Zero-calorie sugar substitute Erythritol linked to heart attacks, strokes, study finds

A sugar substitute called Erythritol (Chinese: erythritol) -- commonly used to add bulk or sweetness to low-sugar products like stevia, monkfruit and keto -- has been revealed in a new study. - Linked to blood clots, stroke, heart attack and death.

"The level of risk is not low," said study lead author Stanley Hazen, MD, director of the Center for Cardiovascular Diagnostics and Prevention at the Lerner Institute of the Cleveland Clinic.

According to the research study on Nature.com. People who already have risk factors for heart disease, such as diabetes, were more likely to have a heart attack or stroke if their blood levels of erythritol were in the top 25 percent, according to research published Monday in the journal Nature Medicine twice as likely as those with erythritol levels in the bottom 25 percent.

Other laboratory and animal studies presented in the paper show that erythritol seems to cause platelets to clot more easily, and the clots can break off and travel to the heart, causing a heart attack, or to the brain, causing a stroke.

"There appears to be a risk of blood clotting with erythritol use," said Andrew Freeman, director of cardiovascular prevention and wellness at Denver Hospital's National Jewish Health Center, who was not involved in the study. "Obviously, more research is needed, but for With caution, it may make sense to limit dietary erythritol at this time."

Responding to reporters, the Calorie Control Council, an industry association, said, “The findings of this study contradict decades of scientific research showing that low-calorie sweeteners like erythritol are safe and that regulators around the world allow them Use in food and drink is proof," said Robert Rankin, executive director of the council.

Rankin said the findings should not be extrapolated to the general population because those involved already had an increased risk of cardiovascular disease.

The European Polyol Producers Association declined to comment, saying it had not reviewed the study.

What is erythritol?

Erythritol, like xylitol and sorbitol, is a sugar alcohol and is a carbohydrate found naturally in many fruits and vegetables. According to experts, erythritol is about 70% as sweet as sucrose and is considered zero-calorie.

Artificial erythritol, which can be mass-produced, has no aftertaste, doesn't spike blood sugar, and is less laxative than some other sugar alcohols."

Erythritol looks like sugar, it tastes like sugar, and you can bake with it," Hazen said.

"It's become trendy in the food industry and is an extremely popular addition to ketogenic and other low-carb products, as well as foods marketed to people with diabetes," he added. contains more erythritol, by weight, than any other ingredient.”

Erythritol is also the highest weight ingredient in many "natural" stevia and monk fruit products, Hazen says. Because the sweetness of stevia and mongoose is about 200 to 400 times that of sucrose, no matter what you do, you only need to put a small amount. Most of these products are erythritol, which adds the sucrose-like crystalline appearance and texture that consumers expect.

The dangers of erythritol

The link between erythritol and cardiovascular problems was found purely by chance, Hazen said. "We never expected that, or even studied it."

Hazen's research has a simple goal: to find unknown chemicals, or compounds, in people's blood that predict their risk of heart attack, stroke, or death over the next three years. To do so, the team set out to analyze 1,157 blood samples from people at risk of heart disease collected between 2004 and 2011.

Hazen said, "We found that this substance seemed to play a big role, but we didn't know what it was, and it turned out to be erythritol, a sweetener."

The human body naturally produces erythritol, but in very small amounts that could not account for the levels they detected, he said.

To confirm the finding, Hazen's team tested another batch of blood samples from more than 2,100 people in the United States, as well as another 833 samples collected by colleagues in Europe before 2018. In all three populations, about three-quarters of participants had coronary heart disease or high blood pressure, and about one-fifth had diabetes; more than half were men in their 60s to 70s, Hazen said.

In all three population groups, the researchers found that higher erythritol levels were associated with an increased risk of heart attack, stroke or death over a three-year period.

but why? To find out, the researchers conducted further animal and laboratory tests and found that erythritol "triggered enhanced thrombosis, or blood clotting, formation," Hazen said.

The blood coagulation function is necessary for the human body, otherwise it will be injured and bleed too much to death; the same process is constantly happening inside the human body. However, the size of the blood clot formed by platelets depends on the size of the trigger that stimulates the cells. If the trigger is only 10%, the blood clot is only 10%.

"But we saw that the action of erythritol made the platelets hypersensitive: just 10 percent of the triggers produced 90 to 100 percent of the clot formation," Hazen said. "For people who are at risk for blood clotting, heart attack and stroke -- like people with heart disease or diabetes -- I think there's enough data here to stay away from erythritol until more research is done."

Oliver Jones, a professor of chemistry at RMIT University in Victoria, Australia, pointed out that this study only revealed a correlation, not a causal relationship. "As the authors themselves note, they found an association between erythritol and blood clotting risk, but there was no conclusive evidence for such a link," Jones, who was not involved in the study, said in a statement.

People should also weigh the possible (as yet unproven) risks of erythritol overdose against the real health risks of consuming too much glucose, according to Jones.

healthy volunteer

In the final part of the study, eight healthy volunteers drank a beverage containing 30 grams of erythritol, which is the amount most Americans consume in the final part of the study, Hazen said. nutritional status.

Then over the next three days, the volunteers would have blood tests to track erythritol levels and clotting risk.

"30 grams is enough to raise the level of erythritol in the blood a thousand-fold," Hazen said, "and it remains 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? Hazen says it's equivalent to eating 1 pint of ketogenic ice cream.

Hazen says that if you look at the nutrition labels on ketogenic ice cream, you'll see "reducing sugar" or "sugar alcohol," which are synonymous with erythritol. Usually 1 pint of ice cream contains 26 to 45 grams of erythritol.

Hazen also said that he and his co-authors had been checking food labels in grocery stores, and they found that a "candy" marketed to diabetics contained about 75 grams of erythritol.

Neither the European Food Safety Authority nor the US FDA has established an "Acceptable Daily Intake (ADI)" for which they consider erythritol generally recognized as safe (GRAS).

"The science needs to do more research on erythritol, and it needs to be done quickly because it's so widespread now," Freeman said. "If it's harmful, we should know."