Beware! Fake Sugar Warning

It may just be the algorithm from my online activity, but my news feeds have been getting blown up over the dangers of fake sugar. Ever since the journal Nature Medicine published the results of a study on erythritol, it seems that most all media outlets have at least one if not multiple stories based on a study that was published February 27th, 2023. It appears that recent research has concluded that erythritol causes blood clots, heart attacks, and strokes.

From Nature Medicine:

Artificial sweeteners are widely used sugar substitutes, but little is known about their long-term effects on cardiometabolic disease risks. Here we examined the commonly used sugar substitute erythritol and atherothrombotic disease risk. In initial untargeted metabolomics studies in patients undergoing cardiac risk assessment (n = 1,157; discovery cohort, NCT00590200), circulating levels of multiple polyol sweeteners, especially erythritol, were associated with incident (3 year) risk for major adverse cardiovascular events (MACE; includes death or nonfatal myocardial infarction or stroke). Subsequent targeted metabolomics analyses in independent US (n = 2,149, NCT00590200) and European (n = 833, DRKS00020915) validation cohorts of stable patients undergoing elective cardiac evaluation confirmed this association (fourth versus first quartile adjusted hazard ratio (95% confidence interval), 1.80 (1.18–2.77) and 2.21 (1.20–4.07), respectively). At physiological levels, erythritol enhanced platelet reactivity in vitro and thrombosis formation in vivo. Finally, in a prospective pilot intervention study (NCT04731363), erythritol ingestion in healthy volunteers (n = 8) induced marked and sustained (>2 d) increases in plasma erythritol levels well above thresholds associated with heightened platelet reactivity and thrombosis potential in in vitro and in vivo studies. Our findings reveal that erythritol is both associated with incident MACE risk and fosters enhanced thrombosis. Studies assessing the long-term safety of erythritol are warranted. (1)

Biological Reactivity Tests, In Vivo are designed to determine the biological response of animals to elastomerics, plastics and other polymeric material with direct or indirect patient contact, or by the injection of specific extracts prepared from the material under test.

 Thrombosis formation in vivo is a method which is used to explore the role of platelets, blood coagulation proteins, endothelium, and the vessel wall during thrombus formation.

Data Available:

There are restrictions to the availability of some of the clinical data generated in the present study (Figs. 1 and 2), because we do not have permission in our informed consent from research subjects to share data outside our institution without their authorization. (1)

First off, I am neither a research scientist, nor am I a medical doctor. However, I am someone who has an inquisitive mind and will question just about everything. This is especially true when it comes to the subject of healthy nutrition. The first red flag for me was when I pulled up more than one article that was using packages of sweeteners that don’t even include erythritol for illustration. Seems to me that if one is going to scare their readers, they could have at least made sure their headline pictures could have been actually related to the stories.

As you can see in the paragraph highlighted in red, there has been no permission given for Nature Journal to have access to all of the study data. In my opinion, it is journalistic malpractice to spread a story when it is clear that the author does not have all of the pertinent information from the study. While there may be cause to continue with further research on erythritol, this “fake sugar” has been studied for several years before it became commercially available in America.

Correlation doesn’t necessarily mean causation.

I believe it is safe to say that erythritol has been found in the blood of people who suffered from a MACE (major adverse cardiac event). But this does not necessarily mean that the individual examined had a cardiac event related to the consumption of erythritol since there are several other factors which can also cause adverse cardiac events. In other words, if several people who committed suicide were found to have cheese in their bellies, we obviously cannot conclude that cheese drives people to suicide.

How much erythritol does it require to cause blood clotting issues?

From the report that Nature Medicine published, and that most media sites are using as their source, we do not know anything about how much erythritol it takes to cause cardiac health problems in people. We have no idea from the published study how much dietary erythritol was consumed by each individual in the study. It is entirely possible that the erythritol found in the study was endogenous erythritol which is actually made in our bodies during glucose metabolism.

A major consideration is that not only do we not know the source of, nor quantity of erythritol consumed by individuals in the study – we also do not know if there were any other mitigating factors behind their cardiac events such as metabolic diseases such as type 2 diabetes, heart disease, and some cancers. It is entirely possible, and highly likely that the individuals used for the study did not have healthy dietary practices.

What exactly is erythritol?

• Erythritol is a type of carbohydrate called a sugar alcohol, or polyol. 
• Erythritol is unique from other sugar alcohols because it contains zero calories. 
• Erythritol occurs naturally in a variety of fruits, vegetables, and fermented foods and beverages. It is also commercially produced through fermentation. Our bodies also produce smaller amounts of erythritol during glucose metabolism. 
• Erythritol does not impact blood glucose or insulin secretion and contributes to oral health. 
• Erythritol’s safety has been confirmed by numerous health authorities around the world, including the U.S. Food and Drug Administration and World Health Organization. Erythritol is approved for use in more than 60 countries. 

 Erythritol has been shown to benefit oral health in a number of ways. Primarily, because it is noncariogenic.  In other words, it doesn’t contribute to cavity formation. It is actually known to  inhibit the growth of the oral bacteria (Streptococcus mutans) which is known to be associated with cavities.

Erythritol is absorbed in the small intestine, but it is not fully metabolized. Instead, it is eliminated unchanged from the body, mainly through the urine. This makes erythritol helpful for people with diabetes because it doesn’t provide carbohydrates, sugar, or calories, and therefore does not affect blood glucose levels or insulin secretion.  

In another study of erythritol,  24 adults with type 2 diabetes found that taking 36 grams of erythritol every day for a month improved the function of their blood vessels, potentially reducing their risk of heart disease.

When it comes to using “fake sugar”, if you are concerned of the health risks, you really should consider weighing the health implications of using actual sugar as opposed to “fake sugar” No matter the excuses we hear about not giving up sugar for erythritol, you would be hard pressed to find any legitimate documentation of erythritol having worst health outcomes than sugar.