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Does Erythritol Increase the Risk of Heart Disease and Stroke?

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In this video, I am reviewing and critiquing the recently published study linking the sugar-substitute erythritol to an increased risk of heart disease and stroke.
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- VIDEO DESCRIPTION -
A recent study published in Nature Medicine linked the sugar substitute erythritol to an increased risk of heart disease and stroke. This publication triggered a major storm on social and traditional media, because erythritol has increasingly been used as a sugar substitute, and is quite popular particularly among people who consume low-carb or keto-diets.
In this video, I will summarize the study findings, and share my top five concerns that collectively cast some doubt about whether dietary erythritol is indeed linked to an increased risk of cardiovascular events, as the paper suggested.
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0:00 Introduction
1:13 Summary of study findings: blood erythritol is associated with heart attacks and strokes
6:55 Concern #1: Lack of generalizability
8:05 Concern #2: Blood erythritol may not be a biomarker of dietary erythritol intake
8:44 Concern #3: Confounding by pre-existing conditions
15:27 Concern #4: Confounding by dietary factors
17:37 Concern #5: Mechanistic studies may not be relevant for humans
20:53 Conclusions
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The content of this video, this RU-vid channel in general, and our blog at www.nourishedbyscience.com is for informational purposes only. Nothing herein shall be construed to be health or medical advice. Although we have made every effort to ensure the accuracy of all information posted to this Website, we can make no guarantees as to how the information and advice provided herein will affect you and your personal situation. If you need or require individual advice or guidance, then you should consult with a professional who can assist you. For our full disclaimer, please refer to nourishedbysci...

Опубликовано:

15 авг 2024

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Комментарии : 72

@marcoantoniosundfelddagama7690 Год назад

Hi Mario, all the points/red flags you raised make perfect sense to me. If anyone who watches this video also takes some time to read your articles, they will notice that you are very careful (or even more careful) when interpreting your own data as well, which is one of the reasons that makes your papers so interesting and pleasant to read. Congrats and please keep making these great videos!

@nourishedbyscience Год назад

Thank you, Marco!

@iliapetrovic3582 10 месяцев назад

Hi Mario, I’m new to your channel and just wanted to thank you for your calm and detailed delivery of information. Although I’m now normalised, I have been pre-diabetic for short periods and I’ve adjusted my diet to achieve this. I’ve used Erythritol on some occasions, but not excessively, I found it helpful when help me stop using sugar when I was first diagnosed with high blood sugar. I still use it, but around 2 teaspoons a month, so very little. I pretty confident this is the case as I don’t knowingly eat UHP foods! I look forward to many more of your videos concerning blood glucose!

@dianadeejarvis7074 Год назад

I haven't had any problems with erythritol. (I don't eat a lot of it.) I have had problems, though, with monk fruit, allulose, and sucralose. I'm suspicious that erythritol is being blamed when the real problem is something else.

@nickolasvlachos4013 5 месяцев назад

Thank you for this quite thorough appraisal. Because I use erythritol (a teaspoon in my espresso, 3 - 4 times a day) this paper got me worried when I became aware of it through popular / laypersons articles which, of course, picked up on the findings to generate scaremongering (and catchy) headlines. I did not have access to the full article but, fortunately, I was able to dispel my concerns rather quickly, finding the glucose-to-erythritol pathway you mentioned, and sufficient summary information to suspect that the cohorts studied likely included people who were metabolising more than a fair amount of glucose from their diet. Also, this publication seemed coincide with lots of bad press for a few other sugar substitutes. It would be interesting to know if any (rigorous) studies have examined the possibility of erythritol synthesis being one of the defense mechanisms that is promoted when other blood glucose sinks are overflowing or not sufficiently accessible.

@michaelhimes8778 Год назад

I really appreciate your expertise and measured approach to these issues. Great work!

@DingbatToast Год назад

Sensible analysis. Thank you ❤

@ruthe3351 3 месяца назад

I'm glad you mentioned that they didn't report on platelet aggregation. I agree they would have reported that if they had found it!

@tanyasydney2235 Год назад

It's a poorly designed study, in my opinion. We don't know in this study how much erythritol found was from endogenous production and how much from consumption. Association does not equal causation. There are usually always fire trucks at the scene of a fire, but this doesn't mean that the firetrucks caused the fire. The other issue is that erythritol production levels in our bodies go up in response to lots of other conditions...diabetes, prediabetes, oxidative stress, osmotic stress, glucose and fructose consumption, etc... Erythritol could simply be a marker of sickness rather than a cause of disease. Having said this, I agree with you that it may be best to err on the side of caution and not overuse Erythritol. I myself love Monk Fruit. Would love to use honey, but being prone to Hypoglycemia, I need to be careful of too much sugar intake.

@annieb8928 Год назад

Both stevia and monk fruit are derived from something natural. Unfortunately some of the companies that produce powdered versions of these substances add other things to them like dextrose or erythritol which cloud the issue. When I grew stevia in my backyard it was just a little leaf that I picked and threw in my glass of tea to sweeten it. If we just powdered the substance and sold it without the additives I think we would be less likely to suffer side effects. However, sugar alcohols are a different story and also can be produced in different ways. I would be leery of consuming large amounts of these chemicals. If you consume stevia or monk fruit you should do your due diligence to read the labels and research further any additives which are listed.

