Today’s Dietitian
Vol. 28 No. 3 P. 24
Dietary triggers sit at the intersection of emulsifiers, eosinophilic esophagitis (EoE), dysphagia, and irritable bowel syndrome (IBS), linking these conditions through food-mediated inflammatory pathways. EoE is a well-established food-triggered disease, commonly driven by non-IgE-mediated reactions to milk, wheat, and eggs. This can lead to chronic eosinophilic inflammation, esophageal remodeling, and clinically significant dysphagia. Dietary elimination remains a cornerstone of treatment, with remission achieved in a substantial proportion of patients.
Emerging research has begun to explore whether components of the modern food supply chain, such as emulsifiers and other additives, may contribute to mucosal barrier disruption and inflammatory responses, potentially influencing the way diseases are expressed. While evidence is still evolving, this line of thinking highlights the growing relevance of food composition and processing in understanding gastrointestinal inflammation and symptom development across disorders characterized by diet-responsive pathology. This article will provide a brief exploration of these connections as well as practical strategies dietitians can use with their patients.
Why Emulsifiers Are Getting More Attention
Before exploring their potential clinical relevance, it is important to define what emulsifiers are and how they function in foods. Emulsifiers are ingredients that help water and fat mix to improve texture, appearance, smell, taste, shelf life, and consistency. They are found in many different food products, from store-bought ice cream to commercial peanut butter to flavored milks. They can also be key ingredients in supplements, cosmetics, detergent, paint, pesticides, and medical nutrition products. Emulsifiers can be found as ingredients in other foods (think soy lethicin, egg protein, or guar gum) and can also be produced in a laboratory setting. All emulsifiers, regardless of origin, are regulated by agencies like the FDA, the European Food Safety Authority, and Food Standards Australia New Zealand and are generally regarded as safe.
While emulsifiers serve important technological roles in food manufacturing, researchers have begun asking whether these same properties may influence the gastrointestinal environment. Emulsifiers represent one of many modern environmental exposures being studied for potential contributions to chronic low-grade gastrointestinal inflammation. There is some evidence that dietary emulsifiers can disturb gut function through the following mechanisms:
- changing the composition of the microbiome;
- increasing the permeability of the intestines;
- degrading the mucosal barrier; and
- increasing inflammatory response, potentially with links to metabolic syndrome and inflammatory bowel disease (IBD).
Lately, there has been increased interest and proposed/preliminary research on how food additives interact with the gut microbiome and intestinal barrier, which can lead to more questions from clients as “gut health” messaging expands. This matters for clinicians, as people with IBS, EoE, and dysphagia due to altered gut function, inflammation, or reliance on processed/texture-modified foods often see headlines or social media posts that make miraculous or outlandish claims and come to their providers seeking answers.
New Research: Emulsifiers & Gut Health in IBS
Their proposed effects on the microbiome and intestinal barrier have made IBS a natural focus of early clinical investigation. What does the current research say? Animal and limited human data show some emulsifiers may alter gut motility, increase intestinal permeability, and change microbiome composition and function.
Evidence from cell models, animal studies, and emerging controlled human trials suggest some emulsifiers may influence epithelial tight junctions, mucus integrity, and microbial activity, although clinical relevance remains uncertain.
The emulsifiers with the most compelling research include carboxymethylcellulose and polysorbate-80.1,2 Studies in Gut and Nature indicate that the introduction of these emulsifiers can lead to a disruption of the sterile mucus layer, a change in the type of bacteria species, and an increase of flagellin—molecules that promote inflammation.1,2 Depending on the individual ingesting the emulsifier, this can appear as metabolic disruption or colitis.1,2
There is limited evidence that consumption of emulsifiers may negatively impact metabolic syndrome and that restriction can be helpful for individuals with Crohn’s disease.3-5 Other current limitations in the research include the way that most evidence is mechanistic or short-term, and animal studies are more prevalent than human studies, particularly double-blind placebo studies with human participants. Direct causation related to IBS symptoms remains unclear and should be a target for future research, along with long-term intake, dose thresholds, and determining if there are symptom-specific effects in IBS subtypes, individuals with EoE, or dysphagia. Recent controlled feeding studies in healthy adults show changes in microbiota composition and short-chain fatty acid production with certain emulsifiers, though without clear increases in systemic inflammation.
Currently, emulsifier reduction is not a formal part of care guidelines for these populations. For IBS, a low FODMAP diet may be a first line defense, not an elimination of foods containing emulsifiers. Despite these mechanistic findings, translating results into clinical recommendations remains challenging.
Yi Min Teo, MS, RD, CNSC, echoes this, saying, “It’s important for RDs to recognize that most of the research linking emulsifiers to gut health comes from animal or highly controlled mechanistic studies, not real-world human trials. The doses, exposures, and conditions often don’t reflect typical eating patterns. Currently, we don’t have strong evidence showing that emulsifiers worsen symptoms or alter disease course in people with IBS. Until human data strengthens, recommendations should remain cautious, individualized, and balanced to avoid unnecessary restrictions, maintaining a healthy relationship with food and supporting overall quality of life.”
