A new study adds to growing evidence that the sugar substitute erythritol increases cardiovascular risk.

A new study from the Cleveland Clinic has found that consuming foods containing erythritol, a popular artificial sweetener, increases the risk of cardiovascular diseases such as heart attack and stroke. Findings from a new intervention study in healthy volunteers show that erythritol may increase the activity of platelets (a type of blood cell), potentially increasing the risk of blood clots. Sugar (glucose) did not have this effect.

Published in Arteriosclerosis, thrombosis, vascular biology, research There is growing evidence that erythritol may not be as safe as it is currently classified by food regulators and should be reevaluated as an ingredient. The study was conducted by a team of researchers at the Cleveland Clinic as part of a series of investigations into the physiological effects of erythritol in general. sugar Replacement.

“Many professional societies and clinicians routinely recommend that people at high risk for cardiovascular disease, including those with obesity, diabetes and metabolic syndrome, consume foods that contain sugar substitutes rather than sugar,” said senior corresponding author Stanley Hazen, MD, chief of the Division of Cardiovascular and Metabolic Sciences and co-chief of the Division of Preventive Cardiology at the Lerner Research Institute at the Cleveland Clinic. “These findings highlight the importance of further long-term clinical studies to evaluate the cardiovascular safety of erythritol and other sugar substitutes.”

Erythritol and other artificial sweeteners are often used as sugar substitutes in low-calorie, low-carb, and “keto” products. Erythritol is about 70% as sweet as sugar and is produced by fermenting corn. After ingestion, erythritol is not significantly metabolized in the body. Instead, it enters the bloodstream and is primarily excreted from the body through urine. The human body naturally produces small amounts of erythritol, so it can build up if consumed in excess.

Erythritol is classified as a GRAS (Generally Recognized as Safe) ingredient by the U.S. Food and Drug Administration and the European Food Safety Authority and has no restrictions on its use in food, primarily because it is a sugar alcohol found naturally in fruits and vegetables and, in small amounts, as a by-product of glucose metabolism in human tissues.

However, a recent study by Dr. Hazen's group found evidence that commonly consumed amounts of erythritol may increase the risk of cardiovascular disease.

The current research is Previous researchpublished last year. Nature MedicineThe results showed that heart disease patients with high erythritol levels were twice as likely to suffer a major heart attack over the next three years compared to patients with low erythritol levels. The study also found that adding erythritol to patients' blood or platelets increased the formation of blood clots. These results were confirmed by preclinical studies.

This new human intervention study was designed to more directly observe the effects on platelets after consuming erythritol in amounts typically found in “sugar-free” sodas and muffins. In 20 healthy volunteers, researchers found that the erythritol group experienced an increase in average post-meal erythritol concentrations of more than 1,000 times their initial concentrations. Results also revealed that participants experienced a significant increase in blood clot formation after consuming erythritol, but no change after consuming glucose.

“This study raises concerns that consuming standard amounts of foods and beverages sweetened with erythritol may acutely stimulate direct thrombogenic effects,” said WH Wilson Tang, M.D., director of heart failure and heart transplant medicine research at Cleveland Clinic and co-author of the study. “Erythritol and other sugar alcohols commonly used as sugar substitutes should be evaluated for possible long-term health effects, especially when such effects are not seen with glucose itself.”

He said the findings were particularly noteworthy because Another recent study The research group showed that xylitol, another common artificial sweetener, caused similar increases in plasma levels and affected platelet aggregation. Healthy Volunteers Similarly, as with erythritol, studies of xylitol also included large observational studies demonstrating that high levels of xylitol were associated with increased risk. heart attackstroke, or death is likely to occur within the next three years.

The authors further Clinical Research The long-term cardiovascular safety of erythritol needs to be evaluated.

“Especially for people who have heart disease, diabetes or other conditions that put them at high risk of blood clots, it may be better to choose small amounts of sugary treats every now and then rather than consuming drinks and foods sweetened with sugar alcohols. metabolic syndromeDr. Hazen advises, “Cardiovascular disease progresses over time. Heart disease It is the leading cause of death worldwide, and we need to make sure the food we eat isn't a hidden cause.”

This study is part of Dr. Hazen's continuing investigation into factors that contribute to residual cardiovascular risk. His team follows patients over time to find chemical signatures in their blood that can predict the future development of cardiac and metabolic disease. He has made pioneering discoveries in the study of atherosclerosis and inflammatory diseases, including the groundbreaking discovery showing a link between gut microbial pathways and cardiovascular and metabolic disease.

Dr. Hazen also serves as director of the Center for Microbiome and Human Health at Cleveland Clinic and is the Jan Bleeksma Professor of Vascular Cell Biology and Atherosclerosis.