Zero Calorie Sweetener Linked to Blood Clots Heart Disease

According to a recent pilot study authored Dr. Stanley Hazen, director of the Center for Cardiovascular Diagnostics and Prevention at the Cleveland Clinic Lerner Research Institute there could be severe health concerns about the safety of erythritol, an artificial sweetener commonly used in products like stevia and monk fruit, particularly in low-carb and keto diets.

The study found that erythritol more than doubled the risk of blood clotting in ten healthy individuals who consumed it, compared to those who consumed glucose.

Key Findings of the Study

Increased Platelet Activity: The study, led by Dr. Stanley Hazen at the Cleveland Clinic, found that erythritol consumption increased platelet activity, which is directly related to blood clotting. This was observed in all participants who consumed erythritol, whereas no such change was noted in those who consumed glucose.
Risk of Cardiovascular Events: Elevated erythritol levels have been associated with an increased risk of heart attacks and strokes. The study suggested that erythritol makes platelets more responsive to clotting signals, which can lead to increased blood clot formation and potentially severe cardiovascular events.
Erythritol Levels and Consumption: The study used a dosage of 30 grams of erythritol, which is similar to amounts found in some sugar-free sodas and desserts. This dosage led to significant increases in blood erythritol levels, which remained elevated for days, enough to affect platelet function.

Context and Implications

Previous Research: Earlier studies have also linked erythritol to higher risks of stroke and heart attack. A larger study involving over 4,000 individuals found that those with the highest erythritol concentrations were twice as likely to suffer from these events.
Industry Response: The Calorie Control Council, representing the sweetener industry, cautioned that the study’s findings should be interpreted carefully due to the small sample size and the high erythritol dosage used, which exceeds typical consumption levels in the U.S.
Need for Further Research: The findings highlight the need for more extensive and long-term studies to fully understand the cardiovascular risks associated with erythritol and other artificial sweeteners

According to reporting by CNN, the number of grams of erythritol used in each drink in the study was 30 grams —ie the equivalent of what is included in typical sugar-free sodas, or in ice creams and muffins. Concerns increase given the fact that most people often consume more than one, Hazen said.

“This research raises some concerns that a standard serving of an erythritol-sweetened food or beverage may acutely stimulate a direct clot-forming effect,” said study coauthor Dr. Wai Hong Wilson Tang, research director for heart failure and cardiac transplantation at the Cleveland Clinic, in a statement.

Other Artificial Sweeteners

Aspartame: Aspartame has been extensively studied and is generally considered safe by many health organizations, though it has faced controversy over potential links to cancer. However, these claims have not been conclusively proven. Aspartame is much sweeter than sugar and is used in smaller quantities.
Sucralose: Known under the brand name Splenda, sucralose is also much sweeter than sugar and has been considered safe. However, there are concerns about its potential to alter gut microbiota, which could have unknown health implications.
Other Sugar Alcohols (e.g., Xylitol): Like erythritol, other sugar alcohols can cause digestive issues when consumed in large amounts. However, erythritol is unique in its potential cardiovascular risks, which have not been observed with other sugar alcohols to the same extent.

Regulatory Status: Despite these concerns, erythritol is still classified as “Generally Recognized as Safe” (GRAS) by the FDA, similar to other artificial sweeteners. However, the recent findings suggest a need for more comprehensive studies to evaluate its long-term safety.

How the body metabolizes erythritol differently from regular sugar

Erythritol is metabolized differently from regular sugar (glucose) in the human body, which contributes to its unique properties as a sweetener.

Absorption and Metabolism of Erythritol

Absorption: Erythritol is absorbed in the small intestine but is not metabolized by the body. This means that it does not undergo the typical metabolic processes that convert sugars into energy.
Excretion: After absorption, erythritol is largely excreted unchanged in the urine. This is in contrast to glucose, which is metabolized into energy through glycolysis and other metabolic pathways.
Metabolization to Erythronate: A small portion of erythritol can be metabolized into erythronate, but this occurs in minimal amounts (less than 10%). This process is not significant enough to provide energy or affect blood sugar levels.

