Common sweetener erythritol tied to higher risk of stroke and heart attack
- Researchers investigated the link between the common artificial sweetener erythritol and cardiovascular risk.
- They found that erythritol is linked to increased cardiovascular risk.
- Further studies are needed to confirm the results.
Individuals with metabolic conditions such as type 2 diabetes and obesity are often
However, there are no long-term clinical trials examining the safety of most sweeteners. Some studies suggest that certain sweeteners may be linked to weight gain,
Erythritol is a commonly used artificial sweetener. Although naturally present in small amounts in fruits and vegetables, it is often added to processed foods in 1,000 times higher quantities.
While some studies show that erythritol may have antioxidant effects in
Further study of the effects of erythritol on cardiometabolic risk could inform healthful dietary practices.
‘A convincing argument’
Recently, researchers examined the link between erythritol consumption and cardiovascular risk.
They found that erythritol consumption increases cardiovascular risk, including the risk of a heart attack or stroke, thrombosis (blood clotting), and death related to a cardiovascular event.
The results appear in
Dr. John Alan Galat, a cardiac surgeon with Novant Health in Charlotte, NC, not involved in the study, commented about its findings to Medical News Today. According to him:
“This article [makes] a convincing argument that one of the more common sugar substitutes — erythritol — may very well increase the risk for heart attack and stroke. [The authors nevertheless] concede that much more investigation needs to be done. The important question is whether the benefits of reduced sugar and caloric intake outweigh the risk of consuming products with these sugar substitutes.”
What the researchers did
The researchers first analyzed blood samples from 1,157 participants. They found multiple compounds linked to cardiovascular risk. However, erythritol had some of the strongest links to the risk of cardiovascular events.
Next, the researchers analyzed blood samples from 2,149 participants from the United States and from 833 European participants. Plasma levels of erythritol were higher among participants with cardiovascular disease.
They also found that participants in the U.S. and European cohorts with the highest 25 percentile erythritol blood levels were 2.5 and 4.5 times more likely to have a cardiovascular event than those in the lowest 25 percentile.
Each
Next, the researchers set out to see how erythritol impacted blood clotting. Through multiple tests, they found that increased erythritol levels indicated higher rates of clot formation and increased thrombosis potential.
Lastly, the researchers examined the effects of consuming a snack or drink containing 30 grams (g) of erythritol in eight participants. While erythritol levels were low at baseline, they remained 1,000-fold higher for hours after ingestion.
“It is important that further safety studies are conducted to examine the long-term effects of artificial sweeteners in general, and erythritol specifically, on risks for heart attack and stroke, particularly in people at higher risk for cardiovascular disease,” notes senior author Dr. Stanley Hazen, chairman of the Department of Cardiovascular and Metabolic Sciences in Lerner Research Institute and co-section head of Preventive Cardiology at Cleveland Clinic.
Erythritol and cardiovascular risk
To understand how erythritol might increase heart attack and stroke risk, MNT spoke with Dr. Rigved Tadwalkar, a board-certified cardiologist at Providence Saint John’s Health Center in Santa Monica, CA, not involved in the study.
He noted that erythritol facilitates mechanisms needed for platelet aggregation and thrombosis, which are both key for developing heart attack or stroke.
“As cardiovascular disease is a process that is more complex than platelet aggregation alone, it is possible that erythritol causes other pathophysiologic changes on the molecular level to increase the risk for a cardiovascular event. Complicating matters, it appears that consuming erythritol-sweetened foods increases plasma erythritol levels for days, potentially prolonging cardiovascular effects.”
– Dr. Rigved Tadwalkar
Dr. John Hwa, professor of cardiology at Yale School of Medicine, not involved in the study, also told MNT that indirect mechanisms by which erythritol increases cardiovascular risk may include effects on the microbiome and nutrient absorption and metabolism.
Study limitations
“Although compelling, the studies are preliminary, and findings indicate an association between erythritol and heart attacks and strokes rather than a causal relationship,” noted Dr. Hwa.
“Longer term studies are needed, measuring both erythritol levels and markers of platelet activation in the same patients, particularly those that had heart attacks and strokes,” he added.
Dr. Tadwalkar further cautioned that although “[a]djustments were made in this study for traditional risk factors that are known to be implicated in cardiovascular disease, including age, smoking status, blood pressure, and cholesterol levels […] it is possible that unmeasured confounders may be present, such as diet, which could have affected the results.”
What experts have to say
“Nutritional metabolism is complex and sometimes unpredictable,” Dr. Hwa pointed out. “Even though erythritol is a naturally occurring substance and made in some cells in the body, if taken in excess may lead to platelet dysfunction.”
“If proven with further studies, caution should be taken in cardiovascular risk patients who may already be prone to ‘extra-sticky’ platelets such as [people with diabetes]. Consultation with one’s own medical practitioner may then be necessary before considering erythritol,” he noted.
MNT also spoke with Dr. Yu-Ming Ni, a cardiologist of noninvasive cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA, not involved in the study.
Commenting on the findings, he noted that “[w]e cannot say for certain that erythritol is the cause for increased heart disease unless this finding can be replicated in larger studies.”
“Until then, it is unclear whether it is necessary to stop all consumption of artificial sweeteners,” said Dr. Ni.
“I often advise my patients to eat food as naturally as possible, as that reduces [the] risk of exposure to potentially harmful chemicals like artificial sweeteners, and to consider sugar substitutes if it serves as a means to help overweight people with weight loss, since overall weight loss has clearer evidence for health improvements.”
– Dr. Yu-Ming Ni
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