Study: A zero-calorie sweetener may cause heart attack and stroke

Dubai, United Arab Emirates (CNN) — A new study shows that the sugar substitute erythritol is linked to blood clotting, stroke, heart attack, and death.

“The risk score was not low,” said Dr. Stanley Hazen, lead author of the study and director of the Center for Cardiovascular Disease Diagnosis and Prevention at the Cleveland Clinic Lerner Research Institute.

The study, published in the journal Nature Medicine on Monday, showed that people with existing 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 higher.

“If the level of erythritol in your blood is 25% higher compared to the lower level of 25%, then there is a twofold higher risk of heart attack and stroke. This means that it is added to the strongest heart risk factors, such as diabetes,” Hazen explained. .

Additional laboratory and animal research presented in the paper revealed that erythritol appears to cause platelets to clot more easily. The clots can break off and travel to the heart, causing a heart attack, or travel to the brain, causing a stroke.

“This definitely sounds an alarm,” said Dr. Andrew Freeman, director of Cardiovascular Disease Prevention and Wellness at National Jewish Health in Denver, who was involved in the research.

“There appears to be a risk of blood clots with the use of erythritol,” Freeman added. “Obviously more research is needed, but with some caution, it may make sense to limit erythritol in your diet for now.”

In response to the study, Robert Rankin, executive director of the Calorie Control Council, an industry association, told CNN, “The results of this study contradict decades of scientific research showing that low-calorie sweeteners like erythritol are safe, as evidenced by global regulatory permissions for their use in sweeteners.” foods and drinks.”

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

What is erythritol?

Like sorbitol and xylitol, erythritol is a sugar alcohol, a carbohydrate found naturally in many types of fruits and vegetables. According to experts, it has about 70% of the sweetness of sugar and is considered to be calorie-free.

Synthetically, erythritol is produced in bulk, does not have a lingering aftertaste, does not spike blood sugar, and has a lesser laxative effect than some other sugar alcohols.

“Erythritol looks like sugar, tastes like sugar, and can be baked with,” said Hazen, who also directs the Center for Microbiome and Human Health at the Cleveland Clinic.

“It has become a favorite in the food industry, and is an extremely popular additive in keto diets and other low-carb products and foods marketed to diabetics,” he added, noting that “some of the diabetes-labelled foods we looked at contained erythritol.” More than any other component by weight.

An unexpected discovery

Hazen said the discovery of the link between erythritol and cardiovascular problems was serendipitous: “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 might indicate a person’s risk of heart attack, stroke, or death in the next three years. To do this, the team started by analyzing 1,157 blood samples of people at risk of heart disease, collected between 2004 and 2011.

“We found this substance that seemed to play a big role, but we didn’t know what it was,” Hazen explained, adding: “Then we discovered that the substance was erythritol, that is, a sugar substitute.”

He said the human body naturally produces erythritol, but in quantities that are too low to account for the levels measured.

To confirm the findings, Hazen’s team tested another set 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 ¾ of the participants in the three populations had coronary artery disease or high blood pressure, and about a fifth of them have diabetes, according to Hazen. More than half of them were males in their 60s and 70s.

Across all three populations, the researchers found that higher levels of erythritol were associated with an increased risk of heart attack, stroke, or death over the next three years.

but why? To find out, the researchers conducted more animal and lab tests, and discovered that erythritol “triggered enhanced coagulation,” or clotting, in the blood, Hazen noted.

Coagulation is necessary in the human body, otherwise the body may bleed to death from cuts and injuries. The same process is constantly happening internally as well.

“Our blood vessels are always under pressure, leaks can occur as a result, and platelets are constantly plugging these holes all the time,” Hazen explained.

He pointed out that the size of the clot made by the platelets depends on the extent of the causative agent that stimulates the cells. For example, if the causative agent is only 10%, the body will only have 10% of the stroke.

“But what we see with erythritol is that the platelets become very responsive: Just 10% of it causes between 90% and 100% of clot formation,” Hazen said.

“For people who are at risk for thrombosis, heart attack, and stroke, such as those with existing heart disease or diabetes, I think there is enough data in our possession to stay off erythritol until more studies are done,” he added.

Oliver Jones, a professor of chemistry at RMIT University in Victoria, Australia, noted that the study only revealed an association, not a causal relationship.

“The authors found an association between erythritol and clotting risk, and this does not constitute definitive evidence of such an association,” Jones, who was not involved in the research, said in a statement.

“Any potential (and as yet unproven) risks of erythritol must be balanced against the very real health risks of excess glucose consumption,” he added.

healthy volunteers

In a final part of the study, eight healthy volunteers drank a drink containing 30 grams of erythritol, the amount most people in the United States consume, according to the National Health and Nutrition Examination Survey, which examines American nutrition each year.

Blood tests over the next three days measured erythritol levels and clotting risk.

“30 grams was enough to raise the levels of erythritol in the blood a thousand times,” Hazen said, pointing out that it “remained high above the threshold needed to stimulate and increase the risk of clotting over the next two to three days.”

“If you look at the nutrition labels on many keto sundaes, you’ll see reduced sugar or sugar alcohols, which are terms used for erythritol. A typical pint contains between 26 and 45 grams,” Hazen explained.

He concluded, “The science needs to delve deeper into erythritol, and quickly, because this substance is now widely available.”

“If it’s harmful, we should know about it,” said Freeman of the National Jewish Health Organization.

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