A new study from the Cleveland Clinic suggests that the widely used artificial sweetener erythritol may increase the risk of cardiovascular disease by promoting blood clots, casting doubt on its safety and requiring further long-term studies.
Erythritol, a common artificial sweetener, is found in baked goods, beverages, gum, and candy.
A recent study from the Cleveland Clinic suggests that consuming foods containing erythritol, a widely used artificial sweetener, may increase the risk of cardiovascular diseases such as heart attack and stroke. The study, conducted in healthy volunteers, found that erythritol increases the activity of platelets (blood cells involved in blood clotting) and increases the likelihood of blood clots. This effect was not seen with sugar (glucose).
The study, published in the journal Atherosclerosis, Thrombosis & Vascular Biology, adds to growing evidence that erythritol may not be as safe as it is currently classified by food regulators and should be reevaluated as an ingredient. The study was conducted by a team of researchers at the Cleveland Clinic as part of a series of investigations into the physiological effects of common sugar substitutes.
“Many professional societies and clinicians routinely recommend that people at high risk for cardiovascular disease, including those with obesity, diabetes and metabolic syndrome, consume foods containing sugar substitutes rather than sugar,” said senior corresponding author Stanley Hazen, MD, director of Cardiovascular and Metabolic Sciences and co-director of Preventive Cardiology at the Lerner Research Institute at the Cleveland Clinic. “These findings highlight the importance of further long-term clinical studies to evaluate the cardiovascular safety of erythritol and other sugar substitutes.”
Erythritol and other artificial sweeteners are often used as sugar substitutes in low-calorie, low-carb, and “keto” products. Erythritol is about 70% as sweet as sugar and is produced by fermenting corn. After ingestion, erythritol is not metabolized much in the body. Instead, it enters the bloodstream and is primarily excreted from the body through urine. The human body naturally produces small amounts of erythritol, so it can build up if consumed in excess.
Regulatory Status and Recent Research
Erythritol is classified as a GRAS (“Generally Recognized as Safe”) ingredient by the U.S. Food and Drug Administration and the European Food Safety Authority and has no restrictions on its use in food, primarily because it is a sugar alcohol found naturally in fruits and vegetables and, in small amounts, as a by-product of glucose metabolism in human tissues.
However, a recent study by Dr. Hazen’s group found evidence that commonly consumed amounts of erythritol may increase the risk of cardiovascular disease.
The current study builds on the team’s previous work, published in Nature Medicine last year, which found that heart disease patients with high erythritol levels were twice as likely to suffer a major heart attack over the next three years compared to patients with low erythritol levels. The study also found that adding erythritol to patients’ blood or platelets increased the formation of blood clots. These findings were confirmed by preclinical studies.
This new human intervention study was designed to more directly observe the effects on platelets after consuming erythritol in amounts typically found in “sugar-free” sodas and muffins. In 20 healthy volunteers, researchers found that the average erythritol concentration after a meal increased by more than 1,000-fold compared to initial levels in the erythritol-consuming group. The results also revealed that participants experienced a significant increase in blood clot formation after consuming erythritol, but no change was observed after consuming glucose.
“This study raises concerns that consuming standard amounts of foods and beverages sweetened with erythritol may acutely stimulate direct prothrombotic effects,” said WH Wilson Tang, M.D., director of heart failure and cardiac transplant medicine research at Cleveland Clinic and co-author of the study. “Erythritol and other sugar alcohols commonly used as sugar substitutes need to be evaluated for possible long-term health effects, especially when such effects are not seen with glucose itself.”
Concerns and Recommendations
He added that the findings are particularly noteworthy because they come on the heels of another recent study by the same research group that found similar increases with xylitol, another common artificial sweetener. plasma It similarly affected platelet aggregation in healthy volunteers. Like erythritol, research on xylitol has also included large observational studies that have demonstrated that high levels of xylitol are associated with an increased risk of heart attack, stroke, or death over the next three years.
The authors note that further clinical studies evaluating the long-term cardiovascular safety of erythritol are needed.
“People at high risk of thrombosis, especially those with heart disease, diabetes or metabolic syndrome, are better off choosing small amounts of sugary treats every now and then rather than consuming drinks or foods sweetened with sugar alcohols,” advises Dr Hazen. “Cardiovascular disease progresses over time and heart disease is the number one cause of death worldwide, so we need to make sure the foods we eat aren’t hidden causes.”
This study is part of Dr. Hazen’s continuing investigation into factors that contribute to residual cardiovascular risk. His team follows patients longitudinally to discover chemical signatures in their blood that can predict future development of cardiac and metabolic disease. He has made pioneering discoveries in the study of atherosclerosis and inflammatory diseases, including the breakthrough discovery linking gut microbial pathways to inflammatory disease. Cardiovascular disease and metabolic diseases.
Reference: “Ingestion of the nonnutritive sweetener erythritol, but not glucose, increases platelet reactivity and likelihood of thrombosis in healthy volunteers,” Marco Witkowski, Jennifer Wilcox, Valesha Province, Zeneng Wang, Ina Nemet, W. H. Wilson Tang, Stanley L. Hazen, August 8, 2024, Arteriosclerosis, Thrombosis, and Vascular Biology.
DOI: 10.1161/ATVBAHA.124.321019
Dr. Hazen also serves as director of the Center for Microbiome and Human Health at Cleveland Clinic and is the Jan Bleeksma Professor of Vascular Cell Biology and Atherosclerosis.
This study National Institutes of Health and the Office of Dietary Supplements.
Disclosure: Dr. Hazen is listed as a co-inventor on pending and issued patents held by Cleveland Clinic related to cardiovascular diagnosis and treatment.
