9 ms·

The artificial sweetener erythritol and cardiovascular event risk

62 points by rswerve 4y ago

8f2ab37a-ed6c 4y ago
Fascinating, I'm a heavy consumer of this stuff and I would love to know how valid this research is. If it's solid work, I guess it's bye bye to a lot of products that felt guilt-free.
- foxyv 4y ago
  They think that erythritol increases platelet activity which may cause thrombosis. They have proven that erythritol does affect platelet reactivity. However the study doesn't prove it adequately to say that it definitively causes thrombosis. That would require a follow up study. They have some correlation in data from people with cardiac disease, but it's not surprising to see erythritol there because a lot of cardiac disease is caused by type 2 diabetes. Without further study there is no way to say if there is an increased risk of thrombosis from this data alone. Just enough to say they should perform further studies to make a determination. In most cases with these studies, the increased risk of thrombosis would so low that you could offset it by taking a walk once a week. I personally won't stop my consumption of erythritol on this data alone, but there ARE other sweeteners. I mostly use Stevia myself.
- latchkey 4y ago
  Many/most of the monk fruit 'sweetener' products contain it as an additive. Super annoying since monk fruit itself doesn't need it.
  - vosper 4y ago
    Most "monk fruit" sweetener I've seen actually has erythritol as the main ingredient, which just a small amount of monk fruit. Presumably this is to get away with calling it "monk fruit sweetener" which appeals to the idea that it's somehow a more "natural" product.
    - 8f2ab37a-ed6c 4y ago
      Even my stevia sweetener has erythritol as its first ingredient, so this has to be ubiquitous. Back to Splenda I guess?
      - Obscurity4340 4y ago
        Trader Joes has pure stevia
    - uberduper 4y ago
      Monkfruit is "300x sweeter than sugar." I have no idea how they measure this. I've never tasted monkfruit or an undiluted extract. They mix it in with erythritol to try and match the sweetness and appearance of sugar.
- bloaf 4y ago
  I, for one, am confused why people choose erythritol over allulose.
  - outworlder 4y ago
    They usually don't. But if you get something like monk fruit, you only need a tiny amount. Erythritol is often added so it will look more like sugar.
  - Alex3917 4y ago
    What are the benefits of allulose over erythritol? I’ve only had the latter, but they seem pretty similar.
    - uberduper 4y ago
      Allulose is about 70% as sweet as sugar but tastes much more like sugar than the other sugar alcohols. Allulose caramelizes (tho you should not try to make caramel with allulose. (you've been warned.)) It dissolves much better than erythritol. Allulose has a consistency more like dextrose than table sugar. More like a powder. It behaves more like sugar in baked goods. Erythritol has a kinda minty aftertaste.. like on the exhale that can be unpleasant if it's not overpowered by something else. All that said, I still prefer an erythritol + monkfruit sweetener in beverages. Erythritol is easier on my stomach in larger quantities.
  - Eduard 4y ago
    Looking over the pond, e.g. EU has not allowed allulose / psicose for human consumption. Also, here is a thread from a week ago that also discussed allulose: https://news.ycombinator.com/item?id=34879059 https://news.ycombinator.com/item?id=34879059
- FriedrichN 4y ago
  I wouldn't worry about it, from what I gather the validity (of the claim erythritol: bad) of the study is questionable. Mainly because the study participants were very ill with hypertension, diabetes, CVD, and they didn't look at erythritol intake, just blood levels. Layne Norton did a quick video explaining the shortcomings of the study. https://www.youtube.com/watch?v=Ad8_scQtHFM https://www.youtube.com/watch?v=Ad8_scQtHFM The problem with studies like this is the reporting on them. I'm fairly sure most people reporting on this study did not actually read it (and you can't read it without paying). And it just plays into the confirmation bias that any non-nutritive sweetener is bad, despite them all being wildly different chemical compounds that all get metabolised in very different ways.
