New Study Links Sweeteners to Heart Risk: What You Need to Know

Is going sugar-free really good advice for patients with cardiometabolic risk factors?

That's the question raised by a new study from the Cleveland Clinic, which suggests that consumption of erythritol, a sweetener commonly found in sugar-free and keto foods, may promote a pro-thrombotic response.

In a study published in 2011, Arteriosclerosis, thrombosis, vascular biologyTen healthy participants ingested 30 grams of erythritol. Thirty minutes later, their blood showed increased platelet aggregation and increased markers of platelet reactivity and activation.

Specifically, the researchers found enhanced stimulus-dependent release of serotonin (a marker for platelet dense granules) and CXCL4 (a marker for platelet alpha granules).

“In every test we did, we saw a prothrombotic effect in everyone,” said study author Stanley Hazen, M.D., director of cardiovascular and metabolic sciences at the Cleveland Clinic in Ohio. In contrast, no such effect was seen in subjects who ingested 30 grams of glucose.

Erythritol itself plateletHazen said it would instead lower the threshold for triggering a reaction, making blood clots more likely to form and risk heart attacks and other heart conditions. stroke The risk increases over time.

How it works is unclear, but Hazen has an idea.

“Platelets appear to have receptors that recognize and sense these sugar alcohols,” Hazen said, “much like the sweet-tasting taste buds have receptors that recognize glucose, or sugar molecules.”

“We're very interested in finding out what that receptor is,” Hazen says, “because we think it represents a very interesting potential target for further investigation and study of how it relates to the pathogenesis of heart disease.”

The past and future of erythritol research

In 2001, the U.S. Food and Drug Administration Erythritol It is “generally recognized as safe” as a food additive. Erythritol, a sugar alcohol found naturally in foods such as melons and grapes, is also made by fermenting sugar. It is about 70% as sweet as table sugar. Humans also naturally produce small amounts of erythritol. Our blood cells Pentose phosphate pathway.

Previous research Hazen's research group has found that erythritol is linked to serious cardiovascular disease and blood clotting risks.

“Based on their previous work, I think this was a really important study to do in healthy individuals,” said Martha Field, PhD, an assistant professor in the Department of Nutritional Sciences at Cornell University in Ithaca, New York, who was not involved in the study.

The previous paper analysed blood samples from subjects whose erythritol intake was unknown, including some taken before they consumed the sweetener, when erythritol was consumed as widely as it is today, making it more difficult to separate the effects of ingesting erythritol from those of naturally produced erythritol.

By showing that consuming erythritol increases markers associated with thrombosis, this new paper highlights the importance of thinking about and better understanding what we put into our bodies.

“Although this study was done in healthy people, it may be particularly dangerous for people who are at high risk of blood clots,” Field said. “There are many gene polymorphisms that increase the risk of blood clotting disorders and the tendency to form blood clots.”

Field hopes to do a similar analysis on xylitol. Sorbitoland other sugar alcohols found in sugar-free foods. And she called for reducing erythritol intake and for more research on erythritol over a longer period of time.

Registered dietitian Varisa E. Hedrick, PhD, agrees. “More research is needed in this area, especially in high-risk groups such as prediabetes and diabetes,” said Hedrick, an associate professor in the department of human nutrition, food and exercise at Virginia Tech in Blacksburg, Virginia, who was not involved in the study.

“Because this study was done in healthy people, the impact of small amounts of glucose was negligible because their bodies were able to regulate their blood sugar levels effectively,” she said. “We know that high blood sugar levels also increase platelet reactivity, which in turn increases the likelihood of thrombosis. So, for people who can't regulate their blood sugar levels, such as those with prediabetes or diabetes, consuming large amounts of sugar may have a similar effect on their body as erythritol.”

At the same time, “people with diabetes or prediabetes may be more likely to use erythritol as a sugar substitute,” Hedrick added, “so it will be important to design studies in these individuals to determine whether erythritol has an additional negative effect on heart attack risk.”

Criticism and influence

Critics have pointed out that the 30-gram amount of erythritol that study participants ingested is unrealistic. Hazen said it's not unrealistic.

Erythritol is often recommended as a one-to-one replacement for sugar, and having a few servings of erythritol-sweetened ice cream or soda could help you make up for 30 grams, says Hazen.

“The doses we used are on the higher side, but still well within physiologically acceptable levels,” he said.

And while some have argued that the findings only apply to people with heart disease, Hazen says they're also important for the general public.

“I think what this study highlights is that there are significant health concerns at a population level,” he said.

in the end, Risk factors for heart disease Like obesity, High blood pressurediabetes, and smoking are common and can build up quickly.

“When you look at middle-aged Americans, most of them who have had a heart attack or stroke say they Coronary artery diseaseand the first recognition is of that event,” Hazen said.

For now, Hazen recommends consuming real sugar in moderation, and he hopes that future research will find nonnutritive sweeteners that don't activate platelets.

The big picture

This new study adds another piece to the puzzle of whether nonnutritive sweeteners are better than sugar.

“I think these results are alarming,” said Joan E. Munson, M.D., chief of preventive medicine at Brigham and Women's Hospital in Cambridge, Massachusetts, and professor of medicine at Harvard Medical School. “They may help explain the surprising results in some observational studies linking artificial sweeteners to an increased risk of cardiovascular disease.”

Manson was not involved in the current study, but has conducted other research linking artificial sweetener use to stroke risk.

In upcoming randomized clinical trials, her team will directly compare sugar-sweetened beverages, beverages sweetened with zero-calorie alternatives, and water to determine which is best for a range of cardiometabolic outcomes.

“Further research is needed on this issue,” she says, “because artificial sweeteners are commonly used and many people believe they are healthier than sugar-sweetened products.”