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Is Erythritol Going to Kill You?

Recently the non-nutritive natural sweetener erythritol has been getting a lot of buzz in the media. Unfortunately, this has been the type of attention that makers of products containing erythritol never want to see. This unwanted attention dates back several weeks when a study was published linking erythritol to heart attack and stroke in people with pre-existing cardiovascular conditions like heart disease or diabetes. The study further showed that in lab studies erythritol lead to increased clotting.

So let’s dissect this study to determine if erythritol is actually dangerous, in my opinion. First, let me state that I do not feel that the study is flawed or the research team did anything wrong. We cannot, however jump to the conclusion that erythritol caused cardiovascular problems based on correlation in an observational study. The research team goes as far as making the statement that this causal relationship cannot be established. There has also been plenty of research that counters this study, where erythritol has been shown to actually be beneficial to the cardiovascular system. But this is the shocking/sexy study with a grandiose headline, so, like a spoiled child in Walmart, it is getting the attention for now.

Here are the basics on what the study looked at. First, the researchers were looking, in my opinion, at super-users of erythritol. These were people who were consuming 30g of erythritol per day. For reference the FDA considers a normal intake of erythritol to be around 13g per day. The FDA also states that a consumption of 30g per day would put a user into the 90th percentile of all users. The participants in the study also had pre-existing heart problems. These were not “healthy” individuals starting out in the study. But, it does need to be stated that given these factors, as erythritol use increased so did these cardiovascular events.

The second part of the study dealt with clotting. It was found that in lab studies (not human studies) clotting was increased in the presence of erythritol. An inappropriate increase in clotting can be detrimental to those already at risk for cardiovascular events. This seems to be the researchers “smoking gun”. Unfortunately, the research team went looking for a mechanism only after they found a result that they didn’t fully understand (the link between erythritol and heart attacks). The problem here, in my opinion, is researcher bias. When you are actively looking for something it becomes much easier to find.

So how much erythritol is actually in foods that contain it? Remember we need to get to 30g per day. Here are just a couple of examples:

  • Truvia Packet 2g – You would need 15 Truvia sweetened coffees/day
  • Hershey’s 0 Sugar – 2g/serving – You would need to turn the bottle upside down and drink it.
  • Vitamin Water Zero – 5g per bottle – how active are you to need 6 of these per day?

It should be clear that getting to this 30g/day level is not the norm.

In my opinion, even though the participants already had pre-existing conditions in place and they were using much more erythritol daily than is normal, the erythritol is still not causing cardiovascular problems. Here are two alternative scenarios that have the same probability of being true.

  1. The participants at the highest risk for cardiovascular events (the most unhealthy) may be the most likely to use erythritol to reduce calories and lose weight to improve their health. In this scenario the participants underlying health problems lead to an increased risk for heart attacks and strokes AND an increase in erythritol use.
  2. The participants in the study that have really lost control of their ability to control their diets could be the ones consuming inordinate amounts of erythritol. These individuals would also likely be at a greater risk due to their out of control diet. In this case the participants mindset causes both the increased risk AND the increased erythritol use.

My point is simply that there is no way to know by this study if erythritol is the issue or any number of other factors.

Finally, if you are concerned with erythritol consumption, it is easy avoidable. You could simply avoid non-nutritive sweeteners. Do we really HAVE to have sweets… really? There are also plenty of 0 calorie sweeteners available that don’t contain erythritol. But are these products actually safer? In my opinion, that is not a determination that should be made off of one observational study.

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