A SWEETENER sold in UK supermarkets has been linked to an increased risk of blood clots, heart attacks and strokes.
Scientists found a standard serving of erythritol (E968) could increase someone’s chances of the deadly events.
The study, published in Arteriosclerosis, Thrombosis and Vascular Biology, adds to growing evidence that erythritol may not be as safe as food regulators currently say it is.
Senior and corresponding author Dr Stanley Hazen, chair of Cardiovascular and Metabolic Sciences in Cleveland Clinic’s Lerner Research Institute and co-section head of Preventive Cardiology, said: “Many professional societies and clinicians routinely recommend that people at high cardiovascular risk – those with obesity, diabetes or metabolic syndrome – consume foods that contain sugar substitutes rather than sugar.
“These findings underscore the importance of further long-term clinical studies to assess the cardiovascular safety of erythritol and other sugar substitutes.
“I feel that choosing sugar-sweetened treats occasionally and in small amounts would be preferable to consuming drinks and foods sweetened with these sugar alcohols, especially for people at elevated risk of thrombosis such as those with heart disease, diabetes or metabolic syndrome.
“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.”
Erythritol is an artificial sweetener that commonly replaces sugar in low-calorie, low-carbohydrate and keto products.
It is also available to buy in bags in shops like Tesco, Asda and Waitrose, and it is an ingredient in some energy drinks like Monster Ultra, protein bars from Quest, low-calorie ice creams like Halo Top, and ‘healthy’ Vitamin Water.
Erythritol is said to be about 70 per cent sweet as sugar and is produced through fermenting corn.
The European Food Safety Authority (EFSA) and the US Food and Drug Administration (FDA) recognise it as safe, meaning it is allowed to be used without restriction in foods and drinks.
This is primarily because it is a sugar alcohol (polyol) found naturally in fruits and vegetables and a byproduct of glucose metabolism in human tissue, although in small quantities, scientists said.
But new research, based on a small sample, suggests erythritol in “typically-consumed amounts” could increase someone’s cardiovascular risk.
Scientists studied the effect that sugar-free fizzy drinks, muffins and ice creams containing erythritol could have on the body.
They asked 20 healthy volunteers to fast overnight before a blood test the following morning.
Participants were then given a drink with either 30g of erythritol or 30g of sugar – about as much as is in the products above.
After 30 minutes, their blood was drawn again.
Erythritol levels increased more than 1,000 times on average in the first group, while blood sugars only rose a small amount in the second.
But researchers found the change in platelet activity the most concerning.
“We saw enhanced clotting, using measures of how quickly clots will occlude a vessel or stop blood flow, which is like a model of a heart attack or a stroke,” Dr Hazen said.
LOWER-or no-calorie sweeteners are substances used instead of sugar to sweeten foods and drinks.
They’re found in products such as drinks, desserts and ready meals, cakes, chewing gum and toothpaste.
Sweeteners approved for use in the UK include:
All have undergone rigorous safety assessments to ensure they are safe.
The law determines how much sweetener can be used and in which products.
Source: NHS
He saw similar results after a study last year in which eight healthy people consumed the same amount of erythritol and saw a thousandfold spike of the substance in their blood.
“Erythritol remained elevated above the threshold necessary to trigger and heighten clotting risk for the following two to three days,” he added.
That study also looked at the blood of more than 4,000 people across the United States and Europe and found that people with the highest levels of erythritol were twice as likely to have a heart attack or stroke.
“What is remarkable is that in every single subject, every measure of platelet responsiveness (clotting) went up following the erythritol ingestion,” Dr Hazen said.
“Glucose doesn’t impact clotting, but erythritol does.”
Co-author Dr Wai Hong Wilson Tang, research director for Heart Failure and Cardiac Transplantation Medicine at Cleveland Clinic, added: “This research raises some concerns that a standard serving of an erythritol-sweetened food or beverage may acutely stimulate a direct clot-forming effect.
“Erythritol and other sugar alcohols that are commonly used as sugar substitutes should be evaluated for potential long-term health effects, especially when such effects are not seen with glucose itself.”
Previous research, published in Nature Medicine, found that cardiac patients with high erythritol levels were twice as likely to experience a major cardiac event in the following three years compared to those with low levels.
The study also discovered that adding erythritol to patients’ blood or platelets increased clot formation.
A separate investigation found that xylitol, another common artificial sweetener, produced similar increases in plasma levels, associated with a heightened risk of heart attack, stroke or death over the next three years.
Other studies have linked other sweeteners, including aspartame, acesulfame potassium, and sucralose, to heart disease.
But speaking to CNN, Carla Saunders, from the Calorie Control Council, urged consumers to interpret all results with “extreme caution” as 30 years of science has shown erythritol to be a “proven safe and effective choice” for sugar and calorie reduction.
Before any sweetener can go on sale here, it must go through an extensive safety assessment
Adam Hardgrave
There is no official accepted daily intake set by the EFSA, but the Panel of Food Additives and Flavourings (FAF) suggests a daily intake of no more than 0.5g per kilogram of body weight per day to avoid laxative effects.
When a polyol such as erythritol is used in a product at more than 10 per cent, it must include a warning that excessive consumption may produce laxative effects.
A EFSA spokesperson added: “Current evidence does not show a connection (i.e. cause and effect) between consuming foods containing erythritol and an increased risk of cardiovascular diseases and related risk factors.
“Nevertheless, further research might be helpful to clarify the nature of the association found in some observational studies.”
Up to 100,000 Brits are hospitalised by heart attacks and the same number suffer strokes every year.
High blood pressure, cholesterol, diabetes, smoking and obesity are all known risk factors.
Sweeteners are often recommended to people suffering from obesity and diabetes as a replacement for sugar.
Andrew Opie, director of food and sustainability at the British Retail Consortium, said: “Food safety is of the upmost importance to retailers, and they follow detailed regulation to ensure the foods they sell are safe.
“Manufacturers only use sweeteners approved by the Government regulator, the Food Standards Agency, who regularly review the safety of food and ingredients.”
Adam Hardgrave, head of food additives, flavourings and food contact materials at the FSA, added: “Before any sweetener can go on sale here, it must go through an extensive safety assessment.
“We keep all sweeteners approved for sale under strict review and if there are any concerns around safety, we will consider if any action needs to be taken to protect consumers.”
All brands and supermarkets mentioned have been approached for comment.
