Paulina Nares
(CNN) — Drinking a beverage containing erythritol — an artificial sweetener used to add bulk to stevia and monk fruit and to sweeten low-carb keto products — more than doubled the risk of blood clotting in 10 healthy people, according to a new pilot study.
Clots can break loose from blood vessels and travel to the heart, triggering a heart attack, or to the brain, causing a stroke. Previous research has linked erythritol to an increased risk of stroke, heart attack and death.
“What was striking was that in all subjects, all measures of platelet response (clotting) increased after erythritol ingestion,” said Dr. Stanley Hazen, senior author of the study and director of the Center for Cardiovascular Diagnosis and Prevention at the Cleveland Clinic Lerner Research Institute.
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Consuming a drink with the same amount of glucose, or sugar, did not affect platelet activity in another group of 10 people, said Hazen, who also holds the Jan Bleeksma Chair in Vascular Cell Biology and Atherosclerosis at the Cleveland Clinic.
“This is the first direct comparison of the effects of glucose versus erythritol ingestion on multiple different measures of platelet function,” Hazen said. “Glucose does not influence coagulation, but erythritol does.”
Although small, the study was “very intriguing and interesting,” said Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver.
“I’m not saying we should stop using these sugar alcohols immediately, but this line of research certainly raises the question: Are they safe or not?” said Freeman, who was not involved in the research.
In response to the study, the Calorie Control Council, an industry trade group, told CNN that 30 years of science has shown erythritol to be a “safe and effective option” for cutting sugar and calories.
“Consumers should interpret the results of this pilot with extreme caution. The limited number of participants, a total of 10, received an excessive amount of erythritol — nearly four times the maximum amount approved in any beverage in the United States,” council chair Carla Saunders said in an email.
However, the amount of erythritol used in each drink in the study — 30 grams — was equivalent to that found in typical sugar-free sodas, ice cream or muffins, of which people typically eat more than one, Hazen said.
“This research raises some concern that a standard serving of an erythritol-sweetened food or beverage may acutely stimulate a direct clot-forming effect,” study co-author Dr. Wai Hong Wilson Tang, director of heart failure and cardiac transplant research at the Cleveland Clinic, said in a statement.
What are sugar alcohols?
Only a tiny bit of artificial sweetener is needed to add a lot of flavour, so fillers such as sugar alcohols are used to create the granules. Hand-drawn images/iStockphoto/
Like sorbitol and xylitol, erythritol is a sugar alcohol, a carbohydrate found naturally in many fruits and vegetables. The human body also produces erythritol as a byproduct of glucose metabolism, but only in small amounts.
Artificially manufactured in large quantities, erythritol leaves no aftertaste, does not raise blood sugar and has less of a laxative effect than other sugar alcohols. It has about 70% of the sweetness of sugar and is considered zero calories, according to experts.
Erythritol is the largest ingredient by weight in many “natural” stevia and monk fruit products, Hazen said. It looks and tastes like sugar and can be used in baking. It’s also a key ingredient in many keto-friendly products, such as ice cream.
“If you look at the nutrition labels on a lot of keto ice creams, you’ll see ‘reducing sugar’ or ‘sugar alcohol,’ which are terms for erythritol,” she told CNN in a previous interview.
“You’ll find that a typical pint is between 26 and 45 grams.”
Artificially created erythritol, along with its cousins, are considered “generally recognized as safe,” or GRAS, by the U.S. Food and Drug Administration (FDA).
A series of studies show similar results
In the new study, published Thursday in the journal Arteriosclerosis, Thrombosis, and Vascular Biology, 20 participants were asked to fast overnight to prepare for a morning blood draw. They were then given a drink containing either 30 grams of erythritol or 30 grams of sugar. After 30 minutes, their blood was drawn again.
Blood levels of erythritol increased 1,000-fold after the drink, while blood sugar levels increased a small amount after the glucose-containing drink. But what was surprising was the change in platelet activity, Hazen said.
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“We look at increased clotting, using measures of how quickly clots occlude a vessel or stop blood flow, which is like a model of a heart attack or stroke,” he said.
Similar results appeared in a 2023 study by Hazen and colleagues in which eight healthy volunteers also consumed the same amount of erythritol and observed a thousand-fold increase in the substance in their blood.
“(Erythritol) remained elevated above the threshold necessary to trigger and increase the risk of clotting for the next two to three days,” Hazen said then.
That study also analyzed the blood of more than 4,000 people in the United States and Europe and found that those with the highest levels of erythritol were twice as likely to suffer a heart attack or stroke.
“What we see with erythritol is that platelets become super-reactive: A mere 10% of the stimulant produces 90% to 100% of clot formation,” Hazen says.
The studies were conducted in healthy people without chronic diseases, but the study’s findings remain valid for the future, Hazen said.
“But if you look at middle-aged Americans, the average person has two to three risk factors for heart disease, and 70 percent of us are going to develop heart disease in our lifetime, so maybe we should all consider taking action,” she said.
When it comes to cardiovascular disease risk, occasional small sugary treats may be preferable to drinks and foods sweetened with sugar alcohols. This is especially true for people at higher risk of blood clots, heart attacks or strokes, such as those with heart disease or diabetes.
“Cardiovascular disease accumulates over time, and heart disease is the leading cause of death worldwide. We need to make sure that the foods we eat are not hidden contributors.”
