Emulsifiers and Metabolic Risk: Why ‘Clean’ Eaters Still Develop Diabetes

Food Additives: When the Whole is Worse than the Sum of its Parts

What a new 100,000+ person study reveals about emulsifiers, metabolic risk, and your patients’ food choices.

For years, we’ve known that individual food additives—like emulsifiers, sweeteners, and artificial colors—can impact health. But a new large-scale French study takes a more real-world approach, analyzing what actually happens when people consume combinations of these substances, as they commonly appear in ultra-processed foods.

The results? Clinically significant!

In this prospective cohort study of 104,139 French adults, researchers found that exposures to specific emulsifiers—and this effect became even more concerning when the additives were combined in typical dietary patterns.

 The Numbers Behind the Concern

• • Mean participant age: 42.7 years (79% female)
  • Follow-up duration: ~6.8 years
  • New T2D diagnoses during study: 1,056
  • Data collection method: Repeated 24-hour dietary records, cross-referenced with multiple food composition databases and lab assays.

This isn’t a mouse model or petri dish scenario. This is high-quality data gathered over nearly 15 years, showing statistically significant risk associations.

Emulsifiers Identified as Contributing to Higher Diabetes Risk

The study, published in PLOS Medicine, found many very common emulsifiers were significantly associated with increased T2D risk  (some with p<.001!).  Here’s the list, along with the emulsifiers numeric codename (E###) which lets processors avoid using the actual chemical name on the label:

• Carrageenans (E407) – Used in plant-based milks and processed meats.
• Tripotassium phosphate (E340) – Found in cereals and processed cheese.
• E472e (Acetyl tartaric acid esters of mono- and diglycerides) – In baked goods and margarine.
• Sodium citrate (E331) – In soft drinks and sauces.
• Guar gum (E412) – In ice creams and gluten-free products.
• Gum arabic (E414) – In candy coatings and diet drinks.
• Xanthan gum (E415) – Found in dressings and soups.

⚠️ These aren’t fringe chemicals—they’re found in products consumed daily by patients who often assume a food is “healthy” because it’s labeled low-carb, dairy-free, or high-protein.

Why This Matters to NMS Clinicians

This study reinforces what we already understand in posture and functional care: multiple sub-threshold stressors—whether biomechanical or biochemical—can and do aggregate into systemic dysfunction.

As with postural imbalances, pattern recognition is key. Being aware that each patient’s load and sensitivities are unique, and teaching them to understand why and how to identify additive overload in their diet could be as vital as reducing unaware asymmetry in their body.

And the physiological mechanisms align: these emulsifiers are known to disrupt gut microbiota, increase systemic inflammation, and impair glucose metabolism. A perfect storm for metabolic dysfunction, which in turn impacts behavior and biomechanics.

✅ What Can You Do?

For clinicians, trainers, and educators working to create sustainable health change, here are actionable takeaways:

1. Screen for ultra-processed food intake in dietary history—even in “clean” diets.
2. Educate about emulsifiers by name. Many patients recognize “sugar” but not HFCS (high fructose corn syrup).
3. Advocate for whole foods, not just “low calorie” or “macro-balanced” ones.
4. Track how food impacts function, just as we track how posture impacts pain.
5. Bridge the perception gap—what feels “healthy” may not be when viewed through a metabolic lens.

🧭 The Bottom Line

Just as we use Interoceptive Posture Pictures (IPPs) to bridge how people feel their body with how it functions, we must help people connect their perception of healthy food with the physiological impact of ingredient combinations. In both movement and metabolism, the goal is the same: awareness that leads to informed, empowered action.

The insights from this emulsifier research underscore a fundamental principle in modern practice: optimal patient outcomes require looking beyond isolated factors to understand how multiple systems interact. Just as food additives work synergistically to impact metabolic health, effective clinical care must address the interconnected nature of nutrition, movement, and postural balance.

➡️ Dive Deeper – Actionable Continuing Education (CE)

Dr. Weiniger’s systematic approach to documenting fall risk and postural patterns (Part E) combined with Dr. Cook’s exploration of fat-soluble vitamin optimization (Part F) in the Modern Chiropractic Integration course exemplifies this comprehensive perspective.

When we understand that a patient’s metabolic dysfunction from emulsifier exposure can be compounded by postural imbalances affecting circulation and nutrient absorption, or that inadequate fat-soluble vitamin status may impair their body’s ability to process inflammatory responses from food additives, we begin to see the patient as an integrated system. This holistic documentation and assessment approach—whether screening for additive overload, fall risk, or nutritional deficiencies—provides the clinical framework needed to address root causes rather than isolated symptoms.

[ Access Modern Chiropractic Integration | Parts E-F ]

Let’s keep helping people make choices that reflect how their bodies truly function—inside and out.

KEY REFERENCES

• Food additive emulsifiers and the risk of type 2 diabetes: analysis of data from the NutriNet-Santé prospective cohort study.  (2024) Lancet Endo Diabetes;Salame, Clara, Javaux, Guillaume, Sellem
• Food Additives Could Combine to Threaten Health: Researchers found mixtures of multiple additives may raise risk of diabetes

ADDITIONAL REFERENCES

• Making Sense of Interoception How we perceive what’s happening inside our bodies and what that means for our health
• Leveraging Interoception to Enhance Postural Alignment and Rehabilitation Outcomes