Artificial Sweeteners and Emulsifier Metabolites Linked to Crohn’s Disease Activity

Higher levels of artificial sweeteners and polysorbate-80 (P-80) metabolites are associated with Crohn’s disease (CD) activity and may serve as noninvasive biomarkers, according to a multicenter study analyzing dietary additive exposure across international cohorts. The findings provide human data supporting prior experimental evidence linking food additives to intestinal inflammation.

Investigators analyzed 1461 biosamples from 487 participants, including 245 patients with CD and 242 controls, across Australia, Hong Kong, and mainland China. Stool, urine, and serum samples were tested for common artificial sweeteners—such as aspartame, sucralose, and saccharin—as well as P-80, an emulsifier widely used in processed foods. Disease activity was assessed using the Crohn’s Disease Activity Index and fecal calprotectin.

Patients with CD had significantly higher levels of artificial sweeteners across all cohorts compared with controls. Distinct metabolic patterns of P-80 were also observed. While the native compound was undetectable, CD-associated metabolites differed from those in controls and were positively correlated with urinary sweetener levels.

Mechanistic experiments provided further insight. In vitro, CD-associated P-80 metabolites increased intestinal permeability, facilitating the translocation of sweeteners across the epithelial barrier. Both sweeteners and P-80 metabolites were elevated in patients with active CD compared with those in remission.

The authors reported that “this is the first human study to demonstrate distinct P-80 metabolism in patients with CD compared with controls,” and found that “dietary sweeteners and P-80 metabolites showed significant correlations with disease activity.”

Reference
Zhang J, Hu J, Tang X, et al.Quantifying artificial sweeteners and emulsifiers in Crohn’s disease and its relationship with disease activity: the ENIGMA study – a novel and targeted approach Gut. Published April 8, 2026. doi: 10.1136/gutjnl-2024-333999