JustSomeNobody 4y ago
Well, this sucks. I use this in my coffee and a smidge on my oatmeal. Is there an artificial sweetener left that doesn't cause issues? Splenda was associated with CVD so that's why I switched.
- Workaccount2 4y ago
  The holy grail of sweetners is left handed sugar. Basically a regular glucose molecule but flipped. Tastes identical to sugar but cannot be metabolized. The catch is that no one has found a way to synthesize it cheaply.
  - jbaber 4y ago
    I don't know. Trans-fat turned out to be super bad. I'm leery of trans-sugar.
  - prmph 4y ago
    Something tells me there is no free lunch here as well. It seems everything that gratifies the tongue is bad in some way.
  - Obscurity4340 4y ago
    Wikipedia says "L-Glucose was also found to be a laxative..."
- stavros 4y ago
  Aspartame?
  - outworlder 4y ago
    No! Aspartame is known to cause serious issues for decades now, even before it was finally approved by the FDA.
    - idiotsecant 4y ago
      Oh? Who is that 'known' by? Certainly not any of the over 100 regulatory agencies around the world who have made aspartame one of the most studied compounds on earth. Unless you have PKU or migraines there is literally no widely accepted science that says otherwise.
mikece 4y ago
[flagged]
- 6LLvveMx2koXfwn 4y ago
  Which you're also being a little coy about for some reason.
  - parvenu74 4y ago
    Perhaps (s)he's concerned about political backlash (via down-voting) on HN?
    - deleted 4y ago
      [deleted]
    - rom-antics 4y ago
      I'm sure he can spare some of his 19876 internet points, just say it FSS
      - mikece 4y ago
        And my comment has been flagged. Too coy now?
    - rootusrootus 4y ago
      You cannot lose that many magical internet points on a single post, so don't worry about it.
- outworlder 4y ago
  I'm pretty sure what you mean but the rate of cardiovascular issues has been increasing for decades, at least since the 70's. The actual politically sensitive possibility is sugar (and even more so, high fructose corn syrup). There's a lot of money involved there.
- jsnell 4y ago
  The studies this paper is based on were started 20 years ago. Does your conspiracy theory include time machines?
DantesKite 4y ago
Well, no worries for me. I found out years ago I'm allergic to this stuff the hard way. Gave me hives all over my face for a few hours. Intensely itchy. Now whenever I drink something new, I always look out for it.
- rootusrootus 4y ago
  Have you had to adjust your diet to eliminate natural sources as well, or does the reaction only happen for high concentrations?
  - DantesKite 4y ago
    It seems to only happen in drinks with high concentrations. Like this one. https://www.safeway.com/shop/product-details.960552358.html https://www.safeway.com/shop/product-details.960552358.html
    - rootusrootus 4y ago
      First ingredient (after water), wow. I guess that is not shocking, a lot of foods have been doing the same thing for years with sugar. One thing I would like to see on labels is concentrations of the various ingredients. I suppose that gets into proprietary recipe information that no manufacturer will be keen on releasing, but it would be nice to know what % of a given concoction is made up by a given ingredient.
f38zf5vdt 4y ago
Weird. It has no effect on survival in rats and the doses were large. > One chronic (78-weeks) study in rats with dietary levels of 0, 1, 3, or 10% erythritol (equal to > 0.46, 1.4 and 5 g/kg bw/day for males and 0, 0.54, 1.7 and 5.7 g/kg bw/day for females) (Til > and van Nesserooij, 1994) and another 2-year chronic toxicity/carcinogenicity study in rats > with dietary levels of erythritol of 0, 2, 5, or 10% (equal to 0, 0.9, 22, and 4.6 g/kg bw/day for > males and 0, 1.0, 2.6, and 5.4 g/kg bw/day) (Lina et al., 1994; 1996) demonstrated that > erythritol did not affect survival and had no carcinogenic effect. https://ec.europa.eu/food/fs/sc/scf/out175_en.pdf https://ec.europa.eu/food/fs/sc/scf/out175_en.pdf From this paper: > In a population-based prospective cohort study with repeated dietary