12FoodChem2022Additives
12FoodChem2022Additives
The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.
Culture of Food Additives
• The use of food additives is not a modern invention. The earliest
food additives, used as long ago as 5,000 years, included vinegar to
pickle vegetables; salting and smoking to help preserve meat and
fish; herbs to improve flavor; and vegetable coloring to improve
appearance of food
• The Egyptians used vegetables for food colorings
• The Romans used honey to preserve fruits
• Marco Polo searched for herbs and spices, additives for flavoring
foods
• The Asians used salt, ginger and garlic to preserve fish and
vegetables
The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.
Reading the Label
• Food and Drug Administration of the United States (FDA) defines a food additive
as “any substance the intended use of which results or may reasonably be expected to
result – directly or indirectly – in it becoming a component or otherwise affecting the
characteristics of any food”
- Direct food additives are those that are added to a food for a specific purpose in that food. For example, xanthan
gum -- used in salad dressings, chocolate milk, bakery fillings, puddings and other foods to add texture - is a direct
additive. Most direct additives are identified on the ingredient label of foods
- Indirect food additives are those that become part of the food in trace amounts due to its packaging, storage or
other handling. For instance, minute amounts of packaging substances may find their way into foods during storage.
Food packaging manufacturers must prove to the U.S. Food and Drug Administration (FDA) that all materials
coming in contact with food are safe before they are permitted for use in such a manner
The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.
Use of Food Additives in Industry
• Fruits and vegetables industries
• Concentrated food industry
• Dairy industry
• Beverage industry
• Fat industry
• Baking industry
• Confectionery industry
• Meat, poultry and fish industry
The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.
Emulsifier
Flavour
enhancers
Perceptual relationship of each class of the food additives use in food industries.
Depiction of the most common additives divided by categories. Represented in orange are the antimicrobials derived from microorganisms. In blue, the antimicrobials
ed from animalsDepiction
and in greenofthe
the most
ones common
derived additives
from plants. divided
The purple colorby categories.
represents Represented
bulk sweeteners and in orange
in yellow theare the
high antimicrobials
potency ones. In black, the antioxidants and
derived
derived from plants. (Forfrom microorganisms.
interpretation In blue,
of the references the antimicrobials
to colour derived
in this figure legend, from isanimals
the reader referredand inweb
to the green the of
version ones
this derived
article.) from
plants. The purple color represents bulk sweeteners and in yellow the high potency ones. In black, the antioxidants
and colors derived from plants.
Trends in Food Science & Technology 45 (2015) 284e295
Types of Food Additives
• Acid regulators
• Anticaking, antifoaming agents
• Antioxidants
• Bulking agent
• Chelating agents (sequestrants)
• Coloring agents
• Emulsifiers and stabilizers
• Firming agents
• Flavor enhancers
• Nutrient supplement
• Packaging gases
• Preservatives
• Sweeteners
The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.
1. Nutrient Supplement
“The primary reason for this practice is to improve the
nutritional value of a product, to replace nutrients lost during
processing and to prevent deficiency in specific nutrients”
The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.
1. Nutrient Supplement
• Other dietary supplements:
- Amino acids: arginine, alanine, aspartic acid, cysteine etc
• Minerals
- Magnesium oxides (also a desiccant-drying agent, color
retention, pH modification), ferric pyrophosphate (water
soluble iron for food fortification), calcium citrate (also a
preservative), copper gluconate
- Iron and B vitamins in white breads
- Iodine in table salt
The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.
