Calorie Council: Study Linking Erythritol to Blood Clots Is Flawed

A new study found that healthy volunteers who consumed erythritol, a sugar substitute, experienced increased platelet activity linked to the formation of blood clots. However, the Calorie Control Council urges consumers to use caution when interpreting the results.

New research by scientists at the Cleveland Clinic has unearthed more evidence that erythritol, an artificial sweetener found in beverages, gum, baked goods, and some keto diet foods, may have unwanted cardiovascular effects.

Erythritol, like sorbitol and xylitol, is a sugar alcohol produced by fermenting corn. Once ingested, the compound enters the bloodstream and is excreted through urination. The body does not effectively metabolize erythritol, so it has a minimal impact on blood sugar levels. The artificial sweetener is found in products such as Truvia, and many other "low-calorie" foods.

However, a previous Cleveland Clinic study published in 2023 found that people with higher levels of erythritol were at increased risk of experiencing a significant cardiovascular event such as heart attack or stroke.

The team's latest study, published on August 8 in Arteriosclerosis, Thrombosis, and Vascular Biology, examined the effects of consuming the sugar substitute at a dose typically found in a sugar-free beverage or muffin.

To conduct the study, the scientists had 20 healthy participants consume 30 grams of erythritol or 30 grams of sugar. When the team tested the participant's blood, they found that after eating the sugar substitute, erythritol concentrations were 1,000 times higher than before consuming the compound.

In addition, the platelets of participants who consumed erythritol became more active, potentially increasing the risk of blood clot formation.

However, participants consuming sugar did not experience this effect.

"This research raises some concerns that a standard serving of an erythritol-sweetened food or beverage may acutely stimulate a direct clot-forming effect," said study co-author W. H. Wilson Tang, M.D., research director for Heart Failure and Cardiac Transplantation Medicine at Cleveland Clinic, in a news release. "Erythritol and other sugar alcohols that are commonly used as sugar substitutes should be evaluated for potential long-term health effects, especially when such effects are not seen with glucose itself."

Food industry association questions study findings

In an emailed statement to Healthnews, Carla Saunders, President of the Calorie Control Council, an international association representing the low- and reduced-calorie food and beverage industry, said, "Consumers should interpret the results of this pilot with extreme caution. The limited number of participants, a total of 10, were given an excessive amount of erythritol, nearly double to triple the maximum amount approved in any single beverage in the United States based on [a] standard 8 to 16 ounce serving."

Saunders added that erythritol levels were only measured once after consumption, and the study lacked control over lifestyle factors that may affect the outcome, which could introduce confounding variables and impact the reliability of the findings.

"Further, erythritol levels were only measured at baseline and 30 minutes after consumption, so there is no way to demonstrate any lasting effect of excessive consumption on any health outcome," Saunders explained. "Consumers need to rely on science, and for 30 years, science has shown that erythritol is a proven safe and effective choice for sugar and calorie reduction."

More research needed

In 2023, the EFSA reevaluated erythritol and concluded that while some studies have investigated the artificial sweetener's role in cardiovascular disease, "there is uncertainty whether the circulating levels of erythritol in these studies reflect dietary exposure from its use as a food additive."

The EFSA says the acceptable daily intake of erythritol is 0.5 grams of erythritol per kilogram of body weight.

Still, the Cleveland Clinic's series of artificial sweetener investigations also revealed that xylitol, a sugar substitute similar to erythritol, may also harbor cardiovascular risks. The study, published in June of this year in the European Heart Journal, found that people with high levels of xylitol in their blood were more likely to experience a cardiovascular event over three years.

With so many unanswered questions remaining, more investigations are needed to fully understand the potential cardiovascular risks of consuming artificial sweeteners like erythritol and xylitol. However, in the meantime, the authors of the latest Cleveland Clinic study suggest people use discernment when choosing low-calorie food products.

"I feel that choosing sugar-sweetened treats occasionally and in small amounts would be preferable to consuming drinks and foods sweetened with these sugar alcohols, especially for people at elevated risk of thrombosis such as those with heart disease, diabetes or metabolic syndrome," said senior study author Stanley Hazen, M.D., Ph.D., the chair of Cardiovascular and Metabolic Sciences in Cleveland Clinic's Lerner Research Institute. "Cardiovascular disease builds over time, and heart disease is the leading cause of death globally. We need to make sure the foods we eat aren't hidden contributors."