Comparison with Regular Sugar (Glucose)

Caloric Content: Erythritol provides almost no calories because it is not metabolized for energy, whereas glucose provides about 4 calories per gram.
Impact on Blood Sugar and Insulin: Erythritol does not raise blood sugar or insulin levels, making it a suitable sweetener for people with diabetes. In contrast, glucose significantly impacts blood sugar and insulin levels.
Digestive Effects: Because erythritol is not fully digested, it can pass into the colon and may cause digestive issues like bloating and diarrhea if consumed in large amounts. Glucose is fully metabolized and absorbed, typically not causing such issues unless consumed in excessive quantities.

Conclusion

The distinct metabolic pathway of erythritol, where it is not used for energy and is excreted unchanged, makes it a low-calorie alternative to sugar. However, the recent studies have raised concerns about potential cardiovascular risks such as increased platelet aggregation and blood clotting, which are not typically associated with glucose consumption. These findings suggest that while erythritol is beneficial for controlling blood sugar levels, its long-term health effects require further investigation.

Consumers, especially those with existing cardiovascular risk factors, may need to exercise caution with erythritol consumption until more conclusive evidence is available. More research is needed to fully understand these risks and to compare them definitively with those of other artificial sweeteners.

Insiders Health Tip

If you’re looking for healthy alternatives to erythritol, several natural sweeteners offer potential health benefits and can be used in various dietary contexts. Here are some of the best options:

1. Stevia

Source: Derived from the leaves of the Stevia rebaudiana plant.
Benefits: Stevia is a zero-calorie sweetener that does not raise blood sugar levels, making it suitable for people with diabetes. It may also help lower blood pressure in some individuals.
Considerations: Some people may find its taste to have a bitter aftertaste, and it can affect gut microbiome health in some cases.

2. Monk Fruit Sweetener

Source: Extracted from monk fruit, also known as luo han guo.
Benefits: Contains zero calories and does not impact blood sugar levels. It is often used in baking and cooking due to its heat stability.
Considerations: Monk fruit sweeteners can be expensive and may sometimes be mixed with other sweeteners like dextrose.

3. Xylitol

Source: A sugar alcohol found in many fruits and vegetables.
Benefits: Xylitol is known for promoting dental health by reducing the risk of cavities. It does not spike blood sugar or insulin levels.
Considerations: It can cause digestive issues like gas and diarrhea if consumed in large amounts, and it is toxic to dogs.

4. Yacon Syrup

Source: Derived from the root of the yacon plant.
Benefits: Acts as a prebiotic, supporting gut health by feeding beneficial bacteria in the gut.
Considerations: It is not as sweet as sugar and may not be suitable for all recipes.

5. Allulose

Source: A naturally occurring sugar found in small quantities in certain fruits.
Benefits: Allulose has minimal calories and does not raise blood sugar levels. It is known for its ability to dissolve well and is suitable for baking.
Considerations: It may cause digestive discomfort in some individuals, and it is banned in some countries due to insufficient research on its long-term safety.

6. Coconut Sugar

Source: Made from the sap of the coconut palm.
Benefits: Has a lower glycemic index compared to regular sugar, which means it may have a smaller impact on blood sugar levels.
Considerations: It still contains calories and should be consumed in moderation.

7. Raw Honey and Maple Syrup

Benefits: Both provide antioxidants and have prebiotic properties that support gut health. They also contain essential minerals like manganese and zinc.
Considerations: They are high in calories and should be used sparingly, especially for those managing blood sugar levels.

These alternatives can provide a range of health benefits while satisfying your sweet cravings. However, it’s important to consume all sweeteners in moderation as part of a balanced diet. See the websites where this information was found below,

https://www.healthline.com/nutrition/healthy-natural-sweeteners

https://www.usatoday.com/story/life/food-dining/2023/06/11/what-is-the-healthiest-sugar-substitute/70283021007/

https://www.health.com/best-and-worst-natural-sweeteners-8358131

https://health.clevelandclinic.org/best-and-worst-sugar-substitutes