Erythritol — a zero-calorie sweetener found in nature and often added to diet products, particularly for the ketogenic or keto diet — might contribute to clogged arteries and strokes, according to a new study from the Cleveland Clinic.
People with the highest level of the sugar substitute erythritol in their blood were found to have twice the risk for stroke, blood clot or death compared with those with the lowest level.
Animal and lab studies reinforced the idea that erythritol might cause clots, said Dr. Stanley Hazen, who led the research and chairs the department of cardiovascular and metabolic sciences at the Cleveland Clinic.
“The very group of people most vulnerable to experiencing adverse cardiac events are the ones we’re recommending these kinds of dietary foods for,” Hazen said.
Erythritol has no calories and is found at low levels in foods including grapes, mushrooms, pears, watermelon, beer, cheese, sake, soy sauce and wine.
It’s added to many processed foods and beverages and commonly found in products targeting people on the keto diet because it doesn’t affect blood glucose. Erythritol is also an ingredient in the sweetener Truvia.
Though many sweeteners provide intense flavor and need to be used in small concentrations, erythritol’s sweetness is close to that of sugar, so it can be used as a substitute in baking.
The body produces erythritol at levels well below what’s found with the added sweetener, according to research by Karsten Hiller, a biochemist and specialist in human metabolism at the Braunschweig Institute of Technology in Germany.
Federal guidelines don’t require listing erythritol among a product’s ingredients, Hazen said. Instead, the label on a food that includes it might say “artificially sweetened with natural products” or “zero sugar.”
Hazen initially set out to study factors that lead people to have heart attacks and strokes even when they’re being treated for high cholesterol, high blood pressure, obesity, diabetes and smoking cessation. Roughly half of treated people have this residual cardiovascular risk.
For the study, published in Nature Medicine, his team collected blood from 1,157 volunteers undergoing cardiac risk assessment. They looked for chemical signatures in the blood and tracked who over the next three years had a heart attack or stroke or died.
Erythritol was “at the very top of the list” of compounds found in the blood of people in the study who turned out to be at the highest risk for a bad outcome, Hazen said. High blood levels of erythritol seemed to lower the threshold for triggering a clot.
The researchers then tested the sugar substitute in mice and in human blood in the lab, trying to explain why this might have happened. That work strongly suggested that erythritol promotes blood clots.
“This is a new pathway we think is contributing to residual cardiovascular risk,” Hazen said.
Robert Rankin, executive director of the Calorie Control Council, an association representing the low- and reduced-calorie food and beverage industry, challenged the findings, saying, “The results of this study are contrary to decades of scientific research showing reduced-calorie sweeteners like erythritol are safe.”
But other studies also have raised questions about erythritol. For one published in 2017, Hiller and colleagues showed that Cornell University freshmen who had a lot of erythritol in their blood at the beginning of their first year gained more weight than students with low levels.
Whether the erythritol was a sign someone was likely to gain weight or a cause of it remains a question, said Martha Field, a Cornell researcher who wasn’t involved in that work but has studied erythritol since.
“It predicts your risk for developing disease,” Field said. ”Theoretically, you can intervene and make changes.”
It‘s not clear whether people with high blood levels of erythritol are consuming more of it or something in their body is leading to that excess, Hiller said. But there’s no doubt eating food sweetened with it will dramatically boost blood levels.
Initial safety studies on erythritol looked only at short-term exposure and found the body cleared it quickly. Field studied what happens in mice if they consume it chronically and found mice fed high levels of erythritol for eight weeks retained blood levels of erythritol 30 times above normal for at least five hours.
It’s too early to definitively say erythritol causes problems for people who consume it regularly. High blood levels of erythritol might be a marker of problems to come rather than a cause of them.
But Hiller, Hazen and Field said they intend to stay away from it as much as possible.
Hiller said the Food and Drug Administration should reconsider its classification of the sugar substitute as “generally recognized as safe” and study it further: “At the current knowledge we have, I would not recommend people use it.”
Read more at USA Today.
