True
That was the first thing I thought of when I saw the headline: how did they control for that. I only glanced through it, so I’m not certain if they addressed that or not. There could also be an interaction at play here, where it might have an effect on people that are at risk.
That’s just never happening for most people, I’d think (who are avoiding sugar), unless they don’t consume any packaged foods. They are in so many things, not just “sweets”.
They did not, it is a concern with the study data. They only looked at people already undergoing a cardiac risk assessment. And the cohort is an average age of 65.
One of the reasons why a larger more diverse cohort is needed.
The thing that is troubling to me, is that they have hypothesized a causation, which a lot of the “OMG artificial sweeteners are bad” studies don’t have. The other troubling thing is that this isn’t based on self-reported eating habits, but actual blood work done, as many of the large scale food studies rely on people self-reporting eating habits.
But, as someone who has a degree in science, and has read the paper, I am very concerned about the use of erythritol in foods now. This paper checks quite a few boxes. It has a large sample size (not extremely diverse, but regionally diverse as it is both EU/US) it has a proposed causation link, and the study is based off of clinical sampling and not self reported eating habits.
The study is saying, in the participants, people with more erythritol or related compounds in their bloodstream, had significantly higher rates of cardiovascular events. And they found evidence that erythritol increased platelet’s ability to clot.
This is concerning. I’ve been doing keto for over three years, now. Fortunately, I don’t consume many keto treats. My usuals are the Quest Peanut Butter Cups and the Munk Pack Keto Nut and Seed Bars.
The peanut butter cups have 8g erythritol. The keto bars use allulose.
I’ll probably cut back a bit on the peanut butter cups, but I don’t think 8g every few days is a lot. At least I hope not.
Our baking products are all erythritol, but we only bake a keto treat once or twice a year. Should be easy enough to replace.
What does high levels mean though? Using the stuff to sweeten yogurt? Replacing all the sugar for baking cakes?
Honestly, this study does not control for enough stuff to draw any kind of conclusion about any of this stuff. I can imagine a ton of confounding factors.
Like, imagine you had some kind of kidney dysfunction. That would potentially decrease the ability to clear Erythritol from your system, leading to higher levels in your blood… But having kidney problems is also going to cause lots of other problems.
Yup, I have 1-2 quest protein bars daily, more when traveling. I’m not worried about it enough to want to find a different product, personally. I think those are my only real source of this particular sweetener. I’m also not at high risk these days.
Agreed. It’s interesting from the standpoint of hypothesis generation and highlights the need for further study. Still, I don’t think it would be silly to pay attention to how much you are eating if you are at high risk.
Sounds like 30g is definitely high. 8g is probably high, too.
They did look into a small sample size as part of this study, about concentrations of Erythritol
We thus examined postprandial erythritol plasma levels in healthy participants (n = 8) following consumption of an erythritol-sweetened drink (30 g), an erythritol exposure comparable to a single can of commercially available artificially sweetened beverage, a pint of keto ice cream or other foods or beverages containing erythritol. While plasma levels of erythritol were low at baseline (median (25th and 75th percentiles), 3.84 (3.27–4.14) µM), they remained 1,000-fold higher (millimolar levels) for hours after ingestion (for example, at 30 min, 5.85 (4.30–7.68) mM), and remained substantially elevated for over 2 d in all participants examined (Fig. 5). Notably, the elevation in erythritol levels observed remained well above thresholds observed for concentrations of erythritol that elicit significant increases in multiple indices of platelet function.
So at least in 8 healthy people, they found concentrations high enough to cause the observed changes in platelet function 2 days later in healthy people. Healthy people with no kidney problems.
I am surprised at how comprehensive this study is. It is just a single study on this compound, and I am sure there is more to discover, but what they have found is actually quite alarming. There has not been a lot of research around these additives, because they have been “naturally derived” or found in foods we already eat. The difference is, we are seeing thousandfold increases in our processed foods over the naturally occurring variety, and research like this is very important to understand how it can affect our health.
I don’t think it is time to ban products or throw out anything you have, but probably a good idea to look at labels, especially if you are someone who is eating a lot of the carb cutting “keto” recipe items and could be ingesting a lot of the stuff.
If you think about the causation being, increases clotting ability of platelets, it is also something that isn’t inherently bad in healthy people. It is also something that would go away as concentrations in the blood decrease after a day or two. Who knows if it has an additive effect? The study was on the elderly who were already pre-disposed for cardiac issues, so it might just be that you need to avoid these foods if you have certain medical conditions.
