A study suggests that eating certain food additives together may increase diabetes risk

. Certain ingredients that make processed food creamy, sugar-free and shelf-stable may work together to increase the risk of Type 2 diabetes.

Eating combinations of common food additives may be tied to a slightly increased risk of Type 2 diabetes, according to a study published Tuesday in the journal PLOS Medicine.

Certain food additives have been linked to cancer, diabetes, heart disease, and changes in the gut microbiome, according to a growing body of evidence. Many of these studies, however, were focused on single ingredients.

Mathilde Touvier, co-author of the new study and director of the nutritional epidemiology research team at Université Sorbonne Paris Nord and the French National Institute of Health and Medical Research, stated, "In real life, we ingest a mixture of additives." More than 108,000 adults from the French NutriNet-Santé cohort, a long-running study of food and health, were analyzed by Touvier and her team over the course of approximately eight years. The researchers looked at the diets that the participants reported and found five common combinations of additives. The combinations look like the list of ingredients on a food that has been extremely processed. Diphosphates, glycerol, sodium carbonates, potassium carbonates, sorbitol, and ammonium carbonates make up Mixture 1. Modified starches, pectins, guar gum, carrageenan, polyphosphates, potassium sorbate, curcumin, and xanthan gum make up the second mixture. Carbonates of magnesium, riboflavin, alpha-tocopherol, and ammonium Alpha-tocopherol, magnesium carbonates, lecithins, diphosphates, sodium carbonates, and ammonium carbonates make up Mixture 4. Acesulfame K, aspartame, sucralose, arabic gum, malic acid, carnauba wax, paprika extract, capsanthin, and capsorubin, anthocyanins, guar gum, and pectins make up Mixture 5. Mengxi Du, a research associate at the Harvard T.H., stated, "It's relatively uncommon for all of them to appear in a single product, but it's entirely possible to consume all of them across different foods throughout the day, especially when eating a variety of processed or ultra-processed foods." Chan School of Public Health who studies nutrition and health and wasn’t involved with the study.

Mixture 2's two components, carrageenan and potassium sorbate, can be found in sweetened condensed milk together. Xanthan gum is frequently found in gluten-free prepared foods and mayonnaise. Pectin is in cream cheese.

Du stated, "These are pretty common products in someone's refrigerator, and a lot of the time we combine them." Two groups — Mixture 2 and Mixture 5 — were linked to an increased risk of Type 2 diabetes, the researchers found. Regardless of how healthy their diet was overall, people who ate more of these combinations were more likely to get the disease. Mixture 2 was heavy in emulsifiers and thickening agents, including carrageenans, which are found in plant-based milks and processed meats, and modified starches, which thicken and stabilize packaged sauces, soups and baked goods. Mixture 5 contained ingredients commonly found in sugary and artificially-sweetened drinks, and included artificial sweeteners, natural dyes and acidifiers.

Still, the study was observational, meaning it doesn’t show cause and effect. Studies that require participants to recall their diets are also notoriously tricky. The limitations make it difficult to draw strong conclusions from the study, which Touvier and her team said will require more research.

“The additives may be markers of something else, rather than causing Type 2 diabetes themselves,” said Dr. Tom Rifai is a doctor who practices internal and lifestyle medicine in the endocrinology, diabetes, and metabolism department at Cleveland Clinic. Rifai owns a lifestyle coaching company that includes nutrition counseling. “These could be a marker for what we call calorie density.”