New study adds to mounting evidence that sugar substitute erythritol increases cardiovascular risk

Research from the New Cleveland Clinic shows that consuming foods with erythritol, a popular artificial sweetener, increases the risk of cardiovascular events such as heart attack and stroke. Findings from a new intervention study in healthy volunteers show that erythritol makes platelets (a type of blood cell) more active, which may increase the risk of blood clots. Sugar (glucose) did not have this effect.

Published in Arteriosclerosis Thrombosis and vascular biology, the research adds to mounting evidence that erythritol may not be as safe as currently classified by food regulatory agencies and should be reevaluated as an ingredient. The study was conducted by a team of Cleveland Clinic researchers as part of a series of studies examining the physiological effects of common sugar substitutes.

“Many professional associations and physicians routinely recommend that people at high cardiovascular risk — those with obesity, diabetes or metabolic syndrome — consume foods that contain sugar substitutes in place of sugar,” says senior and corresponding author Stanley Hazen, M.D., Ph.D. ., chairman of Cardiovascular and Metabolic Sciences at Cleveland Clinic’s Lerner Research Institute and co-section chief of Preventive Cardiology. “These findings underline the importance of further long-term clinical studies to assess the cardiovascular safety of erythritol and other sugar substitutes.”

Erythritol and other artificial sweeteners are common replacements for table sugar 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 poorly metabolized by the body. Instead, it enters the bloodstream and leaves the body mainly through urine. The human body naturally produces small amounts of erythritol, so any additional consumption can accumulate.

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, allowing it to be used in food products without restriction. This is mainly because it is a sugar alcohol that occurs naturally in fruits and vegetables and is a byproduct of glucose metabolism in human tissue, albeit in small amounts.

Recent studies by the group of Dr. However, Hazen found evidence that erythritol in normally consumed amounts may increase cardiovascular risk.

The current research builds on the team’s previous study, which was published last year Naturopathywhich showed that cardiac patients with high erythritol levels were twice as likely to have a major cardiac event in the next three years compared to patients with low erythritol levels. The study also found that adding erythritol to patients’ blood or platelets increased clot formation. These findings were confirmed by preclinical studies.

The new human intervention study was designed to more directly observe the effects on platelets after ingesting erythritol at a dose typically found in a “sugar-free” soft drink or muffin. In 20 healthy volunteers, researchers found that the average erythritol level after eating increased more than 1,000 times in the group that consumed erythritol compared to their original levels. The results also showed that participants showed a significant increase in blood clot formation after consuming erythritol, but no change was observed after consuming glucose.

“This study raises some concern that a standard serving of an erythritol-sweetened food or beverage may acutely stimulate a direct clot-forming effect,” said study co-author WH Wilson Tang, MD, research director for heart failure and heart transplant medicine at Cleveland Clinic . “Erythritol and other sugar alcohols commonly used as sugar substitutes should be evaluated for potential long-term health effects, especially if such effects are not observed with glucose itself.”

He adds that the results of this study are especially notable because they echo another recent study from this research group, which found that xylitol, another common artificial sweetener, caused a similar increase in plasma levels and increased platelet aggregation in affected healthy volunteers in the same way. . Like erythritol, studies of xylitol also include large-scale observational studies showing that high xylitol levels are associated with an increased risk of heart attack, stroke, or death over the next three years.

The authors note that further clinical studies examining the long-term cardiovascular safety of erythritol are warranted.

“I believe that choosing sugar-sweetened treats occasionally and in small quantities is preferable to consuming beverages and foods sweetened with these sugar alcohols, especially for people at increased risk of thrombosis, such as people with heart disease , diabetes or metabolic syndrome,” says Dr. Hazen advises. “Cardiovascular disease accumulates over time, and heart disease is the leading cause of death worldwide. We must ensure that the food we eat does not make hidden contributions.”

The study is part of Dr.’s ongoing research. Hare to factors contributing to residual cardiovascular risk. His team follows patients over time and finds chemical signatures in the blood that can predict the future development of heart and metabolic diseases. He has made groundbreaking discoveries in atherosclerosis and inflammatory disease research, including the groundbreaking discovery linking gut microbial pathways to cardiovascular and metabolic diseases.

Dr. Hazen also directs the Cleveland Clinic’s Center for Microbiome and Human Health and holds the Jan Bleeksma Chair in Vascular Cell Biology and Atherosclerosis.