Hypothesis: Increased consumption of emulsifiers as an explanation for the rising incidence of Crohn's disease

Roberts, Carol L.; Rushworth, Saffy; Richman, Emile; Rhodes, Jonathan M.

doi:10.1016/j.crohns.2013.01.004

Cited by 132 publications

(77 citation statements)

References 18 publications

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“…Bile salts are of course naturally occurring detergents to which the mucosa is exposed but are largely resorbed before they reach the terminal ileum and colon, where they would be likely to have most impact on bacterial translocation [63,64]; moreover, phosphatidylcholine, which is co-secreted in bile, protects against their attack on the mucosa. We have speculated that increased ingestion of emulsifiers might be an environmental factor behind the increase in CD in recent decades [65]. We advise our patients with IBD to avoid processed foods containing emulsifiers and to rinse their dishes well [66]!…”

Section: Potentially Harmful Effects Of Detergents and Emulsifiers Onmentioning

confidence: 99%

Mucosal Barrier, Bacteria and Inflammatory Bowel Disease: Possibilities for Therapy

Merga

Campbell

Rhodes

2014

Dig Dis

Self Cite

157

113

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The mucosal barrier has three major components, the mucus layer, the epithelial glycocalyx and the surface epithelium itself, whose integrity largely depends on tight junction function. In health, there is relatively little direct interaction between the luminal microbiota and the epithelium - the continuous mucus layer in the colon keeps the surface epithelium out of contact with bacteria and the ileo-caecal valve ensures that the distal small intestine is relatively microbe free. Most interaction takes place at the Peyer's patches in the distal ileum and their smaller colonic equivalents, the lymphoid follicles. Peyer's patches are overlain by a ‘dome' epithelium, 5% of whose cells are specialised M (microfold) epithelial cells, which act as the major portal of entry for bacteria. There are no goblet cells in the dome epithelium and M cells have a very sparse glycocalyx allowing easy microbial interaction. It is intriguing that the typical age range for the onset of Crohn's disease (CD) is similar to the age at which the number of Peyer's patches is greatest. Peyer's patches are commonly the sites of the initial lesions in CD and the ‘anti-pancreatic' antibody associated with CD has been shown to have as its epitope the glycoprotein 2 that is the receptor for type-1 bacterial fimbrial protein (fimH) on M cells. There are many reasons to believe that the mucosal barrier is critically important in the pathogenesis of inflammatory bowel disease (IBD). These include (i) associations between both CD and ulcerative colitis (UC) with genes that are relevant to the mucosal barrier; (ii) increased intestinal permeability in unaffected relatives of CD patients; (iii) increased immune reactivity against bacterial antigens, and (iv) animal models in which altered mucosal barrier, e.g. denudation of the mucus layer associated with oral dextran sulphate in rodents, induces colitis. Whilst some IBD patients may have genetic factors leading to weakening of the mucosal barrier, it is likely that environmental factors may be even more important. Some may be subtle and indirect, e.g. the effects of stress on the mucosa barrier, whilst others may be more obvious, e.g. the effect of pathogen-related gastroenteritis, known often to act as trigger for IBD relapse. We have also been very interested in the potentially harmful effects of ingested detergents - either by contamination of cutlery by inadequate rinsing or via ingestion of processed foods containing permitted emulsifiers. In vitro and ex vivo studies show that even very small trace amounts of these surfactants can greatly increase bacterial translocation. Implications for therapy are not yet so obvious. We advise our IBD patients to avoid processed foods containing emulsifiers and to rinse their dishes well - whilst accepting that there is no direct evidence yet to support this. Therapies that aim to enhance the mucosal barrier have yet to come to market, but trials of enteric-delivered phosphatidylcholine in UC are promising. The faecal concentration of mucus-degrading bact...

