Why you shouldn’t believe the alarmist headlines about erythritol, a naturally-occurring zero-calorie sweetener.
“Sugar substitute erythritol, common in keto foods, may increase your risk for stroke.” “Artificial sweetener in diet drinks and protein bars may increase risk of heart attack.” “Zero-calorie sweetener linked to heart attack and stroke, study finds.”The study in question was published in Nature Medicine in late February, and the media has predictably gone full throttle with the alarmist headlines suggesting cardiovascular doom and gloom for those who use erythritol. As is so often the case, the real story is much more nuanced and complicated.
In the new paper, the authors demonstrate that high blood levels of erythritol are associated with elevated risk of major cardiovascular events; additionally, consumption of erythritol was shown to increase blood levels of erythritol.
Before we get into the study, why does all of this matter? Almost all integrative doctors recommend cutting or restricting sugar and refined carbohydrates (like bread and pasta) in the diet. This is due to the many, many negative health effects from eating too much of these foods, including: type 2 diabetes, Alzheimer’s, heart disease, cognition, and decreased learning and memory. Sugar alternatives like erythritol allow health-conscious people to enjoy some sweetness while avoiding the terrible effects of eating sugar-laden foods. Many foods contain monk fruit extract, another popular sugar alternative, which is almost always combined with erythritol to tame down the sweetness (monk fruit extract is 200 times sweeter than sugar); erythritol is in fact the main ingredient in some monk fruit products.
So, is erythritol dangerous? There are many reasons to take the results of this new study, and the conclusions drawn by non-scientists at major media outlets writing sensationalist headlines, with a grain of salt. For one, this is an observational study that established a correlation between high blood levels of erythritol and cardiovascular risk. The study didn’t assess individual’s consumption of erythritol and link it to higher CVD risk. It simply measured people’s erythritol levels and compared those levels to CVD risk. But correlation is not causation, as the study authors point out. The two may be related, but higher blood levels of erythritol may not be the cause of higher cardiovascular disease (CVD) risk. As ANH Board Member Ron Hoffman, MD points out, it may be that overweight people, or those already at high CVD risk, are more motivated to use sugar substitutes. The analysis cannot be used to imply that eating erythritol raised CVD risk, but that didn’t stop the media from spinning the study’s results into misleading and sensationalist headlines.
Further, the body makes erythritol, and those who are overweight or have diabetes make more of it. This again undermines the notion that eating erythritol leads to higher CVD risk; those at higher CVD risk have elevated levels because their bodies produce more of it.
The study also includes an experiment in which 8 volunteers were given a drink containing 30 grams of erythritol, resulting in raised blood levels of erythritol. The issue is that 30g is much, much higher than most people would consume. Erythritol is naturally found in foods like melons, pears, and grapes, soy sauce, wine, miso paste, and sake. Consumption of a few common servings from these foods may add up to less than 0.5 g/day. Some people may add a few grams to sweeten their tea. This experiment does not reflect real world consumption, so it’s hard to draw sweeping conclusions.
Many of the foods listed above are popular in Japan, and indeed, per capita erythritol consumption from natural sources in Japan (106 mg/day) far exceeds that in the US (25mg/day). Yet residents of Japan have the highest life expectancy in the world, which is part due to low mortality rates from heart disease. Despite lower consumption of foods containing erythritol, the US has the second highest mortality rate from ischemic heart disease compared to the 38 other countries in the Organization for Economic Cooperation and Development.
The media is clearly driven to sensationalize news stories to get as many readers clicking on their outrageous headlines as possible. But the media ultimately rely on the support of their advertisers, and junk food companies are big spenders: food and beverage companies spent $2.54 billion on advertising in 2021. Junk food companies stand to benefit when healthier alternatives to their products are cut down in front of the public, and media companies are all too willing to serve their corporate supporters.
Scaring people away from otherwise healthy sugar alternatives does not serve public health. If the concern was legitimate, that would be one thing, but the above analysis shows that the conclusions being drawn by the media are not based in science.
