“ZERO CALORIE SWEETNER LINKED TO HEART ATTACK AND STROKE (Erythritol)…CNN”
Hello friends! This is a very early and premature capture of a sensational headline about the sugar-alcohol molecule, erythritol.
It centers around the hypothesis, based on an association that erythritol (and perhaps xylitol) which are natural sugar alcohols in foods and made in our bodies, when or if ingested in perhaps what is “excessive”, which is not defined or qualified with any newly proven standards by the article, can become problematic to our “cardiometabolic” health.
The article points to conspicuous “platelet aggregation” as noted in their study of the use of sweet erythritol in cardiac and Type 2 Diabetic patients.
It hypothesizes a potential concern of pathological blood clotting from the consumption of erythritol. in perhaps precipitating cardiac and stroke events, as studied in certain aged and not particularly healthy populations, and then superimposes the frequent consumption of “erythritol” and its long clearance time in the blood after high doses in foods as possibly a relevant and interrelated risk factor.
An “in Vitro” study is used to demonstrate in a lab model system how erythritol plus platelet-rich blood serum may develop platelet aggregation.
There you have it–three independent variables with no proven causation relationship –only suggested and admitted as such through an initial concerning association.
Keep in mind, since erythritol is not metabolized, it is in the blood until cleared by the kidneys– first high, and then to tapering off blood levels is no surprise.
But the story gets much deeper and more open to critical and interesting analysis than this, but a few explanations first:
Clotting is a normal, very complex interaction of several variables and several steps.
It’s initiated through tissue damage and the body’s response to damage to start a healing process.
Platelet aggregation is different from clotting, though related since aggregation is a necessary early step, one of many, to form a clot.
Targeting platelet aggregation by itself as a “key marker”, is an independent variable, and should not be extrapolated in making conclusions about the cause
and effect and risk in a cardiac heart event or a stroke. This is even mentioned in the study.
Platelet Clumping ( aggregation) – Glossary | Laboratory, radiology, sleep and genetic | Biron
Platelet clumping occurs when the blood platelets responsible for coagulation stick to one another to form clusters. The presence of platelet clumping has no clinical consequences other than preventing instruments from properly counting blood platelets. EDTA medium, (lavender top can create clumping) vs Citrate medium vs manual count
So one basic question I had, after trying to investigate the methodologies and protocols of their blood draws, was what kind of tube and preserving medium
were the blood samples put into? I could not find this detail yet.
Clotting that occurs inside blood vessels is most often a result of injury to the endothelium lining through oxidative stress, and thus, a sequence of factors occurs
well beyond just aggregation to finally form a “clot”.
As an ironic point of fact, explained later, erythritol is a very good (hydroxyl-fighting) antioxidant in mitigating oxidative stress thus reducing injury to the endothelium from dangerous and damaging oxidants.
However, spontaneous clotting is much higher in hyperglycemia, diabetics, high blood pressure, or older populations—
so there is a predisposition and disparity of possible bias already in place for the study subjects.
“Hyperglycemia is associated with enhanced thrombin formation, platelet activation, and fibrin clot resistance to lysis in patients with acute coronary syndrome”…..Anetta Undas 1, Ilona Wiek, Ewa Stêpien, Krzysztof Zmudka, Wieslawa Tracz
Abstract Objective: Acute hyperglycemia on admission for acute coronary syndrome worsens the prognosis in patients with and without known diabetes. Postulated mechanisms of this observation include prothrombotic effects. The aim of this study was to evaluate the effect of elevated glucose levels on blood clotting in acute coronary syndrome patients.
A “clot” in itself, is a mechanism of protection and healing, however, it can also be a source of potential and even fatal outcomes
if it is pathological and breaks off and circulates as a significant obstruction to blood flow in vulnerable areas, such as the brain and the heart, which could lead to serious morbidity and even instant death.
That’s frightening, especially as we age, so great. and sincere concerns about anything and everything to reduce the risk of such a consequence are highly justified and in everyone’s best interests.
