Erythritol, a "sugar substitute" considered "zero-calorie," is one of the most commonly used artificial sweeteners. Regulatory agencies generally consider such sweeteners safe, and few studies have looked at their long-term health effects.

The artificial sweetener erythritol may be linked to heart attack events, according to a newly published research paper.

Studies have found that elevated levels of erythritol may be associated with an increased risk of blood clots.

In the early morning of February 28, related papers were published online in the international academic journal Nature Medicine. The title was "The artificial sweetener erythritol and cardiovascular event risk."

The corresponding author of the paper is Dr. Stanley Hazen, director of the Center for Cardiovascular Diagnostics and Prevention at the Lerner Institute at Cleveland Medical Center.

Low levels of erythritol are found "naturally" in fruits and vegetables. The body has difficulty metabolizing this substance. As one of the commonly used sugar substitutes, it is added at a high level in processed products.

According to the 2013-2014 survey data of the National Health and Nutrition Examination Survey and the data disclosed by the U.S. Food and Drug Administration (FDA), among the general population of the United States, some people have a high sensitivity to erythritol Intake up to 30 grams / day.

The researchers first conducted a pilot study in 1157 people who had been assessed for heart disease risk and had 3-year outcome data. By analyzing blood chemicals, they observed that levels of several artificial sweetener compounds, especially erythritol, were associated with increased risk of future heart disease and stroke over a three-year follow-up.

This association was confirmed in an independent cohort study. Targeted metabolomics analyzes were performed on 2149 and 833 stable patients undergoing elective cardiac evaluation in the United States and 833 in Europe, respectively.

The researchers believe that at the physiological level, erythritol can increase the reactivity of platelets and promote the formation of thrombus.

They also conducted a prospective intervention study in 8 healthy volunteers: plasma levels were examined after the volunteers ingested 30 g of erythritol beverage. They found that erythritol levels continued to increase in all volunteers, exceeding the threshold for increased clotting risk within 2-3 days.

The researchers said their findings may suggest that elevated levels of erythritol are associated with an increased risk of blood clots.

However, they note that the relevant cohort of patients involved in this study had a high prevalence of cardiovascular risk factors, so it remains to be confirmed whether similar results can be observed in longer-term follow-up of apparently healthy subjects.

The researchers pointed out that because erythritol is widely found in nature, it is generally considered "safe" by agencies such as the US Food and Drug Administration (FDA). It has fast-track approval in many countries and is widely used commercially. In addition, because the FDA does not require the disclosure of erythritol content in food, coupled with the confidentiality policy on food labels, the content of individual additives is difficult to track, which hinders relevant safety assessments and limits people's monitoring The ability of individual sweeteners to have long-term health effects.

Therefore, the researchers suggest that, firstly, in public policy, it is necessary to clarify the reporting requirements, safety documentation requirements and daily intake margins of artificial sweeteners; secondly, in order to evaluate artificial sweeteners especially erythrose Alcohol, and its long-term effects on the risk of heart attack and stroke in people, especially those at higher risk of cardiovascular disease, warrant further safety studies.

Paper link: https://www.nature.com/articles/s41591-023-02223-9