A small study has found that the sugar substitute, erythritol, makes blood more susceptible to clotting, and may explain why it has been linked to a greater risk of heart attack and stroke in previous research in people.
Erythritol is a sugar alcohol found at low concentrations in fruits and vegetables, and is about 70% as sweet as sugar. Our bodies also produce the compound in small amounts.
It contains almost no calories, making it a popular sugar substitute, said Stanley Hazen at the Cleveland Clinic in Ohio, and for several decades, it has been added to products such as chewing gums, beverages and baked goods.
New Scientist reports that although regulatory agencies like the US Food and Drug Administration and the European Food Safety Authority have long classified erythritol as safe, a growing body of evidence indicates it may harm heart health.
A previous study from Hazen and his colleagues showed that people susceptible to heart attack or stroke with high concentrations of the compound in their blood had double the risk of these conditions compared with those with lower concentrations. Animal experiments also found that erythritol can prompt blood clotting.
To see if the same is true for people, Hazen and his colleagues collected blood samples from 10 participants before and 30 minutes after they drank water with 30 grams of erythritol – about the average amount people in the US consume daily.
They repeated the process in a separate group of 10 people, replacing the erythritol with 30 grams of sugar. The participants had no underlying health conditions.
The researchers used two compounds at varying doses to prime blood to form possible clots. This helped them compare susceptibility to clotting before and after sugar and erythritol consumption.
In all of the tests, they found the blood of those who consumed erythritol was significantly more prone to form clots after they ingested the sweetener than before. The samples from those who drank erythritol also had higher levels of molecules that blood cells release during clotting.
Sugar, however, had no significant effect on blood clotting.
These findings indicate that erythritol, but not sugar, increases the likelihood of blood clots, said Hazen, which is concerning, given that medical guidance often recommends people swop sugar for low-calorie sweeteners like erythritol.
“I would argue it is a safer to drink a (sugar)-sweetened drink than an erythritol-sweetened drink in a patient at risk for clotting and having a heart attack or stroke,” he added.
However, Alice Lichtenstein at Tufts University in Massachusetts said more research was needed to evaluate the risk versus the benefit of low-calorie sweeteners compared with sugar, because the latter contributes to other health conditions, like obesity and dental cavities.
Study details
Ingestion of the Non-Nutritive Sweetener Erythritol, but Not Glucose, Enhances Platelet Reactivity and Thrombosis Potential in Healthy Volunteers
Marco Witkowski, Jennifer Wilcox, Stanley Hazen et al.
Published in AHA Journals on 8 August 2024
Abstract
Background
Although artificial and non-nutritive sweeteners are widely used and generally recognised as safe by the US and European Union regulatory agencies, there have been no clinical trials to assess either long-term cardiovascular disease risks or short-term cardiovascular disease–relevant phenotypes. Recent studies report that fasting plasma levels of erythritol, a commonly used sweetener, are clinically associated with heightened incident cardiovascular disease risks and enhance thrombosis potential in vitro and in animal models. Effects of dietary erythritol on thrombosis phenotypes in humans have not been examined.
Methods
Using a prospective interventional study design, we tested the impact of erythritol or glucose consumption on multiple indices of stimulus-dependent platelet responsiveness in healthy volunteers (n=10 per group). Erythritol plasma levels were quantified with liquid chromatography tandem mass spectrometry. Platelet function at baseline and following erythritol or glucose ingestion was assessed via both aggregometry and analysis of granule markers released.
Results
Dietary erythritol (30 g), but not glucose (30 g), lead to a >1000-fold increase in erythritol plasma concentration (6480 [5930–7300] versus 3.75 [3.35–3.87] μmol/L; P<0.0001) and exhibited acute enhancement of stimulus-dependent aggregation responses in all subjects, agonists, and doses examined. Erythritol ingestion also enhanced stimulus-dependent release of the platelet dense granule marker serotonin (P<0.0001 for TRAP6 [thrombin activator peptide 6] and P=0.004 for ADP) and the platelet α-granule marker CXCL4 (C-X-C motif ligand-4; P<0.0001 for TRAP6 and P=0.06 for ADP). In contrast, glucose ingestion triggered no significant increases in stimulus-dependent release of either serotonin or CXCL4.
Conclusions
Ingestion of a typical quantity of the non-nutritive sweetener erythritol, but not glucose, enhances platelet reactivity in healthy volunteers, raising concerns that erythritol consumption may enhance thrombosis potential. Combined with recent large-scale clinical observational studies and mechanistic cell-based and animal model studies, the present findings suggest that discussion of whether erythritol should be re-evaluated as a food additive with the Generally Recognised as Safe designation is warranted.
AHA article – A common low-calorie sweetener raises the risk of blood clotting (Open access)
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Stroke, heart attack risk linked to sweetener – US study
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