Food additives and Crohn’s disease
by Steven Sandberg-Lewis, ND, DHANP
Crohn’s is a type of autoimmune inflammatory bowel disease that plagues as many as 20 out of 100,000 people in the US. Its incidence is rising, and this trend correlates with the increased use of Western processed diets.
Crohn’s disease leads to transmural thickening which means a thickening of all the structures of the portion of the gut affected. Symptoms vary depending on the areas of the digestive system affected and include abdominal pain, diarrhea or constipation. There may or may not be visible blood in the stools.
Crohn’s may occur in any part of the digestive tract - from the mouth to the anus - but the small intestine is most commonly involved.
In the small intestine, cells of the immune system release cytokines, causing swelling, irritation, and – eventually - erosions and ulcers of the intestinal lining. Most of the human immune system resides in the gut lining, also called the mucus membrane. This membrane, which covers the inside of the intestines, is formed of cells called epithelial cells.
The proposed mechanism for this intestinal inflammation involves the patient’s gut immune system reacting to the microbiome. “Microbiome” is a group name for all the normal resident bacteria of the gut.
I am frequently consulted by Crohn’s patients who are responding poorly to standard immunosuppressive treatments or who prefer a more natural approach. Diet is a mainstay for addressing inflammatory bowel diseases with naturopathic medicine. Research proves that it is important to avoid certain dietary food additives, especially carrageenan and carboxymethylcellulose.
Carrageenan and carboxymethylcellulose are additives in many common processed foods. Unfortunately, these additives are not benign and lead to erosion of the protective mucus layer. The mucus layer is essential for separating the intestinal bacteria from the epithelial cells lining the gut. If the bacteria contact the lining, the immune system becomes activated, which increases inflammation. In addition, carrageenan and carboxymethylcellulose also increase the permeability of the digestive lining by opening microscopic spaces between the epithelial cells. This increases the opportunity for undigested food particles, toxins, and microorganisms to pass though the intestinal epithelium. This causes inflammation in other parts of the body and alters the composition of the gut microbiome, triggering the activation of the gastrointestinal immune system and the development of inflammation.
Read labels! Carrageenan is used as a thickener, preservative, and emulsifier in foods such as chocolate milk, whipping cream, coffee creamers, ice cream, nut milk, vegan cheese, and deli meat. Carboxymethylcellulose is a thickener and may extend shelf life of processed foods. You may also find it listed on product labels as cellulose gum, sodium carboxymethylcellulose, or sodium CMC. It is ubiquitous in baked goods including gluten-free products, dairy products, fruit juice, soft drinks, sauces and dressings, candy, jelly, confection fillings and glazes, sausages, hot dogs, and meat analogues.
Sources:
Feuerstein JD, Cheifetz AS. Crohn Disease: Epidemiology, Diagnosis, and Management. Mayo Clin Proc. 2017 Jul;92(7):1088-1103 PMID: 28601423
Costa EM et al. Carboxymethyl Cellulose as a Food Emulsifier: Are Its Days Numbered? Polymers (Basel). 2023 May 22;15(10):2408 PMID: 37242982
Martino JV et al. The Role of Carrageenan and Carboxymethylcellulose in the Development of Intestinal Inflammation. Front Pediatr. 2017 May 1;5:96 PMID: 28507982
https://foodadditivesforhealth.com/emulsifiers/carboxymethyl-cellulose-cmc/
Steven Sandberg-Lewis, ND, DHANP, has been in clinical practice since his 1978 graduation from NUNM. He has been a professor since 1985, teaching a variety of courses but primarily focusing on gastroenterology and GI physical medicine. He is the author of Let’s Be Real About Reflux - Getting to the Heart of Heartburn and the textbook Functional Gastroenterology. Both are available on all online bookstores such as Powell’s.
Hive Mind Medicine blog posts are for educational purposes only and are not intended as medical advice. Please consult with your health care practitioner for personalized guidance.