Sensational Headlines and Erythritol 🙄

Happy Monday! 

Yes, I saw the sensational headlines last week regarding a study [1] linking erythritol, a sugar alcohol used in some low-glycemic sweeteners and low-carb dessert products, with heart attacks and stroke!  Oh my!  First of all, when you see something alarming like this, don’t immediately believe it.  

First of all, erythritol can be made by our bodies as well as consumed in products. Unfortunately, the study did NOT take into account what the patients in the study ate. Yikes. Therefore there is no way to correlate consumption of erythritol with heart attacks. Furthermore, the initial study was looking at very sick patients undergoing cardiac assessment and it is very possible that their bodies made high levels of erythritol because of their condition. Circulating erythritol can be due to many other variables which have already been linked to cardiovascular risk.  Another population that was tested in this study was rodents, which I understand are not particularly useful for learning about humans and cardiovascular disease. The end of the study examined 8 healthy individuals and 8 is not exactly a significant sample size. Lastly, when this study was conducted, it was before erythritol had become a common sweetener. 

Many doctors and nutritionists have jumped from this study to criticizing the keto diet and its impact on lipids and health.  Fair enough.  The keto diet is a high fat, low carb diet and many people go crazy with keto desserts which are often sweetened with erythritol but are high in fat.  But the study did not make a causal relationship between the keto diet and heart attacks so we cannot then validate the study with this relationship.

That said, erythritol is a sugar alcohol that may adversely affect your gut. Some people cannot tolerate it and there are likely different thresholds for each of us. I use a low-glycemic sweetener called Lakanto (not sponsored) which is monkfruit and erythritol in very small quantities in my matcha.  I have no problem with it.  Sometimes I use a few drops of stevia. I can tolerate that too.  Very occasionally I use half Lakanto and half sugar or maple syrup in a dessert.  But I am not eating erythritol-sweetened desserts regularly.  Are “natural” sweeteners like honey and maple syrup better?  Well, not for people who can’t handle a blood sugar spike. 

If you need a low-glycemic sweetener for drinks or baking, monkfruit and allulose seem to be the safest, but that doesn’t guarantee everyone can tolerate it.  

My strategy with desserts is still the same: sugar is sugar. I try to bake desserts that will have less of an impact on my blood sugar by using LESS of an amount of a concentrated sweetener, by minding my portions, and eating desserts in moderation (which for me means no more than a few times a week.) When I eat dessert, I enjoy it very much and have no shame or guilt afterwards.  I have noticed in the last few years though that too much sugar late at night (for example, out to dinner with friends) negatively impacts my sleep. And sugar on an empty stomach does not leave me feeling good. I am not here to tell you what to eat. That is for you to decide since you are different from me and everyone else. 

What are your feelings about this study?  Have you tried products containing erythritol or other sugar substitutes?

References: 

[1] Witkowski M, Nemet I, Alamri H, Wilcox J, Gupta N, Nimer N, Haghikia A, Li XS, Wu Y, Saha PP, Demuth I, König M, Steinhagen-Thiessen E, Cajka T, Fiehn O, Landmesser U, Tang WHW, Hazen SL. The artificial sweetener erythritol and cardiovascular event risk. Nat Med. 2023 Feb 27. doi: 10.1038/s41591-023-02223-9. Epub ahead of print. PMID: 36849732. 

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