Zero-calorie sweetener linked to heart attack, stroke, research

CNN
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A sugar substitute called erythritol — used to add bulk and sweetness to stevia, monk fruit, and reduced-sugar keto products — It’s linked to blood clots, stroke, heart attack, and death, according to new research.

“The risk level was not moderate,” said lead author Dr. Stanley Hazen, director of the Cardiovascular Diagnostic and Prevention Center at the Cleveland Clinic. Lerner Institute.

Studies have shown that people with pre-existing risk factors for heart disease, such as diabetes, were twice as likely to experience a heart attack or stroke when their blood levels of erythritol were the highest. published on monday in the journal Nature Medicine.

“If you have erythritol blood levels in the top 25% compared to the bottom 25%, your risk of heart attack and stroke is about twice as high. ” said Hazen.

Additional laboratory and animal studies published in this paper revealed that erythritol appeared to cause platelets to clot more readily. Or it can travel to the brain and cause a stroke.

“This certainly raises alarm bells,” said Dr. Andrew Freeman, director of cardiovascular prevention and health at National Jewish Health, a hospital in Denver, Colorado, who was not involved in the study. .

“There appears to be a risk of clotting with erythritol use,” Freeman said. That might make sense.

In response to the study, the Calorie Control Council, an industry group, told CNN: in food and beverages,” the council’s executive director, Robert Rankin, said in an email.

The results “should not be extrapolated to the general population because participants in the intervention are already at increased risk of cardiovascular events,” Rankin said.

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

Like sorbitol and xylitol, erythritol is a sugar alcohol, a carbohydrate found naturally in many fruits and vegetables. According to experts.

Erythritol, which is artificially manufactured in large quantities, has no aftertaste and does not spike blood sugar levels. laxative effect than other sugar alcohols.

“Erythritol looks like sugar, tastes like sugar, and you can bake with it,” said Hazen, who is also director of the Center for Microbiome and Human Health at the Cleveland Clinic.

“It has become a sweetheart of the food industry and is a very popular addition to keto and other low-carb products and foods marketed to diabetics,” he added. Some foods labeled for diabetes contained more erythritol by weight than any other food.

Erythritol is also the largest ingredient by weight in many “natural” stevia and monk fruit products. stevia Monk fruit is about 200 to 400 times sweeter than sugar, so a small amount is enough for any product. The bulk of the product is erythritol, which adds the sugar-like crystalline look and texture that consumers have come to expect.

The discovery of the link between erythritol and cardiovascular problems was purely accidental. we weren’t looking for that. ”

Hazen’s research goals were simple. It was to find unknown chemicals or compounds in a person’s blood to predict the risk of heart attack, stroke, or death in the next three years. To that end, the team began analyzing her 1,157 blood samples from people at risk for heart disease, collected between her 2004 and her 2011 years.

“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 the sweetener erythritol.”

The human body naturally produces erythritol, but in very small amounts that cannot explain the levels measured, Hazen said.

To confirm their findings, Hazen’s team tested another batch of blood samples from more than 2,100 patients in the United States, and an additional 833 samples collected by colleagues in Europe through 2018. Approximately three-quarters of participants in all three cohorts had coronary artery disease or hypertension. About a fifth of the pressure was diabetes, he said, Hazen. More than half of them are men in their 60s and 70s.

In all three populations, researchers found that higher levels of erythritol were associated with a higher risk of heart attack, stroke, or death within three years.

but why? To find out, the researchers conducted further animal and laboratory studies and found that erythritol “caused enhanced thrombosis,” i.e., caused clotting in the blood.

The human body needs coagulation. The same process is happening internally all the time.

“Our blood vessels are under constant pressure, they leak, and platelets are constantly blocking these holes,” Hazen said.

But the size of the clots made by platelets depends on the size of the trigger that stimulates the cells, he explained.

“But what we see with erythritol is that the platelets become very sensitive. As little as 10% of the stimulant produces 90-100% of clot formation,” Hazen said. .

“I think we have enough data to tell us to stay away from people who are at risk of blood clots, heart attacks and strokes, such as those with heart disease and diabetes. Erythritol until more research is done.

Oliver Jones, a professor of chemistry at RMIT University in Victoria, Australia, who was not involved in the study, noted that the study only revealed correlation, not causation.

“As the authors themselves point out, they found an association between erythritol and clotting risk, but there is no conclusive evidence that such an association exists.

“The possible (and as yet unproven) risks of excess erythritol need to be balanced against the very real health risks of excessive glucose consumption.

In the final part of the study, eight healthy volunteers drank a beverage containing 30 grams of erythritol. This is the amount consumed by many people in the United States. National Health and Nutrition Survey, Every year I look up nutrition in America.

Blood tests over the next 3 days tracked erythritol levels and clotting risk.

“Thirty grams was enough to increase blood levels of erythritol by a factor of 1000,” Hazen said. It remained elevated beyond.”

How much is 30g of erythritol? Hazen said it’s like eating a pint of keto ice cream.

“If you look at the nutrition label on many keto ice creams, you’ll see the term ‘reducing sugar’ or ‘sugar alcohol’ for erythritol. A typical pint is found to contain 26 to 45 grams. he said.

“My co-author and I went to the grocery store and looked at the labels,” Hazen said. ’ was found.”

There is no hard and fast “acceptable daily intake” or ADI set by governments. European Food Safety Authority or U.S. Food and Drug Administration Consider Erythritol Generally Recognized as Safe (GRAS).

“Erythritol is now widely available, so science urgently needs to dig deeper into erythritol. If it’s harmful, we need to know about it,” said Freeman of National Jewish Health. I got

Hazen agrees. “But I think this needs to be carefully considered.”