Artificial sweetener erythritol likely linked to risk of blood clots, study warns

Artificial sweetener erythritol linked to blood clots, study warns

Kate Graham Show

Sugar-free foods and beverages may not be the healthiest choice after all. Erythritol, an artificial sweetener used since the 1990s in everyday products from gum and candy to cookies and diet soda, is 70% as sweet as sugar but has far fewer calories. It’s also commonly mixed with stevia-based sweeteners to give it a sugar-like texture, bulk and sweetness. Although the Food and Drug Administration considers erythritol safe, in recent years experts have suggested that erythritol may have adverse effects on cardiovascular health. A study published this month suggests that erythritol may have adverse effects on cardiovascular health. Arteriosclerosis, thrombosis, vascular biology It has been found that erythritol may be associated with an increased risk of thrombosis, the formation of blood clots that block blood vessels.

The new study found significant changes in the platelets of all participants who drank the erythritol-containing beverage — tiny pieces of cells that circulate through the blood and collect around wounds to stop bleeding. These changes included an increased tendency for platelets to clump together, says study co-author Stanley Hazen, a physician and cardiovascular medicine researcher at the Cleveland Clinic. He says erythritol “increased the susceptibility of people and their platelets to clotting, which is consistent with all the data we’ve collected so far.”

Erythritol is chemically described as a “sugar alcohol.” Small amounts are naturally found in certain fruits and vegetables, and in fermented foods such as cheese and wine. The compound is also produced naturally in some cells of the human body. However, emerging evidence is emerging that consuming erythritol as a sugar substitute may pose health risks. The new study builds on a 2023 study by Hazen and a team from the Cleveland Clinic. In that study, plasma samples from more than 4,000 participants suggested an association between high levels of erythritol and increased incidence of heart attacks and strokes. “This is an unrecognized concern,” Hazen says. “In every cohort we looked at, high levels of erythritol correlated with increased risk of future (cardiovascular) events.”

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The new study looked more closely at erythritol’s effects in a small group of 20 healthy subjects. The researchers first examined each subject’s plasma to determine a baseline level of platelet clotting activity. Then, a group of 10 people drank 30 grams of erythritol (the average amount consumed by Americans per day, according to the FDA), while the other subjects consumed 30 grams of glucose (regular sugar). Thirty minutes later, the plasma was examined again to determine clotting activity. The subjects who consumed erythritol had a more than 1,000-fold increase in their blood erythritol levels, which significantly increased platelet clotting activity. No such changes were seen in subjects who consumed glucose.

“The data we currently have argues that moderate consumption of glucose-sweetened beverages is actually a safer choice than beverages sweetened with erythritol,” Hazen says.

Inadvertent clotting can cause major problems for blood vessels, leading to strokes, pulmonary embolism, heart attacks, and other complications. The research team has not yet identified the underlying mechanism by which erythritol appears to promote clotting. Hazen suspects it may have to do with “receptors on the platelet surface that interact with erythritol.” Such an interaction could change the way platelets process signals about when to clot.

While the recent findings have raised concerns about erythritol, other experts in the field believe more research is needed before the sweetener can be deemed “unsafe.”

“This study didn’t look at long-term exposure to erythritol in the diet,” says Duane Mellor, a British registered dietitian. “It looked at the metabolic effects of high doses in a beverage, and plasma levels minutes after ingestion.” Mellor believes it’s premature to directly link immediate increases in erythritol levels to long-term cardiovascular disease risk. “It’s a big extrapolation or leap from one to the other,” he says. Mellor adds that “diet is not the only source of erythritol,” and the new study doesn’t take into account erythritol produced by normal metabolic processes in the body.

Also, this recent study had a relatively small sample base, so larger human trials are needed to confirm the findings. Alice Lichtenstein, senior scientist and cardiovascular nutrition team leader at the Jean Mayer USDA Center for Aging and Human Nutrition Research at Tufts University, hopes that a broader, more comprehensive study of multiple sweeteners will “systematically compare different nonnutritive (or artificial) sweeteners to each other and to sugar.” Much of what researchers currently know is “putting different pieces of the puzzle together,” she says. She explains that different studies of sweeteners use different analytical methods or only consider effects piecemeal. For example, one sweetener may have been examined for the risk of heart attacks, while another may have only been tested for its effect on blood sugar levels. “Often, studies are not directly comparable,” she points out.

Hazen agrees that more research is needed on both the health effects of erythritol in the diet and possible safer alternatives. Overall, previous studies on the efficacy of sweeteners for weight loss and diabetes management have shown mixed results, he says. “Even the[World Health Organization]recommends avoiding artificial sweeteners because there isn’t enough evidence to support their efficacy,” Hazen says. Until there is more data, he remains cautious about erythritol. “As a physician who works with patients with diabetes and those at risk for thrombosis, I used to recommend artificial sweeteners,” he says. “Now I tell my patients, ‘Avoid artificial sweeteners until we know more.'”