appear in nature. Processed foods, like apple sauce, have gone through at least one level of processing that has changed their original form. In contrast, ultra-processed foods like apple jelly babies, have gone through multiple levels of processing and are usually full of extra fats, colours and preservatives

‘Emulsifiers are widely used around the world, here in the UK there are more than 6000 foods with emulsifiers added to them,’ he said. 

‘Emulsifiers are types of food additives usually, but not always, described on food labels ranging from E400 to E499.’

However, he added that the French study, while large and taking place over a long period wasn’t strong enough to call for people to avoid eating emulsifiers.

‘The evidence is not yet strong enough to advise everybody avoids eating emulsifiers,’ he said.

READ MORE: EU health chiefs pull apart ultra-processed food warnings: Studies warning of increased heart attack and stroke risk should be ‘considered with caution’ 

Experts warned that the UK faces a ‘tidal wave of harm’ from the over-consumption of ultra-processed food, after two studies suggested they raise the risk of heart attacks and strokes, but dietitians argue this classification is causing confusion

‘To identify a cause and effect we need to do clinical trials.’

Professor Kevin McConway, an expert in applied statistics at the Open University, also poured cold water over the findings.

He said even supposing the increased risk of cardiovascular disease from eating certain emulsifiers was true, the real-world impact would be relatively minor.

‘The number of coronary heart disease cases in 1,000 participants during the follow-up period would go up from 11 to 12,’ he said. 

‘Unfortunate for that one extra person out of 1,000, certainly, but “modest” does seem an appropriate word here.’

The latest study follows two pieces of research presented at the European Society of Cardiology Congress in Amsterdam which also linked the consumption of UPF, such as cereals and fast food, to cardiovascular disease.

A team from the University of Sydney studied more than 10,000 middle-aged women over 15 years, finding that 39 per cent were more likely to develop high blood pressure compared to those with the lowest intake of UPFs.

The second study, presented by Yang Qu on behalf of the researchers at China’s Fourth Military Medical University, found those who ate the most UPF were nearly 25 per cent more likely to suffer from a heart attack, stroke, or angina.

Reacting to the findings former Government food adviser and co-founder of the Leon restaurant chain Henry Dimbleby said they served as a ‘wake-up call’ for the UK.

‘If we do nothing, a tidal wave of harm is going to hit the NHS,’ he warned. 

Similar concerns have been echoed in the US, where dieticians have urged Americans to steer clear of UPFs. 

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