Does Erythritol Cause Heart Attacks?

Does Erythritol Cause Heart Attacks?

Does Erythritol Cause Heart Attacks?

A recent study published in Nature Medicine showed that there is a connection between higher blood levels of erythritol and a higher risk of stroke and heart attacks. Does this mean that we should all stop having erythritol-sweetened products? Read on to see how Bret Scher, MD recommends that we look at this study.

Bret Scher, MD

What is erythritol?

Erythritol is an “artificial” sweetener, but really, it’s not artificial. Erythritol is something that exists normally in small concentrations in our bodies, in nature and in some foods. When used as an artificial sweetener, it’s usually put in keto products to make them taste sweet, as it doesn’t give you the glucose and insulin response that sugar does. Like a lot of other artificial sweeteners that aren’t really artificial – like monk fruit and others – it’s used in keto products like ice cream, cookies, pancakes, waffles, coffee and tea, or in keto cereals. People often choose to have erythritol-sweetened products because they don’t want to feel deprived when they’re following nutritional ketosis or they like having something sweet and they feel they have to appease their sweet tooth.

What did the study find?

The first part of the study was an observational study. It looked at the blood concentration of erythritol in individuals, and they realized the higher the blood level of erythritol, the higher the risk of cardiovascular events. But this is just an observation found through measuring blood levels. We have no idea if it was endogenously produced, meaning their bodies were producing more, or if it was exogenously ingested, meaning they were eating more erythritol. All the study shows is that there is a correlation with higher blood levels.

A great thing about this study is that they didn’t just stop with observation. They took the next step and said, “Okay, if this observation is true, why? Why would higher erythritol levels increase risk of heart disease or strokes?’” What they found is that, by raising the erythritol level in test tubes or mice, you can increase platelet aggregation. What is platelet aggregation? Basically, it’s how sticky your blood is and how likely it can be to form clots.

Now, we have the observation, and we have a mechanism, however it’s still not conclusive.

What are peers in the space saying?

Dr. Nick Norwitz, Dr. Adrian Soto-Mota and Dr. Nicola Guess have all done very good assessments of the study. If you want to learn more, go check them out.

What Dr. Nicola Guess did is she said, “Look, we can’t trust this a whole lot.” She dug into the preregistration of the study. Anytime you’re doing a study, you should pre-register it to say what you’re looking for. There were six primary outcomes, which is a lot. It could be interpreted that they weren’t exactly sure what they were looking for. They were supposed to have 40 people in the study, but they only reported the results of eight and it wasn’t randomized.

All of those things do weaken the findings. They don’t completely negate the findings, but they weaken it. Interestingly, they did say there are more studies going on and they’re going to be reporting more data later. I’m curious to see what that shows.

What does this mean for you?

There’s not a simple yes or no answer. If you’re going to take anything away from this study, I recommend it be a time for self-reflection about why we’re using sweetened products and if we really need them.

What is erythritol?

Erythritol is an “artificial” sweetener, but really, it’s not artificial. Erythritol is something that exists normally in small concentrations in our bodies, in nature and in some foods. When used as an artificial sweetener, it’s usually put in keto products to make them taste sweet, as it doesn’t give you the glucose and insulin response that sugar does. Like a lot of other artificial sweeteners that aren’t really artificial – like monk fruit and others – it’s used in keto products like ice cream, cookies, pancakes, waffles, coffee and tea, or in keto cereals. People often choose to have erythritol-sweetened products because they don’t want to feel deprived when they’re following nutritional ketosis or they like having something sweet and they feel they have to appease their sweet tooth.

What did the study find?

The first part of the study was an observational study. It looked at the blood concentration of erythritol in individuals, and they realized the higher the blood level of erythritol, the higher the risk of cardiovascular events. But this is just an observation found through measuring blood levels. We have no idea if it was endogenously produced, meaning their bodies were producing more, or if it was exogenously ingested, meaning they were eating more erythritol. All the study shows is that there is a correlation with higher blood levels.

A great thing about this study is that they didn’t just stop with observation. They took the next step and said, “Okay, if this observation is true, why? Why would higher erythritol levels increase risk of heart disease or strokes?’” What they found is that, by raising the erythritol level in test tubes or mice, you can increase platelet aggregation. What is platelet aggregation? Basically, it’s how sticky your blood is and how likely it can be to form clots.

Now, we have the observation, and we have a mechanism, however it’s still not conclusive.

What are peers in the space saying?

Dr. Nick Norwitz, Dr. Adrian Soto-Mota and Dr. Nicola Guess have all done very good assessments of the study. If you want to learn more, go check them out.

What Dr. Nicola Guess did is she said, “Look, we can’t trust this a whole lot.” She dug into the preregistration of the study. Anytime you’re doing a study, you should pre-register it to say what you’re looking for. There were six primary outcomes, which is a lot. It could be interpreted that they weren’t exactly sure what they were looking for. They were supposed to have 40 people in the study, but they only reported the results of eight and it wasn’t randomized.

All of those things do weaken the findings. They don’t completely negate the findings, but they weaken it. Interestingly, they did say there are more studies going on and they’re going to be reporting more data later. I’m curious to see what that shows.

What does this mean for you?

There’s not a simple yes or no answer. If you’re going to take anything away from this study, I recommend it be a time for self-reflection about why we’re using sweetened products and if we really need them.

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