Could Emulsifiers Play a Role in EoE?
While IBS research focuses largely on microbiome and barrier disruption, similar questions about immune activation and mucosal integrity are beginning to emerge in EoE discussions. EoE is a chronic condition characterized by an abundance of white blood cells that lead to inflammation in the esophagus.6,7 Its pathology can be due to food allergy or an immune response, but is traditionally triggered by food proteins like dairy, wheat, soy, seafood, etc, and not food additives.8 The IMPACT behaviors outlined in Gastroenterology indicate that manipulation of food type, texture, and eating time tends to be more effective than elimination.6,7
An area of proposed research involves exploring how barrier function and immune activation overlap with IBS research models. Currently, there is no established direct link between emulsifiers and EoE, but per Courtney Colbert, RDN, CSNC, “Emerging evidence suggests some emulsifiers can disrupt the gut microbiome and negatively impact the intestinal barrier thus contributing to inflammation and intestinal hyperpermeability. Excessive intake of ultraprocessed foods often triggers GI symptoms, making temporary elimination of certain foods with cautious reintroduction a practical clinical approach.” Although epithelial barrier dysfunction is central to EoE pathophysiology, no studies have directly linked emulsifier intake to disease onset or activity, making current connections speculative.
The clinical reality is that we currently have insufficient evidence to justify emulsifier elimination in EoE, and that step-up food elimination remains best practice. Samina Qureshi, RDN, LD, a board-certified specialist in digestive health, wants other dietitians to know that “the current evidence linking emulsifiers to gut health outcomes in humans is limited and low quality. The International Organization for the Study of Inflammatory Bowel Diseases 2020 guidelines rate the evidence for reducing processed foods containing emulsifiers and thickeners as very low.9,10 While some epidemiological studies suggest associations between emulsifier intake and IBD incidence, causality has not been established. At this time, the evidence does not support broad recommendations for emulsifier avoidance in the general population or in GI conditions. Individualized nutrition support is recommended based on each patient’s diet, medical history, and health concerns.”
Considerations for Dysphagia
When thinking about the intersection of emulsifiers and dysphagia, the goal is to balance priorities for these clients. In clinical practice, inflammation associated with EoE often intersects with swallowing challenges, making dysphagia an important consideration. Initial priorities include swallow safety and ensuring adequate intake, and addition of “gut healthy” foods like kimchi should not be added if there is a concern regarding texture acceptance.
It’s essential to help this population identify where emulsifiers most commonly appear, which may include texture-modified foods, oral nutrition supplements, and thickened liquids. Practical strategies for this population may include the following:
- identifying when emulsifiers are necessary vs optional;
- exploring simpler formulations when tolerated; and
- monitoring GI symptoms without unnecessary restriction.
Qureshi explains that for her clients, “reducing emulsifiers is not a first-line nutrition intervention for IBS.” Taken together, these condition-specific considerations highlight the broader counseling challenges dietitians face across GI populations and underscore the need for practical, patient-centered approaches. Regardless of diagnosis, many of the same communication strategies apply when clients raise concerns about food additives.
Counseling Approaches
It’s helpful to normalize questions without validating fear. It’s important to start by explaining what emulsifiers are: food additives that help blend two substances (like oil and water) that typically separate when they are combined, often resulting in a smoother and creamier texture. They also help products like mayonnaise, sliced cheese, dairy alternatives, salad dressings, and various sauces stay shelf-stable and safe for longer periods of time, which is important for large-scale food production.
Supporting Health Literacy
Qureshi says, “I frame label reading as a tool, not a requirement. For some clients, it can support symptom awareness. For others, it can increase anxiety and hypervigilance around food. We discuss when label reading is helpful and when it may be counterproductive. If a client chooses to read labels, I explain ingredient lists in simple terms. Ingredients listed earlier appear in larger amounts, while those listed later are present in smaller quantities. We also discuss frequency and context. Eating a food occasionally is different from relying on it for every single eating occasion. I emphasize that convenience foods can play an important role in nourishment, especially during busy periods or symptom flares when they may not have the energy to make full meals for themselves. ‘Fed is best’ applies to adults too!”
Practically speaking, Qureshi starts off a conversation asking what the client heard, what the source is, and what they are most worried about. Not surprisingly, “many fears stem from social media or noncredentialed sources, so we discuss health literacy and how to evaluate nutrition claims critically. This helps contextualize the information without dismissing the client’s experience. I then explain what emulsifiers are and their functional role in food production, such as improving texture, stability, and consistency. I keep the discussion neutral and evidence based. Rather than labeling emulsifiers as “good” or “bad,” we explore how these ingredients fit into the client’s overall dietary pattern and whether there is any consistent, individual symptom response. My focus during nutrition consults remains on nourishment, adequacy, and flexibility rather than ingredient avoidance.”