3. Flavoring Agents (Enhancers)
“Food with little or no flavor of their own are accentuated for natural flavor of foods”
• To produce or modify flavors and to intensify flavors already present (flavor
enhancers)
• Most used additives: Salt (NaCl), monosodium glutamate (MSG). Promotes the
sensory perception of the meat-like aroma in frozen, dehydrated or canned fish
and meat products
• Hydrolyzed vegetable protein (HVP): To enhance flavor in instant soups, salad
dressing, mixed sauces, chips, restaurant foods
• The nucleotides, such as 5′-inosine monophosphate and 5′-guanosine
monophosphate are used in soups, sauces, canned meat and tomato juices, to
provide sensations of freshness and naturalness
• Others, like chemical concentrates of a flavor such as strawberry; to boost
flavor. Maltol and ethyl maltol, are often present in candy and foodstuffs
produced from fruit
3. Flavoring Agents (Enhancers)
Flavours Flavour enhancers are used to bring out the
flavour in a wide range of savoury or sweet taste
without adding a flavour of their own
The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.
4. Coloring Agents
“To enhance the color of the food; To adjust or correct color change during food
processing or storage”
• Natural colour pigments (plant, animal or mineral) e.g. carotenoids, red beet
pigments and caramels
• Artificial colours preferred by the food industries due to their stability, ease of
handling during the processing of the foodstuff and control over the intensity of
the colourant and thereby low cost
• Regulated by the Color Additives Amendment of the USFDA. This legislation
recognizes three categories of certified colors:
- FD&C colors, D&C colors and Ext. D&C colors. In this system, common names are
not used: for example, amaranth is described as FD&C Red No.2
• Average per capita consumption of food colors is about 50 mg per day
The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.
4. Coloring Agents
Most artificial colorings are synthetic chemicals. FDA
approved ones, examples:
• Blue 1: Baked goods, candy, ice cream, condiments
• Blue 2: ice cream, candy, beverages
• Green 2: canned peas, process vegetables, fish, ice cream,
candy
• Green 3 : candy and beverages
• Orange B: only in some hot dog and sausage casings
• Red 3: canned fruits, sausage casings, cake decorations
• Red 2: use only in the peels of oranges (sprayed on some Florida
oranges early in the season)
• Red 40: beverages, breakfast cereals, flavoured yoghurts,
chips, dessert powders
• Yellow 5 : pickles, honey, mustard, dessert powders
• Yellow 6: beverages, sausage, baked goods, hot chocolate mix
• Other examples of Color names: brilliant black (E151),
Green S (E142), Orange yellow (E110), Patent blue (E131)
etc)
4. Coloring Agents
Big picture…
or nature identical. The use of E128 was suspended in 2007 as colors permitted for use in Council Directive 94/36/EC to the
studies on three and eight/nine-year old children (McCann sodium benzoate. The authors concluded that there was a sig-
there was sufficient evidence relating to its carcinogenicity Regulation 1333/2008 reveals that colors E154 and E160f were
REFERENCE
et al., 2007). The researchers used two mixtures of food addi- nificant reduction in hyperactive behavior during the with-
(Commission Regulation (EC) No 884/2007). Current legisla- removed from the list of approved colors, the former due to the
tives: one containing sunset yellow, carmoisine, tartrazine, pon- drawal phase and an increase in hyperactivity during the
tion (Regulation (EC) No 1333/2008) specifies the colors per- fact it was no longer used and there was not sufficient data ceau
on 4R, and sodium benzoate; the second was composed of exposure to artificial food additives. The findings of these stud-
mitted in food and is based on the state of knowledge, the its safety, the latter because it was no longer offered by the
sunset yellow, carmoisine, quinoline yellow, allura red AC, and ies were widely discussed and debated among the scientific
technological need, and their practical use. A comparison of manufacturer (Commission Regulation (EU) No 1129/2011).
4. Natural vs. synthetic colors
The common belief is that natural colors are better from a health
4.2. Caramel
perspective and consumers demand their use instead of synthetic
4. Coloring Agents
substances (Downham and Collins, 1991). Some synthetic food
dyes such as tartrazine can cause an intolerance reaction in
Caramel is produced from sugar heated at high temperature.
Some concerns have been raised recently about formation of
Table 1. Comparison of the synthetic dyes authorized for use in food in different global regions.
