You can find it in grocery stores, you can buy it online, and you may already be consuming it in “keto friendly” ice cream, or in some non-caloric stevia and monk fruit sweeteners where it is used as a filler. And now you can find it popping up in headlines. We are talking about “erythritol,” a compound that like lactitol, maltitol, sorbitol and xylitol, is naturally produced in small amounts from sugars in plants, as well as in our bodies. These compounds are not readily metabolized and are excreted in the urine. Since sugar alcohols taste sweet and can be readily produced by fermentation methods, they have found application as non-caloric sweeteners. Some people note a laxative effect, but by and large, sugar alcohols have been deemed to be safe. Now, the safety of one, erythritol, is being questioned, at least for people who have pre-existing risk factors for heart disease such as diabetes, high blood pressure or elevated cholesterol.
Interestingly, this finding was an accidental one. Researchers at the Cleveland Clinic were studying blood samples from people with existing cardiovascular disease risk factors with a view towards finding any component that might predict the risk for a heart attack or stroke. They were surprised to find a connection with erythritol. People with an erythritol blood level in the top 25% had double the risk of a heart attack or stroke when compared with those in the bottom 25%. The risky levels can only be reached by consuming foods that contain added erythritol which may be simply declared on a label as “sugar alcohol” or “reducing sugar.”
Was this just some sort of chance association, or was erythritol a causative factor? One possibility was that erythritol affects the blood’s ability to clot since clot formation is a cause of heart attack and stroke. Indeed, when erythritol was added to blood samples in the lab, clot formation was enhanced. Circulating erythritol levels in the blood of mice were also found to be related to the extent of clot formation in response to an injury of their carotid artery. The researchers then followed up by having eight volunteers drink a beverage containing 30 grams of erythritol, an amount many people who are trying to reduce their caloric intake from carbohydrates, may regularly consume. Their blood levels of erythritol increased a thousand-fold, and for the next couple of days their risk of clot formation was elevated.
Producers of erythritol-containing foods and sweeteners claim that the compound has been shown to be safe and has been approved by regulatory agencies around the world. That is true, but such approval is based on toxicity studies in animals, and erythritol indeed in non-toxic. But the approval process does not require studying cardiovascular risk in populations with already increased risk, or in any population. Finding that erythritol has an effect on blood clotting was serendipitous and should not be ignored.
What we have here is yet another example that purported “quick and easy” solutions to weight control can have negative features that may not be immediately apparent. Instead of relying on “zero-calorie” sweeteners, why not just cut down on sugar and refined carbohydrate consumption? No worries about erythritol in the blood then.
