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New research from Cleveland Clinic (pdf) finds erythritol, a common artificial sweetener, was associated with a significantly increased risk of heart attack and stroke—but experts said the findings aren’t as worrying as they sound.
Erythritol Is Naturally Produced in Our Bodies
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 U.S. Food and Drug Administration.
It’s a type of carbohydrate called sugar alcohol, like xylitol and mannitol, which are approved for use in many food products. Manufactured for decades, this compound is also found naturally in foods like watermelon, pears, grapes, and mushrooms.
It’s also produced in our bodies.
Erythritol is one of several low-nutritive sweeteners, and it’s made using a type of yeast to ferment glucose from corn or wheat starch.
Our bodies don’t produce the enzymes needed to break down erythritol, so after consumption, it’s 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 those with diabetes or metabolic syndrome.
Researchers Found Erythritol Is Associated with Cardiac Events
The Cleveland Clinic researchers studied over 4,000 people in the United States and Europe to find those with higher blood erythritol levels had an elevated risk for a major adverse cardiac event, including heart attack, stroke, or death.
The study was split 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 three-year risk of major adverse cardiovascular events (MACE), defined as nonfatal myocardial infarction (heart attack), stroke, or cardiovascular death.
Then the association of erythritol with MACE was reproduced in large U.S. and European groups of patients undergoing elective cardiac evaluation.
Next, researchers looked at the effects of adding erythritol to whole blood or isolated platelets (cell fragments that gather to stop bleeding and contribute to blood clots). Their analysis showed erythritol made platelets easier to activate and form a clot.
“Increased platelet adhesion can be one of the mechanisms leading to cardiovascular events such as strokes and heart attacks,” Dr. Michael Goyfman, chief of cardiology and director of echocardiography at Long Island Jewish Forest Hills, part of Northwell Health in New York, told The Epoch Times.
Finally, eight healthy volunteers drank a beverage containing 30 grams of erythritol, equivalent to what’s contained in a pint of keto ice cream. Their blood was tested over the following three days to track erythritol levels and clotting risk.
Researchers found blood levels of erythritol “remained 1,000-fold higher (millimolar levels) for hours after ingestion,” and remained substantially elevated for over two days in all participants.
Study authors said this is well above thresholds observed for concentrations of erythritol that “elicit significant increases in multiple indices of platelet function.”
Senior author Dr. Stanley Hazen, chairman of the Department of Cardiovascular & Metabolic Sciences at Lerner Research Institute and co-section head of preventive cardiology at Cleveland Clinic, emphasized the need for more in-depth research regarding long-term effects, as sweeteners like erythritol increase in popularity.
“Cardiovascular disease builds over time, and heart disease is the leading cause of death globally. We need to make sure the foods we eat aren’t hidden contributors,” he said in a statement.
Study Had Crucial Limitations
It’s important to note that this was a clinical observation study that could not establish causation.
Dr. Jayne Morgan, cardiologist and clinical director of the COVID Task Force at the Piedmont Hospital/Healthcare in Atlanta, noted that although the study did draw a correlation between erythritol levels and poor cardiovascular outcomes, this is “not the same thing as a cause and effect.
“This particular research did not parse between naturally occurring 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 of age, overweight, most had high blood pressure, over 20 percent had diabetes (type unspecified), over 13 percent smoked, and over 70 percent had existing cardiovascular problems.
Every one of these factors carries a significant risk for MACE.
These make confounding factors difficult to elucidate, said Morgan. “That being said, any time there is increased platelet clumping without a precipitating event or injury, it is troublesome.”
Goyfman said an argument could be made that people who ingest many highly processed foods tend to have overall unhealthy lifestyles, including poor diet and lack of exercise, which may be linked to the increase in adverse outcomes.
“So erythritol may merely be a marker of unhealthy lifestyles as opposed to a causative agent,” he said. “In addition, what happens to platelets in a test tube is not always the same thing as what happens to them in a human body.”
However, Goyfman added that after reviewing the mechanistic studies also performed by the researchers, “they make a very compelling argument.”
According to previous studies, erythritol is considered generally safe regarding reproductive health, genotoxicity, and carcinogenicity. Excessive intake is linked to gut problems including nausea, abdominal bloating, and diarrhea, but it demonstrates fewer digestive side effects than sorbitol and xylitol.
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