Food Additives: Interpreting the Ingredients List

Written by: Kelsey Schaffstall Young MS, RDN, LDN

What is ultra-processed food?

Nearly all food is processed to some degree, however the more processing a food has undergone, the more likely it is to include additives that could have negative health effects.

Minimally processed foods include fresh meat, milk, whole grains, legumes, nuts, fruits, and vegetables. In minimally processed food, the nutritional properties of the original food is not altered, and the food remains recognizable to its original form.5 Some methods of processing used to produce minimally processed foods include cleaning, removal of inedible fractions, portioning, refrigeration, freezing, pasteurization, fermenting, pre-cooking, drying, skimming, bottling, and packaging.5

Ultra-processed foods are often sold as products that are ready-to-eat or ready-to-heat. These foods are derived from substances extracted from whole foods such as oils, fats, starches, and sugars which have no real resemblance to the original ingredients.5 Additives are often required to improve the texture and shelf stability of ultra-processed food products such as packaged snacks, cookies, sauces, and dressings.

What is the prevalence of food additives?

The use of additives in food processing is regulated by the FDA and, under the 1958 Food Additive Amendment, more than 10,000 chemicals are allowed to be added to food in the United States, either directly or indirectly.6

Several surveys (conducted in Europe, the US, Canada, New Zealand, and Brazil) have suggested that ultra-processed food products contribute between 25-50% of total daily calorie intake. The consumption of ultra-processed foods is increasing among US adults as well, from 53.5% of calories in 2001-2002 to 57% of calories in 2017-2018.4

What are the health effects of processed food consumption?

A large prospective study showed a 10% increase in ultra-processed foods in the diet was associated with a significant increase of ~10% in risks of overall and breast cancer and 10-15% in the risk of heart disease and diabetes.2,3

Research is emerging regarding one category of food additives. Emulsifiers, such as carboxymethylcellulose (CMC), soy lecithin, mono- and diglycerides, and polysorbates, are used to improve the texture and shelf life of food products such as nut milks, ice cream, sauces, and dressings, have been shown to negatively impact gut health.1

In a small randomized controlled trial, 16 healthy volunteers ate the same emulsifier-free diet in an inpatient setting, but the intervention group received 15g carboxymethylcellulose (CMC) daily for 10 days.1 Subjects fed CMC displayed greater changes in microbiota composition than controls, reduced microbial richness, and the reduction of beneficial metabolites including short chain fatty acids and essential amino acids. 1 Two subjects also displayed bacterial encroachment into the inner mucus layer of the gut, which is a common feature of IBS. 1

Strategies to limit additives

In this day and age, it would be nearly impossible to avoid food additives completely, but there are a few simple ways that you can minimize food additive intake. First, when comparing products, a shorter ingredient list usually indicates less additives. Choose products with whole food ingredients as often as possible and opt for convenient forms of minimally processed ingredients to promote home cooking (plain frozen fruit and vegetables, precut fruit and vegetables, frozen meats, etc.). Practice meal prep strategies to simplify home cooking, and start making your own sauces, dressings, doughs, and batters from scratch. Finally, enjoy fast food and restaurant meals in moderation. Consider making an appointment with a Registered Dietitian who can assist you in making sustainable dietary changes that fit your lifestyle.



  1. Chassaing, Benoit, et al. “Randomized controlled-feeding study of dietary emulsifier carboxymethylcellulose reveals detrimental impacts on the gut microbiota and metabolome.” Gastroenterology 162.3 (2022): 743-756.
  2. Chazelas, Eloi, et al. “Nitrites and nitrates from food additives and natural sources and cancer risk: results from the NutriNet-Santé cohort.” International Journal of Epidemiology (2022).
  3. Fiolet, Thibault, et al. “Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohort.” bmj 360 (2018).
  4. Juul, Filippa, et al. “Ultra-processed food consumption among US adults from 2001 to 2018.” The American Journal of Clinical Nutrition 115.1 (2022): 211-221.
  5. Monteiro, Carlos A. “Nutrition and health. The issue is not food, nor nutrients, so much as processing.” Public health nutrition 12.5 (2009): 729-731.
  6. Trasande, Leonardo, et al. “Food additives and child health.” Pediatrics 142.2 (2018).

