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  #1   ^
Old Mon, Feb-27-23, 17:22
JEY100's Avatar
JEY100 JEY100 is offline
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Default Erythritol may increase risk for heart attack, blood clots

https://www.msn.com/en-us/health/ot...oke/ar-AA17ZLkx

Quote:
A sweetener found in nature and often added to diet products, particularly for the ketogenic diet, may actually contribute to clogged arteries and strokes, a new study suggests.

People with the highest level of the sugar substitute erythritol in their blood were shown to have twice the risk for stroke, blood clot or death compared with those with the lowest level.

Animal and lab studies reinforced the idea that erythritol might cause clots, said Dr. Stanley Hazen, who led the research and chairs the department of cardiovascular and metabolic sciences at the Cleveland Clinic.

"The very group of people most vulnerable to experiencing adverse cardiac events are the ones we're recommending these kinds of dietary foods for," he said.

What is erythritol? Erythritol, considered a sugar alcohol, has no calories and is found naturally at low levels in some foods, including grapes, mushrooms, pears, watermelon, beer, cheese, sake, soy sauce and wine. The sugar substitute is added to many processed foods and beverages and is commonly found in products targeting people on the ketogenic diet because it does not affect blood glucose. Erythritol is also an ingredient in the sweetener Truvia.
Though many sweeteners provide intense flavor and need to be used in small concentrations, erythritol's sweetness is close to that of sugar, so it can be used as a substitute in baking. The body actually produces erythritol but at levels well below what's found with the added sweetener, according to research from Karsten Hiller, a biochemist and specialist in human metabolism at the Braunschweig Institute of Technology in Germany.
Current federal guidelines do not require that erythritol has to be included on a product's ingredient list, Hazen said. The label might simply say "artificially sweetened with natural products," or "zero sugar." Study suggests erythritol promotes blood clots
initially set out to study the factors that lead people to have heart attacks and strokes even when they're treated for high cholesterol, high blood pressure, obesity, diabetes and smoking cessation. Roughly half of treated people have this so-called residual cardiovascular risk. For the study published Monday in Nature Medicine, his team collected blood from 1,157 volunteers undergoing cardiac risk assessment. They looked for chemical signatures in the blood and tracked who had a heart attack, stroke or died over the next three years.

Erythritol was "at the very top of the list" of compounds that predicted subjects at highest risk for a bad outcome, he said. High blood levels of erythritol seemed to lower the threshold for triggering a clot.

Then the researchers tested the sugar substitute in mice and in human blood in the lab, looking to explain why this might have happened.

That exploration strongly suggests erythritol promotes blood clots. "This is a new pathway we think is contributing to residual cardiovascular risk," Hazen said.


What does other research on erythritol show?

“The results of this study are contrary to decades of scientific research showing reduced-calorie sweeteners like erythritol are safe,” said Robert Rankin, executive director of the Calorie Control Council, an association representing the low- and reduced-calorie food and beverage industry. The people in the study were at increased risk for cardiovascular problems, Rankin said in a statement, so the results "should not be extrapolated to the general population."

Other studies have also raised questions about the role of erythritol.

In a paper published in 2017, Hiller and colleagues showed that Cornell University freshmen who had a lot of erythritol in their blood at the beginning of their first year gained more weight than students with low levels.

Whether the erythritol was simply a sign someone was likely to gain weight or a cause of it remains a question, said Martha Field, a Cornell researcher who was not involved in the work but has studied erythritol since.

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  #2   ^
Old Mon, Feb-27-23, 20:17
Nancy LC's Avatar
Nancy LC Nancy LC is offline
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I saw that! And I have thrown out all my erythritol products. It was my favorite sweetener. /sigh Goodbye Monin syrups! I've still got allulose, but it gives me gas. And there's stevia and monk fruit, but monk fruit is often combined with erythritol. I really don't care for stevia and even monk fruit is kind of not great.

I have Leiden Factor V so I don't need to mess around with anything that might cause clotting.
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  #3   ^
Old Tue, Feb-28-23, 04:59
JEY100's Avatar
JEY100 JEY100 is offline
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Plan: P:E/DDF
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Quite a few LC doctors on Twitter (I know, but a necessary evil to follow Dr Naiman) have cautioned their patients not to use any sugar alcohols (all of them that end in -ol) until more is known. This study raised enough serious red flags to be cautious with them.

DrTro "Interesting study and certainly enough for me to limit use if possible".

Dr Chris Palmer: "It's not all based on association.
"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. "

MD, PhD Data Scientist: "Just finished reading THE erythritol paper 👇
I actually disagree with the conclusions. We don't need long-term follow-up studies and RCTs.
At least to me, these data look strong enough to recommend against it"

It's not just Low Carb doctors, plant-based, General eat Whole Foods types..all sharing and commenting.


