Consumption of popular artificial sweetener, erythritol, is associated with an increased risk of heart attack and stroke, according to a study which calls for further safety research to examine the long-term effects of such products.
Researchers at Cleveland Clinic studied over 4,000 people in the US and Europe and found those with higher blood erythritol levels were at elevated risk of experiencing a major adverse cardiac event such as heart attack, stroke or death.
They also examined the effects of adding erythritol to either whole blood or isolated platelets, which are cell fragments that clump together to stop bleeding and contribute to blood clots.
The study, published in the journal Nature Medicine, found that erythritol made platelets easier to activate and form a clot. Pre-clinical studies confirmed ingestion of erythritol heightened clot formation.
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Artificial sweeteners are present in thousands of food and beverage brands worldwide, however they remain a controversial topic and are currently being re-evaluated by the European Food Safety Authority, the World Health Organization, and other health agencies.
The findings from a large-scale study published in the British Medical Journal in September last year found a potential direct association between higher artificial sweetener consumption, especially aspartame, acesulfame potassium, and sucralose, and increased cardiovascular disease risk.
”Sweeteners like erythritol have rapidly increased in popularity in recent years but there needs to be more in-depth research into their long-term effects,” said senior study author Stanley Hazen, co-section head of Preventive Cardiology at Cleveland Clinic.
”Cardiovascular disease builds over time, and heart disease is the leading cause of death globally. We need to make sure the foods we eat aren’t hidden contributors,” Hazen said in a statement.
Artificial sweeteners, such as erythritol, are common replacements for table sugar in low-calorie, low-carbohydrate and “keto” products. Sugar-free products containing erythritol are often recommended for people who have obesity, diabetes or metabolic syndrome and are looking for options to help manage their sugar or calorie intake.
People with these conditions also are at higher risk for adverse cardiovascular events like heart attack and stroke.
The researchers noted that erythritol is about 70 per cent as sweet as sugar and is produced through fermenting corn. After ingestion, erythritol is poorly metabolised by the body.
Instead, it goes into the bloodstream and leaves the body mainly through urine. The human body creates low amounts of erythritol naturally, so any additional consumption can accumulate.
Measuring artificial sweeteners is difficult and labelling requirements are minimal and often do not list individual compounds.
Erythritol is “Generally Recognised As Safe (GRAS)” by the US FDA, which means there is no requirement for long-term safety studies. The authors of the latest study note the importance of follow-up research to confirm their findings in the general population.
The study had several limitations, including that clinical observation studies demonstrate association and not causation.
”Our study shows that when participants consumed an artificially sweetened beverage with an amount of erythritol found in many processed foods, markedly elevated levels in the blood are observed for days — levels well above those observed to enhance clotting risks,” said Hazen.
”It is important that further safety studies are conducted to examine the long-term effects of artificial sweeteners in general, and erythritol specifically, on risks for heart attack and stroke, particularly in people at higher risk for cardiovascular disease,” Hazen added.