“Zero-calorie” “sugar substitute” may be related to heart disease?

Erythritol, a sugar substitute that is considered "zero calorie," is one of the most commonly used artificial sweeteners. Regulators generally consider such sweeteners to be safe, and few studies have looked at their long-term health effects.

A newly published research paper claims that the artificial sweetener erythritol may be linked to heart disease events .

Studies have found that increased erythritol levels may be associated with an increased risk of thrombosis . In the early morning of February 28, a related paper was published online in the international academic journal Nature Medicine. The title is "The artificial sweetener erythritol and cardiovascular event risk." The corresponding author of the paper is Dr. Stanley Hazen, director of the Cardiovascular Diagnosis and Prevention Center at the Lerner Research Institute of the Cleveland Clinic in the United States.

Erythritol is found "naturally" in low levels in fruits and vegetables. It is difficult for the human body to metabolize. As one of the commonly used sugar substitutes, it is added at higher levels in processed products.

Survey data from the National Health and Nutrition Examination Survey in the United States from 2013 to 2014 and data disclosed by the U.S. Food and Drug Administration (FDA) show that among the general population of the United States, some people consume up to 30 grams of erythritol per day.

The researchers first conducted a preliminary study in 1,157 people who had been assessed for heart disease risk and had 3-year outcome data. By analyzing chemicals in the blood, they observed that levels of compounds from multiple artificial sweeteners, especially erythritol, were associated with an increased risk of future heart disease and stroke over a three-year follow-up.

This association was confirmed in an independent cohort study, in which researchers conducted targeted metabolomics analysis in 2,149 and 833 stable patients undergoing elective cardiac evaluation in the United States and Europe, respectively.

Researchers believe that at a physiological level, erythritol can increase platelet reactivity and promote the formation of blood clots .

They also conducted a prospective intervention study in eight healthy volunteers: after the volunteers consumed a 30-gram erythritol beverage, their plasma levels were examined. They found that erythritol levels in all volunteers continued to increase, exceeding the threshold for increased clotting risk within 2-3 days.

The researchers said their findings may suggest that elevated erythritol levels are associated with an increased risk of blood clots.

However, they also pointed out that the incidence of cardiovascular risk factors in the relevant patient cohort involved in this study was relatively high, so it remains to be confirmed whether similar results can be observed in longer-term follow-up of apparently healthy subjects.

The researchers pointed out that because erythritol is widely present in nature, it is generally considered "safe" by the U.S. Food and Drug Administration (FDA) and other agencies. At the same time, it is considered to have antioxidant effects, and its use has been quickly approved in many countries around the world and is widely used commercially. In addition, because the FDA does not require the disclosure of the erythritol content in food, coupled with the confidentiality policy on food labels, the content of individual additives is difficult to track, which hinders relevant safety assessments and limits people's ability to monitor the long-term health effects of individual sweeteners.

Therefore, the researchers suggest that, first, it is necessary to clarify the reporting requirements, safety documentation requirements and daily intake margins of artificial sweeteners in public policies; second, in order to evaluate the long-term effects of artificial sweeteners, especially erythritol, on the risk of heart attacks and strokes in people (especially patients with a higher risk of cardiovascular disease), further safety studies are necessary.