Clinical Insights and Nuance
Teo encourages centering context, with a focus on individualized health goals. All these approaches align with emphasizing the importance of a healthy overall dietary pattern vs fear over single ingredients. Colbert recommends that clinicians “frame the conversation around individual tolerance, context, and empowerment rather than ‘good vs bad’ foods. Emphasize that emulsifiers are generally safe, but some people with sensitive stomachs may notice symptoms—like how lactose or high-FODMAP foods affect some but not all individuals. Dietitians should use neutral language like ‘may be a trigger for some people’ instead of ‘always damaging,’ and highlight that dose and overall diet quality matter more than a single ingredient.”
In some cases, a trial reduction of a certain emulsifier or food may be appropriate. This could include if symptoms persist even with evidence-based guideline therapy and if the client is strongly motivated and has little risk of nutrition deficiency from an elimination diet. This would not be appropriate for clients with a history of disordered eating/eating disorder.
An example of this would be gum emulsifiers, which Colbert cautions “may be problematic for people with IBS, dysbiosis, or SIBO [small intestinal bacterial overgrowth] because many of them act as fermentable fibers that increase gas production, bloating, and abdominal pain. They may also draw water into the colon and alter motility, which can worsen diarrhea or urgency for some sensitive individuals.”
Some clients may even require an elimination protocol, based on the severity of their symptoms and in taking into account their environment, history, etc. Best practices for elimination protocols include making certain that individuals are consuming adequate sources and amounts of fiber and fluid, along with symptom tracking across multiple disease states (eg, IBS and EoE or dysphagia). RDs can assist in identifying foods and beverages to provide variety safely while adhering to protocol.
Final Takeaway
When viewed together, current research and clinical experience reinforce a balanced and nuanced perspective. Some emulsifiers may influence gut health through their impact on the microbiome, barrier function, and inflammation, but human data is still limited. For IBS, evidence-based dietary approaches should remain the foundation. For EoE, food protein elimination (not additives) may drive remission. The provision of thoughtful, personalized counseling helps clients stay nourished, reduce fear, and manage symptoms with confidence. Keeping the focus on foods that are eaten frequently, not occasionally, and avoiding long “no lists” are key strategies that can prevent overwhelm, decision-making fatigue, and hopelessness. As Teo reminds us, “current research does not yet support routine emulsifier reduction for IBS symptom management.”
— Alexandria Hardy, RDN LDN, is a registered dietitian and writer located in Lancaster, Pennsylvania.
References
1. Chassaing B, Koren O, Goodrich JK, et al. Dietary emulsifiers impact the mouse gut microbiota promoting colitis and metabolic syndrome. Nature. 2015;519(7541):92-96.
2. Chassaing B, Van de Wiele T, De Bodt J, Marzorati M, Gewirtz AT. Dietary emulsifiers directly alter human microbiota composition and gene expression ex vivo potentiating intestinal inflammation. Gut. 2017;66(8):1414-1427.
3. Bancil A, Rossi M, Sandall A, et al. DOP097 Emulsifier restriction is an effective therapy for active Crohn’s disease: the ADDapt trial – a multi-centre, randomised, double-blind, placebo-controlled, re-supplementation trial in 154 patients. J Crohns Colitis. 2025;19(Suppl 1):i262.
4. Sellem L, Srour B, Javaux G, et al. Food additive emulsifiers and risk of cardiovascular disease in the NutriNet-Santé cohort: prospective cohort study. BMJ. 2023;382:e076058.
5. Sellem L, Srour B, Javaux G, et al. Food additive emulsifiers and cancer risk: results from the French prospective NutriNet-Santé cohort. PLoS Med. 2024;21(2):e1004338.
6. Dellon ES, Muir AB, Katzka DA, et al. ACG clinical guideline: diagnosis and management of eosinophilic esophagitis. Am J Gastroenterol. 2025;120(1):31-59.
7. Visaggi P, Mariani L, Pardi V, et al. Dietary management of eosinophilic esophagitis: tailoring the approach. Nutrients. 2021;13(5):1630.
8. Harusato A, Chassaing B, Dauriat CJG, Ushiroda C, Seo W, Itoh Y. Dietary emulsifiers exacerbate food allergy and colonic type 2 immune response through microbiota modulation. Nutrients. 2022;14(23):4983.
9. Levine A, Rhodes JM, Lindsay JO, et al. Dietary guidance from the International Organization for the Study of Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol. 2020;18(6):1381-1392.
10. Ananthakrishnan AN, Kaplan GG, Bernstein CN, et al. Lifestyle, behaviour, and environmental modification for the management of patients with inflammatory bowel diseases: an International Organization for Study of Inflammatory Bowel Diseases consensus. Lancet Gastroenterol Hepatol. 2022;7(7):666-678.