EU US Japan India China
E102 tartrazine FD&C yellow No. 5. Food yellow No. 4 Tartrazine Tartrazine
E104 quinoline yellow Quinoline yellow
E110 sunset yellow FCF FD&C yellow No. 6. Food yellow No. 5 Sunset yellow FCF Sunset yellow
E122 azorubine Carmoisine Carmoisine
E123 amaranth Food red No. 2 Amaranth
E124 ponceau 4R Food red No. 102 Ponceau 4R Ponceau 4R
E127 erythrosine FD&C red No. 3. Food red No. 3 Erythrosine Erythrosine
E129 allura red AC FD&C red No. 40. Food red No. 40 Allura red
E131 patent blue V
E132 indigotine FD&C blue No. 2. Food blue No. 2 Indigo carmine Indigotine
E133 brilliant blue FCF FD&C blue No. 1. Food blue No. 1 Brilliant blue FCF Brilliant blue
E142 green S
E151 brilliant black BN
E155 brown HT
E180 litholrubine BK
FD&C green No. 3 Food green No. 3 Fast green FCF
orange B
citrus red No. 2.
Food red No.104 (phloxine B)
Food red No.105 (rose bengal)
Food red No.106 (acid red 52)
New red
The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.
4. Coloring Agents
The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.
The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.
The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.
5. Emulsifiers, Stabilizers and Thickeners
• Stabilizers and Thickeners
- The properties of stabilizers are influenced by
the pH, temperature, concentration, molecular
weight and ionic forces. Used in broths,
desserts, sweets, preserves, ice creams, pasta,
dairy products, processed foods, bakery, soups,
biscuits, juices and chocolates
Examples:
- Starch: thickening food, to improve their
consistency
- Gum & carrageenan: thicken beverages; stabilize
foam in beer; emulsify salad dressing; stabilize ice
cream and prevent large ice crystal formation in
frozen desserts
- Casein & gelatin (protein): used in ice cream, jelly,
milk, infant formula
- Sodium carboxymethylcellulose: prevents sugar
from crystallization
5. Emulsifiers, Stabilizers, and Thickeners
Emulsifiers Emulsifiers such as Lecithins (E322), help mix ingredients
and together that would normally separate, such as oil and water
Stabilizers
Stabilisers, such as locust bean gum (E410) made from carob
beans, help stop these ingredients from separating again
The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.
The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.
“These additives are used to neutralize the acidity or alkalinity of certain foods”
• The acidity regulators are substances capable of controlling or modifying the pH
of foodstuffs, thereby influencing the smell, flavour, viscosity, texture and,
mainly, shelf-life, by directly impacting on the oxidation/enzymatic reactions and
inhibition of microbiological growth
• Mainly organic acids, inorganic acids, bases and conjugated salts, and can act
alone or in conjunction with the buffering system
• Salts of the phosphates, lactates and citrates, are used for pH stabilization,
producing a buffering in the foodstuffs system, colour retention and
complexation reactions of metals, to improve the sensorial quality of the
foodstuffs
• Acids exert multiple effects: Citric acid, tartaric and malic acid used to add
tartness to certain foods, e.g. fruit/soft drinks, processed cheese and candy.
• Phosphoric acid: cola type beverages to reduce pH
• Lactic acid: Spanish olives, cheese-making
• Sodium bicarbonate produce gas in the leavening agents
7. Antioxidants
“Antioxidants retard the oxidation of unsaturated fats and oils, coloring, and
flavorings”
The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.
7. Antioxidants (Examples)
Natural:
• Ascorbic acid (vitamin C): helps to maintain the red color of cured meat and
prevents the formation of nitrosamines which promote cancer
• Tocopherols and carotenoids: naturally found in food but can be added to oil
base food products
• Efficiency is increased by the synergism among antioxidants; two or more
antioxidants with different mechanisms (e.g., a combination of ascorbic acid and
tocopherol)
• Tocopherol: used in bacon, meat, oils, dairy products
• b-Carotene: used in baked goods, eggs, dairy products
Synthetic:
• Citric acid, potassium, sodium citrate: remove prooxidants, e.g. copper and
iron)
• Butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT),
propyl gallate: retard rancidity in oils and oil-containing foods by terminating
free radical chains
The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.
