Thank you for delving into this study, Robb. I saw it earlier today and admit it concerned me. I started inspecting my various low-carb products (e.g., Ancient Nutrition Bone Broth Protein Powder) for erythritol, stevia, and monk fruit. That pretty much wipes out the kitchen cabinet of keto-friendly sweeteners.
At first, I thought it may be another comical attempt to find a culprit for the spike (pun intended) in excess mortality that started in 2021, but then I saw this was based on blood samples collected between 2004 and 2011.
I hope there are further high-quality studies to probe these findings. Meanwhile, I’ll start reducing my intake as a precaution.
If they don’t say erythritol on the ingredients, it’s fine. The deal here is monk fruit and stevia are very sweet but have no bulk. Erythritol essentially replaces the bulk of sugar, and stevia/monk fruit make it sweeter.
I'm confused. If the blood samples were taken 2004-2011 which were used to conduct the study, why is this just becoming an issue now? Why weren't these studies done prior to erythritol being marketed to the public?
Great questions, Jen. My understanding is the erythritol findings were accidental as the study wasn't focused on that specifically, but it was found to be a correlating factor for CVD and stroke risk during the analysis.
Thanks for the response, I've personally never used erythritol, I can't stand the taste lol. It's so hard to decipher what's safe to consume these days.
Haha, you're lucky. It's been my go-to sweetener ever since I discovered it. Fortunately, I have already given up making desserts, but I am well-stocked up on items like the protein powder and Skinny Mixes keto syrups, dang it.
Thanks Robb. I'd love to see more articles coming out from you. You keep promising new substack pieces on Healthy Rebellion podcast but they are nowhere to be seen. Maybe the topics make your blood boil too much which probably increases your risk of CVD more than Erythritol LOL!!
I wonder if this correlates to the digestive problems some face with erythritol consumption. Microbiome effects? There's something about it that the body wants to kick it out fast.
All sugar alcohols (polyols - look for -ol on the end of the name) can cause issues with the people like me who are more sensitive to FODMAPS (fermentable carbohydrates - the P in that word stands for polyols). It's a common IBS trigger. That's why you will see warnings about the laxative effect of overconsuming maltitol, xylitol etc. Years ago when I first read about erythritol there was an opinion that it was the least problematic of the polyols for some people (not me though - they all cause excess gas and diarrhea at even modest quantities).
For example, she acknowledges erythritol is upregulated in metabolic disease. Ok, does it induce thrombosis? Is it benign if consumed in large amounts? Idk, I may be missing something and fully acknowledge her criticisms.
Yeah not sure. This is an area I’m very new to. Are you implying that, for the moment, direction of causality isn’t 100% crucial because it’s linked to metabolic disease and that’s a concern? Whether endogenous or exogenous?
Thank you, Robb. This was very timely as I had a text from a friend this morning asking if I was aware of the study. I had just finished reading it and was going to reply back to her when your email came through. I was struggling with understanding what AHG is and why it would be used in comparison to erythritol and glucose. I appreciate your insights.
I haven't read the full article, but wonder if the action pathway for MACE is only via clotting directly from the presence of erythritol or is there any mention of insulin playing a role and the metabolic effects of the cephalic phase of digestion? Curious! Thank you!
Well, I alluded to that to some degree. endogenous erythritol production increases in lockstep with insulin resistance, and may in fact precede it. There is clearly something going on there but they DID verify this effect appears to occur in healthy people. It's possible that is an inaccurate finding, but there are a lot of arrows pointing a similar direction.
My question for Robb - are you going to limit your Erythritol as a result of this study? I've got a boatload quests bars sitting around that I am considering pitching :)
oh sorry i did not see that and now as i am looking for it I still don't see where you mentioned who funded the study but apparently i'm just missing it. lol
I just said "nothing looked out of line" as there were a ton of funding agencies. Another person said one of those outfits produces another non-nutritive sweetener. I've not tracked that down, so possible.
Awesome breakdown of the study. My question would be if the rather large dose (30g) of erythritol and it's elevated levels/duration would be at all attenuated by consuming it with a meal, esp a complete meal with protein+fats. My rather uneducated guess is that the 30g in a beverage was just erythritol+water and that concentration on an empty stomach may be the issue, where normal consumption (in a pint of ice cream or in a sugar-free cookie) wouldn't be have as much of a spike.
This is Rebel Creamery’s response to Erythritol issue:
“This study was focused and performed on a segment of participants who had coronary disease, high blood pressure, or were otherwise at an increased risk for cardiovascular events. We've seen similar studies and headlines about meat, butter and eggs. Erythritol is produced endogenously in our bodies and has many decades of studies showing its safety. In fact, a recent study (PubMed 24366423) found erythritol improved blood pressure in participants. The authors of this latest study admit they found an association with erythritol, not causation. It was merely observational, and they don't even know what the subjects ate, if they even consumed erythritol. It was naturally produced in their bodies. This one study does not disprove the numerous scientific research showing erythritol's safety and benefits.
