Common sweetener erythritol linked to higher risk of stroke, heart attack

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A common sweetener can significantly increase cardiovascular risk, according to a new study. Image credit: PatriciaEnciso/Getty Images.
  • Researchers investigated the link between the common artificial sweetener erythritol and cardiovascular risk.
  • They found that erythritol is linked to increased cardiovascular risk.
  • More studies are needed to confirm the results.

Individuals with metabolic problems such as type 2 diabetes and obesity are often advised consume products that replace sugars with artificial sweeteners to improve blood sugar levels and facilitate weight loss.

However, there are no long-term clinical trials examining the safety of most sweeteners. Some studies suggest that certain sweeteners may be linked to weight gain, cardiovascular diseaseIt is Type 2 diabetes.

Erythritol is a commonly used artificial sweetener. While naturally present in small amounts in fruits and vegetables, it is often added to processed foods in amounts 1,000 times greater.

Although some studies show that erythritol may have antioxidant effects in animal models of diabetes, others show that it may be linked to increased weight gain in college students and the onset of Type 2 diabetes.

Further study of the effects of erythritol on cardiometabolic risk may inform healthy eating practices.

Recently, researchers have examined the link between erythritol consumption and cardiovascular risk.

They found that erythritol consumption increases cardiovascular risk, including the risk of heart attack or stroke, thrombosis (blood clotting) and death related to a cardiovascular event.

The results appear in Nature.

Dr. John Alan Galat, a cardiac surgeon at Novant Health in Charlotte, NC, not involved in the study, commented on his findings to medical news today. According to him:

“This article [makes] a compelling argument that one of the most common sugar substitutes – erythritol – may well increase the risk of heart attack and stroke. [The authors nevertheless] admits that much more research needs to be done. The important question is whether the benefits of reducing sugar and caloric intake outweigh the risk of consuming products with these sugar substitutes.”

The researchers first analyzed blood samples from 1,157 participants. They found several compounds linked to cardiovascular risk. However, erythritol had some of the strongest links to the risk of cardiovascular events.

Next, the researchers analyzed blood samples from 2,149 US participants and 833 European participants. Plasma erythritol levels were higher among participants with cardiovascular disease.

They also found that participants in the US and European cohorts with the highest 25th percentile blood erythritol levels were 2.5 and 4.5 times more likely to have a cardiovascular event than those in the lowest 25th percentile.

Each micromole increased erythritol levels were associated with a 21% and 16% increase in the risk of cardiovascular events in the US and European cohorts, respectively.

Then researchers began to see how erythritol affected blood clotting. Through various tests, they found that increased levels of erythritol indicated higher rates of clot formation and increased potential for thrombosis.

Finally, researchers examined the effects of consuming a snack or beverage containing 30 grams (g) of erythritol on eight participants. Although erythritol levels were low at first, they remained 1,000 times higher for hours after ingestion.

“It is important that more safety studies be conducted to examine the long-term effects of artificial sweeteners in general, and erythritol specifically, on heart attack and stroke risks, particularly in people at increased risk of cardiovascular disease,” notes the report. senior author Dr. Stanley Hazen, chairman of the Department of Cardiovascular and Metabolic Sciences at the Lerner Research Institute and co-chair of the Preventive Cardiology Section at Cleveland Clinic.

To understand how erythritol can increase the risk of heart attack and stroke, MNT talked with Dr. Rigved Tadwalkar, a board-certified cardiologist at Providence Saint John’s Health Center in Santa Monica, CA, who was not involved in the study.

He noted that erythritol facilitates the mechanisms necessary for platelet aggregation and thrombosis, which are essential for the development of heart attack or stroke.

“As cardiovascular disease is a more complex process than just platelet aggregation, it is possible that erythritol causes other pathophysiological changes at the molecular level to increase the risk of a cardiovascular event. To complicate matters, it appears that consuming foods sweetened with erythritol increases plasma levels of erythritol for days, potentially prolonging cardiovascular effects.”

dr. Rigveda Tadwalkar

Dr. John Hwa, a professor of cardiology at the Yale School of Medicine who was not involved in the study, also said MNT that indirect mechanisms by which erythritol increases cardiovascular risk may include effects on the microbiome and on nutrient absorption and metabolism.

“While compelling, the studies are preliminary and the results indicate an association between erythritol and heart attacks and strokes rather than a causal relationship,” noted Dr. Hwa.

“Long-term studies are needed, measuring both erythritol levels and markers of platelet activation in the same patients, particularly those who have had heart attacks and strokes,” he added.

The Doctor. Tadwalkar further warned that although “[a]Adjustments were made in this study for traditional risk factors that are known to be implicated in cardiovascular disease, including age, smoking, blood pressure and cholesterol levels. […] It is possible that unmeasured confounders could be present, such as diet, which could have affected the results.”

“Nutritional metabolism is complex and sometimes unpredictable,” Dr. Hwa. “Although erythritol is a natural substance and produced in some cells in the body, if taken in excess it can lead to platelet dysfunction.”

“If proven with further studies, caution should be exercised in patients at cardiovascular risk who may already be prone to ‘extra sticky’ platelets, such as [people with diabetes]. Consultation with one’s physician may be required before considering erythritol,” he noted.

MNT also spoke with Dr. Yu-Ming Ni, a noninvasive cardiology cardiologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA, who was not involved in the study.

Commenting on the findings, he noted that “[w]We cannot say with certainty that erythritol is the cause of the increase in heart disease unless this finding can be replicated in larger studies.”

“At this time, it is unclear whether it is necessary to stop all consumption of artificial sweeteners,” said Dr. Ni.

“I often advise my patients to eat foods as naturally as possible, as this reduces [the] risk of exposure to potentially harmful chemicals such as artificial sweeteners, and consider sugar substitutes if they serve as a means of helping overweight people with weight loss, as overall weight loss has clearer evidence of health improvements ”.

– Dr. Yu-Ming Ni

Common sweetener erythritol linked to higher risk of stroke, heart attack

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