7. Antioxidants (Examples)
Mixed tocopherols
The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.
8. Chelating Agent (Sequestrants)
“Bind with metal ions, copper and iron, which are active in oxidation to inhibit
oxidation”
• “Trap trace metal atoms that would otherwise make food to discolor” e.g.
carboxylic acid, amino acid. Metals interfere in foodstuffs, modifying the flavour,
smell and colours and, consequently, promote alterations in the final product
stability
• In industrial processes, the sequestrant or chelating agents employed are chemical
compounds that present the functional groups –NR2, -S-, -OH, -SH, -O-, C=O, -
COOH and H2PO3−, which have an unshared pair of electrons that can react with
metals ions
8. Chelating Agent (Sequesterants)
Examples:
Ethylenediamine tetraacetic acid (EDTA)
• EDTA traps metal impurities, which otherwise promote rancidity and the
breakdown of artificial colors
• Used in canned seafood to prevent the formation of glassy crystals, and in
vegetables and fruits to inhibit the discolouration reactions
Citric acid, phosphoric acid
• Used in soft drinks
(Natural) Chlorophyll that complexes with magnesium; ascorbic acid that complexes
iron to improve its ingestion
The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.
9. Sweeteners
"Give sweetness greater than sucrose”
• Natural or synthetic (artificial sweeteners)
• Non-nutritive: aspartame, cyclamate, saccharin
- Cyclamate: gives 30 to 40 times sweeter than sucrose
- Saccharin: is 300 times sweeter than sucrose
Cause a bitter and residual metal taste if used excess
• Nutritive: e.g., fructose, isomalt, sugar alcohols (xylitol, sorbitol),
maltodextrin are based on different types of carbohydrates and have less
energy than sugar, but they are not calorie-free
• Low in calorie: Corn syrups, dextrose, fructose, maltitol, cyclamate,
aspartame, saccharin. Used in soft drink, low calorie frozen desserts and
drinks, jams, chocolates, candy
• Polyols (xylitol, sorbitol) sweeteners but also promote control of the texture,
crystallisation and viscosity, humidity retention and diminution in the water
activity, improves the softness and water rehydration properties of foodstuffs
The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.
9. Sweeteners
Sweeteners Sweeten foods without adding a flavour of their own
The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.
Regulations
• FDA: all labels must list
additives by the common
name/function
The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.
The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.
The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.
Food Additives: Health Effects
Potential side effects
• Artificial sweetener e.g. Saccharin
- Lower-calorie sweeteners
- Limited carcinogenic effect in animal studies. Not enough
Artificial
evidencesweetener
regarding carcinogenicity in human: Not
◦ Lower-calorie
classifiable sweeteners
Saccharin
Category Description Human Animal evidence
evidence
1 Carcinogenic to humans Sufficient None, inadequate, limited,
or sufficient
2A Probably Limited Sufficient
2B Possibly None or Sufficient
inadequate
3 Not classifiable None or Inadequate or limited
inadequate
4 Probably not carcinogenic Suggests not Suggests not carcinogenic
carcinogenic
◦ Limited carcinogenic effect in animal studies
◦ Not
The University enough
of Hong evidence
Kong, Copyrighted and Allregarding
Rights Reserved,carcinogenicity
Dr. Jetty Lee. in human
Food Additives: Health Effects
• Artificial sweetener e.g. Aspartame
- Lower-calorie sweeteners
- Breaks down in small intestine to aspartic acid, phenylalanine,
methanol
- Phenylalanine harmful to phenylketonuria (PKU) patients
(genetically in born with problem in phenylalanine metabolism)
brain damage
The University of Hong Kong, Copyrighted and All Rights Reserved, Dr. Jetty Lee.
