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In findings published in Nature Medicine, researchers studied more than 4,000 people in Europe and the United States. They found that people with higher blood levels of erythritol were at high risk of experiencing a major adverse cardiac event such as heart attack, stroke, or death.
“Sweeteners like erythritol have grown rapidly in popularity in recent years, but more research is needed on their long-term effects,” said lead author Stanley Hazen, chair of the Department of Cardiovascular and Metabolic Sciences at Lerner Research Institute. . “Cardiovascular disease develops over time and heart disease is the leading cause of death worldwide. We need to make sure the foods we eat are not hidden contributors.
Erythritol occurs naturally in a variety of foods, such as pears and watermelons, but in recent years it has increasingly become a common ingredient in low calorie foods as a sugar replacement sweetener. Artificial sweeteners, such as erythritol, commonly replace table sugar in low-calorie, low-carb, and “keto” products.
What explains the association with an elevated risk of heart attack or stroke? Erythritol is about 70% as sweet as sugar and is produced by the fermentation of corn. After ingestion, erythritol is poorly metabolized by the body. Instead, it goes into the bloodstream and leaves the body primarily through urine. The human body naturally creates low amounts of erythritol, so any additional consumption can build up, according to the study.
This finding echoes a 2017 study that identified erythritol as a biomarker for increasing fat mass. Contrary to previous assumptions and research, this study revealed that erythritol can be metabolized by the human body and even produced in it.
The researchers found that students who had gained weight and belly fat over the year had fifteen times more blood erythritol at the start of the year than their counterparts who were stable or who had lost weight and body fat over the academic year.
But clinical observational studies demonstrate association, not causation
Sugar-free products containing erythritol are often recommended for people with obesity, diabetes, or metabolic syndrome looking for options to help manage their sugar or calorie intake.
However, people with these conditions are also at higher risk for adverse cardiovascular events such as heart attacks and strokes. This fact was seized upon by the Calorie Control Council (CCC), the international association representing the low-calorie and reduced-calorie food and beverage industry, in response to this latest research on erythritol.
Erythritol is incorrectly labeled as an artificial sweetener because it occurs naturally in a variety of fruits and can also be produced by the human body from glucose, the CCC pointed out. In addition to the observational design, the untargeted and targeted metabolomics analyzes included people who were already at increased risk for adverse cardiovascular events.
“The results of this study are contrary to decades of scientific research showing that low-calorie sweeteners like erythritol are safe, as evidenced by global regulatory approvals for their use in food and beverages, and should not be extrapolated to the general population, as participants in the intervention were already at an increased risk of cardiovascular events,” said CCC CEO Robert Rankin.
Additionally, in vitro studies cannot mimic the complex physiological environment of the human body that includes absorption, metabolism and excretion, the CCC asserted. Finally, he says, since most commercial products containing erythritol typically contain a small amount, usually mixed with other sweeteners, the intervention where subjects were asked to consume 30g of erythritol dissolved in 300 ml of water in two minutes does not reflect a true- world serving.
For more than 30 years, erythritol has been commercially produced and added to foods and beverages to provide sweetness, as well as improve taste and texture. In addition to providing zero calories, erythritol is well tolerated, does not affect blood glucose or insulin levels, and does not cause dental caries.
The safety of erythritol as a food ingredient under the conditions of its intended use is supported by a number of human and animal safety studies, including short-term feeding studies. and long-term, multi-generational reproduction and teratology. The Joint WHO/FAO Expert Committee on Food Additives (JECFA) reviewed the safety of erythritol in 1999 and established an ADI “not specified”, the highest possible safety category. Its use in food has already been approved in more than 50 countries, including Canada, the United States, Brazil, Mexico, Australia and the European Union, and petitions have been submitted to other agencies. governments around the world to expand the use of erythritol.
“Erythritol is a proven safe and effective choice for sugar and calorie reduction and for over 30 years it has been used in reduced sugar foods and beverages to provide sweetness, as well as to improve their taste and texture,” Rankin added. “Along with exercise and a healthy diet, low-calorie sweeteners are an essential tool that can help consumers manage their body weight and reduce the risk of non-communicable diseases, such as cardiovascular disease.”
The authors of the latest study noted that it had several limitations, including that clinical observational studies demonstrate association, not causation. They insisted that long-term safety studies on erythritol are still needed, despite its approval as safe for use in food in the EU and US.
“Our study shows that when participants consumed an artificially sweetened beverage with an amount of erythritol present in many processed foods, markedly elevated levels in the blood were seen for days on end – levels well above those seen to increase clotting risks,” Dr. Hazen said. “It is important that further safety studies be conducted to examine the long-term effects of artificial sweeteners in general, and erythritol in particular, on the risk of heart attack and stroke, particularly in people at higher risk of cardiovascular disease.”
The references
Cleveland Clinic study finds common artificial sweetener linked to higher rates of heart attack and stroke
LOG
natural medicine
DOI: 10.1038/s41591-023-02223-9
Common sweetener in low calorie foods also a marker of weight gain
CORNELL UNIVERSITY
LOG
Proceedings of the National Academy of Sciences
DOI: 10.1073/pnas.1620079114
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