records, ingestion of multiple artificial sweeteners (for example, aspartame, acesulfame potassium and sucralose) was associated with CVD risk. Ok, let's look at that reference. > Results Total artificial sweetener intake was associated with increased risk of cardiovascular diseases (1502 events, hazard ratio 1.09, 95% confidence interval 1.01 to 1.18, P=0.03); absolute incidence rate in higher consumers (above the sex specific median) and non-consumers was 346 and 314 per 100 000 person years, respectively. Artificial sweeteners were more particularly associated with cerebrovascular disease risk (777 events, 1.18, 1.06 to 1.31, P=0.002; incidence rates 195 and 150 per 100 000 person years in higher and non-consumers, respectively). Aspartame intake was associated with increased risk of cerebrovascular events (1.17, 1.03 to 1.33, P=0.02; incidence rates 186 and 151 per 100 000 person years in higher and non-consumers, respectively), and acesulfame potassium and sucralose were associated with increased coronary heart disease risk (730 events; acesulfame potassium: 1.40, 1.06 to 1.84, P=0.02; incidence rates 167 and 164; sucralose: 1.31, 1.00 to 1.71, P=0.05; incidence rates 271 and 161). This study shows the same thing with _all_ artificial sweeteners, and has way more people (n=103,388) than the present Nature study (n=1,157). And we know that erythritol is often used by type 2 diabetics due to its low effect on insulin levels. That population is predisposed to cardiac events to begin with. When adjusting the US/EU cohorts for cardiovascular risk factors, the observed effect with erythritol are smaller and closer to this study of other artificial sweeteners. > Consistent with the results observed within the discovery cohort (adjusted HR = 2.95 (1.70–5.12) P < 0.001; Fig. 1 and Supplementary Table 4), the association between erythritol levels (fourth quartile versus first quartile) and incident MACE risk remained significant in both US and European validation cohorts following adjustments for cardiovascular risk factors (adjusted HR (95% CI) = 1.80 (1.18–2.77) and 2.21 (1.20–4.07), P = 0.007 and P = 0.010, respectively I'm not convinced of the validity of this study. They ignored the rat chronic toxicity data and proposed a mechanism for what they saw in a small cohort of humans, but it should be reproducible in mammals.
SoftTalker 4y ago
I just avoid artificial sweetener as a category. They all taste like chemicals to me anyway. I used to drink a lot of Diet Coke but have hardly touched it for years. It tastes like weed killer to me now.
- sgerenser 4y ago
  Erythritol isn't an artificial sweetener, it's a sugar alcohol.
deleted 4y ago
[deleted]
creamyhorror 4y ago
Oh boy, so now the promising erythritol is also under suspicion. A while ago I read about its benefits for dental health, which seemed to exceed xylitol's, so I even bought a bag (which also included the stevia-class sweetener Reb M). I've read 2022 studies on various non-sugar sweeteners, and statistically, sucralose seems to have a slight advantage over aspartame and acesulfame-k in regards to cancer risk correlation.[1] Whereas aspartame and stevia didn't significantly impair glycemic response / glucose tolerance over a 2-week trial, but sucralose and saccharin did.[2] So each sweetener probably has different downsides. In the end, I think they seem safe enough to have occasionally in place of sugar, though I wouldn't go wild with them. (It's also interesting that this new study comes from Stanley Hazen's lab. He's also published research about the potential cardiovascular risk impact of choline through its metabolite TMAO.) [1] [(Mar 2022) Artificial sweeteners and cancer risk: Results from the NutriNet-Santé population-based cohort study](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003950 https://journals.plos.org/plosmedicine/article?id=10.1371/jo...). [2] 2022 Suez: https://www.cell.com/cell/fulltext/S0092-8674(22)00919-9 https://www.cell.com/cell/fulltext/S0092-8674(22)00919-9 - from https://www.reddit.com/r/ScientificNutrition/comments/wt813r/personalized_microbiomedriven_effects_of/ https://www.reddit.com/r/ScientificNutrition/comments/wt813r...

