Erythritol, a popular zero-calorie sugar substitute, has been linked to blood clotting, stroke, heart attack, and death, according to a study published online in Nature Medicine journal Monday.
“The degree of risk was not modest,” lead study author Dr. Stanley Hazen, director of the center for cardiovascular diagnostics and prevention at the Cleveland ClinicLerner Research Institute told CNN.
“For people who are at risk for clotting, heart attack and stroke — like people with existing cardiac disease or people with diabetes — I think that there’s sufficient data here to say stay away fromerythritol until more studies are done,” Hazen also said.
“This certainly sounds an alarm,” Dr. Andrew Freeman, director of cardiovascular prevention and wellness at Denver’s National Jewish Health hospital told the outlet. Freeman was not involved in the research.
“There appears to be a clotting risk from using erythritol,” Freeman also said.
“Our findings reveal that erythritol is both associated with incident MACE risk and fosters enhanced thrombosis,” the authors say in their study.
MACE is an acronym for major adverse cardiovascular events. MACE includes death or nonfatal myocardial infarction or stroke. Thrombosis occurs when blood clots block veins or arteries.
The study found that people already at risk for heart disease had double the likelihood of having a heart attack or a stroke if they had the highest level of erythritol in their blood, CNN reported.
“It’s on par with the strongest of cardiac risk factors, like diabetes,” Hazen told CNN. Hazen was referring to people who had blood levels of erythritol in the top 25% of the study group.
The study involved people who were already at risk for cardiovascular problems. For that reason, the results’ applicability to the broader population are unknown.
The authors encourage further studies assessing the long-term safety of erythritol.
Erythritol is a sugar alcohol like xylitol, sorbitol, and malitol, according to Healthline. It looks and tastes like sugar, though not as sweet. It contains less than 1/4 calorie per gram. Unlike sugar, erythritol does not result in blood sugar or insulin spikes.
It is found naturally in foods like grapes and mushrooms and is also produced commercially via fermentation, Food Insight explains. It is poorly metabolized and mostly excreted in urine, the study authors note, which is why it is characterized as “zero-calorie.”
The erythritol found naturally in food is in low amounts, the study’s authors explained. When it is 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 bulk sweetener appears in a number of products, including branded sweeteners like Truvia, products marketed for “keto” diets, and reduced-sugar products marketed to people who have diabetes.