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Section: Potentially Harmful Effects Of Detergents and Emulsifiers Onmentioning

confidence: 99%

Mucosal Barrier, Bacteria and Inflammatory Bowel Disease: Possibilities for Therapy

Merga

Campbell

Rhodes

2014

Dig Dis

Self Cite

157

113

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“…Recently a growing number of scientific studies indicate a causal association between surfactant emulsifier consumption and the development of allergic, inflammatory and autoimmune diseases by increasing intestinal permeability (Csáki, 2011;Mine, 2003;Roberts, 2010;Roberts, 2013). The incidences of diseases related to impaired intestinal barrier function has increased over the past fifty years in developed countries (Hermann, 2003;Rubio-Tapia, 2009) parallel with the excessive use of food emulsifier additives (Csáki, 2011;Roberts, 2013).…”

Section: Description Of the Issuementioning

confidence: 99%

“…The incidences of diseases related to impaired intestinal barrier function has increased over the past fifty years in developed countries (Hermann, 2003;Rubio-Tapia, 2009) parallel with the excessive use of food emulsifier additives (Csáki, 2011;Roberts, 2013).…”

Section: Description Of the Issuementioning

confidence: 99%

Annual report of the Emerging Risks Exchange Network 2014

2015

EFSA Supporting Publications

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EFSA established an Emerging Risks Exchange Network (EREN) to exchange information between EFSA and the MSs on possible emerging risks for food and feed safety in 2010. The Network is currently composed of delegates from 21 Member States and an EFTA country (Norway) designated through the Advisory Forum of EFSA and observers from the European Commission, EU pre-accession countries, the Food and Drug Administration of the USA (FDA) and the Food and Agricultural Organisation of the United Nations (FAO). The Network met twice in 2014. The Network discussed a total of 10 signals of potential emerging issues that were presented and assessed. Among the 10 issues discussed 9 originated from Member States. The issues discussed were from the areas of chemical hazards, illegal activities, microbiological hazards, biotoxins, animal health, new consumption trends and new technologies and processes. EREN concluded that 4 issues were to be considered as emerging issues. Recommendations for follow up actions were provided, such as (i) EFSA should monitor the issue, (ii) generation of data is needed, (iii) EFSA should consult other bodies such as European sister agencies, the Stakeholder Consultative Group on Emerging Risk (StaCG-ER) or the recently established Food Fraud Network of DG SANTE.

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“…There is a correlation between per capita emulsifier consumption and incidence of CD both geographically across countries and by time within Japan [49]. We therefore recommend that patients with IBD avoid intake of processed foods containing emulsifiers and take care to rinse dishes and cutlery to remove detergent.…”

Section: Barrier Enhancersmentioning

confidence: 99%

IBD: Microbiota Manipulation through Diet and Modified Bacteria

Simpson

Campbell²,

Rhodes³

2014

Dig Dis

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Background/Aims: Crohn's disease (CD) and ulcerative colitis (UC) are both typified by an altered intestinal microbiota, and gene associations imply various defects in the mucosal barrier and in the innate immune response to bacteria. This review aims to assess how alterations in diet or use of modified bacteria could have therapeutic effects in CD or UC. Methods: A MEDLINE search using the terms ‘prebiotic', ‘genetically modified bacteria', ‘mucosal barrier in association with ulcerative colitis', ‘Crohn's disease‘ or ‘microbiota'. Results: A large body of data from in vitro and animal studies shows promise for therapeutic approaches that target the microbiota. Approaches include dietary supplementation with fermentable fibres (prebiotics) and soluble fibres that block bacterial-epithelial adherence (contrabiotics), enhancement of the mucosal barrier with phosphatidylcholine, and use of genetically modified bacteria that express IL-10 or protease inhibitors. Vitamin D supplementation also shows promise, acting via enhancement of innate immunity. Clinical trials have shown benefit with enterically delivered phosphatidylcholine supplementation in UC and near-significant benefit with vitamin D supplementation in CD. Conclusion: Strategies that target the microbiota or the host defence against it appear to be good prospects for therapy and deserve greater investment.

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Hypothesis: Increased consumption of emulsifiers as an explanation for the rising incidence of Crohn's disease

Cited by 132 publications

References 18 publications

Mucosal Barrier, Bacteria and Inflammatory Bowel Disease: Possibilities for Therapy

Mucosal Barrier, Bacteria and Inflammatory Bowel Disease: Possibilities for Therapy

Annual report of the Emerging Risks Exchange Network 2014

IBD: Microbiota Manipulation through Diet and Modified Bacteria

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