More research is definitely needed, but this particular studies had the alarm bells ringing in my mind. They found a VERY strong link between blood levels of erythtritol and adverse cardiac events.
Their summary conclusion hits the nail on the head.
In summary, the present studies suggest that trials investigating the impact of erythritol specifically, and artificial sweeteners in general, with appropriate duration of follow-up for clinically relevant outcomes, are needed. Following exposure to dietary erythritol, a prolonged period of potentially heightened thrombotic risk may occur. This is of concern given that the very subjects for whom artificial sweeteners are marketed (patients with diabetes, obesity, history of CVD and impaired kidney function) are those typically at higher risk for future CVD events
This is the BIG problem. A lot of these foods with artificial sweeteners are targeting people with health problems as the “healthy alternative” to sugars, and it may very well be those people are the most at risk of consuming products with high levels of erythritol.
Erythritol was one of the few sugar substitutes that are recommended as “good” for Type 2 diabetes, in that it supposedly doesn’t spike blood sugar, unlike others.
Probably no such thing as good though, just not as bad as others…
That is what has me most concerned. People with diabetes or other health conditions could look towards these healthy “natural” sugar substitutes and be doubling up on risk.
I may, indeed, have embodied that concern. For instance, I had cut out ice cream and switches to Halo Top and Enlightened. Thankfully I cut those out and shifted to sorbet as prices for the “healthy” brands skyrocketed. I only hope cutting this particular sweetener out of my diet has reduced my risk levels back to “bad” instead of “even worse.”
Strokes have consistently had quite an effect on my erythra.
I’m increasingly coming to the conclusion that if you’re going to eat sugar, eat real sugar. But try to avoid added sugar.
I still put splenda in my coffee, though.
-Aspartame is broken down into methanol - which is toxic, your liver can probably handle it, but overall not healthy
-Erythritol affects blood clot formation - pretty scary really
-Sucralose - linked to Crohn’s disease which is in my family, also affects metabolism and a bunch of other health issues that can’t pass statistical significance
-Saccharin - linked to impaired liver and kidney function
-Xylitol - kills dogs, probably no better than others for humans
-All of them - linked to diabetes and weight gain / obesity, and the hand-waving away ‘correlation not causation’ is starting to look a bit like hand-waving away
This all sucks as my daughter has diabetes, plus I’m trying to manage calories the lazy way by eating sweeteners.
Certainly doesn’t help that most products that use these sweeteners try to match the sweetness of a regular sugary item. I can’t help but think these things would be way less harmful in moderation and would be a good bridge to curbing a sweet tooth.
Xylitol is supposed to be really good for your teeth, actually. Bacteria think they can eat it, but they can’t.
Unfortunately for keto enthusiasts, xylitol has 4g of carbs in a teaspoon so it’s not a good substitute for us (you didn’t say it was, I was simply adding this comment!).
And that is the real problem, a lot of these naturally occurring sugars are present in normal volumes, and these products have to use 1000’s of times the amount to mimic the sweetness of sugar. As these are newer to the market, there isn’t a lot of research about their use in the large amounts.
To me, aspartame seems like the safe bet. ol’ reliable. Been around forever and there haven’t been any strong links to a specific mechanism or health problems. My 2 diet coke a day habit is fine.
The other thing that is notable about this study, is that they weren’t looking for erythritol initially, they were just reviewing the blood samples of a cardiac study cohort and found a heavy correlation with blood levels of erythtritol (and other sugar alcohols) and MACE (major adverse cardiac events), and the entire study started from there.
Apparently the study didn’t control for how much erythritol each person ate, only how much they had in the system, which might not be exactly the same for everyone, depends on how well each person will process what they eat.
While that is true.
They did a very small (n=8) sample size of healthy individuals and found that high levels of erythritol (the same as in the cardiac patients) were present in their blood 2 days later. That was after drinking 1 sweetened beverage (soda) with 30g of erythritol. Which would be the equivalent to 2.5 cans of soda, actually, as best as I could find Virgil’s root beer uses 12g erythritol per can. But, if you are on a keto diet, you are probably consuming multiple foods with this sugar replacement. So, 30g is probably pretty typical.
So, more study is definitely needed on that front, but it appears that at least 8 healthy people, the levels in the blood were high.