Nicotine and Diabetes

Written by Cara Schrager, MPH, RD, CDCES


It is well known that smoking cigarettes causes a multitude of health problems including but not limited to cancer, heart disease, stroke, COPD and diabetes. Studies have shown that cigarette smokers are 30-40% more likely to develop type 2 diabetes than non-cigarette smokers (1). Those who have diabetes and smoke have an elevated risk of heart disease and stroke. Because smoking is a factor in increasing risk for diabetes complications, it is among one of the diabetes ABCs (A1C, Blood Pressure, Cholesterol, Stop Smoking) to prevent diabetes complications.


Nicotine is the chemical in tobacco that is highly addictive and leads to increased heart rate, blood pressure, narrowing of blood vessels, and hardening of arterial walls. Nicotine may impact blood sugar control by elevating blood glucose levels. Research found that nicotine may raise hemoglobin A1C (a 3 month average of blood glucose) up to 34% (2).


E-cigarettes and “vaping” have become very popular over the last decade, targeting young adults and youth. A 2022 study found that those who use cigarettes are  22% more likely to develop prediabetes based on self-report (3). Those who smoke regular cigarettes have a 40% chance of developing prediabetes.


E-cigarettes are often regarded as a healthier choice to regular cigarettes, however they still contain nicotine. Because nicotine raises blood glucose levels, it makes diabetes more difficult to manage. People with diabetes who smoke often need higher doses of insulin to manage their blood glucose levels to target range (3). A study in rats found that a specific diabetes associated gene plays a role in pathways for responsiveness to nicotine and insulin production, leading to higher blood glucose levels by way of the pancreas and increased consumption of nicotine (4). 


Whether or not you have diabetes, vaping can increase your risk of developing the disease or make managing the disease more challenging. If you are looking for support to quit smoking check out these resources from the CDC and talk with your doctor about a plan that’s best for you.

Nutrition and Health Effects of Cannabis: A Review of the Evidence

Written by Kelsey Schaffstall Young MS, RDN, LDN

More than 100 different cannabinoids have been identified, the most well studied being tetrahydrocannabinol (THC) and cannabidiol (CBD), which have both been shown to have therapeutic and medicinal properties.1 The health effects of cannabis are directly related to our body’s innate ability to bind cannabinoids. Interestingly, the human body naturally produces cannabinoids and therefore is equipped with an entire network of cannabinoids receptors, also known as the endocannabinoid system. 1

What does the research say?

According to a review conducted by the American Heart Association conducted in 2020, there is strong scientific evidence to support the use of cannabis for a variety of medical conditions. First, cannabis has been shown to improve pain caused by neuropathy and fibromyalgia. 1 Cannabis is also effective at increasing appetite and promoting weight gain in people suffering from cancer or HIV related weight loss. 1 In addition to benefitting appetite, cannabis has also been shown to prevent chemotherapy-induced nausea and vomiting. 1 Other conditions such as Multiple Sclerosis and Epilepsy have also been studied, for which cannabis has been shown to improve pain and spasticity and seizures, respectively. 1 Moderate evidence also exists to suggest that cannabis could be effective in treating opiate withdrawal and dystonia. 1 Despite this, research on cannabis has been limited due to decades of cannabis being classified as a controlled substance. However, advancements have been made in the area of medical marijuana with three prescription cannabinoids (Marinol, Cesamet, and Epidiolex) now being authorized for use in the US. 1

Are there any risks associated with cannabis use?

Despite the potential therapeutic benefits, cannabis use does not come without risks. Chronic long-term use of cannabis can reduce the availability of CB1 receptors, impacting the systemic response when used long term. 1 For example, use in moderation can improve nausea and vomiting while chronic daily use can result in uncontrolled vomiting known as hyperemesis syndrome. 1 Use in adolescents younger than 16-18 years of age has also shown increased risk of psychosis and schizophrenia as well as poorer attention. 1 CBD can also inhibit some enzymes in the CYP450 family and alter the metabolism of certain drugs, either decreasing or increasing their concentration in the bloodstream. 1

Lifestyle Considerations

If you are trying to decide whether or not to use cannabis to support your health, there are a number of things to consider. First, in terms of dosing, a responsible approach would be to begin with the lowest possible dose and increase slowly until you feel the desired benefits. Also, be sure to choose high quality products and seek out reputable companies that provide consumers with a certificate of analysis detailing the cannabinoid content as well as the presence of any heavy metals or pesticides. Proof of third-party testing is also important as it can ensure the purity and potency of the final product.

