[HN Gopher] The artificial sweetener erythritol and cardiovascul...
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       The artificial sweetener erythritol and cardiovascular event risk
        
       Author : rswerve
       Score  : 39 points
       Date   : 2023-02-27 19:43 UTC (3 hours ago)
        
 (HTM) web link (www.nature.com)
 (TXT) w3m dump (www.nature.com)
        
       | 8f2ab37a-ed6c wrote:
       | Fascinating, I'm a heavy consumer of this stuff and I would love
       | to know how valid this research is. If it's solid work, I guess
       | it's bye bye to a lot of products that felt guilt-free.
        
         | foxyv wrote:
         | They think that erythritol increases platelet activity which
         | may cause thrombosis. They have proven that erythritol does
         | affect platelet reactivity. However the study doesn't prove it
         | adequately to say that it definitively causes thrombosis. That
         | would require a follow up study. They have some correlation in
         | data from people with cardiac disease, but it's not surprising
         | to see erythritol there because a lot of cardiac disease is
         | caused by type 2 diabetes.
         | 
         | Without further study there is no way to say if there is an
         | increased risk of thrombosis from this data alone. Just enough
         | to say they should perform further studies to make a
         | determination. In most cases with these studies, the increased
         | risk of thrombosis would so low that you could offset it by
         | taking a walk once a week.
         | 
         | I personally won't stop my consumption of erythritol on this
         | data alone, but there ARE other sweeteners. I mostly use Stevia
         | myself.
        
         | latchkey wrote:
         | Many/most of the monk fruit 'sweetener' products contain it as
         | an additive. Super annoying since monk fruit itself doesn't
         | need it.
        
           | vosper wrote:
           | Most "monk fruit" sweetener I've seen actually has erythritol
           | as the main ingredient, which just a small amount of monk
           | fruit. Presumably this is to get away with calling it "monk
           | fruit sweetener" which appeals to the idea that it's somehow
           | a more "natural" product.
        
             | 8f2ab37a-ed6c wrote:
             | Even my stevia sweetener has erythritol as its first
             | ingredient, so this has to be ubiquitous. Back to Splenda I
             | guess?
        
         | bloaf wrote:
         | I, for one, am confused why people choose erythritol over
         | allulose.
        
           | outworlder wrote:
           | They usually don't. But if you get something like monk fruit,
           | you only need a tiny amount. Erythritol is often added so it
           | will look more like sugar.
        
       | JustSomeNobody wrote:
       | Well, this sucks. I use this in my coffee and a smidge on my
       | oatmeal.
       | 
       | Is there an artificial sweetener left that doesn't cause issues?
       | Splenda was associated with CVD so that's why I switched.
        
         | bloaf wrote:
         | Allulose? https://en.m.wikipedia.org/wiki/Psicose
        
         | sva_ wrote:
         | Back when I still used sugar I found Xylitol pretty neat. It
         | has about 1/2 of the calories of normal sugar but mostly tastes
         | the same (I actually prefer it to 'real' sugar by taste). There
         | are some claims about health benefits but I remain skeptical
         | about them.
         | 
         | All in all, I decided pretty early on that eating stuff that
         | tastes extremely sweet but does not cause the associated
         | glucose spike is a weird way of fooling one's body, and it just
         | doesn't seem like a great idea to me...
         | 
         | Reducing sugar/overly sweet stuff intake has this nice by-
         | effect that everything else starts tasting much, much more
         | intense. I'm very much into savory stuff nowadays, and when I
         | sometimes let someone trick me into trying something sweet, I
         | usually regret it - purely based on the disappointing taste.
        
           | jsnell wrote:
           | There should be no question about xylitol being beneficial
           | for dental health. (Not just less harmful than sugar, but
           | actively beneficial.)
        
         | Axien wrote:
         | Ugh. Splenda has been my go to sweetener for 15 years now.
        
         | mrmincent wrote:
         | Instead of a sweetener maybe try a sprinkle of cinnamon in your
         | oats.
        
         | stavros wrote:
         | Aspartame?
        
