Ultra-processed foods: Implications for gastrointestinal health

Table 8 Available randomised studies on the dietary emulsifier restriction and their effect

Ref.	Type of study	Population characteristics, n	Outcome parameters	Key findings
Bhattacharyya et al[125], 2017	RCT	Cases (n = 5): UC in remission on 100mg carrageenan-containing capsule; Controls (n = 7): UC in remission on placebo capsules	Relapse in two groups at different time points (3, 6, 9, and 12 months); Relapse is defined as an increase of two (or more) points on the SCCAI	Relapses were higher with the carrageenan diet (P = 0.046); Increase in interleukin-6 (P = 0.02) and fecal calprotectin (P = 0.06) in carrageenan diet group
Chassaing et al[126], 2022	RCT	Cases (n = 7): Diet enriched with 15 g/day of CMC; Controls (n = 9): Emulsifier-free diets	Metabolic impact in healthy volunteers: Effect on human gut microbiota composition and gene expression	CMC reduced microbiota richness with a decrease in evenness and Shannon indices; CMC consumption affected the fecal metabolome with depletion of short-chain fatty acids and free amino acids
Fitzpatrick et al[127], 2025	RCT	HED (n = 12) vs LED (n = 12) was provided for 4 weeks in patients with CD		The emulsifier content did not influence disease activity in CD
Bancil et al[128], 2025	Multicentric RCT	LED (n = 75) vs LED plus emulsifier re-supplementation (Controls, n = 79) was provided for 8 weeks in active CD	Primary endpoint: Proportion of patients achieving CDAI response (≥ 70 reduction) at 8 weeks; Secondary endpoint: CDAI remission and fecal calprotectin	CDAI response was achieved in 39 (49.4%) on LED vs 23 (30.7%) in the control group (P = 0.019); Patients on LED are more than twice as likely to experience CDAI remission (adjusted RR: 2.1, 95%CI: 1.0-4.42) and > 50% reduction in FCP (adjusted RR: 2.9, 95%CI: 1.1-8.0)

CD: Crohn’s disease; CDAI: Crohn’s disease activity index; FCP: Fecal calprotectin; RCT: Randomized controlled trial; UC: Ulcerative colitis; SCCAI: Simple Clinical Colitis Activity Index; CMC: Carboxymethylcellulose; HED: High emulsifier diet; LED: Low emulsifier diet; RR: Relative risk.