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Preventive Cardiology Clinic

Zero-Calorie Sweeteners & Heart Attacks

Yet another study has shown that when we get cute with our food, unintended consequences are possible.

The study, published in Nature Medicine, examined the health effects of erythritol, a common sweetener found in many processed foods. Investigators looked at people at higher baseline cardiovascular risk and found higher event rates in those consuming erythritol. This does not prove causation - but the additional finding that enhanced platelet reactivity and aggregation was noted in individuals with higher circulating erythritol levels points to a plausible mechanism of action. Platelets are blood components that are responsible for the formation of blood clots and when they are stimulated to aggregate in heart arteries or brain arteries they can cause heart attacks and strokes (respectively). To put this in perspective, increased platelet reactivity and aggregation is felt to be responsible for the increased risk of cardiovascular events related to smoking.

Although erythritol, a “sugar alcohol”, is a natural substance and can be found in miniscule amounts in many fruits and vegetables, manufactured erythritol has found its way into many processed food items in un-naturally high levels. Because it has no effect on blood sugar while delivering a lot of sweetness with almost no calories, it has become a go-to ingredient in foods touting reduced calorie content, those designed for diabetics, and those following a keto diet. Because it has no unpleasant taste notes, it’s also used as a component of other artificial sweeteners that would otherwise be less pleasant tasting on their own.

Some familiar items that contain erythritol include Truvia, Splenda, Vitamin Water Zero, and Halo Top Ice Cream, but any chewing gum, jelly, chocolate, hard candy, ice cream, yogurt, diet drink or flavored water could contain this ingredient. Because erythritol is not a sugar and because the inclusion of “sugar alcohols” on the Nutrition Facts Panel is voluntary, you need to look in the Ingredient List to determine if the food you are eating contains this substance. Seeing “sugar alcohols” in the ingredient list may be the only clue that erythritol is present in the food.

The best way to satisfy your sweet tooth without adding sugar (or sugar substitutes) is to eat foods that are naturally candy-like but come with a whole host of beneficial nutrients as well as fiber. Grapes, pineapple, mangos, bananas, melon, cherries, apples, pears, plums, peaches, figs and even cherry tomatoes can be incredibly sweet in their fresh forms, while dried raisins, dates and apricots can be even sweeter than actual candy.


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