           | outworlder wrote:
           | No! Aspartame is known to cause _serious_ issues for decades
           | now, even before it was finally approved by the FDA.
        
             | idiotsecant wrote:
             | Oh? Who is that 'known' by? Certainly not any of the over
             | 100 regulatory agencies around the world who have made
             | aspartame one of the _most studied compounds on earth_.
             | Unless you have PKU or migraines there is literally no
             | widely accepted science that says otherwise.
        
               | Axien wrote:
               | Aspartame is linked to an 18% increase in stroke:
               | 
               | https://www.health.harvard.edu/heart-health/sugar-
               | substitute...
        
             | baal80spam wrote:
             | Isn't this a many times debunked myth that just keep coming
             | back?
        
         | causality0 wrote:
         | Saccharin, aka good old fashioned Sweet n Low.
        
         | vosper wrote:
         | If it's not too many cups of coffee each day, and just a smidge
         | on your oatmeal, then could you use regular sugar?
        
         | 404mm wrote:
         | I assume you make oatmeal with water, right? Try to make it
         | with milk (2% is fine) instead of water. Probably not the
         | healthiest alternative but I think better than sugar or
         | sweetener.
        
         | tharkun__ wrote:
         | Abstinence.
         | 
         | Hear me out.
         | 
         | I have never had such sweet bread as I had after being on Keto
         | for a year. As in actual Ketosis, doctor verified.
         | 
         | When I started eating "normal" again, lots of things tasted way
         | sweeter than I remembered. But like saltiness and other things
         | you get used to it.
        
           | 404mm wrote:
           | I can attest to this. You don't even have to avoid all carbs.
           | Just cut out sweet sugary stuff and things will start tasting
           | sweeter. It works with salt too.
        
           | Workaccount2 wrote:
           | I cut down on salt and eating out now kind of sucks,
           | everything tastes like a salt stick.
        
             | latchkey wrote:
             | It is either that or stuff is loaded with butter. I can't
             | think of a single restaurant that I've been to in the last
             | two years that I crave going to again. I keep thinking it
             | is the area I live in or the places I've been, but at the
             | end of the day, I think I'm just spoiled by cooking at
             | home.
        
           | koolba wrote:
           | You can also force the contrast by having something bitter,
           | like unsweetened black coffee, before something not normally
           | considers sweet, like bread.
        
         | Workaccount2 wrote:
         | The holy grail of sweetners is left handed sugar. Basically a
         | regular glucose molecule but flipped. Tastes identical to sugar
         | but cannot be metabolized.
         | 
         | The catch is that no one has found a way to synthesize it
         | cheaply.
        
       | mikece wrote:
       | [flagged]
        
         | outworlder wrote:
         | I'm pretty sure what you mean but the rate of cardiovascular
         | issues has been increasing for decades, at least since the
         | 70's.
         | 
         | The actual politically sensitive possibility is sugar (and even
         | more so, high fructose corn syrup). There's a lot of money
         | involved there.
        
         | jsnell wrote:
         | The studies this paper is based on were started 20 years ago.
         | Does your conspiracy theory include time machines?
        
         | 6LLvveMx2koXfwn wrote:
         | Which you're also being a little coy about for some reason.
        
           | parvenu74 wrote:
           | Perhaps (s)he's concerned about political backlash (via down-
           | voting) on HN?
        
             | rootusrootus wrote:
             | You cannot lose that many magical internet points on a
             | single post, so don't worry about it.
        
             | rom-antics wrote:
             | I'm sure he can spare some of his 19876 internet points,
             | just say it FSS
        
               | mikece wrote:
               | And my comment has been flagged. Too coy now?
        