Exactly. Good job!
http://www.imjournal.com/index.cfm/fuseaction/Content.Main/id/65?fbclid=IwAR0V5GJe93U5IJUI-15ugLKb6gymtj4bEA-EPKBnivebQrbKS5fJelhU3Kw#7
Truly the only problematic sweeteners are Equal, Splenda and SweetNLow. Anyone following a keto diet plan knows that allulose, erythritol, monk fruit and stevia have been used for a long time. Stevia is also natural and comes from a plant. If you go out, bring your own sweetener.
It is well documented tjat the sugar industry spent millions trying to convince people that fats were worse for us than sugar. It would be amazing if they did not spend massive amounts now trying to convince people that sugar is better for us than erythritol.
I purchased Erythritol, due in part to an article I read years ago. I have a large bag that is just sitting on my shelf. I don’t like it.
I like Stevia. Organic liquid stevia with nothing else in it except a small amount of alcohol.
I guess it is easy for me to believe something is bad for me when it is something I don’t like.
However, I am starting to lean toward becoming more of a purest. I think the closer to eating or drinking the whole plant is the better way to go.
Extracting only parts of a plant may have long term consequences we have yet to discover, and who knows what combining those parts with parts of something else can do, because that is NOT what nature intended??
Just sayin’
Although this study appears to be flawed, many people who regularly/chronically use alcohol sugars could easily exceed the “deemed”safe amount. And whether they’re found in nature or not, it’s a safe bet is to avoid anything artificially processed, as the chemistry of nature is exponentially different than the highly controlled laboratory production of erythritol and xylitol, which often produce an perfectly equal balance of isomers, not usually found in nature.
My only beef with erythritol is that most of it, apparently, is made from corn, and most of corn is GMO. Which may be why I don’t do well with this sweetener. If I am wrong about this, could someone let me know?
Thank you for this intelligent analysis as I was genuinely concerned before reading this.
Those sugar alternatives are awful and make our family sick!!
Please report on sucralose (Splenda) studies. I see articles saying even small amounts poison the biome. Are studies about sucralose any more valid than this one on erythritol??? Does it really have bad effects? Most of the public doesn’t really know how to determine validity of tests and we could use your help!
I totally agree on this, along with the fact that they probably did studies on A number of people that took the Covid vaccine which is causing clotting problems in some people!
I think too much still remains unknown about the causal players leading to strokes to be able to say whether erythritol consumption does or does not increase risk of stroke.
However, ANH’s response is troubling, as many of ANH’s points are both irrelevant and non-supportive of the position taken:
1) The new study is not an attack; it merely points out an association and calls for more study. Perhaps you will recall a paper that found an association between MMR and autism that called for more study, whose author is STILL being accused of scaring people away from the product in question?
2) ANH’s argument “the body makes erythritol” does not in any way prove that erythritol isn’t linked to stroke risk. The body makes formaldehyde, too, but that’s not necessarily something we want to inject or otherwise consume.
3) The study linked to supposedly support the point that those who are overweight or have diabetes make more erythritol (implying it’s somehow “safe”) actually notes that people make erythritol from consumed glucose or fructose.
4) Erythritol specifically FROM NATURAL FOOD SOURCES (like melons, peaches, mushrooms, and fermented foods like soy sauce) has been estimated (by ONE source) as much higher in Japan than the US. That’s not the same thing as TOTAL erythritol consumption, as ANH’s point seems to imply. Furthermore, it’s ridiculous to even bring up life expectancy in relation to erythritol consumption when comparing groups of people with different racial heritage AND different environmental exposures AND different foods and eating habits AND different exercise rates AND different lifestyle and cultural norms.
Perhaps, rather than leaping to defend against imagined attacks against sugar substitutes, ANH might better use their efforts to advocate for more healthful food choices, like fresh fruit instead of artificially sweetened snacks.
Stevia is a safe sweetener too, no harmful effects at all and works well.
My first and only thought is they are trying to create a reason for sudden death syndrome other than the mRNA biological weapon.
Where is the published study? I would love to read it.
My blood pressure dropped 10 points when I quit erythritol.
Well, the main stream is trying to blame the cardio problems caused by vaxx on anything, and everything. Grasping at straws.
Even grasping at “generally safe” erythriol.