You likely have reverse causality here. The study did not measure erythritol intake. Metabolically sick people have a very active pentose phosphate pathway. This is not people getting sick from high levels of erythritol in their blood, but they have high levels of erythritol in their blood because they're so sick.”
Appreciate your work very much Robb! Thank you for all you do to help others. Did you see the Methods about how they a) used platelet rich plasma, added clot-inducing factors to force aggregation, and that no clotting occurred without those factors? How they injured the mouse carotid artery to induce thrombosis, and so on? I have an MSc in Personalised Nutrition and Functional Medicine. My MSc Dissertation was a Mechanism Review on Fructose and Atherosclerosis Cardiovascular Disease. I thus studied the pathophysiology of heart disease in detail. I have been studying sweet compounds for the past 10 years, reading every paper that comes out on non-sucrose/sugar sweetening ingredients, including erythritol. This is my deep dive analysis of the paper. Hope it may be helpful. https://www.linkedin.com/pulse/erythritol-pathways-physiology-sakiko-reuterski%25C3%25B6ld/?trackingId=QTRwABYaTGypVl9wpsnjTw%3D%3D
Thank you for delving into this study, Robb. I saw it earlier today and admit it concerned me. I started inspecting my various low-carb products (e.g., Ancient Nutrition Bone Broth Protein Powder) for erythritol, stevia, and monk fruit. That pretty much wipes out the kitchen cabinet of keto-friendly sweeteners.
At first, I thought it may be another comical attempt to find a culprit for the spike (pun intended) in excess mortality that started in 2021, but then I saw this was based on blood samples collected between 2004 and 2011.
I hope there are further high-quality studies to probe these findings. Meanwhile, I’ll start reducing my intake as a precaution.
What's wrong with stevia and monkfruit?
I wouldn’t normally cite CNN as a source unless I’m using it as an example of propaganda, but their article (https://www.cnn.com/2023/02/27/health/zero-calorie-sweetener-heart-attack-stroke-wellness/index.html) on this study notes that erythritol is used to sweeten stevia and monkfruit.
But not all stevia and monkfruit have this!
Great to know! How do we tell which ones are erythritol-free, though?
If they don’t say erythritol on the ingredients, it’s fine. The deal here is monk fruit and stevia are very sweet but have no bulk. Erythritol essentially replaces the bulk of sugar, and stevia/monk fruit make it sweeter.
Do you see any potential issues with stevia/monkfruit that use dextrose as a bulking agent? Thanks.
What a relief, and thanks for the tip! That means my favorite protein powder is okay 😅
I'm confused. If the blood samples were taken 2004-2011 which were used to conduct the study, why is this just becoming an issue now? Why weren't these studies done prior to erythritol being marketed to the public?
Great questions, Jen. My understanding is the erythritol findings were accidental as the study wasn't focused on that specifically, but it was found to be a correlating factor for CVD and stroke risk during the analysis.
Thanks for the response, I've personally never used erythritol, I can't stand the taste lol. It's so hard to decipher what's safe to consume these days.
Haha, you're lucky. It's been my go-to sweetener ever since I discovered it. Fortunately, I have already given up making desserts, but I am well-stocked up on items like the protein powder and Skinny Mixes keto syrups, dang it.
Thanks Robb. I'd love to see more articles coming out from you. You keep promising new substack pieces on Healthy Rebellion podcast but they are nowhere to be seen. Maybe the topics make your blood boil too much which probably increases your risk of CVD more than Erythritol LOL!!
Just a lot of work, not much time!
I wonder if this correlates to the digestive problems some face with erythritol consumption. Microbiome effects? There's something about it that the body wants to kick it out fast.
It’s just metabolized by some bacteria and can give you gas!
All sugar alcohols (polyols - look for -ol on the end of the name) can cause issues with the people like me who are more sensitive to FODMAPS (fermentable carbohydrates - the P in that word stands for polyols). It's a common IBS trigger. That's why you will see warnings about the laxative effect of overconsuming maltitol, xylitol etc. Years ago when I first read about erythritol there was an opinion that it was the least problematic of the polyols for some people (not me though - they all cause excess gas and diarrhea at even modest quantities).
Good post Robb. No idea what to think about this. But some red flags about the study (That don’t think you touched on) are summarized here: https://twitter.com/dr__guess/status/1630548171666456578?s=46&t=3We7GhfcdsTlYRpWRWeamQ
Thanks! I covered most of that and am a bit less convinced there is nothing here. I will still use it.