Most importantly, pay attention to whether cannabis is promoting or inhibiting health behaviors. For example, is it enhancing appetite to the point that you are overeating or making poor nutrition choices? Is the quality of your sleep improving or declining? These are important questions to ask yourself when making any behavior change, and a Registered Dietitian can help you to examine the impact of cannabis on your nutrition and health behaviors. Finally, be sure to consult your doctor to ensure that cannabis use will not interfere with any of your current medications.

It is an exciting time to explore the wide array of THC and CBD products on the market, and hopefully as legalization efforts continue to evolve so will the scientific research on the use of cannabis to promote health.

  1. Page, Robert L., et al. “Medical marijuana, recreational cannabis, and cardiovascular health: a scientific statement from the American Heart Association.” Circulation 142.10 (2020): e131-e152.


Spotting Metabolic Syndrome and 3 Ways to Reduce Your Risk

What is Metabolic Syndrome?

You may have heard the name but there is often some confusion about what exactly is metabolic syndrome, in fact,  keyword research shows over 74,000 Google searches for “metabolic syndrome” in just the past 24 hours.  Also called syndrome x, metabolic syndrome is the name for a group of conditions that raise the risk of cardiovascular diseases and diabetes.  When an individual has three of the five conditions a diagnosis of metabolic syndrome can be made. According to data from the National Health and Nutrition Examination Survey (NHANES) the prevalence of metabolic syndrome has been on the rise since the early 1990s and by 2012 it’s estimated that more than one-third of US adults met the diagnostic criteria.    

The World Health Organization (WHO) defines Metabolic Syndrome diagnosis with any three of the following:

  • High blood pressure ( systolic reading of 135 mm Hg over diastolic 85 mm Hg or greater)
  • Impaired glucose tolerance (fasting blood glucose of 100 mg/dL or greater)
  • High waist circumference (greater than 40 inches in men and 35 inches in women)
  • High triglycerides (150 mg/dL or greater)
  • Low HDL cholesterol (less than 40 mg/dL in men and 50 mg/dL in women)


3 Ways to Reduce Your Risk

Metabolic syndrome is treated by addressing the conditions that contribute to the diagnosis. Interventions with diet and lifestyle can often help to reverse the conditions that make up metabolic syndrome.  For example, a weight loss of as little as 3% can lead to improvements in blood lipids and meeting minimum recommendations for daily exercise can help keep blood pressure in check.  If you are looking to reduce your risk, try starting with the three tips below:


1. Know Your Numbers

Being an active participant in your healthcare and knowing where you stand can help you better understand your risk. Blood pressure, fasting glucose and blood lipids are tests that should be done each year at your annual check-up visit.  Knowing where you stand now and watching the trends year after year can help you take action sooner if one area starts to creep up.


2. Don’t Ignore Your Weight

A prospective study published in the American Journal of Medicine in 2000 estimated that the average American gains and then maintains about a pound of weight annually.  This may not seem clinically significant enough to warrant intervention at an annual check-up visit however year after year of gradual gains can become significant and contribute to the development of metabolic syndrome.  Your weight may not fit perfectly within the BMI scale but knowing what’s a healthy range for you and watching your trends is important.

3. Strive For 150

Participating in some form of physical activity is well established in the research to have protective effects against the conditions that contribute to metabolic syndrome including lowering blood pressure, maintaining weight and reducing insulin resistance.  Check in to see how close you are getting to meeting the minimum recommendations of 150 minutes of physical activity per week.  Already there? See if you can reach 300 minutes a week for additional benefits.  For more on the benefits of exercise check out my post on the 2018 Exercise Guidelines from the US Department of Health and Human Services.