New research from the Cleveland Clinic (pdf) finds that erythritol, a common artificial sweetener, was associated with a significantly increased risk of heart attack and stroke, but experts say the results are not as disturbing as they seem.
Erythritol is produced naturally in our body
Erythritol is a widely used artificial sweetener increasingly used in many processed and “low carb” foods. Artificial sweeteners like erythritol are generally recognized as safe (GRAS) by the United States Food and Drug Administration.
It is a type of carbohydrate called a sugar alcohol, like xylitol and mannitol, which is approved for use in many food products. Made for decades, this compound is also found naturally in foods like watermelon, pears, grapes, and mushrooms.
It is also produced in our body.
Erythritol is one of many low-nutrition sweeteners, and it’s made using a type of yeast to ferment glucose from corn or wheat starch.
Our body does not produce the necessary enzymes to break down erythritol, so after consumption it is excreted in its original state in our urine.
A mouse study found that erythritol inhibited any increase in blood sugar and insulin levels. This makes it an excellent substitute for people with diabetes or metabolic syndrome.
Researchers have found that erythritol is associated with cardiac events
Cleveland Clinic researchers studied more than 4,000 people in the United States and Europe to find that those with elevated blood levels of erythritol were at high risk for a major adverse cardiac event, including heart attack, stroke or death.
The study was divided into several parts.
First, they studied a group of patients undergoing cardiac risk assessment to find that high levels of polyols, particularly erythritol, were associated with an increased risk of major adverse cardiovascular events (MACE) out of three. years, defined as non-fatal myocardial infarction (heart attack). , stroke or cardiovascular death.
Next, the association of erythritol with MACE was replicated in large American and European groups of patients undergoing elective cardiac evaluation.
Next, the researchers looked at the effects of adding erythritol to whole blood or isolated platelets (cell fragments that come together to stop bleeding and contribute to blood clots). Their analysis showed that erythritol made platelets easier to activate and form a clot.
“Increased platelet adhesion may be one of the mechanisms leading to cardiovascular events such as strokes and heart attacks,” said Dr. Michael Goyfman, Chief of Cardiology and Director of Echocardiography at Long Island Jewish Forest Hills, which is part of Northwell Health in New York. The Epoch Times.
Finally, eight healthy volunteers drank a beverage containing 30 grams of erythritol, which is equivalent to what a pint of keto ice cream contains. Their blood was tested over the next three days to track erythritol levels and the risk of clotting.
The researchers found that blood levels of erythritol “remained 1,000 times higher (millimolar levels) for hours after ingestion”, and remained significantly elevated for more than two days in all participants.
The study authors said this is well above the observed thresholds for erythritol concentrations that “cause significant increases in multiple indices of platelet function”.
Lead author Dr. Stanley Hazen, chair of the Cardiovascular and Metabolic Sciences Department at the Lerner Research Institute and co-chief of the Preventive Cardiology Section at the Cleveland Clinic, stressed the need for more research into the long-term effects term because sweeteners like erythritol increase in popularity.
“Cardiovascular disease develops over time and heart disease is the leading cause of death worldwide. We need to make sure the foods we eat are not hidden contributors,” he said in a statement.
The study had crucial limitations
It is important to note that this was a clinical observational study that could not establish causation.
Dr. Jayne Morgan, cardiologist and clinical director of the COVID task force at Piedmont Hospital/Healthcare in Atlanta, noted that while the study correlated erythritol levels with poor cardiovascular outcomes, this is not “not the same as a cause”. and effect.
“This particular research did not analyze between natural consumption and external consumption,” she continued.
Another problem with this study is that the participants were far from healthy.
According to the study, they were on average between 63 and 75 years old, were overweight, most had high blood pressure, more than 20% had diabetes (type not specified), more than 13% smoked and more than 70% had existing cardiovascular problems.
Each of these factors poses a significant risk to MACE.
These make confounding factors difficult to elucidate, Morgan said. “That being said, any time there is an increase in platelet clumping without a precipitating event or injury, it’s troublesome.”
Goyfman said an argument could be made that people who ingest a lot of highly processed foods tend to have overall unhealthy lifestyles, including poor diet and lack of exercise, which may be linked to increased side effects.
“Thus, erythritol may simply be a marker of unhealthy lifestyles as opposed to a causative agent,” he said. “Also, what happens to platelets in a test tube is not always the same as what happens to them in a human body.”
However, Goyfman added that after reviewing the mechanistic studies also done by the researchers, “they present a very compelling argument.”
Based on previous studies, erythritol is considered generally safe for reproductive health, genotoxicity, and carcinogenicity. Excessive consumption is linked to intestinal problems, including nausea, abdominal bloating and diarrhea, but it has fewer digestive side effects than sorbitol and xylitol.