A recent article published in Nature Medicine reported an association between erythritol and cardiovascular events in humans as well as a plausible physiologic mechanism for a cause and effect relationship. Since artificial sweeteners are used in some prepared foods to reduce sugar content while maintaining the sweet taste, let's look at what we know so far, and what needs more research.
What is erythritol?
Erythritol is a naturally occurring sweetener derived from corn. It is naturally found in foods like melon, watermelon, pears and grapes. It is used to sweeten foods with a texture and taste that resembles table sugar but with low calories. Monk fruit and stevia are other "natural" non- nutritive (contain no calories) sweeteners.
Why is erythritol used?
Erythritol is used to sweeten food in a way that tastes and feels like table sugar but with low calories. These types of sweeteners typically show up as "sugar alcohols" on food labels.
What is the concern about erythritol?
There were 3 parts to this article which describes an association found between erythritol and cardiovascular events. In the first part, the researches looked at the levels in blood of artificial sweeteners and then observed to see who had a cardiovascular event over the next three years. They observed that people with higher levels of erythritol and several related artificial sweeteners and a higher risk of cardiovascular events. In the second step, the researchers then looked to see how the erythritol may increase the risk of heart attacks and strokes. They exposed human platelets (blood clotting cells) to erythritol in test tubes and saw that these platelets were more sensitive to things that caused clots. They also tested this in mice and observed the same thing. In the third step, they did an intervention in which they had humans consume a drink sweetened with erythritol and then measured the levels of this in their bloodstreams. It showed levels increased more than 1,000 fold and remained elevated for more than 2 days.
What should you do with this information?
I recommend taking this information as yet another opportunity to recognize the crucial relationship between factors that we can control and our health. Read the ingredients list on your foods and read the labels. The shorter the ingredients, probably the better. On the label, look for as little sugar added. Sugar alcohols is what will quantify erythritol. Some protein bars contain 25 grams of sugar alcohols. A daily intake of 10 grams or less per day is a great place to start. Most of the Rainier Medical products contain zero to 3 grams of sugar alcohols and many are sweetened with monk fruit or a stevia extract. The ones that do contain erythritol (such as vanilla flavor packets) are being reformulated without that ingredient. Don't worry, there are many choices without erythritol.
Steps you can take.
Reach for progress, not perfection. Don't lose sight of the forest for the trees. I think of these priorities when making your health choices, probably in this order:
Reach and maintain as healthy a body weight as possible for you.
When it comes to quantity of food, keeping calorie intake at an appropriate level is crucial.
When it comes to quality of food, simplest is best.
Physical fitness and volume of activity and exercise are critical.
Keeping harmful things out of the body and mind needs just as much attention (if not more) as what you put into it.
Let's look more closely at these things.
Priority 1: Reach and maintain as healthy a body weight as possible.
Overweight and obesity is a chronic inflammatory state. It has been well known that chronic inflammation leads to increased risk of cardiovascular events, as well as cancers.
Priority 2: Quantity of food: keep the calorie intake appropriate.
In rats, the thing that led to a longer life was simply consuming fewer calories. Fewer calorie meant less metabolism, which means less oxidants, and slower shortening of the telomeres, which are the ends of our DNA. Calorie intake is linked to body weight, but it is not the same thing. Probably, the less that you put into your body, the better.
Priority 3: Quality of food: simplest is best.
The food industry has done a lot of things to the food we see in the grocery store. The more you can eat very simple, whole, unprocessed foods, the better. And, you will not have to worry about additives that are known to be harmful or the next round of research that says something is harmful. If you eat vegetables, fruit, nuts, seeds, eggs, and meat that is just a slaughtered animal with herbs on it, you will never need to worry about the next news cycle.
Priority 4: Physical fitness and volume of exercise are important.
Exercise reduced inflammation even if it does not change your weight. Remember how I said that obesity is a chronic inflammatory state? Remember how I said the study predisposed platelets to clotting? (That is different than causing platelets to clot with no stimulus). With exercise, it does the opposite; it calms the inflammation and makes clotting and cancer less likely. People grossly underestimate, typically, the volume of exercise studies show is needed. It takes about an hour a day to maintain weight loss of actual exercise, not activity. So, if you are worried about clotting, more exercise everyday is a great lever to pull.
Priority 5: Keep harmful things out of the body and mind.
Much of health risks comes from things we expose our body to: alcohol, chemicals, and stress, for example. Cutting things out is a great way to avoid doing harm to your body or getting in the way of your body's natural healing processes. If you want to do something good for your body, consider eliminating alcohol, limiting screen time to as little as you can, staying away from things that cause stress, if you can, such as news and social media.
Here is a nice summary of the article.
Here is the original article itself.
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Take Back Your Food,
Valerie Hope-Slocum Sutherland, MD