Study links artificial sweetener erythritol to heart disease

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A new study suggests a popular artificial sweetener may not be as harmless as thought. Researchers say they have found evidence in animals and humans that erythritol, a sugar alcohol commonly included in keto diets, may increase the risk of cardiovascular disease in some people. Importantly, the study only demonstrates a correlation, not a direct cause-and-effect relationship, and further research will be needed to untangle any possible link.

The Erythritol and Heart Disease Study

The work was led by researchers at the Cleveland Clinic. According to the authors, they were simply looking for hidden risk factors in a sample of patients having heart exams when they first noticed the link. Patients who had higher levels of sugar alcohols in their bloodstream, particularly erythritol, appeared to have a higher subsequent risk of major adverse cardiovascular events, such as heart attacks and strokes. Curious, they scoured other patient datasets in the US and Europe and found the same association.

They then conducted laboratory and animal studies, finding that exposure to erythritol appears to alter the behavior of platelets, which then appears to increase the risk of clotting. And finally, in a very small study of human volunteers (eight in total), researchers found that people who ingest erythritol continued to have higher and sustained levels of erythritol (over two days) circulating in their blood.

“Our results reveal that erythritol is both associated with incident [major adverse cardiac events] risk and promotes improvement [clotting]“, write the authors in their article, published Tuesday in Nature Medicine.

The different lines of research are a strength of the study. And scientists expose a plausible mechanism for how erythritol may increase the risk of stroke and heart disease. At the same time, their theory is still based on circumstantial evidence, not definitive evidence. It’s also possible that such a risk only first affects people who are vulnerable to cardiovascular disease, since the researchers first found the association in people who were already at risk for these problems.

What is erythritol?

Erythritol and other sugar alcohols are common sugar substitutes, either used alone in combination with other types of sweeteners. It has become more popular with the rise of keto diets. Erythritol is also produced by the body and is found naturally in many fruits and fermented foods. Eating too many of these sugar alcohols at once can cause stomach pain and other gastrointestinal issues, although it appears to be less risky with erythritol especially. This study appears to be one of the first to suggest a risk of more serious health problems from erythritol.

Interestingly, at least one small study has suggested that erythritol may actually improve the health of blood vessels in people with diabetes and thus protect them from cardiovascular disease. One major caveat, however, this study was funded by Cargill, a producer of erythritol.

This current research certainly seems worth taking seriously, but it’s just the beginning. More work, ideally from other research teams, will have to try to verify what these scientists have found, hopefully sooner rather than later.

“Studies evaluating the long-term safety of erythritol are warranted,” the authors wrote.

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