CNN
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Consuming beverages containing erythritol, an artificial sweetener used to sweeten stevia, monk fruit or low-carb keto foods, more than doubled the risk of blood clots in 10 healthy people, according to a new pilot study.
A clot can break a blood vessel and travel to the heart, causing a heart attack, or travel to the brain, causing a stroke. Previous studies have shown that erythritol can increase the risk of stroke, heart attack, and death.
“What’s noteworthy is that all measures of platelet reactivity (clotting) increased in all subjects after erythritol ingestion,” said Dr. Stanley Hazen, director of the Center for Cardiovascular Diagnostics and Prevention at the Cleveland Clinic Lerner Research Institute and lead author of the study.
Drinking the same amount of a drink containing glucose, or sugar, had no effect on platelet activity in another group of 10 people, said Hazen, who is also the Jan Blakesma Professor of Vascular Cell Biology and Atherosclerosis at the Cleveland Clinic.
“This is the first direct comparison of the effects of glucose ingestion and erythritol ingestion on different measures of platelet function,” Hazen says. “Glucose doesn’t affect clotting, but erythritol does.”
Though small, the study is “very interesting and intriguing,” said Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver.
“We’re not saying that people need to immediately stop using these sugar alcohols, but this body of research certainly raises the question: are sugar alcohols safe?” said Freeman, who was not involved in the study.
In response to the study, the Calorie Control Council, an industry group, told CNN that 30 years of scientific research has proven erythritol “to be a safe and effective option” for reducing sugar and calories.
“Consumers should interpret the results of this study with great caution. The limited sample size – 10 participants total – was given excessive amounts of erythritol, nearly four times the maximum amount allowed in a single beverage in the United States,” the council’s president, Carla Sanders, said in an email.
But the amount of erythritol used in each drink in the study (30 grams) is comparable to the amount found in a typical unsweetened soda, ice cream or muffin, which people often eat one or more servings of, Hazen said.
“This study raises concerns that consuming standard amounts of foods and beverages sweetened with erythritol may acutely stimulate direct thrombogenic effects,” Dr. Wai Hong Wilson Tan, director of heart failure and heart transplant research at the Cleveland Clinic and co-author of the study, said in a statement.
Like sorbitol and xylitol, erythritol is a sugar alcohol, a carbohydrate found naturally in many fruits and vegetables. The human body also produces erythritol as a by-product of glucose metabolism, but in small amounts.
Erythritol, which is produced artificially in large quantities, has no aftertaste, does not spike blood sugar levels, and has less of a laxative effect than other sugar alcohols. Experts say that erythritol is about 70% as sweet as sugar, but has no calories.
Erythritol is the most prevalent ingredient in many “natural” stevia and monk fruit products, where it looks and tastes similar to sugar and can be used in baking, according to Hazen. It’s also a key ingredient in many ketogenic diet-friendly products, such as ice cream, he said.
“If you look at the nutritional facts labels of a lot of keto ice creams, they’ll say ‘reducing sugars’ or ‘sugar alcohols,’ which is erythritol,” he told CNN in a previous interview.
“A typical pint contains 26-45 grams.”
Artificially produced erythritol, along with its cousins, is considered “generally recognized as safe,” or GRAS, by the U.S. Food and Drug Administration.
In the new study, published Thursday in the journal Atherosclerosis, Thrombosis and Vascular Biology, 20 subjects were asked to fast overnight in preparation for a morning blood draw. They were then given a drink containing either 30 grams of erythritol or 30 grams of sugar. Thirty minutes later, their blood was drawn again.
“Erythritol levels in the blood rose 1,000-fold after drinking just one drink containing the substance, whereas blood sugar levels rose only slightly after drinking the drink containing glucose. But the surprising change was in the activity of platelets,” Hazen said.
“We saw enhanced clotting by measuring how quickly blood clots block blood vessels and stop blood flow, as in models of heart attack and stroke,” he said.
A 2023 study by Hazen and colleagues found similar results, finding that when eight healthy volunteers consumed the same amount of erythritol, their blood erythritol levels increased 1,000-fold.
“[Erythritol]remained elevated for the next two to three days, above the threshold needed to induce and increase the risk of clotting,” Hazen said at the time.
The study also analyzed the blood of more than 4,000 people from the United States and Europe and found that those with the highest levels of erythritol were twice as likely to suffer a heart attack or stroke.
“What we’re seeing with erythritol is that platelets become highly responsive. With just 10% of the stimulant, you’re producing 90% to 100% of the clot formation,” Hazen said.
Although the study was conducted on healthy people without chronic diseases, Hazen said the findings are applicable to the future.
“But when you look at middle-aged Americans, the average person has two to three risk factors for heart disease, and 70 percent of us will develop heart disease in our lifetime, so maybe we should all consider taking action,” he said.
When it comes to cardiovascular disease risk, he said, eating a small amount of sugary treats every now and then may be better than consuming drinks and foods sweetened with sugar alcohols. This is especially true for people who are at highest risk of blood clots, heart attacks and strokes, such as those with heart disease or diabetes.
“Cardiovascular disease progresses over time, and heart disease is the number one cause of death worldwide,” he said. “We need to make sure the foods we eat aren’t the hidden causes.”