FDA ban
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FDA bans
Agency 7 to
responds synthetic food
evidence that flavorings
chemicals can cause cancer in animals Smiling
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Agency responds to evidence that chemicals can cause cancer in animals he U.S. Food & Drug Administration has banned the use of six synthetic flavorings in
OCTOBER 9, 2018
by Britt E. Erickson
OCTOBER 9, 2018 candy, cookies, ice cream, and all other foods and beverages because the chemicals U.S. age
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have been shown to cause cancer in laboratory animals. The affected chemicals— consum
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benzophenone, ethyl acrylate, eugenyl methyl ether, myrcene, pulegone, and pyridine—are typically
listed as “artificial flavors” on food labels, so consumers have no way of knowing which products
contain them.
FDA has also banned the use of styrene as a synthetic flavoring agent in food. The agency says that
it did not make the decision because styrene is a carcinogen, but rather because it is no longer used
by the food industry. The U.S. National Toxicology Program classified styrene as a “reasonably
anticipated” human carcinogen in 2011.
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FDA’s action comes in response to a 2015 petition from a coalition of consumer and health
FDA bans 7 synthetic food flavorings
advocacy groups. The petitioners provided FDA with evidence that the flavorings are carcinogenic in
Charges dropped against UCLA
chemistry professor Patrick Harran f
death of Sheri Sangji after lab fire
laboratory animals.
Making liquid-nitrogen ice cream safe MOST POPULAR IN SAFETY
Credit: Shutterstock
Replacing methylene chloride in pain
FDA bans 7 synthetic food flavorings
FDA has banned seven synthetic flavorings from use in candy and other foods.
FDA claims that the chemicals
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T he U.S. Food & Drug Administration has banned the use of six synthetic flavorings in
intended use,” but the agency
Smiling bracelet monitors personal U
exposure cannot
Charges droppedlegally
againstauthorize
UCLA the use of food additives that have been
chemistry professor Patrick Harran f
candy, cookies, ice cream, and all other foods and beverages because the chemicals shown
U.S. to cause
agency struggling with cancer
organohalogen flame retardants in
in animals.
death of Sheri Sangji after lab fire
have been shown to cause cancer in laboratory animals. The affected chemicals— consumer products
benzophenone, ethyl acrylate, eugenyl methyl ether, myrcene, pulegone, and pyridine—are typically Making liquid-nitrogen ice cream safe
‘The bans go into effect on Oct. 9 when FDA publishes the final rule in the Federal Register,
listed as “artificial flavors” on food labels, so consumers have no way of knowing which products https://cen.acs.org/safety/consumer-safety/FDA-bans-7-synthetic-food/96/web/2018/10?utm_source=Newsletter&utm_medium=Newsletter&u
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FDA has banned seven synthetic flavorings from use in candy and other foods. strippers
but FDA does not intend to enforce the rule until Oct. 9, 2020, to give manufacturers time to
FDA has also banned the use of styrene as a synthetic flavoring agent in food. The agency says that
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it did not make the decision because styrene is a carcinogen, but rather because it is no longer used
Smiling bracelet monitors personal U
https://cen.acs.org/safety/consumer-safety/FDA-bans-7-synthetic-food/96/web/2018/10?utm_source=Newsletter&utm_medium=Newsletter&utm_campaign=CEN 1/2
FDA has also banned the use of styrene as a synthetic flavoring agent in food. The agency says that
it did not make the decision because styrene is a carcinogen, but rather because it is no longer used
by the food industry. The U.S. National Toxicology Program classified styrene as a “reasonably
anticipated” human carcinogen in 2011.
