One study linked erythritol to heart attack. Should You Be Worried?

smallOgar substitutes are everywhere in food and drinks. But despite their ubiquity, the scientific verdict on whether or not table tennis poses a health risk is back and forth. Every once in a while, though, a study comes out with a conclusion so shocking that it makes people reevaluate their closets. A February 27 study published in the journal Nature Medicine It now appears to have dealt such a blow to the sweetener erythritol, with data suggesting a link between the ingredient and cardiovascular events such as clotting, stroke and heart attack.

However, before you clear your shelves of all products containing erythritol, keep in mind that no single study—including this one—should be considered the final word on whether a product is healthy or not. The research is still evolving.

The researchers recruited multiple groups of people with pre-existing heart risk factors in the US and Europe and tracked their health over time after taking blood samples to measure the amount of various compounds in the body. Stanley Hazen, director of the Center for Cardiovascular Diagnosis and Prevention at the Cleveland Clinic Lerner Research Institute, says his team had no real intention of studying erythritol and instead stumbled upon their new findings. “Our original intention was to see if we could find compounds in the blood whose levels predict the future development of heart attack, stroke or death,” he says. “In looking at the data, the very top compound … was erythritol.” Of the 4,000 people included in the study’s data set, those with high levels of erythritol in their blood were more likely to have a major heart attack within three years than those with lower levels.

The study includes several other experiments to clarify the link between erythritol and heart disease — including giving the sweetener to mice, which the researchers found promoted blood clot formation, and feeding it to eight people, which showed the researchers that was still present in blood plasma after a day of fasting. Further experiments, involving laboratory exposure of blood, platelets and plasma to erythritol, all showed the same risk of clotting. in washed human platelets, an increased collagen “stickiness” was almost immediately apparent. The amounts of erythritol they tested in these lab experiments were “completely within the range of what we see in the bloodstream of patients,” Hazen says. “And the result is pretty quick. “The presence of erythritol for a few minutes was all that was necessary to change the function of the platelets and make them more prone to clots.”

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Erythritol is considered one of the most “natural” sugar substitutes that has emerged as an alternative to the artificial options that have become popular over the last half century. This older group of synthetic sugar substitutes includes sucralose (found in the original version of Splenda), saccharin (found in Sweet’N Low), and aspartame (found in Equal, Nutrasweet, and others). While these artificial options are generally considered safe in small amounts, studies in animal models (and some observational research in humans) have linked them to a variety of health risks. Aspartame, for example, has been found to have a possible causal link with cancers, while long-term consumption of saccharin has been linked to obesity, diabetes and other conditions in animal models.

In the last decade or so, food manufacturers have begun to favor more “natural” types of sugar-free sweeteners to help address these potential health concerns. This category includes sweeteners such as stevia leaf and monk fruit extracts, along with erythritol and other sugar alcohols or polyols—recreations of low-calorie substances found in fruits and plants. (If you shop at a typical grocery store, there’s a very good chance you have something with erythritol in your kitchen right now.) Erythritol is also popular as a keto-friendly sugar substitute in baking, as it’s known to have less of an artificial aftertaste than some other sweeteners. Despite extensive research, erythritol and other polyols have not previously been linked to long-term health risks or disease, although in the short term they may cause laxative effects and other gastrointestinal problems.

But when considering how concerned you are about the current study, it’s important to know that the presence of erythritol in the blood before a heart attack does not necessarily mean that erythritol is causing the event. Previous research has found that excess erythritol—which is also produced and metabolized by the human body—tends to stay at higher concentrations in the blood before a heart attack, London-based nutritionist Nicole Guess noted in an Instagram post about study. Erythritol in the body can be a marker for cardiometabolic disease, but it’s not clear whether this volume is determined by diet or by what the body has that it just isn’t getting rid of.

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The body’s production of erythritol has even been shown to increase when a person is under oxidative stress—a condition that often leads to disease, says Dr. Idrees Mughal, a British doctor with a master’s degree in nutritional research. These potentially confounding variables mean that the scary headlines about erythritol don’t always match the more complex reality, as correlation is not causation. “I think the main problem with the media was just the statement that was being made, that eating this sweetener was the reason for the increased risk of strokes or heart attacks,” he says.

Experts also questioned the fact that the data set used for the analysis only included people over the age of 60, all of whom had pre-existing cardiovascular disease or were classified as being at high risk for developing it.

Of course, definitively linking erythritol intake to heart disease would be difficult to make. “You’re not going to easily do a randomized trial where your intention is to try to see if you’re causing a heart attack or not,” Hazen says.

So should people give up snacks that contain erythritol? “At this point, I would say to definitely avoid erythritol and not worry or get upset about very moderate amounts of sweeteners that are natural,” like honey or pure sugar, Hazen says. In his opinion, reducing the intake of sweets is safer and more effective than using a sugar substitute. For those looking to lose weight, for example, the data doesn’t show that skipping sugar in favor of low- and no-calorie alternatives actually contributes to weight loss. However, eating too much sugar has health risks, Mughal adds, and in his opinion, “the relative risks from excess refined sugar far outweigh any of the sweeteners.”

The bottom line; Like so many foods that are the focus of nutritional research, more research is needed before you clean out your pantry.

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