You may have seen the recent headlines about the zero calorie sweetener, erythritol, linked to an increased risk of heart attack and stroke (1). This month, I’m taking a detour from my typical topics to provide you with context around these recent headlines as a way to help you make informed decisions when you shop.
What is erythritol? Erythritol is a sugar alcohol. Sugar alcohols (others you may be familiar with are xylitol, and sorbitol) have a sweet taste, but they are not absorbed into the body. As a result, they contribute negligible calories, and do not raise blood sugar levels. Erythritol occurs naturally in small amounts in fruit. The majority of erythritol, however, is consumed as a sugar substitute and can be found in blends like Swerve, Splenda and Truvia, monk fruit sweeteners, as well as sugarless gum, candies, soda, sugar-free baking mixes, ice cream, fruit spreads, protein powders, protein shakes, and energy bars (1, 2).
As low-sugar” and “low-carb” trends gained popularity in recent years, erythritol increasingly became a key ingredient in products marketed as "low" or "0g" sugar, ”, keto" or "diabetes friendly.” Erythritol added to foods products typically appears in levels 1,000 times greater than levels found naturally in foods.
What are the concerns about erythritol? In February, 2023, a paper was published in the Nature Medicine journal describing several different studies, including data from 4,000 adults (age 63-75) who were at risk for heart disease. The analyses concluded that people with the highest blood levels of erythritol were about twice as likely to have cardiovascular events as those with the lowest levels. Lab studies suggest that erythritol, in amounts found in a single serving of an erythritol-sweetened soda, sped up blood clot formation and artery blockage in mice (blood clots can lead to heart attacks and strokes). (1,3)
What should you do with this information? First, and very important to remember - the studies currently only describe an observation of an association between erythritol and heart events. A direct link between a cause and effect has not been established, and research is underway to learn more (4)
Should you avoid erythritol? Right now, the information suggests that if you are someone who has heart disease, or you are at an increased risk for heart disease due to family history or other health issues, you should avoid erythritol in processed foods. Note, the small, naturally occurring amounts in fruit is not a concern.
If you are a healthy individual without a increased risk of heart disease, you can still act on this information. Here are 3 steps I recommend:
Awareness is always the first step: Get an idea of how much erythritol are you currently consuming. Open your pantry and read the ingredients list on products you use daily. Keep in mind, as a sugar alcohol, erythritol may be listed individually in the ingredients, or it may appear under the catch-all phrase "sugar alcohols." Do the best you can in your detective work. You may find erythritol appears in several products you consume on a daily basis. If so, it makes sense to begin to reduce your reliance on erythritol until we have more information.
Begin with easy product swaps: It can be as easy as swapping to a different protein powder or snack bar without erythritol.
Is there a whole food swap for the more processed product? Swap your energy bar for a whole food snack of fruit + nuts. Try 2 tsp of honey or maple syrup instead of a sugar substitute to help you step down your preference for highly sweet flavors. Honey and maple syrup offer added health benefits including prebiotic, effects and naturally occurring minerals. Used in moderation, they can be part of a health supporting diet.
Your takeaway: While the latest information suggests that there may be cause for concern around erythritol and stroke and heart events, please don't be act from a place of fear. Integrate this new information into your life by identifying where erythritol appears in your day-to-day food choices, and then create an action plan to reduce your intake by reading labels, and exploring new food choices. You will find your favorite new go-tos in no time at all.
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Erythritol and cardiovascular events available at www.nih.gov/news-events/nih-research-matters/erythritol-cardiovascular-events
Witkowski, M et al. The artificial sweetener erythritol and cardiovascular event risk. Published: February 27 2023. Abstract available at: https://www.nature.com/articles/s41591-023-02223-9
Consumption of Oral Artificial Sweeteners on Platelet Aggregation and Polyol Excretion (COSETTE) https://clinicaltrials.gov/ct2/show/NCT04731363