62 points by rswerve 4y ago

Fascinating, I'm a heavy consumer of this stuff and I would love to know how valid this research is. If it's solid work, I guess it's bye bye to a lot of products that felt guilt-free.

foxyv 4y ago
They think that erythritol increases platelet activity which may cause thrombosis. They have proven that erythritol does affect platelet reactivity. However the study doesn't prove it adequately to say that it definitively causes thrombosis. That would require a follow up study. They have some correlation in data from people with cardiac disease, but it's not surprising to see erythritol there because a lot of cardiac disease is caused by type 2 diabetes. Without further study there is no way to say if there is an increased risk of thrombosis from this data alone. Just enough to say they should perform further studies to make a determination. In most cases with these studies, the increased risk of thrombosis would so low that you could offset it by taking a walk once a week. I personally won't stop my consumption of erythritol on this data alone, but there ARE other sweeteners. I mostly use Stevia myself.
latchkey 4y ago
Many/most of the monk fruit 'sweetener' products contain it as an additive. Super annoying since monk fruit itself doesn't need it.
- vosper 4y ago
  Most "monk fruit" sweetener I've seen actually has erythritol as the main ingredient, which just a small amount of monk fruit. Presumably this is to get away with calling it "monk fruit sweetener" which appeals to the idea that it's somehow a more "natural" product.
  - 8f2ab37a-ed6c 4y ago
    Even my stevia sweetener has erythritol as its first ingredient, so this has to be ubiquitous. Back to Splenda I guess?
    - Obscurity4340 4y ago
      Trader Joes has pure stevia
  - uberduper 4y ago
    Monkfruit is "300x sweeter than sugar." I have no idea how they measure this. I've never tasted monkfruit or an undiluted extract. They mix it in with erythritol to try and match the sweetness and appearance of sugar.
bloaf 4y ago
I, for one, am confused why people choose erythritol over allulose.
- outworlder 4y ago
  They usually don't. But if you get something like monk fruit, you only need a tiny amount. Erythritol is often added so it will look more like sugar.
- Alex3917 4y ago
  What are the benefits of allulose over erythritol? I’ve only had the latter, but they seem pretty similar.
  - uberduper 4y ago
    Allulose is about 70% as sweet as sugar but tastes much more like sugar than the other sugar alcohols. Allulose caramelizes (tho you should not try to make caramel with allulose. (you've been warned.)) It dissolves much better than erythritol. Allulose has a consistency more like dextrose than table sugar. More like a powder. It behaves more like sugar in baked goods. Erythritol has a kinda minty aftertaste.. like on the exhale that can be unpleasant if it's not overpowered by something else. All that said, I still prefer an erythritol + monkfruit sweetener in beverages. Erythritol is easier on my stomach in larger quantities.
- Eduard 4y ago
  Looking over the pond, e.g. EU has not allowed allulose / psicose for human consumption. Also, here is a thread from a week ago that also discussed allulose: https://news.ycombinator.com/item?id=34879059 https://news.ycombinator.com/item?id=34879059
FriedrichN 4y ago
I wouldn't worry about it, from what I gather the validity (of the claim erythritol: bad) of the study is questionable. Mainly because the study participants were very ill with hypertension, diabetes, CVD, and they didn't look at erythritol intake, just blood levels. Layne Norton did a quick video explaining the shortcomings of the study. https://www.youtube.com/watch?v=Ad8_scQtHFM https://www.youtube.com/watch?v=Ad8_scQtHFM The problem with studies like this is the reporting on them. I'm fairly sure most people reporting on this study did not actually read it (and you can't read it without paying). And it just plays into the confirmation bias that any non-nutritive sweetener is bad, despite them all being wildly different chemical compounds that all get metabolised in very different ways.

JustSomeNobody 4y ago

Well, this sucks. I use this in my coffee and a smidge on my oatmeal. Is there an artificial sweetener left that doesn't cause issues? Splenda was associated with CVD so that's why I switched.