To reiterate, and can’t be emphasized enough, the early study was done with already highly predisposed subjects, some already with heart disease, high blood pressure or Type 2 diabetes consuming around 30 g or more of erythritol-which is aggressive, but as a total daily dose, is not unreasonable.
Even the researchers remark to be careful– not to over-extrapolate this with normal people–can be very different.
- There will be a prospective study with healthy subjects planned–very good and important, however, this first study was a data-driven “retrospective” relationship, not a causation study, and its finding was explained as highly suggestive and worthy to take seriously.
- It also measured, as it thought consequential, “how long erythritol remained in the blood”, but no cause or effect was established at this point by their study.
- Regular “sugar” however in large amounts and frequency can significantly stimulate adverse clotting, glycation, high cholesterol, and other bad things to one’s health.
So keep in mind, it’s not the intent of the researchers to persuade us to “skip sugar alcohols and consume sugar”!
- Perhaps the point is to ideally establish a “dose-response” curve–that means, how much at what amount one begins to see an actual adverse and causal event
factoring in health, age, and predisposing health tendencies. As one of my scientific colleagues once mentioned, with anything we consume with frequency and in higher amounts, the “poison is in the dose”!
Every food or ingredient follows a “bell-shaped” curve where there is little problem or effect, a certain amount balances the good, and too much creates stress on metabolism and health.
- The principle of moderation and balance remains centrally axiomatic in optimal health and nutrition.
- On the other hand, erythritol (and xylitol) also have very well-documented and established remarkable health properties in moderation.
- Thus, establishing a “happy zone” of safety and tolerance is always the prime directive for any kind of supplementation, unusual food, or even regular food.
- Next is an actual prospective study done back in 2018–well before the current study of our discussion and its proposed prospective study.
“Effects of erythritol on endothelial function in patients with type 2 diabetes mellitus: a pilot study”
Nir Flint 1, Naomi M Hamburg, Monika Holbrook, Pamela G Dorsey, Rebecca M LeLeiko, Alvin Berger, Peter de Cock, Douwina Bosscher, Joseph A Vita
Abstract
Participants (n = 24) consumed erythritol 36 g/day as an orange-flavored beverage for 4 weeks and a single dose of 24 g during the baseline and final visits.
We assessed vascular function before and after acute (2 h) and chronic (4 weeks) erythritol consumption.
Acute erythritol improved endothelial function measured by fingertip peripheral arterial tonometry (0.52 ± 0.48 to 0.87 ± 0.29 au, P = 0.005).
Chronic erythritol decreased central pulse pressure (47 ± 13 to 41 ± 9 mmHg, P = 0.02) and tended to decrease carotid-femoral pulse wave velocity (P = 0.06).
Thus, erythritol consumption acutely improved small vessel endothelial function, and chronic treatment reduced central aortic stiffness. Erythritol may be a preferred sugar substitute for patients with diabetes mellitus.
With all the above discussed and with this abstract let’s double back to the contention that high, tapering off blood levels of erythritol
is necessarily worrisome as the Cleveland study seems to suggest.
–If one takes lots of Vitamin C, there will be a high and tapering off blood level until absorbed by cells and if in excess orally, will be passed out by the
bowel and kidneys. However, in the meantime, it destroys dangerous oxidants in the blood and intracellularly.
–If one consumes erythritol, there will be a high and tapering-off level until passed out by the kidneys.
However, in the meantime, it’s a very good antioxidant in the blood against hydroxyl radicals and protects the inner lining of blood vessels against oxidative damage and stiffness –a big deal!
–Then, if one takes lots of regular sugar, there will be high hyperglycemia, and then tapering off blood level with insulin release going wild, likely adverse glycation with proteins, induction of greater oxidative stress, and eventual damage to cell structures and the metabolism in general.
So, the underlying point is, “tapering off blood levels” of something that is expected should not be construed as something unique, adverse, and dangerous!
Finally, another factual morsel worth mentioning is that erythritol and xylitol, have strong anti-dental plague abilities so that mouth bacteria, cannot form their biofilm to engender tooth decay and gum disease— rather important?
Also, xylitol enhances mineral absorption so it is considered bone and teeth healthy–indeed a good thing if you can tolerate this sugar alcohol in small doses.
