According to a new Cleveland Clinic study, erythritol, a zero-calorie sweetener found in nature and commonly added to diet products, notably for the ketogenic or keto diet, may contribute to blocked arteries and strokes.
Individuals with the highest levels of the sugar substitute erythritol in their blood had double the chance of having a stroke, blood clot, or dying as those with the lowest levels.
According to Dr. Stanley Hazen, who conducted the research and leads the department of cardiovascular and metabolic sciences at the Cleveland Clinic, animal and lab experiments confirmed that erythritol might induce clots.
“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.
Since it has no effect on blood glucose, it is added to many processed foods and beverages and is typically found in goods aimed at persons following the keto diet. Truvia, a sweetener, also contains erythritol.
Whilst many sweeteners have a strong flavour and must be used in tiny amounts, erythritol has a sweetness similar to sugar and may be used as a replacement in baking.
According to Karsten Hiller, a scientist and researcher in human metabolism at the Braunschweig Institute of Technology in Germany, the body manufactures erythritol at levels far below those observed with the additional sweetener.
Federal guidelines don’t require listing erythritol among a product’s ingredients, Hazen said. Instead, the label on food that includes it might say “artificially sweetened with natural products” or “zero sugar.”
Hazen’s primary goal was to investigate the variables that cause patients to suffer heart attacks and strokes while being treated for high cholesterol, high blood pressure, obesity, diabetes, and smoking cessation. This residual cardiovascular risk affects almost half of those who have been treated.
His team gathered blood from 1,157 individuals undergoing cardiac risk assessment for the research, which was published in Nature Medicine. Scientists examined for chemical markers in the blood and monitored who had a heart attack, stroke, or died over the next three years.
According to Hazen, erythritol was “near the very top of the list” of substances identified in the blood of persons in the research who turned out to be at the highest risk for a negative result. Increased erythritol levels in the blood appeared to reduce the threshold for initiating a clot.
The sugar replacement was then tested in mice and human blood in the lab, with the researchers attempting to explain why this occurred. That research strongly showed that erythritol enhances blood clot formation.
“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.
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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 unclear if people with high erythritol blood levels consume more of it or whether something in their bodies causes the excess, according to Hiller. Nonetheless, there is no question that eating foods sweetened with sugar would significantly increase blood levels.
Early erythritol safety studies focused on short-term exposure and discovered that the body eliminated it fast. Field investigated what occurs in mice when they ingest it on a regular basis and discovered that animals given high amounts of erythritol for eight weeks kept blood levels of erythritol 30 times higher than usual for at least five hours.
It is too soon to tell conclusively that erythritol creates issues for persons who consume it on a regular basis. Elevated erythritol levels in the blood may be a predictor of future issues rather than a cause of them.
Nonetheless, Hiller, Hazen, and Field have said that they seek to avoid it as much as possible.
Hiller believes the FDA should reevaluate the categorization of the sugar replacement as “generally regarded as safe” and do additional research: “With the current information we have, I would not recommend anyone use it.”