Workaccount2 4y ago
The holy grail of sweetners is left handed sugar. Basically a regular glucose molecule but flipped. Tastes identical to sugar but cannot be metabolized. The catch is that no one has found a way to synthesize it cheaply.
- jbaber 4y ago
  I don't know. Trans-fat turned out to be super bad. I'm leery of trans-sugar.
- prmph 4y ago
  Something tells me there is no free lunch here as well. It seems everything that gratifies the tongue is bad in some way.
- Obscurity4340 4y ago
  Wikipedia says "L-Glucose was also found to be a laxative..."
stavros 4y ago
Aspartame?
- outworlder 4y ago
  No! Aspartame is known to cause serious issues for decades now, even before it was finally approved by the FDA.
  - idiotsecant 4y ago
    Oh? Who is that 'known' by? Certainly not any of the over 100 regulatory agencies around the world who have made aspartame one of the most studied compounds on earth. Unless you have PKU or migraines there is literally no widely accepted science that says otherwise.

mikece 4y ago

[flagged]

6LLvveMx2koXfwn 4y ago
Which you're also being a little coy about for some reason.
- parvenu74 4y ago
  Perhaps (s)he's concerned about political backlash (via down-voting) on HN?
  - deleted 4y ago
    [deleted]
  - rom-antics 4y ago
    I'm sure he can spare some of his 19876 internet points, just say it FSS
    - mikece 4y ago
      And my comment has been flagged. Too coy now?
  - rootusrootus 4y ago
    You cannot lose that many magical internet points on a single post, so don't worry about it.
outworlder 4y ago
I'm pretty sure what you mean but the rate of cardiovascular issues has been increasing for decades, at least since the 70's. The actual politically sensitive possibility is sugar (and even more so, high fructose corn syrup). There's a lot of money involved there.
jsnell 4y ago
The studies this paper is based on were started 20 years ago. Does your conspiracy theory include time machines?

DantesKite 4y ago

Well, no worries for me. I found out years ago I'm allergic to this stuff the hard way. Gave me hives all over my face for a few hours. Intensely itchy. Now whenever I drink something new, I always look out for it.

rootusrootus 4y ago
Have you had to adjust your diet to eliminate natural sources as well, or does the reaction only happen for high concentrations?
- DantesKite 4y ago
  It seems to only happen in drinks with high concentrations. Like this one. https://www.safeway.com/shop/product-details.960552358.html https://www.safeway.com/shop/product-details.960552358.html
  - rootusrootus 4y ago
    First ingredient (after water), wow. I guess that is not shocking, a lot of foods have been doing the same thing for years with sugar. One thing I would like to see on labels is concentrations of the various ingredients. I suppose that gets into proprietary recipe information that no manufacturer will be keen on releasing, but it would be nice to know what % of a given concoction is made up by a given ingredient.

