Industrial Bread Composition: Potential Implications for Patients with Inflammatory Bowel Disease

Abstract

Background: Ultra-processed food (UPF) intake, particularly that of industrial breads rich in food additives (FAs) like emulsifiers, has been linked to higher risk of inflammatory bowel diseases (IBD). Here, we screened the ingredients and FAs used in the bread industry and reviewed their potential biological effects. Methods: We consecutively screened breads available at supermarket and health food store chains in Israel. Bread products were analyzed by dietitians and categorized into three categories based on their composition: low processed (traditional ingredients), medium processed (additives like malt and fibers), and highly processed (FAs like emulsifiers and preservatives). We conducted a literature review to explore the links between the identified FAs, microbial composition and intestinal inflammation. Results: Of the 233 breads screened, 195 (84%) were highly processed, 9 (4%) medium-processed and 29 (12%) low-processed. We identified 37 different FAs and ingredients used. Most breads contained preservatives-189 (81%), and emulsifiers-178 (76%). Calcium propionate (E-282) was the most prevalent preservative present in 112 (48%) breads, while sodium-stearoyl-2-lactylate (SSL-E-481) was the most prevalent emulsifier present in 86 (37%) breads. The literature review revealed that 19 (51%) FAs used in the bread industry were associated with the exacerbation of inflammation or gut microbiome dysbiosis by increasing cytokine production and adversely affecting microbial composition. Conclusions: Most of the available breads in Israel are highly processed, containing FAs that may mediate intestinal inflammation. Low-processed breads are available and may be more recommended to patients with IBD. Further understanding of the role of FAs in IBD etiology may guide dietary recommendations.

Keywords: emulsifiers; food additives (FAs); inflammatory bowel disease (IBD); microbiome; preservatives; ultra-processed foods (UPFs).

Figure 1

Food processing levels of industrial breads. (A) Levels of food processing. All screened breads were assigned into one of three categories: low processed (green), medium processed (orange), or highly processed (red). (B) Number of FAs in each category beyond the basic bread recipe, compared across processing levels using the Kruskal–Wallis test followed by Dunn’s post hoc analysis. (C) Bread prices per 100 g compared across processing levels using the Kruskal–Wallis test. *** p < 0.001.

Figure 2

Prevalence of FAs and technological ingredients in industrial breads. (A) Commonly used FAs and technological ingredients. Prevalence rates of FAs and technological ingredients in industrial breads (n = 233). The colors represent the classification of each FA to a different processing level, medium processed (orange) or highly processed (red). FAs, food additives. (B) Prevalence of emulsifiers and preservatives in breads. The two groups of the most common additives were furthermore analyzed. A star or a circle signifies if it was linked to microbiome alterations or IBD or gut inflammation, respectively, in the literature review. E-481, Sodium stearoyl lactylate; E-471, Mono- and diglycerides of fatty acids; E-472e, DATEM; E-466, Sodium carboxy methyl cellulose (CMC); E-282, Calcium propionate; E-202, Potassium sorbate; E-260, Acetic acid; E-203, Calcium sorbate; E-262(ii), Sodium diacetate. (C) The prevalence of leavening agents. Yeast (n = 119), Yeast + Sourdough (n = 80), Sourdough (n = 30), None (n = 4).