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Warning issued over sweetener erythritol after new study shows dangers
Erythritol is used as a zero-calorie sweetener, which can be problematic.
Fox – 2 Detroit
Erythritol, a popular sugar substitute found in ketogenic products, candy and low-calorie or no-calorie diet drinks, may increase the risk of heart attack and stroke, a new study suggests.
A study led by the Cleveland Clinic and published Thursday in the medical journal Arteriosclerosis, Thrombosis and Vascular Biology found that the sweetener made blood platelets more active, increasing the risk of blood clots, while foods sweetened with sugar did not have the same effect.
The study was small — it involved only 20 patients — and researchers who were not involved say people should be cautious when interpreting its results.
Erythritol is a zero-calorie sugar substitute used to sweeten hundreds of products, including protein bars, yogurt, cookies, and ice cream. It is a sugar-like thickening agent and the primary sweetener in the low-carb, high-fat ketogenic diet. In 2001, the Food and Drug Administration determined that erythritol was “generally recognized as safe.”
However, the researchers said that participants in the National Institutes of Health-funded study who drank erythritol-sweetened water showed signs that their blood platelets had been activated, while people who drank glucose-sweetened water did not experience a similar effect.
“After drinking an erythritol-sweetened beverage, you have an increased risk of clotting and your platelet function changes — and that was seen in all of the subjects tested,” said Stanley Hazen, MD, a cardiologist and chair of cardiovascular and metabolic sciences at the Cleveland Clinic’s Lerner Research Institute.
The findings follow a larger 2023 study, also led by Hazen, that linked the popular sugar substitute to cardiovascular problems. Last year’s study tested blood samples from more than 1,100 people who underwent a three-year cardiac risk assessment and followed another group of more than 2,100 non-emergency patients. The study linked erythritol to an increased risk of heart attack, stroke, and death. The study also found that the sweetener caused blood clots in mice that consumed it.
Sweetener vs Sugar
After his 2023 study, Hazen said people started asking his research team what types of sweeteners they should eat or drink instead of erythritol. His team wanted to compare the clotting risk of consumers who drank a liquid sweetened with erythritol or sugar.
The study involved 20 nonsmokers with normal kidney health and no history of heart disease, high blood pressure or diabetes. After an overnight fast, participants had blood tests before and 30 minutes after drinking water sweetened with 30 grams of glucose or erythritol. That dose is about the amount in an erythritol-sweetened soda or muffin and is equivalent to the daily intake based on a 2014 national survey and documents filed with the Food and Drug Administration, the researchers said.
Study participants who drank sugar water saw their average erythritol levels increase more than 1,000 times compared to their pre-drinking levels. The study also reported that participants showed a significant increase in blood clot formation after consuming erythritol. No such changes were seen in the glucose group.
The new study does not say how long consumers might face an increased risk of clotting after eating foods or drinking beverages containing a sugar substitute.
Instead of erythritol, Hazen advised consumers to opt for moderate amounts of natural sweeteners containing sugar, glucose, honey or fruit. Natural sweeteners do not put consumers at increased risk of clotting, “whereas we believe that will occur within days of ingesting erythritol,” he said.
Research ‘should not alarm consumers’
Researchers not involved in the study said consumers should not be alarmed by the study’s results.
Alice H. Lichtenstein is a professor and director of the Cardiovascular Nutrition Laboratory at Tufts University in Boston. She says the study should be read in the context of other reports on the topic, because no single study dictates policy.
“We don’t know enough about the overall effect of nonnutritive sweeteners compared to sugar to accurately assess their relative health effects,” Lichtenstein said.
Lichtenstein said there is a need to better assess how much sweetener people can safely consume. She added that the risks and benefits should be analyzed by comparing “non-nutritive” sweeteners to sugar based on factors such as body weight, dental health and heart risk.
She advised people to drink water and sparkling water and to limit the consumption of foods or drinks containing sugar or sweeteners.
“Whenever possible, choose whole foods in their natural state and use common sense,” Lichtenstein said.
Joanne Slavin, a professor in the department of food science and nutrition at the University of Minnesota-Twin Cities, said consumers should consider the risks and benefits of choosing alternative sweeteners.
“This study adds another piece to the puzzle, but it should not alarm consumers into thinking they are risking their health,” Slavin said. “Alternative sweeteners are easy to avoid, but they are helpful for diabetics and others who need to avoid digestible carbohydrates.”
Food industry defends erythritol
Food industry groups have criticized the Cleveland Clinic study, citing the limited number of participants and the amount of erythritol participants consumed.
The 10 study participants received a dose of erythritol two to three times higher than what’s typically found in an 8- or 16-ounce beverage sold in the United States, said Carla Saunders, president of the Calorie Control Council, a group that represents the low- and reduced-calorie food and beverage industry.
Saunders noted that the researchers measured erythritol levels only once after participants consumed the sugary drinks and that the study did not control for lifestyle factors that could have affected the results.
Since erythritol levels were measured before and 30 minutes after consumption, “there is no way to demonstrate any lasting effect of excessive consumption on any health outcome,” Saunders said.
The Calorie Control Council said more than 250 food and beverage manufacturers use erythritol as a sweetener in alcoholic beverages, snacks, pet foods and supplements.
“Consumers need to trust the science, and for 30 years, science has shown that erythritol is a safe and effective choice for reducing sugar and calories,” Saunders said.
But Hazen said his latest study was not “isolated” and that there was growing evidence of potential harm.
“I hope this will be a call to arms for more research on this topic, especially given the prevalence and ubiquity of erythritol as an artificial sweetener,” Hazen said.