Erythritol (and all sugar alcohols) is absorbed through the intestinal brush borders, as with other sugars, as we discussed in a former article.
However, it does something rather special–it inhibits by competitive inhibition, the sucrase enzyme ( an alpha glucoside enzyme), also present at the brush border, and thus slows down and blocks sugar absorption from the food you are eating at the same time–this is significant because it lowers the sugar load and hyperglycemia when in the same meal!
So where does the sugar go?
Into the GI tract to either more safely and more slowly be absorbed or becomes “prebiotic” food for your flora!
An overview of the role of bioactive α-glucosidase inhibitors in ameliorating diabetic complications
Yokozawa et al., 2002). In a recent study, it was demonstrated that erythritol can control postprandial hyperglycemia by inhibiting α-glucosidase. Erythritol strongly inhibit α-glucosidase with IC50 value of 6.43 mg/mL (52.7 mM). Enzyme kinetics study reveals that erythritol exhibits competitive inhibition by binding to the active site of α-glucosidase. The (-OH) group on the C1 atom
of erythritol forms, hydrogen bonds with Asp69 and Arg446 in the active site of α-glucosidase via H113 water molecules, and another (-OH) group on the C4 atom form identical bonds with Asp215, Arg213, and Asp352 via H132 water molecules, clearly suggesting the occupancy of erythritol in the active site of α-glucosidase (Wen et al., 2018). So, erythritol can be considered a potential α-glucosidase inhibitor and it can overcome the drawbacks of the traditional α-glucosidase inhibitors due to its negligible side effects and caloric value.
But we do not have to look beyond an “apple” for example in bringing all these elements together for our enlightenment and Nature’s instruction.
Do you realize that an apple contains, sugar, sugar alcohols–a fair amount, as well as fiber, and most significantly, phenolic antioxidants?
Apple from a study—composition and sugar alcohols: The two main monosaccharides in apples are glucose and fructose, whereas sucrose is the main disaccharide (Table 2). D-sorbitol, in the form of alcoholic sugar (but also traces of xylose), is abundant in apples with a concentration of 300 to 800 mg/100 mL of apple juice (less concentrated in whole apples).
All these ingredients interplay. especially antioxidants/fiber with the sugars as a cohesive composition, in effecting an outstanding and broad outcome rather than isolating and exaggerating one component where an outcome may be less dramatic.
Why do I bring this up as a parenthetical subject?
Because an “apple” in its totality, and being representative of many fruits and vegetables with sugar alcohols and phenolic antioxidants, also has what is called
alpha-glucosidase blocking activity–that is blocking regular dietary sugar from entering the bloodstream too quickly–again, it all starts with your diet!
Abstract
The beneficial health effects of apple consumption are well known, however, little is known about the potential of its phenolic fractions to inhibit α-glucosidases
and thereafter to treat diseases related to carbohydrate metabolisms, such as postprandial hyperglycemia and diabetes.
In the present study, the α-glucosidase inhibition and antioxidant activity of different phenolic fractions of apples were evaluated using the 2,2-diphenyl-1-picrylhydrazyl and hydroxyl radical scavenging activity. The purified extract (not fractionated) had the highest α-glucosidase and hydroxyl radical inhibitions. The purified extract and fractions III and IV were more active against the enzyme activity than the positive control acarbose, the drug used by diabetic patients to treat postprandial hyperglycemia. Our results show that apple phenolic extracts (ed: I would add sugar alcohols in addition) strongly inhibit α-glucosidase activity, validating their potential to be used in the management of type 2 diabetes.
Even with some contesting viewpoints of the headline research, I remain humble and cautious in not over-assuming or overstating a position, and eager in being surprised and enlightened by having solid scientific, medical, and health evidence with new findings brought to my attention that may expand or even change my position on a particular subject or belief.
In conclusion, with what I know and believe at this time, I have no problem using erythritol in moderation diet-wise, as part of a “smart diet”, or in some of my formulas—indeed, there is usually much more to a story and more to learn than what initially meets the eye but always keep an open mind and remain a curious “student” for new findings, and new information!