Erythritol — Artificial Sweetener in Keto — Increases Blood Clot, Stroke, Heart Attack Risk
But Other Experts Argue
New Study Links Erythritol to Cardiovascular Issues
A recent study by the Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, published in the journal Nature Medicine has linked erythritol (a zero-calorie sugar replacement commonly used in keto, reduced-sugar, and “natural” products) to blood clotting, stroke, heart attack, and death. The study assessed over 4,000 patients undergoing cardiac risk assessment. While erythritol is considered a zero-calorie sweetener and has been approved for use in foods and beverages by global regulatory authorities, some health experts are recommending that people limit their intake of erythritol, at least until further research is done.
Discovery of the Connection
According to Dr. Stanley Hazen, lead study author and director of the Center for Cardiovascular Diagnostics and Prevention at the Cleveland Clinic Lerner Research Institute, the discovery of the connection between erythritol and cardiovascular issues was purely accidental.
Hazen aimed to discover unfamiliar chemicals or substances in an individual’s bloodstream that could anticipate their likelihood of experiencing a heart attack, stroke, or fatality within the following three years.
To accomplish this, the group initiated the examination of 1,157 blood specimens collected from individuals who were susceptible to heart disease between 2004 and 2011. Hazen explained that they came across a component that appeared to have a significant influence, but its identity was unknown. Later, they uncovered that it was actually erythritol, a type of sweetener.
Erythritol’s Use in Food Products
Erythritol is a sugar substitute that occurs naturally in numerous fruits and vegetables. It possesses approximately 70% of the sweetness of sugar but is deemed as a zero-calorie sweetener.
In several “natural” stevia and monkfruit goods, erythritol is the primary ingredient in terms of weight. Since stevia and monkfruit are significantly sweeter than sugar, only a small quantity is required in any product. Erythritol makes up the majority of the product, lending it the crystalline texture and appearance that consumers anticipate.
Erythritol is also incorporated into various keto and low-carb items and foods designed for individuals with diabetes.
Increased Risk of Cardiovascular Issues
Individuals with pre-existing risk factors for heart disease, such as diabetes, had twice the likelihood of suffering a heart attack or stroke if they had the highest erythritol levels in their bloodstream.
The research indicated that those with erythritol blood levels in the top 25% were about two times more prone to heart attack and stroke than those in the bottom 25%.
Hazen stated that this was equivalent to the most potent cardiac risk factors, such as diabetes. Additional animal and laboratory experiments included in the paper indicated that erythritol may be making blood platelets more susceptible to clotting. Clots may disengage and travel to the heart, triggering a heart attack, or to the brain, resulting in a stroke.
Industry Response
The Calorie Control Council, an industry group, countered the research findings in a statement to CNN. They say that the results of this study contradict decades of scientific evidence demonstrating the safety of low-calorie sweeteners like erythritol, which is supported by global regulatory approvals for their use in food and beverage items.
However, Dr. Andrew Freeman, the director of cardiovascular prevention and wellness at the National Jewish Health hospital in Denver, who was not involved in the study, also said that this is “undoubtedly worrisome” and adds to the growing pool of evidence, and that we should be cautious about these chemicals and replacements.
Arguments Contradicting the Conclusions of the Study
Since the study suggests that elevated levels of circulating erythritol were at high risk of serious cardiovascular events, other health experts argue that there are flaws regarding the interpretation of the study.
Erythritol is naturally produced by the human body and often in response to oxidative stress. Previous research has also associated erythritol levels with cardiometabolic disease risks.
So some scientists say that:
rather than claiming that dietary erythritol intake is increasing CVD risk, it is more accurate to indicate that erythritol blood level (which is the total of endogenously produced erythritol plus those taken from external sources ) is a biomarker of CVD and CVD may be the one leading to elevated erythritol levels rather than the other way around.
Recommendations from Health Experts
Despite the opposition from industry groups and the need for further investigation, some healthcare experts are recommending caution when it comes to consuming erythritol. Dr. Freeman suggests limiting the consumption of erythritol for now.
The findings of this study may encourage the food industry to reconsider the use of erythritol in their products. Hazen noted that there is no universal solution when it comes to sugar substitutes, and the long-term health effects of these products are still uncertain.
To be safe, consumers may want to choose natural sweeteners such as honey or maple syrup or simply decrease their overall sugar intake. It is always advisable to consult with a healthcare professional before making significant changes to one’s diet or lifestyle regarding any health concern.
REFERENCE:
[1] Witkowski, M., Nemet, I., Alamri, H. et al. The artificial sweetener erythritol and cardiovascular event risk. Nat Med (2023). https://doi.org/10.1038/s41591-023-02223-9
