Tag Archive for: sugar alcohol

Erythritol: Reserve Judgment for Now

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The study published in Nature Medicine on erythritol is complex to say the least. I gave you three quarters of the results. There was one more part that I want to cover and then give you my primary issues with the study. As I said in Tuesday’s Memo, I’ve posted a Straight Talk on Health podcast for Members and Insiders that gives my complete thoughts on sugar alcohols, especially erythritol (remember to log in first).

Erythritol and Clotting

The final part of the study was actually a preliminary report on a much larger study. They had eight subjects drink 30 grams of erythritol mixed with 300 ml of water. That corresponds to estimates of what a high intake would be. Then they tracked serum erythritol levels in the subjects for seven days. They also tested for indicators of blood clotting factors and found that some were increased for a few days after consuming the erythritol drink. The implication is that high intake of erythritol might contribute to blood clots forming. The question is: who is at risk?

Primary Issues

My primary concern is the lack of adequate controls. This was an observational study, not a clinical trial, so no cause and effect can be determined. Researchers took measurements on several cohorts of subjects with diagnosed coronary artery disease (CAD). Those subjects had a host of risk factors including high blood pressure, type 2 diabetes, high LDL- cholesterol, and on and on. The ages in each cohort ranged from a median of 65 in the Discover cohort up to 75 in the European cohort.

They did not have a comparable cohort of apparently healthy controls in the same age group. They could have chosen a group of subjects who had blood drawn at their annual physical but no apparent diagnosis of CAD. While still not getting to cause and effect, it would have strengthened the basic observations if major adverse cardiovascular events (MACE) was seen or not seen in the controls.

The same is true for the study on the erythritol drink. Why not get a group with diagnosed CAD and see if the same clotting effect happened? If not that, why not just do a simple test that measures clotting time? That’s done for anyone who takes a blood thinner such as warfarin.

The Bottom Line

The researchers called for more research on erythritol to examine the increased adverse events in the present study, and I agree. Because erythritol is part of many low-carbohydrate foods and drinks designed for diabetics and those on a ketogenic diet, we need to know more about the risks. This was a good research paper but incomplete. The best we can say as to whether we should use sugar alcohols is that we must reserve judgment until a lot more research is done.

If you’re concerned about artificial sweeteners, try to cut back and use a variety of them to reduce the risks associated with any particular one. But for your health’s sake, don’t switch to sugar; the risks of high sugar consumption are even greater than those associated with artificial sweeteners. For ideas of asking the right questions in those future trials and more on sugar alcohols, check out the Straight Talk on Health just posted by becoming a Member or Insider.

What are you prepared to do today?

        Dr. Chet

Reference: Nature Medicine. 2023. https://www.nature.com/articles/s41591-023-02223-9

Is Erythritol Safe?

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Health writers have been talking pro and con about a new study that was published about erythritol, a commonly used sugar alcohol. The paper demonstrated an increased risk of major adverse cardiovascular events (MACE) if a person had too much of the sweetener in their bloodstream. In that sugar alcohols are found in more and more products, especially those geared toward the ketogenic diet, are people really at risk for a major cardiac event, or worse, death? Let’s take a look at the results of the study.

The researchers used data collected during consecutive heart catheterizations at the Cleveland Clinic, termed the Discovery cohort, a U.S. population extracted from a large genetic study conducted by the Cleveland Clinic, called U.S. validation cohort, and a European validation cohort similar to the one selected from the population in the Discovery cohort. The two key elements were that all subjects had blood samples drawn that could be studied and all were tracked for at least three years. Researchers developed tests to specifically identify the quantity of erythritol found in subjects’ blood.

The researchers separated the subjects into quartiles and compared those with the lowest levels of erythritol with those with the most. In all three cohorts, with blood samples taken in different parts of the U.S. and Europe and over different years, the highest quartile had a significant increased risk of MACE in over three years compared to the lowest quartile—two to three times as high.

In Saturday’s Memo, I’m going to review the major issue with the study. I’ll also post a Straight Talk on Health for Members and Insiders that takes a deeper dive into all the issues surrounding the study and whether this is something to be concerned about or not.

What are you prepared to do today?

        Dr. Chet

Reference: Nature Medicine. 2023. https://www.nature.com/articles/s41591-023-02223-9