A sugar substitute called erythritol, used to add bulk or sweeten reduced-sugar stevia, monkfish and keto products. it has been linked to blood clotting, strokes, heart attacks and death, according to a new study.
“The degree of risk was not modest,” said the study’s lead author, Dr. Stanley Hazen, director of the Cleveland Clinic Center for Cardiovascular Diagnosis and Prevention. Lerner Research Institute.
People with 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 levels of erythritol in their blood, according to the study, posted on monday in the journal Nature Medicine.
“If your blood erythritol level was in the top 25% compared to the bottom 25%, there was a twice the risk of heart attack and stroke. It is on par with the strongest heart risk factors, such as diabetes,” Hazen said.
Additional laboratory and animal research presented in the article revealed that erythritol appeared to be causing blood platelets to clot more easily. Clots can break off and travel to the heart, causing a heart attack, or to the brain, causing a stroke.
“This certainly sounds like an alarm,” said Dr. Andrew Freeman, director of cardiovascular wellness and prevention at National Jewish Health, a hospital in Denver, who was not involved in the research.
“There appears to be a clotting risk from the use of erythritol,” Freeman said. “Obviously more research is needed, but with an abundance of caution, it might make sense to limit erythritol in your diet for now.”
In response to the study, the Calorie Control Council, an industry association, told CNN that “the results of this study are contrary to decades of scientific research showing that reduced-calorie sweeteners like erythritol are safe, as evidenced by global regulatory permissions for its use. in food and beverage,” Robert Rankin, the council’s chief executive, said in an email.
The results “should not be extrapolated to the general population, as intervention participants were already at increased risk of cardiovascular events,” Rankin said.
The European Association of Polyol Producers declined to comment, saying it had not reviewed the study.
Like sorbitol and xylitol, erythritol is a sugar alcohol, a carbohydrate found naturally in many fruits and vegetables. It has about 70% of the sweetness of sugar and is considered zero calories, according to experts.
Artificially manufactured in massive quantities, erythritol does not leave a lingering aftertaste, does not raise blood sugar, and is less laxative effect than some other sugar alcohols.
“Erythritol looks like sugar, tastes like sugar, and you can bake with it,” said Hazen, who also directs the Cleveland Clinic Center for Microbiome and Human Health.
“It has become a darling of the food industry, an extremely popular additive to the ketogenic diet and other low-carb products and foods marketed for people with diabetes,” he added. “Some of the foods labeled for diabetes that we tested had more erythritol than any other item by weight.”
Erythritol is also the largest ingredient by weight in many “natural” stevia and monk fruit products, Hazen said. Because stevia and monkfish are 200 to 400 times sweeter than sugar, only a small amount is needed in any product. The majority of the product is erythritol, which adds the sugar-like crystalline appearance and texture consumers expect.
The discovery of the connection between erythritol and cardiovascular problems was purely accidental, Hazen said: “We never expected this. We weren’t even looking for it.”
Hazen’s research had a simple goal: to find unknown chemicals or compounds in a person’s blood that could predict their risk of heart attack, stroke, or death in the next three years. To do so, the team began analyzing 1,157 blood samples from people at risk for heart disease collected between 2004 and 2011.
“We found this substance that seemed to play an important role, but we didn’t know what it was,” Hazen said. “Then we found out it was erythritol, a sweetener.”
The human body naturally creates erythritol, but in very low amounts that would not account for the levels they measured, he said.
To confirm the findings, Hazen’s team tested another batch of blood samples from more than 2,100 people in the United States and an additional 833 samples collected by colleagues in Europe through 2018. About three-quarters of the participants in the three populations they had coronary heart disease or arterial hypertension. blood pressure, and about a fifth had diabetes, Hazen said. More than half were men and were between the ages of 60 and 70.
In all three populations, the researchers found that higher erythritol levels were linked to increased risk of heart attack, stroke, or death within three years.
But why? To find out, the researchers did more animal and laboratory tests and found that erythritol was “causing increased thrombosis,” or clotting, in the blood, Hazen said.
Coagulation is necessary in the human body, or we would bleed to death from cuts and wounds. The same process is also constantly occurring internally.
“Our blood vessels are always under pressure, and we leak, and blood platelets constantly plug these holes all the time,” Hazen said.
However, the size of the clot formed by the platelets depends on the size of the activator that stimulates the cells, he explained. For example, if the trigger is only 10%, you will only get 10% of a clot.
“But what we’re seeing with erythritol is that platelets become very sensitive: a mere 10% stimulant causes 90 to 100% of clot formation,” Hazen said.
“For people who are at risk of blood clots, heart attacks and strokes, such as people with existing heart disease or people with diabetes, I think there is enough data here to say to stay away from erythritol until further studies are done,” Hazen said.
Oliver Jones, a professor of chemistry at RMIT University in Victoria, Australia, noted that the study had revealed only correlation, not cause-and-effect.
“As the authors themselves note, they found an association between erythritol and clotting risk, but not definitive proof that such a link exists,” Jones, who was not involved in the research, said in a statement.
“Any possible (and as yet unproven) risks of excess erythritol should also be weighed against the very real News-thread risks of excessive glucose consumption,” Jones said.
In a final part of the study, eight healthy volunteers drank a beverage containing 30 grams of erythritol, the amount consumed by many people in the US, Hazen said, according to the National Health Survey and Nutrition Examination, which examines American nutrition each year.
Blood tests over the next three days tracked erythritol levels and clotting risk.
“Thirty grams was enough to increase erythritol levels in the blood a thousandfold,” Hazen said. “It remained elevated above the threshold needed to trigger and increase the risk of clotting for the next two to three days.”
How much is 30 grams of erythritol? The equivalent of eating a pint of keto ice cream, Hazen said.
“If you look at the Nutrition Facts labels on many keto ice creams, you’ll see ‘reducing sugar’ or ‘sugar alcohol,’ which are terms for erythritol. You will find that a typical pint is between 26 and 45 grams,” he said.
“My co-author and I have been going to grocery stores and looking at the labels,” Hazen said. “He found a ‘candy’ marketed for people with diabetes that had about 75 grams of erythritol.”
There is no firm “accepted daily intake,” or ADI, set by the European Food Safety Authority or the United States Food and Drug Administration, which consider erythritol generally recognized as safe (GRAS).
“Science needs to dig deeper into erythritol and hurry, because this substance is widely available right now. If it’s harmful, we need to know,” said Freeman of National Jewish Health.
Hazen agreed: “I don’t normally get on a pedestal and sound the alarm,” he said. “But this is something I think we need to look at carefully.”