According to a new study, the sugar substitute erythritol has been related to blood coagulation, stroke, heart attack, and death. It is used to add bulk to or sweeten goods made with stevia, monk fruit, and other reduced-sugar ingredients, as reported by CNN.
Cardiac risk factors
Dr. Stanley Hazen, head of the Center for Cardiovascular Diagnostics and Prevention at the Cleveland Clinic Lerner Research Institute and the study’s primary author, noted that the degree of risk was not negligible.
The study, which was released on Monday in the journal Nature Medicine, found that people with pre-existing risk factors for heart disease, such as diabetes, were twice as likely to have a heart attack or stroke if they had the highest amounts of erythritol in their blood.
There was an approximately two-fold increased risk for heart attack and stroke if your blood level of erythritol was in the top 25% as opposed to the lowest 25%. It’s comparable to the most serious cardiac risk factors, such as diabetes, said Hazen.
Erythritol appeared to be making blood platelets clot more easily, according to additional lab and animal experiments included in the publication. A stroke or a heart attack may result from clots breaking off and travelling to the brain or the heart, respectively.
This obviously rings an alert, according to Dr. Andrew Freeman, head of cardiovascular prevention and wellness at National Jewish Health, a hospital in Denver. Freeman was not involved in the study.
Erythritol usage appears to carry a risk of blood clotting, according to Freeman. Further research is undoubtedly needed, but for the time being, it might make sense to reduce erythritol in your diet out of an abundance of caution.
The Calorie Control Council, an industry group, responded to the study by telling CNN that “the results of this study are contrary to decades of scientific research showing reduced-calorie sweeteners like erythritol are safe, as evidenced by global regulatory permissions for their use in foods and beverages,” according to an email from Robert Rankin, the council’s executive director.
The participants in the intervention were already at elevated risk for cardiovascular events, so the results “should not be extended to the general population,” according to Rankin.
Despite not having read the paper, the European Association of Polyol Manufacturers declined to comment.
What is erythritol?
Erythritol is a sugar alcohol that is naturally present in many fruits and vegetables, along with sorbitol and xylitol. Almost 70% of the sweetness of sugar is present, and experts say it has no calories.
Erythritol is a sugar alcohol that is artificially produced in large quantities. It has no aftertaste, doesn’t cause blood sugar to increase, and has a milder laxative impact than certain other sugar alcohols.
Hazen, who also oversees the Cleveland Clinic’s Center for Microbiome and Human Health, noted that erythritol has a similar appearance to sugar, a similar flavour to sugar, and may be used in baking.
He continued, “It’s become the darling of the food business, an incredibly well-liked ingredient to keto and other low-carb products and foods promoted to individuals with diabetes. Some of the foods with diabetes labels that we examined included more erythritol by weight than any other substance.”
According to Hazen, erythritol makes up a sizable portion of many “natural” stevia and monk fruit products. Just a small amount of stevia or monk fruit is required in any product because they are 200 to 400 times sweeter than sugar. Erythritol, which makes up the majority of the product, gives it the crystalline appearance and texture that consumers expect from sugar.
An unexpected discovery
According to Hazen, the finding of the link between erythritol and cardiovascular problems was completely by chance. Even so, we weren’t looking for it.
Finding unidentified molecules or compounds in a person’s blood that might indicate their propensity for a heart attack, stroke, or death during the subsequent three years was the straightforward aim of Hazen’s research. The scientists started doing this by examining 1,157 blood samples from heart disease-at-risk individuals that were gathered between 2004 and 2011.
Hazen stated, “We discovered this molecule that seemed to have a significant role, but we didn’t know what it was.” Finally we realised it was the sweetener erythritol.
He explained that although the amount of erythritol produced by the human body is relatively little, it does not account for the quantities they detected.
Hazen’s team evaluated an additional batch of blood samples from over 2,100 persons in the United States and an additional 833 samples collected by associates in Europe through 2018 to corroborate the findings. According to Hazen, around a fifth of participants in each of the three populations had diabetes, and about three-quarters had high blood pressure or cardiovascular disease. Males who were 60 or older made up the majority.
Higher levels of erythritol were linked, the researchers discovered, to a higher risk of heart attack, stroke, or death within three years in all three populations.
Yet why? In order to find out, scientists conducted more laboratory and animal testing. They found that erythritol was “inducing greater thrombosis,” or blood clotting, Hazen said.
The human body needs to clot otherwise we would bleed to death from wounds and injuries. Internally, the same procedure is continuously taking place.
Blood platelets are continually sealing these holes because our blood vessels are constantly under pressure, according to Hazen.
But, he added, the size of the trigger that activates the cells determines the size of the clot formed by platelets. For instance, if the trigger is only 10%, you will only experience a 10% clot.
Yet, Hazen noted that when given erythritol, platelets become extremely sensitive; just 10% of a stimulant results in 90% to 100% of clot formation.
“I think that there is adequate data here to suggest stay away from erythritol until more studies are done,” Hazen said of those who are susceptible to blood clotting, heart attacks, and strokes, such as those with existing cardiac illness or those who have diabetes.
Chemistry professor Oliver Jones from RMIT University in Victoria, Australia, pointed out that the study had merely found a correlation, not a cause-and-effect relationship.
Jones, who was not involved in the study, commented that the findings were only a relationship between erythritol and clotting risk, not confirmation that a connection existed.
The very real health concerns of consuming too much glucose would need to be weighed against any potential (and as of yet unsubstantiated) hazards of excess erythritol consumption, according to Jones.
Eight healthy volunteers participated in the study’s last phase, which involved drinking a beverage containing 30 grammes of erythritol, which is the amount that many Americans consume, according to the National Health and Nutrition Examination Survey, which studies American nutrition annually.
Erythritol levels and clotting risk were monitored through blood tests during the following three days.
Thirty grammes was sufficient to cause a 1,000-fold increase in erythritol levels in the blood, according to Hazen. For the next two to three days, it remained above the level required to cause and increase clotting risk.
How much erythritol is in 30 grammes? Hazen said it was like consuming a pint of keto ice cream.
Several keto ice creams have nutrition labels that list erythritol as ‘reducing sugar’ or ‘sugar alcohol,’ which are terminology for erythritol. You’ll discover that an average pint has between 26 and 45 grammes, he said.
Hazen stated, “My co-author and I have been visiting grocery stores and inspecting labels. He discovered a “confectionery” with roughly 75 grammes of erythritol that was sold to diabetics.”
The European Food Safety Authority and the US Food and Drug Administration do not have a set “accepted daily intake,” or ADI, for erythritol that is generally acknowledged to be safe (GRAS).
“Since erythritol is already abundantly available, science urgently needs to dive further into this chemical. “If it’s hazardous, we should be aware of it,” Freeman of National Jewish Health said.
I generally don’t get on a pedestal and sound the alarm, Hazen concurred. But I believe we should give this some careful consideration.
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