Artificial sweetener erythritol and cardiovascular event risk



by LORENZO CIOTTI

Artificial sweetener erythritol and cardiovascular event risk

Erythritol is a polyalcohol naturally present in fruit and fermented foods. It is successfully used as a natural sweetener as it has zero calories and a great flavor with no aftertastes. At an industrial level it is obtained from sugary substrates through microbial fermentation by selected osmophilic yeasts.

As a food additive, erythritol can perform various functions, but it is mainly used as a sweetener: the aromatic profile is very similar to sucrose, with a sweetening power of about 60-70% and this makes it a useful alternative to traditional sugar, used in combination with intensive sweeteners it can increase the sweetness of ingredients, add body and mask unwanted aftertastes.

Furthermore, recent studies have highlighted the anti-radical activity of erythritol, which has proven to be an excellent scavenger of hydroxyl radicals, with protective properties for cell membranes. Erythritol therefore acts as an antioxidant in vivo and can help reduce the glycemic impact of foods and beverages, counteracting the effects of free radicals induced by hyperglycemia.

However, a recent study has showcased some side effects of erythriol. The artificial sweetener erythritol and cardiovascular event risk, published in the Nature medicine, told us: "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, circulating levels of multiple polyol sweeteners, especially erythritol, were associated with incident (3 year) risk for major adverse cardiovascular events.Subsequent targeted metabolomics analyzes in independent US and European validation cohorts of stable patients undergoing elective cardiac evaluation confirmed this association, fourth versus first quartile adjusted hazard ratio, 1.80 and 2.21.At physiological levels, erythritol enhanced platelet reactivity in vitro and thrombosis formation in vivo.

Finally, in a prospective pilot intervention study, erythritol ingestion in healthy volunteers induced marked and sustaine increases in plasma erythritol levers ls 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."