The sweetener erythritol could increase the risk of heart attack and stroke

A recent study associated the consumption of free sugars with a higher probability of developing cardiovascular diseases, a global health problem, since they are considered the first cause of death worldwide and each year around 17.5 million die from them. people. To prevent these diseases it is essential to have healthy habits and, among them, a balanced diet, rich in fruits and vegetables and low in saturated fat, salt and sugar.

Now, new research from the Cleveland Clinic has associated the edulcorante erythritol at increased risk of cardiovascular disease and in particular, stroke e myocardial infarction. Erythritol or E-968 is a sweetener of natural origin which has become popular in recent years and is used to sweeten foods instead of sugar because it provides very few calories. It belongs to the group of polyalcohols or polyols, like maltitol, xylitol or sorbitol, and its excessive intake has laxative effects. The results have been published in Nature Medicine.

In the article the authors explain that the long-term effects of consuming artificial sweeteners are not well known and that their objective was to analyze the effect of consuming erythritol as a substitute for sugar in the diet on the risk of developing atherothrombotic disease. To do this, the researchers studied more than 4,000 people in the US and Europe and found that those with higher levels of erythritol in their blood were at increased risk of experiencing a major adverse cardiac event, such as a heart attack, stroke, or stroke. stroke or death. They also examined the effects of adding erythritol to whole blood or isolated platelets, which are fragments of cells that clump together to stop bleeding and contribute to blood clots. The results revealed that erythritol facilitated platelet activation and clot formation. Preclinical studies confirmed that erythritol ingestion increased clot formation.

Their findings, they state, show that erythritol is associated with the “risk of major adverse cardiovascular events (MACE; includes death or non-fatal myocardial infarction or stroke) and promotes enhanced thrombosis.” For this reason, they consider that it is justified to carry out new studies that evaluate the long-term safety of erythritol.

“The authors suggest that higher erythritol levels may increase the risk of blood clots and this, in turn, may increase the risk of disease.”

Erythritol is approximately 70% as sweet as sugar and is produced by fermenting corn. After ingestion, the body poorly metabolizes erythritol. 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 intake can add up.

“The authors have not only found a potentially important association between blood levels of the artificial sweetener erythritol and health effects, but have also gone to the trouble of showing a viable pathway by which the effect they have found could be produced. . Although this study cannot prove by itself whether this is the case or not, the authors suggest that higher erythritol levels might increase the risk of blood clots, and this, in turn, might increase the risk of disease, he explained. Oliver JonesProfessor of Chemistry at RMIT University (Australia), in statements to SMC Spain.

And he adds that because the study participants “already had many cardiovascular risk factors, it cannot be shown that it was not one of these other factors that caused the increased risk of coagulation rather than erythritol. Although some effects were seen in a test with healthy volunteers, this study only included 8 people and only lasted a few days. This is not enough to draw firm conclusions, and the authors do not attempt to do so.” This expert points out that further research is necessary and recalls that “this study only analyzes erythritol and, in general, artificial sweeteners are considered safe. Any possible (and as yet unproven) risks of excess erythritol would also have to be weighed against the very real health risks of excessive glucose consumption.”

A dose of erythritol much higher than usual consumption

However, the tests were carried out with doses of erythritol that are well above those that are usually included in the diet. Thus, also in statements to SMC Spain, the Professor of Nutrition and Food Science at the University of Reading (United Kingdom), Gunter Kuhnle, has certain objections to the results because, he explains, “the authors decided to use an amount of sweetener that – at least in the United Kingdom and Europe – is not realistic. The concentration of sweetener they used was 10 times the amount allowed and the single dose they used was more than most of us would ingest for a whole day.”

“The authors also find other physiological effects of erythritol, but mainly at plasma concentrations higher than those found in the study cohort and presumably also in the general public. These results suggest a potentially adverse effect of erythritol when consumed in amounts greater than those generally consumed in Britain or the EU, and this is one of the reasons why regulators set limits for the use of Food Additives in sweeteners: to protect the public and ensure intake is in a safe range.”

“The results of the study are surprising, since only the group with increased plasma erythritol concentration have a higher risk of disease, but not others. This group also has the oldest participants, and when the authors adjust for this, the observed association with risk becomes much smaller.”

“The interesting question here is the origin of plasma erythritol, as this could potentially explain some of the results: erythritol is not only used in food, but also in other products such as toothpaste and medicines. Especially the latter could affect the observed results, since higher plasma concentrations could indicate that the participants receive different medical treatments”, warns Kuhnle.

In the opinion of Rafael Urialde de Andres, professor at the Complutense University of Madrid and at the San Pablo-CEU University, and member of the Board of Directors of the Spanish Nutrition Society: “This study, although the n= 8 of the pilot study is very small, at least in the title of the work clearly specifies that its conclusions cannot be extrapolated to other sweeteners beyond erythritol. It also has to serve, even if it is based on an observational study, to be able to go deeper and especially with clinical trials with a sufficiently large size and with use below the ADI (Admissible Daily Intake). This implies carrying out long-term studies”, according to what he declares to SMC Spain.

“The reassessment of the additives and therefore of the sweeteners, of each of them individually or also with a vision of synergistic aspects, must be constant because the data or techniques or protocols can change, but they have to be the safety authorities food those who carry it out. Through their evaluations and approvals, the authorities will have to carry out the approval and authorization in a legislative manner, if applicable, and with the conditions of use if they exist ”, he concludes.


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