Sudan I
Food Additives: Health Effects
Non-permitted colours and health risk:
• Sudan I is considered to be genotoxic both in vitro and in vivo. Subcutaneous
administration of this dye in mice resulted in liver tumors. Also showed to be
carcinogenic in rats after oral administration (IARC, 1975; NTP, 1982; EFSA,
2005)
• Sudan II was shown to be genotoxic in vitro; but no in vivo data are currently
available. It is considered to be potentially genotoxic and a possible carcinogen as
the increase in the incidence of bladder cancer was reported in mice following
implantation of sudan II pellets (IARC, 1975; EFSA, 2005). Due to limited data,
sudan III, sudan IV, and para red are all considered to be potentially genotoxic
and possibly carcinogenic as they are structurally related to sudan I (IARC,
1975; EFSA, 2005)
• In vitro mammalian cells study and in vivo tests showed a potential genotoxic
effect of orange II, while data on carcinogenicity are limited (EFSA, 2005)
• Methyl yellow was shown to be carcinogenic in rats and it is classified as group
2B (slide 47) carcinogen-possibly carcinogenic to humans (IARC, 1975)
Food Additives: Health Effects Sunset yellow
Permitted colours and children behaviour:
• In 2004, a group of researchers reported the adverse effect of the artificial food
colorings (sunset yellow, tartrazine, carmoisine, ponceau 4R) on the
behavior of three-year old children: evidence that some mixtures of food
additives could be linked to the increase in hyperactive behaviors in children.
Artificial colors can also induce IgE-independent histamine release Carmoisine
• EFSA stated based on evidence available quinoline yellow, sunset yellow FCF,
ponceau 4R, carmoisine, and allura red AC can be linked to some sensitivity
reactions to children. Tartrazine may bring about intolerance reactions in a small
part of the population
• US researchers (2012) found a statistically significant effect of the reduction of Ponceau 4R
the ADHD symptoms when synthetic food colour additives free diet is
applied. Another group of US researchers (2013) found a link between
consumption of soft drinks and behavioural problems in five-year old children
and suggested that one of the possible explanations might be the presence of
artificial food colours in these products Tartrazine
• Artificial food colours and additives administered to female rats before and
during gestation can cause an alteration in the expression of N- methyl-D-
aspartate receptors (NMDARs) and nicotinic acetyl- choline receptors (nACHRs)
in their offspring: these are linked learning and memory-generating processes
Food Additives: Health Effects
“Europe takes a “precautionary
principle” approach towards food
additives that are potentially risky. They
ban or add warning labels to these
additives for their citizens. The US does
not take this approach.
Food Additives
E-Numbers
Some additives have been approved for use in the EU. These additives
have E-numbers. The E-number tells us what the additive is used for.
Number Type
E128 (red), E131 (blue), E163 (anthocyanidin), Food colours
E175 (gold)
E200 (sorbic acid), E210 (benzoic acid), E220 Preservatives
(sulphur dioxide), E251 (sodium nitrate)
E300 (ascorbic acid), E310 (propyl gallate), Antioxidants
E307-309 (tocopherol), E321 (BHT)
E322 (lecithin), E418 (konjac gum), E412 (guar Emulsifiers, Stabilisers,
gum), E492 (sorbitan tristearate), E440 (pectin) Thickeners, Gelling Agents
E420 (sorbitol), E950 (acesulfame-K), E951 Sweeteners
(aspartame), E965 (malitol), E967 (xylitol)
E260 (acetic acid), E334 (tataric acid), E330 Others
(citric acid), E422 (glycerol), E508 (potassium
chloride, E504 (magnesium carbonates)
E150a: Caramel colour
E500: Sodium carbonates (acidity regulator)
E627: Disodium guanylate (flavour enhancer)
E322: Lecithin (emulsifier)
E330: Citric acid (acidifier)
E306: Tocopherol (antioxidant)
E401: Sodium alginate (thickener)
If you’re living in the US, then the fries you order at
McDonald’s might have more than just natural vegetable oil
and salt used in the cooking process. While the Quaker instant
oatmeal you make yourself for breakfast is also much, much
healthier in the UK. When considered broadly, quite a few food
products have healthier UK alternatives. This brings into focus
the question of whether the extra ingredients are having an
effect on Americans and what it might be.
The U.S. spends 2.5 times more on
health care than any other nation and
when compared with 16 other developed
nations, and come last in terms of
health. More than two-thirds of U.S.
citizens are overweight and more than
18% of children are obese. After
smoking, obesity is America’s biggest
cause of premature death. “