New Study Highlights Potential Cardiovascular Risks of Erythritol: Is Your Low-Calorie Sweetener Safe?

Erythritol, an acceptable low-calorie sugar alcohol sweetener, fails the litmus test for safety yet again with new evidence that seems to link it to cardiovascular diseases. Researchers from the Cleveland Clinic recently conducted a new study on erythritol, which is an artificial sweetener used often in foods promoted as ‘ketogenic,’ baked goods, and candies. Based on their research, they concluded that erythritol could be potentially damaging to the heart and circulatory system contrary to ordinary sugar (glucose). 
Although the study includes only a limited sample of patients, it can be considered as the first attempt to directly compare blood levels in patients who took erythritol and glucose. According to Dr. Stanley Hazen, a cardiologist at the Cleveland Clinic and the study's lead author, the results were stark: The sister compound, glucose did not cause any of the problems seen with erythritol. 
Erythritol is thus one of the many nonsugar sweeteners that are steadily appearing in low-calorie and sugar-free foods. Another similar substance is erythritol, sweetener which is a type of sugar alcohol that is said to possess a great taste and has almost one-third of calorie content of normal sugar. It is often blended with other natural sweeteners such as stevia and conversely, xylitol is used in things like gum, mouthwash or toothpaste. 
More recent research done in Hazen’s lab, one study done last year and another done in June, had pointed towards sugar alcohals and the possibility of upping the risk of heart attacks and strokes. The earlier research, which has been discussed above, established that sugar alcohols could raise the platelet stickiness and hence make blood clot earlier; this condition can lead to the blockage of veins or arteries, a situation that causes heart attack or stroke. 
In this most recent study, Hazen and his partners wanted to expand on these concerns by examining the possible differences between the cardiovascular impacts of erythritol and standard sugar, glucose. The research sample consisted of two groups of healthy middle-aged men and women of White Caucasian origin. Each group consisted of 10 participants: in one group, the subjects consumed erythritol while in the other group they consumed glucose. 

Before the experiments, the participants avoided food ingestion and the blood samples were taken in the morning to determine the platelet activity. Next, the volunteers consumed a beverage with either glucose or erythritol dissolved in water at a rate of 30 grams. Hazen also stressed that this quantity is relative to the erythritol that normally occurs in foods that are sweetened with this sugar alcohol. 

After half an hour, both the participants were requested to get their blood samples retested, following which they had their blood samples retested. The outcomes showed that the subjects who consumed erythritol respectively had their platelet aggregation ratios higher meaning their blood clotted more often. However, using the glucose-sweetened water the same subjects did not experience increase in platelet aggregation. 

A four-fold increase of blood erythritol levels were recorded by the researchers in the group that consumed erythritol which even shocked Hazen. Speaking of the levels, he stated that they were significantly higher than the traces of erythritol presence in the blood. ”The amount component present in sugar substitutes is thousands of times more than the natural production of compounds that our body synthesizes,” Hazen elaborated. Thus, referring to it as ‘natural’ must be blown off. Our advice is that one should steer clear of these sugar surrogates, much more sugar alcohols, as their consumption raises one’s propensity to clot dramatically. 

Even if currently the FDA approved artificial sweeteners such as erythritol and xylitol as GRAS or Generally Recognized As Safe, Hazen still expects that with more evidence coming, the FDA may reconsider data on these sugar alcohols. 
Thus, while concerns regarding erythritol intake are not unique to the USA only, For example, last year the European Food Safety Authority (EFSA) advised that the European Commission seek data on the exposures of erythritol in available foods with a view of helping to establish its risks. 

The question arises: that is, whether erythritol is worse than high-calorie sugar? Cleveland Clinic delegates’ study was corroborated by Valisa Hedrick, a registered dietitian at Virginia Tech, where he noted that diets that include many sugary foods increase blood glucose concentration, which causes strokes and clotting risks. To conclude, Hedrick admitted that the Cleveland Clinic study has certain flaws. However, the given study involved a limited number of participants and only investigated the consequences of the test compounds – erythritol and glucose, at a single time point – before and immediately after the consumption of sorbillylle instead of sorbitol. 

Furthermore, the quantities of glucose administered in research amounts to 120 calories of sugar barely detectable by the taste buds. However, sodas, juices and most other beverages are routinely with much higher proportions of sugar. For example, a 12-ounce can of Coca-Cola provides for approximately 39 grams of sugar which is slightly higher amount that 46 grams of sugar contained in Mountain Dew. 

Michael Goran from the University of Southern California Keck School of Medicine jumped into the discussion and proposed that perhaps, it is also essential to compare erythritol to both fructose and glucose. He pointed out that the consumption of fructose and glucose together is closer to what people take from sodas and juices than the consumption of glucose alone. Goran was not a member of the new study. 
The Cleveland Clinic study focused exclusively on glucose, and while it did not identify any negative effects from glucose consumption, the researchers were cautious in their conclusions. They emphasized that the data does not imply that sugar is harmless. Higher amounts of sugar could potentially produce similar platelet effects, particularly in individuals with diabetes who struggle to manage elevated blood glucose levels effectively.

Hazen's study specifically targeted healthy individuals, excluding those with diabetes. Dr. Michelle Pearlman, a gastroenterologist and CEO of the Prime Institute in Miami, suggested that it might also be important to investigate whether the cardiovascular effects of erythritol differ when consumed in food versus in water. She noted that factors such as protein, fat, fiber, and other nutrients might influence the body’s response.

Ultimately, the new study highlights the need for further research comparing the health effects of various sweeteners with those of sugar. Hazen and his colleagues concluded their research by calling for additional studies to investigate the potential cardiovascular risks associated with erythritol, particularly in individuals who are already at a higher risk of strokes and clotting.