             | [deleted]
        
       | f38zf5vdt wrote:
       | Weird. It has no effect on survival in rats and the doses were
       | large.
       | 
       | > One chronic (78-weeks) study in rats with dietary levels of 0,
       | 1, 3, or 10% erythritol (equal to > 0.46, 1.4 and 5 g/kg bw/day
       | for males and 0, 0.54, 1.7 and 5.7 g/kg bw/day for females) (Til
       | > and van Nesserooij, 1994) and another 2-year chronic
       | toxicity/carcinogenicity study in rats > with dietary levels of
       | erythritol of 0, 2, 5, or 10% (equal to 0, 0.9, 22, and 4.6 g/kg
       | bw/day for > males and 0, 1.0, 2.6, and 5.4 g/kg bw/day) (Lina et
       | al., 1994; 1996) demonstrated that > erythritol did not affect
       | survival and had no carcinogenic effect.
       | 
       | https://ec.europa.eu/food/fs/sc/scf/out175_en.pdf
       | 
       | From this paper:
       | 
       | > In a population-based prospective cohort study with repeated
       | dietary records, ingestion of multiple artificial sweeteners (for
       | example, aspartame, acesulfame potassium and sucralose) was
       | associated with CVD risk.
       | 
       | Ok, let's look at that reference.
       | 
       | > Results Total artificial sweetener intake was associated with
       | increased risk of cardiovascular diseases (1502 events, hazard
       | ratio 1.09, 95% confidence interval 1.01 to 1.18, P=0.03);
       | absolute incidence rate in higher consumers (above the sex
       | specific median) and non-consumers was 346 and 314 per 100 000
       | person years, respectively. Artificial sweeteners were more
       | particularly associated with cerebrovascular disease risk (777
       | events, 1.18, 1.06 to 1.31, P=0.002; incidence rates 195 and 150
       | per 100 000 person years in higher and non-consumers,
       | respectively). Aspartame intake was associated with increased
       | risk of cerebrovascular events (1.17, 1.03 to 1.33, P=0.02;
       | incidence rates 186 and 151 per 100 000 person years in higher
       | and non-consumers, respectively), and acesulfame potassium and
       | sucralose were associated with increased coronary heart disease
       | risk (730 events; acesulfame potassium: 1.40, 1.06 to 1.84,
       | P=0.02; incidence rates 167 and 164; sucralose: 1.31, 1.00 to
       | 1.71, P=0.05; incidence rates 271 and 161).
       | 
       | This study shows the same thing with _all_ artificial sweeteners,
       | and has way more people (n=103,388) than the present Nature study
       | (n=1,157). And we know that erythritol is often used by type 2
       | diabetics due to its low effect on insulin levels. That
       | population is predisposed to cardiac events to begin with.
       | 
       | When adjusting the US/EU cohorts for cardiovascular risk factors,
       | the observed effect with erythritol are smaller and closer to
       | this study of other artificial sweeteners.
       | 
       | > Consistent with the results observed within the discovery
       | cohort (adjusted HR = 2.95 (1.70-5.12) P < 0.001; Fig. 1 and
       | Supplementary Table 4), the association between erythritol levels
       | (fourth quartile versus first quartile) and incident MACE risk
       | remained significant in both US and European validation cohorts
       | following adjustments for cardiovascular risk factors (adjusted
       | HR (95% CI) = 1.80 (1.18-2.77) and 2.21 (1.20-4.07), P = 0.007
       | and P = 0.010, respectively
       | 
       | I'm not convinced of the validity of this study. They ignored the
       | rat chronic toxicity data and proposed a mechanism for what they
       | saw in a small cohort of humans, but it should be reproducible in
       | mammals.
        
       | DantesKite wrote:
       | Well, no worries for me. I found out years ago I'm allergic to
       | this stuff the hard way.
       | 
       | Gave me hives all over my face for a few hours. Intensely itchy.
       | 
       | Now whenever I drink something new, I always look out for it.
        
         | rootusrootus wrote:
         | Have you had to adjust your diet to eliminate natural sources
         | as well, or does the reaction only happen for high
         | concentrations?
        
           | DantesKite wrote:
           | It seems to only happen in drinks with high concentrations.
           | 
           | Like this one.
           | 
           | https://www.safeway.com/shop/product-details.960552358.html
        
       | SoftTalker wrote:
       | I just avoid artificial sweetener as a category. They all taste
       | like chemicals to me anyway. I used to drink a lot of Diet Coke
       | but have hardly touched it for years. It tastes like weed killer
       | to me now.
        
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       (page generated 2023-02-27 23:00 UTC)