I never did much LC baking because I was lazy, but in the past 2+ years of eliminating them all and eating whole food, sweetened with berries, my health is much improved. More likely because of the Nutrients I added, not removing sweeteners, but who knows?

Last edited by JEY100 : Tue, Feb-28-23 at 08:21.
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  #4   ^
Old Tue, Feb-28-23, 05:13
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cotonpal cotonpal is offline
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I was fortunate that at the beginning of my low carb journey, which is now 2 decades ago, I read a book called "Neanderthin" that advocated a paleo diet of real foods and I've pretty much stuck with it all these years. I occasionally would try out artificial sweeteners but mostly I just decided I didn't need sweetened foods. It somehow just seemed like the prudent way to proceed. Even if it wasn't necessary to be such a purist I figured it couldn't hurt and it possibly was the most beneficial way to eat, not so much for merely weight loss but in terms of overall health. Because I was dealing with health issues that went way beyond obesity I have always had a broad focus on staying not just reasonably thin but as healthy as possible regardless of what my weight was.
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  #5   ^
Old Tue, Feb-28-23, 06:17
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WereBear WereBear is online now
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Even when I keto-baked I would use half the sweetener called for. Now I’m off almonds because of their high oxalate content. I’ve dropped ALL artificial sweeteners. Plus the binders, emulsifiers, and fortified vitamins that come with them.

But even if they are “keto treats” they are still not satiating. In fact, experiencing the difference between my homesmade smoothies and the quick’n’easy mixes really dramatized how much junk is in even the “best” processed products.

I’m probably a far left outlier because of my sensitivities? Or is it that no one should be eating this way?

Maybe I’m just a canary in everyone’s coal mine.
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  #6   ^
Old Tue, Feb-28-23, 06:54
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Ms Arielle Ms Arielle is offline
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Thanks for posting this. I found it yesterday on another source which linked a CNN written article with a great detail.

I had noticed weird racing heart over recent months. Now Im wondering if it's the erythritol.

The CNN article mentions the dose is a factor.

Last edited by Ms Arielle : Tue, Feb-28-23 at 08:57.
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  #7   ^
Old Tue, Feb-28-23, 06:59
Ms Arielle's Avatar
Ms Arielle Ms Arielle is offline
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Quote:
Originally Posted by WereBear
Even when I keto-baked I would use half the sweetener called for. Now I’m off almonds because of their high oxalate content. I’ve dropped ALL artificial sweeteners. Plus the binders, emulsifiers, and fortified vitamins that come with them.

But even if they are “keto treats” they are still not satiating. In fact, experiencing the difference between my homesmade smoothies and the quick’n’easy mixes really dramatized how much junk is in even the “best” processed products.

I’m probably a far left outlier because of my sensitivities? Or is it that no one should be eating this way?

Maybe I’m just a canary in everyone’s coal mine.


WB

Ideally we should all return to eating clean, like we did before food became chemical concoctions. .

Im with you. You can be the canary in my coalmine. My consumption of "sweets" is far below the 150#/yr sugar consumption and my foods are nearly 100% clean.

Your journey is an inspiration for others.

Last edited by Ms Arielle : Tue, Feb-28-23 at 08:58.
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  #8   ^
Old Tue, Feb-28-23, 08:18
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GRB5111 GRB5111 is offline
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Quote:
Originally Posted by cotonpal
I was fortunate that at the beginning of my low carb journey, which is now 2 decades ago, I read a book called "Neanderthin" that advocated a paleo diet of real foods and I've pretty much stuck with it all these years. I occasionally would try out artificial sweeteners but mostly I just decided I didn't need sweetened foods. It somehow just seemed like the prudent way to proceed. Even if it wasn't necessary to be such a purist I figured it couldn't hurt and it possibly was the most beneficial way to eat, not so much for merely weight loss but in terms of overall health. Because I was dealing with health issues that went way beyond obesity I have always had a broad focus on staying not just reasonably thin but as healthy as possible regardless of what my weight was.

That's my approach as well. I decided early on that attempting a healthy replication of foods that were already overly sweetened didn't make sense from an adaptation and overall health perspective. Now, I'm not pretending to have all the answers, and I know many on this forum successfully rely on sweeteners, but I get uneasy with anything human made or adapted purely for the sweet sensation. Even stevia, while something I tried early on, doesn't make sense and there are claims it disrupts my gut bugs. We need more research like this to truly understand what we are ingesting and how it impacts us long term. Happy to see this report; although, it's not surprising. I strongly believe that today's "foods" we are able to buy continue to overemphasize sweet tastes to our health detriment. I also believe that claims of certain sweeteners not stimulating insulin response are spurious at best.

