The sweetener erythritol, which is increasingly used in the food industry, increases the tendency of blood to form clots and increases the risk of stroke and heart attack in people with poor cardiovascular health, according to research that has analyzed data from more than 4,000 patients from the United States and Europe.
The authors of the work demand that the effects of erythritol and other sweeteners on health be further investigated. “Although generally considered safe, little is known about the long-term health effects of sweeteners,” the researchers write in Nature Medicine, where they are presenting their results today.
Erythritol provides zero calories and tastes very similar to sugar, which is why it has become an increasingly used sweetener in the food industry in recent years. After having perfected its production from the fermentation of corn, its market share among sweeteners is expected to double in the next five years, the authors of the research point out.
Since it does not increase the level of sugar in the blood or provide calories, until now it has been considered suitable for people with obesity and/or diabetes. But the researchers found, in a first analysis of 1,157 patients who had undergone cardiology check-ups, that the number of strokes, heart attacks, and deaths from cardiovascular causes in the following three years was higher among those who ingested more erythritol.
Specifically, three times as many cardiovascular events were recorded in the 25% of patients who consumed higher amounts of erythritol than in the 25% who consumed lower amounts.
The increased risk was found to be independent of other cardiovascular risk factors in the patients, who had a mean age of 65 years at the start of the study. This suggested that the patients were not consuming more erythritol because they were at higher risk, but were at higher risk because they were consuming more erythritol.
From there, the association between erythritol and cardiovascular risk was investigated in two other groups of patients: a sample of 2,149 patients from the United States and another of 833 patients from Europe. Again, the risk was found to be significantly higher among people who drank a higher amount of the sweetener.
This increased risk, warn the authors of the research, has been observed in people who already had a high cardiovascular risk, so the results cannot be extrapolated to the general population.
Since erythritol passes from the digestive tract into the blood and is excreted in the urine, the researchers reasoned that its cardiovascular effect must occur when it was circulating in the blood. Experiments carried out in the laboratory with human blood samples showed that erythritrol increases the adhesion of platelets and, from there, the tendency of the blood to form clots.
Subsequent experiments with mice confirmed that when erythritol in the blood increases, more thrombi form in the animals’ circulatory system.
Finally, the researchers examined the erythritol levels in the blood of eight volunteers after ingesting 30 grams of erythritol – the usual amount in a can of beverage. “Plasma erythritol levels remained substantially elevated for more than two days in all participants,” they report in Nature Medicine. “The elevation of the erythritol level remained well above concentrations that impair platelet function.”
Foods sweetened with erythritol include -in addition to beverages- baked goods, pastries, chocolates, candies and chewing gum. It is also found naturally in small amounts in fruits such as -among others- grapes, peaches and watermelons, as well as in fermented foods such as cheeses and beers, which is why it is considered a natural sweetener. Even the human body produces erythritol naturally, although the amount ingested with food is much higher.
“Its long-term effects need to be investigated further,” Stanley Hazen, director of the research, said in a statement from the Cleveland Clinic. “Cardiovascular disease progresses over time. We have to make sure that the food we eat doesn’t contribute to it in hidden ways.”
Previous studies had suggested that other sweeteners such as saccharin, sucralose or aspartame increase cardiovascular risk instead of reducing it, although their results were not considered conclusive. New research on erythritol provides data from more patients and clarifies why this particular sweetener increases cardiovascular risk.
“After ingesting erythritol, there may be a prolonged period of elevated risk of thrombosis,” conclude the researchers in Nature Medicine, who urge further study “the effects of erythritol in particular and of sweeteners in general. (…) It is worrying because the people for whom sweeteners are marketed are the ones with the highest risk of future cardiovascular accidents”.
