CNN
–
A sugar substitute called erythritol – used to bulk or sweeten stevia, monk fruit and other reduced-sugar products – According to a new study, it has been linked to blood clots, stroke, heart attack and death.
“The degree of risk was not modest,” said lead study author Dr. Stanley Hazen, director of the Center for Cardiovascular Diagnosis and Prevention at the Cleveland Clinic. Lerner Research Institute.
According to the study, people with existing risk factors for heart disease, such as diabetes, were twice as likely to experience a heart attack or stroke if they had the highest levels of erythritol in their blood. published on Monday in the journal Nature Medicine.
“If your blood erythritol level was in the top 25% compared to the bottom 25%, there was about twice the risk of heart attack and stroke. It’s on par with the strongest cardiac risk factors, like diabetes,” Hazen said.
Additional laboratory and animal research presented in the paper found that erythritol appeared to cause 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 an alarm,” said Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health, a hospital in Denver, who was not involved in the research.
“There appears to be a risk of clotting from using erythritol,” Freeman said. “Obviously, more research is needed, but with an abundance of caution, it may 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 such as erythritol are safe, as evidenced by permits global regulations for their use. in food and beverage,” said Robert Rankin, the council’s executive director, in an email.
The results “should not be extrapolated to the general population, as participants in the intervention were already at increased risk for cardiovascular events,” Rankin said.
The European Polyol Producers Association 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% the sweetness of sugar and is considered zero calorie, according to experts.
Artificially produced in mass quantities, erythritol does not have a lingering aftertaste, does not raise blood sugar and has 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’s Center for Microbiome and Human Health.
“It has become the darling of the food industry, an extremely popular additive to keto and other low-carb products and foods marketed to people with diabetes,” he added. “Some of the diabetes-labeled foods we looked at had more erythritol than any other item by weight.”
Erythritol is also the largest ingredient by weight in many “natural” stevia and monkfruit products, Hazen said. BECAUSE Stevia and monk fruit is about 200 to 400 times sweeter than sugar, only a small amount is needed in each product. The bulk of the product is erythritol, which adds the sugar’s crystalline appearance and texture that consumers expect.
Discovering the link between erythritol and cardiovascular issues was purely accidental, Hazen said: “We never expected that. 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 a heart attack, stroke or death in the next three years. To do this, 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 a big role, but we didn’t know what it was,” Hazen said. “Then we discovered it was erythritol, a sweetener.”
The human body naturally makes 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 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 three-quarters of the participants in the three populations had coronary disease or high blood pressure and about a fifth had diabetes, Hazen said. Over half were male and in their 60s and 70s.
In all three populations, the researchers found that higher erythritol levels were associated with a greater risk of heart attack, stroke or death within three years.
But why? To find out, the researchers did further tests in animals and labs and found that erythritol was “causing increased thrombosis,” or blood clotting, Hazen said.
Coagulation is necessary in the human body, otherwise we would bleed to death from cuts and injuries. The same process is constantly happening internally.
“Our blood vessels are always under pressure, and we’re leaking springs, and blood platelets are constantly plugging these holes all the time,” Hazen said.
However, the size of the clot made by the platelets depends on the size of the stimulus that stimulates the cells, he explained. For example, if the trigger is only 10%, then you only get 10% of a clot.
“But what we’re seeing with erythritol is that the platelets become super responsive: A simple 10% stimulant produces 90% to 100% of a clot formation,” Hazen said.
“For people who are at risk for clots, heart attack and stroke — like people with existing heart disease or people with diabetes — I think there’s enough data here to say stay away erythritol until more studies are done,” Hazen said.
Oliver Jones, a professor of chemistry at RMIT University in Victoria, Australia, noted that the study had only found correlation, not causation.
“As the authors themselves note, they found an association between erythritol and clotting risk, not conclusive evidence that such an association exists,” Jones, who was not involved in the research, said in a statement.
“Any potential (and as yet unproven) risk of excess erythritol will also need to be balanced against the very real health risks of excess glucose consumption,” Jones said.
In a final part of the study, eight healthy volunteers drank a drink that contained 30 grams of erythritol, the amount that many people in the U.S. consume, Hazen said. National Health and Nutrition Examination Survey, which reviews American food every year.
Blood tests over the next three days tracked erythritol levels and clotting risk.
“Thirty grams was enough to raise blood erythritol levels a thousandfold,” Hazen said. “It remained elevated above the threshold needed to cause and increase the risk of clotting for the next two to three days.”
How much does 30 grams of erythritol cost? The equivalent of eating a pint of keto ice cream, Hazen said.
“If you look at the nutrition labels on many keto ice creams, you’ll see ‘reduced sugar’ or ‘sugar alcohol,’ which are terms for erythritol. You’ll find a typical lyncher contains anywhere between 26 and 45 grams,” he said.
“My co-author and I have gone to grocery stores and looked at labels,” Hazen said. “He found a ‘sweet’ marketed for people with diabetes that had about 75 grams of erythritol.”
There is no “acceptable daily intake,” or ADI, set by European Food Safety Authority or the US Food and Drug Administration, which consider erythritol generally recognized as safe (GRAS).
“Science needs to take a deeper dive into erythritol, and quickly, because this substance is widely available now. If it’s harmful, we need to know about it,” Freeman told National Jewish Health.
Hazen agreed: “I don’t normally put myself on a pedestal and sound the alarm,” he said. “But it’s something I think we need to look at carefully.”