Last edited by GRB5111 : Tue, Feb-28-23 at 08:23.
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  #9   ^
Old Tue, Feb-28-23, 10:13
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BawdyWench BawdyWench is offline
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I've never used erythritol, but the study just said there's a link. Correlation doesn't mean causation. Still, it's probably best to not use artificial sweeteners at all. The people who go low-carb or keto and try to replicate all the sweet treats they love instead of working to LOSE the sweet tooth are also the ones with the least long-term success.
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  #10   ^
Old Tue, Feb-28-23, 10:58
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Nancy LC Nancy LC is offline
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I'm kind of doubting that all the sweeteners ending with -ol are an issue. Erythritol was different because the molecule was small that it was absorbed out of the small intestine and went into the blood stream, and out the urine. Whereas the other ones have bigger molecules and hit the large intestines where they are partially digested, which is why they give us gas and diarrhea when gut bacteria ferment them. But who wants the gas and bloating?
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  #11   ^
Old Tue, Feb-28-23, 10:58
doreen T's Avatar
doreen T doreen T is offline
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This study's abstract is available here .. https://www.nature.com/articles/s41591-023-02223-9. While it doesn't provide any details beyond what's in media reports, there's reference to another (not yet published) study by the same team, outlined at ClinicalTrials.gov ....
Quote:
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.

That study looks at xylitol as well as erythritol ..
"In vitro data using human platelets revealed that the polyols xylitol and erythritol at the levels observed in fasting patients induce platelet aggregation potential. The investigator's data shows that erythritol and xylitol impact platelet function and may, therefore, contribute to cardiovascular mortality."

The study participants were given either:
  • a drink consisting of 300mL of water containing 30g of xylitol as a single oral dose. ... or
  • a drink consisting of 300mL of water containing 30g of erythritol as a single oral dose.
.. then test blood drawn 30 minutes later.

Notice the amount of sweetener used .. 30g. Thirty grams!!! I checked my pouch of Swerve (erythritol) .. serving size 1 tsp = 4g. Thirty grams is 7½ times the recommended serving. It's reasonable to assume that 30g is the standard test amount across most, if not all the current studies, in order to validate results.

So it does seem the most negative effects are dose-related. I'd like to see a comparative study using normal amounts of these sweeteners. That being said, I'm in agreement with others that it's best to wean oneself off the need for a sweet taste or very infrequent indulgence. IMO, 1 tsp/4g erythritol provides more than enough sweetening power.

FWIW .. insulin resistance, high blood sugar and chronic inflammation are also linked to platelet aggregation and increased risk for clots


.
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  #12   ^
Old Tue, Feb-28-23, 11:00
Nancy LC's Avatar
Nancy LC Nancy LC is offline
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A 4 gram serving of erythritol would only be about as sweet as half a tsp of sugar. A packet of erythritol, to equal 2 tsp of sugar, would have to contain close to 15 or so grams. So, it would be very easy to get 30g of erythritol in one day. Plus, doses smaller than that might be an issue as well.

Can you imagine what this is going to do to many businesses? A whole industry might be wiped out. For good reason, still the impacts are tremendous.

Last edited by Nancy LC : Tue, Feb-28-23 at 11:48.
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  #13   ^
Old Tue, Feb-28-23, 16:49
Ms Arielle's Avatar
Ms Arielle Ms Arielle is offline
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Dr ken Berrys opinion:

https://youtu.be/U0p-EOHv6gY

The CNN write up:

https://www.cnn.com/2023/02/27/heal...ness/index.html

No one has given opinion of the study itself. Imho if the study is based on 6 subjects, that calls into question the confidence of the data.

If 6 people died in car accidents, do you stop driving a car? We need more information.

Last edited by Ms Arielle : Tue, Feb-28-23 at 16:55.
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  #14   ^
Old Tue, Feb-28-23, 17:09
Nancy LC's Avatar
Nancy LC Nancy LC is offline
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Well, in vitro studies showed that erythritol makes blood cells "sticky", thus clots more likely to happen. So, we've probably got some causation to go along with the correlation. Holds up in mice studies too. As someone with clotting disorders anyway, this is probably something I should avoid.
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  #15   ^
Old Tue, Feb-28-23, 18:11
doreen T's Avatar
doreen T doreen T is offline
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Quote:
Originally Posted by Nancy LC
A 4 gram serving of erythritol would only be about as sweet as half a tsp of sugar. A packet of erythritol, to equal 2 tsp of sugar, would have to contain close to 15 or so grams. So, it would be very easy to get 30g of erythritol in one day. Plus, doses smaller than that might be an issue as well.

Nancy, I hear you . I've seen many lowcarb and keto recipes that call for as much as 2 Tbsp (=6 tsp or 24g) erythritol per serving. Yikes! For reference, that's 1 cup of powdered erythritol for a recipe making 8 servings.

Weaning off sweeteners has not been easy. It took me a very long time, slow and gradually cutting down. I'm in awe of those who've been able to go cold turkey overnight.

Health reasons aside, using less or even no sweetener(s) is a definite cost-saver. In my region, erythritol and also xylitol based sweeteners are very, very expensive.

.
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