Did you see the headlines last week? 
Sigh. 
Another reminder that what we put in and on our bodies can impact our health. 

Artificial sweeteners are extremely common in many packaged & processed foods- especially those found in low carb products. 

They are even recommended by some healthcare professionals as a healthier substitute for sugars. 

On a personal note,  they are in my new favorite oatmeal too… 

Ugh..

Which had been a super easy (and delicious!) way to increase the fiber and protein in my morning routine.

So what is erythritol? 

Erythritol is a 4-carbon sugar alcohol (a polyol) that is commonly used as a sugar substitute. It is naturally present in low amounts in fruits and vegetables, but when incorporated into processed foods, it is typically added at levels 1,000-fold higher than endogenous levels (for example, up to 60% of food weight in some creams or pastry products) due to lower sweetness compared to sucrose. The daily intake of erythritol in the total US population has been estimated to reach up to 30 g per day in some participants based on the 2013–2014 National Health and Nutrition Examination Survey data and FDA filings. It also can be naturally produced in the body as well. 

When I see headlines- especially medical headlines, I always take a deep breath and then dig in. 

The reality is that sensation and emotion sell so I always have a bit of skepticism.

So how bad is it? What do we need to be considering? 

So let’s breakdown the study:

The researchers took blood samples from 1,157 people undergoing a risk assessment for cardiovascular disease and continued to follow these patients for 3 years monitoring for those who ended up suffering from MACE (death, heart attack, and stroke). They analyzed the blood samples from those who suffered MACE versus those who did not looking for substances that were associated with increased risk.

In other words, they didn’t go looking specifically to find erythritol, but they found it! 

The problem is that doesn't tell us specifically where the erythritol is coming from- was it consumed or was it made at higher levels in these folks who had MACE events? 

Then they worked to validate their findings by looking at more people both in the US (N=2149) and Europe (N=833) which confirmed the increased risk with higher levels. 

Again though this points to correlation not causation and doesn't tell us where the erythritol came from.

How is erythritol causing a problem? 

It appears to increase the stickiness of platelets through multiple different cell surface receptors including selectins and glycoproteins which causes blood to clot more easily. 

What is the magnitude of the increase? 

The researchers found that levels of erythritol remained substantially elevated in the bloodstream after ingesting 30 grams (the equivalent of a typical sweetened drink or keto ice cream) for up to 2 days. These were levels above the thresholds that triggered increased clotting activity. Unfortunately, they didn't have a control group or randomize the people who were tested so this data is not ideal. 

They calculated a hazard ratio of 1.8. This means that the risk of MACE was nearly doubled in folks who had higher rates of erythritol in their blood stream. 

Sooo… 

What to do? 

Well, we need more data- this is just 1 study and was in folks prone to heart disease that were older in age. There wasn't a control group and we don't know where the erythritol was coming from (diet or produced at higher rates in people at higher risk).

That said, 
We all have different levels of risk tolerance. 

So here is my takeaway….

I already do my best to minimize processed foods and artificial type ingredients- within reason. I will do my best to continue to minimize erythritol and artificial sweeteners.
I did see they were included in my new favorite oatmeal product- but not all of the flavors. So I am going to be more conscientious of reading labels again to get a sense of how often this is making its way into my diet.

With an autoimmune or inflammatory diagnosis like Sjogren’s in my case, I am already at a higher risk of cardiovascular disease- this is in large part why I focus so much on eating a plant-forward diet and have been mindful to re-introduce exercise as a regular part of my daily routine so I am also going to keep my eye out for more data as this certainly will not be the last that we hear about this. 

Want to check out the article? 

Here is the link: 
https://www.nature.com/articles/s41591-023-02223-9

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