Study links sweetener erythritol to increased risk of heart issues; industry group questions methodology

02-Mar-2023 - Last updated on 02-Mar-2023 at 14:37 GMT

Source: Getty/Bill Boch

Artificial sweeteners have gained in popularity as consumers seek out products without sugar, but a new study suggests a potential link between keto-friendly sweetener erythritol and an elevated risk of heart attack or stroke.

However, the alternative sweeteners industry finds fault in the study’s methodology, pointing out that researchers did not take into consideration study subjects’ inherent increased cardiovascular risk factors or overall diet and exercise.

Published in the journal Nature Medicine, the study examined more than 4,000 people in the U.S. and Europe and found that subjects with higher blood erythritol levels had an increased chance of experiencing adverse cardiac events within three years.

Additionally, the study assessed the effects of adding erythritol to whole blood or isolated platelets, finding that erythritol made platelets more inclined to form a clot.

The study authors emphasize the importance of further research on the topic and erythritol’s long-term effects.

“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,” said study author Stanley Hazen of the Cleveland Clinic.

According to the Cleveland Clinic, erythritol is approximately 70% as sweet as sugar and is produced through fermenting corn. It’s used as a common replacement for sugar in “low-calorie, low-carbohydrate and ‘keto’ products,” and sugar-free products with erythritol are often recommended for patients with obesity or diabetes to help manage sugar intake.

The news comes not long after a study published in The BMJ, which found that “total artificial sweetener intake was associated with increased risk of overall CVD and cerebrovascular disease.”

Results should not be extrapolated

The Calorie Control Council maintained that the study’s results do not establish causality and “should not be extrapolated to the general population, as the participants in the intervention were already at increased risk for cardiovascular events.”

Further, the results are at odds with global regulatory approval for use in food and beverages and decades of safe use of reduced-calorie sweeteners like erythritol, the trade group points out.

“Erythritol is a proven safe and effective choice for sugar and calorie reduction and, for more than 30 years, has been used in reduced-sugar foods and beverages to provide sweetness, as well as enhance their taste and texture,” according to Robert Rankin, executive director of the Calorie Control Council.

The trade group, which represents the low- and reduced-calorie food and beverage industry, also takes issue with the characterization of erythritol as an artificial sweetener, as it is naturally present in certain fruits and can be produced by the human body from glucose.

Additionally, the Calorie Control Council notes that the amounts of erythritol used in the study were well beyond the small volumes that are typically used in most commercial products. As part of the study, some subjects were instructed to consume 30 grams of erythritol dissolved in 300mL of water within two minutes, which “does not reflect a typical real-world serving.”

From the Cleveland Clinic’s point of view, the study instead shows that participants who consumed an artificially sweetened beverage “with an amount of erythritol found in many processed foods,” showed elevated erythritol levels in blood for days following, at “levels well above those observed to enhance clotting risks,” Hazen said.

EWG: Sweeteners should be avoided

Meanwhile, the Environmental Working Group characterized the study results as “quite concerning,” especially given the variety of products erythritol is used in, including ice cream, beverages and protein powders.

“It's also concerning because people may be consuming erythritol without being aware, since it's often a filler for other sweeteners like stevia,” EWG senior scientist Tasha Stoiber told FoodNavigator-USA.

She suggested the study demonstrates a need for better food industry oversight, and that it’s an example of a “GRAS loophole” - that is, that food additives are subject to FDA premarket review and approval unless qualified experts deem them Generally Recognized As Safe.

The loophole “allows the food industry to decide what's safe without enough information about long-term health effects,” Stoiber suggested.

Coupled with the BMJ research published in the fall, the erythritol study serves as evidence that “artificial sweeteners should be avoided by those who can,” she concluded.