CNN: Zero-calorie sweetener (erythritol) linked to heart attack and stroke, study finds

This sweetener was just mentioned on the forum a day or two ago. So when I saw this article I thought I'd post it here.

Fair warning, I have not looked at the study and don't have the ability to analyze it to see how accurate this CNN article is.

https://www.cnn.com/2023/02/27/health/zero-calorie-sweetener-heart-attack-stroke-wellness/index.html

 

Stevia users are presumably sweet-toothed people who have cause for concern about their weight or other risk factors, so there are a host of possible correlates involved.

 

I would assume that being vegan would considerably reduce the risk, as I believe that veganism reduces clotting risk.

"Additional lab and animal research presented in the paper revealed that erythritol appeared to be causing blood platelets to clot more readily."

Animal research is extremely unreliable.

"the participants in the intervention were already at increased risk for cardiovascular events,” Rankin said."

"Oliver Jones, a professor of chemistry at RMIT University in Victoria, Australia, noted that the study had revealed only a correlation, not causation.

“As the authors themselves note, they found an association between erythritol and clotting risk, not definitive proof such a link exists,” Jones, who was not involved in the research, said in a statement.

“Any possible (and, as yet unproven) risks of excess erythritol would also need to be balanced against the very real health risks of excess glucose consumption,” Jones said."

 

Nature: The artificial sweetener erythritol and cardiovascular event risk

Abstract

"Artificial sweeteners are widely used sugar substitutes, but little is known about their long-term effects on cardiometabolic disease risks. Here we examined the commonly used sugar substitute erythritol and atherothrombotic disease risk. In initial untargeted metabolomics studies in patients undergoing cardiac risk assessment (n = 1,157; discovery cohort, NCT00590200), circulating levels of multiple polyol sweeteners, especially erythritol, were associated with incident (3 year) risk for major adverse cardiovascular events (MACE; includes death or nonfatal myocardial infarction or stroke). Subsequent targeted metabolomics analyses in independent US (n = 2,149, NCT00590200) and European (n = 833, DRKS00020915) validation cohorts of stable patients undergoing elective cardiac evaluation confirmed this association (fourth versus first quartile adjusted hazard ratio (95% confidence interval), 1.80 (1.18–2.77) and 2.21 (1.20–4.07), respectively). At physiological levels, erythritol enhanced platelet reactivity in vitro and thrombosis formation in vivo. Finally, in a prospective pilot intervention study (NCT04731363), erythritol ingestion in healthy volunteers (n = 8) induced marked and sustained (>2 d) increases in plasma erythritol levels well above thresholds associated with heightened platelet reactivity and thrombosis potential in in vitro and in vivo studies. Our findings reveal that erythritol is both associated with incident MACE risk and fosters enhanced thrombosis. Studies assessing the long-term safety of erythritol are warranted."

New Scientist article:
Artificial sweetener erythritol linked to heart attacks and strokes

"A commonly used sweetener called erythritol has been linked with a higher rate of heart attacks and strokes.
The claim comes after researchers spotted a correlation between cardiovascular problems and the concentration of erythritol in the blood. It is supported by laboratory work on animals, and by tests on human blood samples that show the sweetener can make blood clots more likely." Full story at link.

 

Couild it be that erythritol users are more likely to be overweight, therefore having greater cardiovascular risk?

 

For those worried about using sweeteners that contain erythriol:

From the NS article:

"As what is termed “observational research”, the studies didn’t prove that erythritol was causing the higher risk – something else could explain the correlation. So the team then explored the effects of erythritol on blood, as both heart attacks and strokes can be caused by the formation of blood clots."

"When eight volunteers considered at low risk of heart attack or stroke consumed food and drinks containing 30 grams of erythritol – such as half a litre of low-carb ice cream – their blood levels of the sweetener jumped from about 4 micromoles (a measure of concentration) to about 6000 micromoles, and remained high for several hours."

"But Duane Mellor, a spokesperson for the British Dietetic Association, says most people wouldn’t be eating high enough quantities of it to reach the levels tested for clotting effects in this study. Mellor says the findings should not cause people to stop consuming food and drinks with the sweetener. “We need to reduce our sugar intake,” he says."

My bold - and half a litre of ice cream !!!

 

Half a litre of ice cream is not a large amount for me to consume.

My understanding is that it's not a lot for anyone with control over access to consume.

However I am puzzled as to how something marketed as zero calories, due to being indigestible, manages to get into the blood stream.

 

I think half a liter of ice cream is roughly the size of a pint container. (someone please correct me if I've screwed this up!)

That's the small size often sold in stores.

The label on most pints have a suggested serving size of 1/2 cup (100 grams) = 4 servings in a pint. But many folks tend to eat larger servings than that.

I've never eaten a full pint (I think my largest serving would be 1/2 pint at the very most) but I have several friends who have complained that they can easily eat a pint of ice cream straight from the carton, as seen in this photo.

 

I wonder about xylitol? That’s a sugar alcohol too. It’s good for your teeth as it inhibits bacterial adhesion, but is it molecularly similar to erythritol and would the same concerns apply?

 

I think the stevia is okay so far as we know, just the erythritol that’s almost just used as a bulking agent in this case has been flagged up for concern.

I just use micro doses of stevia to sweeten cocoa for a hot chocolate drink and add some coconut plant milk, tastes delicious!

 

I use approximately half a teaspoon of Truvia as it's so sweet. I just checked the ingredients; unfortunately, it's stevia mixed with erythritol.

Plain stevia might be the better option.

 

I avoid xylitol as much as possible as it's toxic to dogs. Really seriously toxic. But erythritol isn't, so they must have an important difference.

 

I'm not sure about the other sweeteners but I have some diabetic people in my family and when I baked/cooked for them, I used xylitol, as you can substitute sugar 1:1 with it, so baking with it is less complicated. And ugh, xylitol is also a biological weapon in larger amounts, ehehe. (Namely it gives you diarrhea.) It is not necessarily obvious in a cake but we have some sweet soups here and the effect is quite strong in those. One needs to be careful with these sweeteners on many levels.

 

Reactions from experts collected by the Science Media Centre (SMC): https://www.sciencemediacentre.org/...erythritol-and-cardiovascular-disease-events/