For example, she acknowledges erythritol is upregulated in metabolic disease. Ok, does it induce thrombosis? Is it benign if consumed in large amounts? Idk, I may be missing something and fully acknowledge her criticisms.
Yeah not sure. This is an area I’m very new to. Are you implying that, for the moment, direction of causality isn’t 100% crucial because it’s linked to metabolic disease and that’s a concern? Whether endogenous or exogenous?
This is a very thorough analysis, similar to mine...confirmation bias!? https://twitter.com/adriansotomota/status/1630971795409862658?s=46&t=N4iVmNpqo8ZVvTZrNUs_Fw
Nice to see your article, Robb!
I personally don't use sweeteners myself as my body reacts to them either more or less, so they're definitely bad for my body.
Thank you, Robb. This was very timely as I had a text from a friend this morning asking if I was aware of the study. I had just finished reading it and was going to reply back to her when your email came through. I was struggling with understanding what AHG is and why it would be used in comparison to erythritol and glucose. I appreciate your insights.
I haven't read the full article, but wonder if the action pathway for MACE is only via clotting directly from the presence of erythritol or is there any mention of insulin playing a role and the metabolic effects of the cephalic phase of digestion? Curious! Thank you!
Well, I alluded to that to some degree. endogenous erythritol production increases in lockstep with insulin resistance, and may in fact precede it. There is clearly something going on there but they DID verify this effect appears to occur in healthy people. It's possible that is an inaccurate finding, but there are a lot of arrows pointing a similar direction.
Thank you for breaking it down for us!
Typo in the first paragraph: "wuite" -> "quite"
There are a dozen in there…I had a tight timeline!
My question for Robb - are you going to limit your Erythritol as a result of this study? I've got a boatload quests bars sitting around that I am considering pitching :)
Not really!
Thank you for this, Robb. Great information.
so who funded the study? there should be no discussion of a study without noting who paid for it and what their agenda may be.
I mentioned that above and it was nothing noteworthy. Ie-looked above board.
oh sorry i did not see that and now as i am looking for it I still don't see where you mentioned who funded the study but apparently i'm just missing it. lol
I just said "nothing looked out of line" as there were a ton of funding agencies. Another person said one of those outfits produces another non-nutritive sweetener. I've not tracked that down, so possible.
Awesome breakdown of the study. My question would be if the rather large dose (30g) of erythritol and it's elevated levels/duration would be at all attenuated by consuming it with a meal, esp a complete meal with protein+fats. My rather uneducated guess is that the 30g in a beverage was just erythritol+water and that concentration on an empty stomach may be the issue, where normal consumption (in a pint of ice cream or in a sugar-free cookie) wouldn't be have as much of a spike.
I doubt a meal will alter the kinetics on this.
Would xylitol, also being a sugar alcohol possibly have the same effects?
Well….it’s looking less and less likely there is ANY signal here. I think the worst either of them present is gas if over consumed.
This is Rebel Creamery’s response to Erythritol issue:
“This study was focused and performed on a segment of participants who had coronary disease, high blood pressure, or were otherwise at an increased risk for cardiovascular events. We've seen similar studies and headlines about meat, butter and eggs. Erythritol is produced endogenously in our bodies and has many decades of studies showing its safety. In fact, a recent study (PubMed 24366423) found erythritol improved blood pressure in participants. The authors of this latest study admit they found an association with erythritol, not causation. It was merely observational, and they don't even know what the subjects ate, if they even consumed erythritol. It was naturally produced in their bodies. This one study does not disprove the numerous scientific research showing erythritol's safety and benefits.
You likely have reverse causality here. The study did not measure erythritol intake. Metabolically sick people have a very active pentose phosphate pathway. This is not people getting sick from high levels of erythritol in their blood, but they have high levels of erythritol in their blood because they're so sick.”
Appreciate your work very much Robb! Thank you for all you do to help others. Did you see the Methods about how they a) used platelet rich plasma, added clot-inducing factors to force aggregation, and that no clotting occurred without those factors? How they injured the mouse carotid artery to induce thrombosis, and so on? I have an MSc in Personalised Nutrition and Functional Medicine. My MSc Dissertation was a Mechanism Review on Fructose and Atherosclerosis Cardiovascular Disease. I thus studied the pathophysiology of heart disease in detail. I have been studying sweet compounds for the past 10 years, reading every paper that comes out on non-sucrose/sugar sweetening ingredients, including erythritol. This is my deep dive analysis of the paper. Hope it may be helpful. https://www.linkedin.com/pulse/erythritol-pathways-physiology-sakiko-reuterski%25C3%25B6ld/?trackingId=QTRwABYaTGypVl9wpsnjTw%3D%3D