13/03/2023
Best breakdown and full explanation I've seen thus far.
You’ve likely seen the headlines about erythritol.
I’ve seen little else. Seriously, my email, messages, texts, and social media are blown up with questions, alarm, panic. I understand why. The headlines are scary. No one wants to risk poor health while working to improve health. Me included.
Let’s take a deeper dive, not into the news media headlines, but into the studies cited by the media. Full disclosure: I have a PhD in research, which includes qualitative and quantitative methodologies. My own dissertation used hierarchical linear modeling which is a methodology most often used in medicine, particularly with testing medications. In other words, pretty strict methodology. Also, full disclosure, I use erythritol in developing recipes and for my personal use.
First, here is the study referenced by most of the media. Yesterday the full article was free. I read all of it, including following some of their citations and looked at the graphs and charts. Today, it’s behind a paywall. https://www.nature.com/articles/s41591-023-02223-9https
1. The researchers were not investigating erythritol initially. Instead, they were looking at a large cohort of folks who were mostly over the age of 60 and obese, and male, and, most of whom had high blood pressure 72%, a history of cardiovascular disease (CVD) 75%. About 22% of them had diabetes and nearly half had already had a heart attack. So... they were doing labs and noticed higher levels of erythritol, which MAY suggest a relationship, but doesn't equate a causal relationship. The researchers also note that some of the erythritol circulating in blood is ingested (eaten) and some is endogenous (made by the body). I didn't see a breakdown of how the sources of erythritol may have been associated with risk. Remember, the study was not designed to evaluate erythritol.
2. The conclusion of the article states: "In summary, the present studies suggest that trials investigating the impact of erythritol specifically, and artificial sweeteners in general, with appropriate duration of follow-up for clinically relevant outcomes, are needed. Following exposure to dietary erythritol, a prolonged period of potentially heightened thrombotic risk may occur. This is of concern given that the very subjects for whom artificial sweeteners are marketed (patients with diabetes, obesity, history of CVD and impaired kidney function) are those typically at higher risk for future CVD events."
I'm not sure that the last sentence is fair.
3. Remember that no one looked at what the participants were eating WITH the erythritol in either of the human studies. In the large study where they stumbled over this info, these patients were older and had a history of health issues (see my comments above). Here's the other thing we know. People who don't consume erythritol are at high risk of stroke or cardiovascular disease IF they have diabetes, obesity, high blood pressure, or any of the other conditions that these "subjects" had.
Always read the source and then track down their sources. There was no control of any confounding variables. Yes they had erythritol in their blood BUT what else were they eating? 75% of participants had high blood pressure. 72% had cardiovascular disease. The cohort was not healthy people. Perhaps their labs were worse before they started using erythritol? There’s no comparison data because the study design did not even include specifically researching erythritol. It’s like saying there were 400 car accidents in a year and 60% of those cars were white so white cars cause accidents. Uhm… no. A link does not mean CAUSE.
In addition to the concerns raised in the article, the article refers to previous studies that evaluated the use of erythritol and noted positive effects, including this one: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4037362/
And isn’t this interesting? Researchers must disclose any potential conflicts of interest. This is taken from the end of the article. Proctor and Gamble…
Competing interests
Hazen reports being named as co-inventor on pending and issued patents held by the Cleveland Clinic relating to cardiovascular diagnostics and therapeutics, being a paid consultant formerly for Procter and Gamble and currently with Zehna Therapeutics. He also reports having received research funds from Procter and Gamble, Zehna Therapeutics and Roche Diagnostics, and being eligible to receive royalty payments for inventions or discoveries related to cardiovascular diagnostics or therapeutics from Cleveland HeartLab, a wholly owned subsidiary of Quest Diagnostics, Procter and Gamble and Zehna therapeutics. Tang reports being a consultant for Sequana Medical A.G., Owkin Inc., Relypsa Inc. and PreCardiac Inc., having received an honorarium from Springer Nature for authorship/editorship and American Board of Internal Medicine for exam writing committee participation—all unrelated to the subject and contents of this paper. The other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Bottom line:
If you have any history of CVD or impaired kidney function, I wouldn't blame you for avoiding erythritol. Am I worried enough to stop using it? Not really. Am I worried enough to stop feeding it to loved ones? Not really, because it makes sense that patients with a history of diabetes, obesity, CVD and/or impaired kidney function would be at a heightened risk of thrombosis (clotting issues). I'm not convinced that using erythritol CAUSES this as the folks in the initial study already had these conditions. Perhaps their lab values were actually improved compared to when they started using erythritol? We don't know.
