New research suggests that erythritol, a common sugar substitute found in keto products, sweets, and low- or no-calorie diet drinks, may raise the risk of heart attack and stroke.
The sweetener increased blood platelet activity and increased the risk of blood clots, according to a Cleveland Clinic study published on Thursday in the medical journal Arteriosclerosis, Thrombosis and Vascular Biology. Food sweetened with sugar did not have the same effect.
Just 20 patients were examined in this small study, and researchers who were not involved advise people to exercise caution when interpreting the findings.
Erythritol is a zero-calorie sugar alternative that is used to sweeten ice cream, protein bars, yogurt, cookies, and hundreds of other products. It is the main sweetener in the high-fat, low-carb keto diet and works as a thickening agent similar to sugar. Food and Drug Administration declared erythritol to be “generally recognized as safe” in 2001.
However, those who drank glucose-sweetened water did not exhibit a similar effect, according to researchers who noted that participants in the National Institutes of Health-funded study who drank water sweetened with erythritol displayed indications that their blood platelets had been activated.
“Every individual who was tested showed altered platelet function and an increased risk of clotting after consuming an erythritol-sweetened beverage,” according to Dr. Stanley Hazen, a cardiologist and chair of cardiovascular and metabolic sciences at Cleveland Clinic’s Lerner Research Institute.
The results come from a bigger 2023 study headed by Hazen as well, which connected the well-liked sugar substitute to heart issues. In the previous year’s study, blood samples from over 1,100 individuals who had their heart risk evaluated over a three-year period were tested, and over 2,100 non-emergency patients were followed up with. Erythritol was associated in the study with a higher risk of heart attack, stroke, and death. The study also discovered that mice fed the sweetener developed blood clots as a result of it.
Sweetener vs. sugar
People started asking Hazen’s research team what kinds of sweeteners they should consume instead of erythritol after his 2023 study, he said. His group aimed to compare the risk of clotting for consumers who drank beverages sweetened with sugar or erythritol.
Twenty nonsmokers without a history of diabetes, high blood pressure, or heart disease and normal kidney function were included in the study. Participants had their blood drawn before and 30 minutes after consuming water sweetened with 30 grams of glucose or erythritol following a night of fasting. Based on a 2014 national survey and Food and Drug Administration filings, the dosage is equivalent to daily intake and is roughly equivalent to the amount in a muffin or soda with erythritol sweetened, according to researchers.
When compared to their pre-consumption levels, the average erythritol levels of the study participants who drank the sweetened water increased by a factor of 1,000. The study also found that after erythritol consumption, participants’ blood clot formation significantly increased. Those in the glucose-drinking group showed no such change.
The duration for which consumers may be at increased risk of clotting after consuming food or beverages containing the sugar substitute is not specified in the recent study.
Hazen suggested that instead of using erythritol, people should use natural sweeteners like sugar, glucose, honey, or fruit in moderation. In contrast to erythritol, which he believes will cause clotting in the days that follow ingestion, natural sweeteners do not increase the risk of clotting for consumers.
Research ‘should not alarm consumers’
The results of this study should not concern consumers, according to researchers who were not involved in the investigation.
Professor Alice H. Lichtenstein oversees the cardiovascular nutrition laboratory at Tufts University in Boston in addition to her role as director. Since no single study can determine policy, she said the study should be interpreted in light of other reports on the subject.
“We do not know enough about the overall effect of non-nutritive sweeteners vs. sugar to accurately assess their relative effects on health outcomes,” Lichtenstein stated.
According to Lichtenstein, it’s important to assess the appropriate daily intake of sweeteners for individuals. According to her, “non-nutritive” sweeteners should be compared to sugar in order to assess the risks and benefits for variables like body weight, heart risk, and dental health.
She recommended limiting consumption of foods and beverages high in sugar or sweeteners and sticking to a diet of water and seltzer.
“As much as possible, choose whole foods in their natural state and use common sense,” Lichtenstein stated.
Professor Joanne Slavin of the University of Minnesota-Twin Cities’ department of food science and nutrition advised consumers to weigh the advantages and disadvantages of different sweeteners.
“This study adds another piece to the puzzle, but should not alarm consumers that they are risking their health,” Slavin stated. “It is easy to avoid alternative sweeteners, but they are useful tools for diabetics and others who need to avoid digestible carbohydrates.”
Food industry defends erythritol
The Cleveland Clinic study was criticized by food industry groups, who pointed out the study’s small sample size and participants’ high erythritol consumption.
According to Carla Saunders, president of the Calorie Control Council, a group that represents the low- and reduced-calorie food and beverage industry, the 10 research participants were given an erythritol dosage that was two to three times higher than what is typically found in an 8- or 16-ounce beverage sold in the United States.
Saunders pointed out that the study did not account for lifestyle variables that might have influenced the outcomes, and that erythritol levels were only measured once after participants drank the sweetened beverages.
Since measurements of erythritol levels were made both before and 30 minutes after consumption, “it is not possible to show that excessive consumption has any long-term effects on any health outcome,” Saunders said.
More than 250 food and beverage manufacturers use erythritol as a sweetener in alcoholic beverages, snacks, pet food, and supplements, according to the Calorie Control Council.
“Consumers need to rely on science, and for 30 years, science has shown that erythritol is a proven safe and effective choice for sugar and calorie reduction,” Saunders stated.
However, Hazen noted that there is mounting evidence of possible risks and that his most recent study is not “standing in isolation”.
“I’m hoping this will be a call to arms for more research on this topic, especially given how prevalent and ubiquitous erythritol is as an artificial sweetener,” Hazen stated.