f38zf5vdt 4y ago

Weird. It has no effect on survival in rats and the doses were large. > One chronic (78-weeks) study in rats with dietary levels of 0, 1, 3, or 10% erythritol (equal to > 0.46, 1.4 and 5 g/kg bw/day for males and 0, 0.54, 1.7 and 5.7 g/kg bw/day for females) (Til > and van Nesserooij, 1994) and another 2-year chronic toxicity/carcinogenicity study in rats > with dietary levels of erythritol of 0, 2, 5, or 10% (equal to 0, 0.9, 22, and 4.6 g/kg bw/day for > males and 0, 1.0, 2.6, and 5.4 g/kg bw/day) (Lina et al., 1994; 1996) demonstrated that > erythritol did not affect survival and had no carcinogenic effect. https://ec.europa.eu/food/fs/sc/scf/out175_en.pdf https://ec.europa.eu/food/fs/sc/scf/out175_en.pdf From this paper: > In a population-based prospective cohort study with repeated dietary records, ingestion of multiple artificial sweeteners (for example, aspartame, acesulfame potassium and sucralose) was associated with CVD risk. Ok, let's look at that reference. > Results Total artificial sweetener intake was associated with increased risk of cardiovascular diseases (1502 events, hazard ratio 1.09, 95% confidence interval 1.01 to 1.18, P=0.03); absolute incidence rate in higher consumers (above the sex specific median) and non-consumers was 346 and 314 per 100 000 person years, respectively. Artificial sweeteners were more particularly associated with cerebrovascular disease risk (777 events, 1.18, 1.06 to 1.31, P=0.002; incidence rates 195 and 150 per 100 000 person years in higher and non-consumers, respectively). Aspartame intake was associated with increased risk of cerebrovascular events (1.17, 1.03 to 1.33, P=0.02; incidence rates 186 and 151 per 100 000 person years in higher and non-consumers, respectively), and acesulfame potassium and sucralose were associated with increased coronary heart disease risk (730 events; acesulfame potassium: 1.40, 1.06 to 1.84, P=0.02; incidence rates 167 and 164; sucralose: 1.31, 1.00 to 1.71, P=0.05; incidence rates 271 and 161). This study shows the same thing with _all_ artificial sweeteners, and has way more people (n=103,388) than the present Nature study (n=1,157). And we know that erythritol is often used by type 2 diabetics due to its low effect on insulin levels. That population is predisposed to cardiac events to begin with. When adjusting the US/EU cohorts for cardiovascular risk factors, the observed effect with erythritol are smaller and closer to this study of other artificial sweeteners. > Consistent with the results observed within the discovery cohort (adjusted HR = 2.95 (1.70–5.12) P < 0.001; Fig. 1 and Supplementary Table 4), the association between erythritol levels (fourth quartile versus first quartile) and incident MACE risk remained significant in both US and European validation cohorts following adjustments for cardiovascular risk factors (adjusted HR (95% CI) = 1.80 (1.18–2.77) and 2.21 (1.20–4.07), P = 0.007 and P = 0.010, respectively I'm not convinced of the validity of this study. They ignored the rat chronic toxicity data and proposed a mechanism for what they saw in a small cohort of humans, but it should be reproducible in mammals.

SoftTalker 4y ago

I just avoid artificial sweetener as a category. They all taste like chemicals to me anyway. I used to drink a lot of Diet Coke but have hardly touched it for years. It tastes like weed killer to me now.

sgerenser 4y ago
Erythritol isn't an artificial sweetener, it's a sugar alcohol.

deleted 4y ago

[deleted]

creamyhorror 4y ago

Oh boy, so now the promising erythritol is also under suspicion. A while ago I read about its benefits for dental health, which seemed to exceed xylitol's, so I even bought a bag (which also included the stevia-class sweetener Reb M). I've read 2022 studies on various non-sugar sweeteners, and statistically, sucralose seems to have a slight advantage over aspartame and acesulfame-k in regards to cancer risk correlation.[1] Whereas aspartame and stevia didn't significantly impair glycemic response / glucose tolerance over a 2-week trial, but sucralose and saccharin did.[2] So each sweetener probably has different downsides. In the end, I think they seem safe enough to have occasionally in place of sugar, though I wouldn't go wild with them. (It's also interesting that this new study comes from Stanley Hazen's lab. He's also published research about the potential cardiovascular risk impact of choline through its metabolite TMAO.) [1] [(Mar 2022) Artificial sweeteners and cancer risk: Results from the NutriNet-Santé population-based cohort study](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003950 https://journals.plos.org/plosmedicine/article?id=10.1371/jo...). [2] 2022 Suez: https://www.cell.com/cell/fulltext/S0092-8674(22)00919-9 https://www.cell.com/cell/fulltext/S0092-8674(22)00919-9 - from https://www.reddit.com/r/ScientificNutrition/comments/wt813r/personalized_microbiomedriven_effects_of/ https://www.reddit.com/r/ScientificNutrition/comments/wt813r...