@karis3647 Год назад

Monk fruit can be purchased as a single ingredient powder. It's pricey, but very sweet. I use just a pinch in my coffee. I dilute it in water and store it in the fridge for my husband when he making his early morning coffee. The powder is very light. It's easy to make a mess, so the diluted monk fruit is easier to use in a rush to get out the door.

@zag221 Год назад

You can buy 100% pure green stevia powder and my older white one has only stevia listed as ingredient

@silkenissen7409 Год назад

Thanks for this high quality information and scientific discussion. Angenehm sachlich und gut verständlich. Keep going!

@johnchardine1886 Год назад

Excellent summary and critique of the study. One wonders how it got published! One comment at 15' 50": I agree that confounding factors in the diet need to be controlled for, and were not. However, if you are on a low-carb diet which includes erythritol as a sugar replacement, and a higher intake of good fat (animal fats olive oil), recent data show very positive effects on metabolic health. Aren't we moving away from the 50 year old idea that saturated fats are bad?

@nourishedbyscience Год назад

Thank you for your feedback. Regarding the dietary confounding, I just listed a few dietary factors that are likely different between high vs. low erythritol consumers. We'll talk about saturated fatty acids and their relationship to CVD later on this channel.

@Sassylarita Год назад

I truly believe this as I started having rapid heart beats, up to 160 resting. I had started eating Quest Chocolate Chip cookies once a day for months. I stopped eating them for about a month to save money. I bought more last week. After one and a half cookies over a two day period, the fast heart beat started up again. It finally dawned on me it had to be the cookies.

@rickrollrizal2747 Год назад

Same for me. I don't like it, but all the stevia and monk fruit always had erythritol. Started having palpitations, then chest pain. I only used 3 teaspoons in a cup of unsweetened chocolate.

@johndoles3713 3 месяца назад

Only 3😅

@AnneAndersonFoxiepaws Год назад

I have been paranoid about strokes since my aunt aged about 35 died of one when I was 18. It freaks me out even now, I'm 65 on my birthday but, because of my aunt, my history of migraine (which isnt nearly as bad as it used to be) and having slightly raised blood pressure these days, it is something I worry about. I tend to eat wholefood, much of which is plant based and dont usually eat processed food, but I dont want to take any chances, so this video is much appreciated.

@elizabethk3238 Год назад

Try Berberine to naturally lower your BP. If on meds speak with your (hopefully enlightened) GP. I say this because most of them are not bothered that they have not kept up with research.

@IPMan-me6lo 8 месяцев назад

Super, thank you for your review for erythritol. The factor diet could be a good explanation, from my own experience. People with high sugar intake, hoping by simply replacing sugar with erythritol, let them losing weight and been healthier without changing any other aspect in their diet. They must have a higher level of erythritol, for sure. Another thing, I think 4 years ago a studied nutritionist told me, erythritol have a negatively effect on our microbiome, and suggested stopping taking it. I did not ask him about the amount he is talking about.

@JPage-fj7mb 11 месяцев назад

When erythritol is a naturally occurring product of glucose metabolism in the body, how could they possibly separate the erythritol from glucose breakdown and the dietary erythritol intake? This study is messed up.

@IPMan-me6lo 2 месяца назад

Hallo Mario, any chance you do an Update after the new study came out in June 2024, which pointed at the higher risk of heart attack and stroke?

@galaxywanderer5945 Год назад

Another question please Dr Kratz; How do you classify HIGHER INTAKE? by grams?frequency of intake? and what is the scale of what is considered "NORMAL" intake of anything? For example; Butter, cheese, eggs, milk and cream!

@rickrollrizal2747 Год назад

He said 30 grams of erythritol in one study allegedly produced some effect. 7:18 he does say he has problems with the way the study was conducted

@johndoles3713 3 месяца назад

No grain no pain🎉

@dylany7701 10 дней назад

hi have you talked about the studies of other artificial sweeteners on the microbiome? Curious your thouhgts on those. thanks!

@nourishedbyscience 10 дней назад

Not yet, but planned. Cheers Mario

@dylany7701 10 дней назад

@@nourishedbyscience Great, I will look forward to that. I read the 2014 study from Nature today, and in some respects it seemed compelling but I suspect there are flaws.

@raystaar Год назад

Back to date sugar. The appearance of harm is enough for me. It doesn't taste that good anyway.

@nourishedbyscience Год назад

That's a reasonable take. Personally, if I had to place a bet on this, I would wager that dietary erythritol will turn out to be fine, but it's fair to say that it isn't clear yet and the potential for harm exists. Cheers Mario

@clicquot2271 Год назад

I agree with both of your points. Coconut sugar works well for me. I don’t get much of a glucose increase vs cane sugar in recipe swaps.

@michaelhimes8778 Год назад

It is very confusing the way doctors disagree on these issues. For example, Dr. Gregor says date sugar (or ground dates as he puts it) is his only acceptable “green light” sweetener because it has some fiber and minerals. Nephrologist Rick Johnson, however, on Peter Attia’s podcast said that dates are probably the worst fruit due to the insanely high fructose levels driving liver stress and metabolic disease. He even admitted your probably better off drinking a diet soda than 100% fruit juice. Crazy.

@galaxywanderer5945 Год назад

One question if I may: On the can of Stevia it states; ZERO calories but for every gram of Stevia consumed there is ONE carbohydrate?! The ingredient listed are: bulking agent Erythritol, acacia gum, sweetener: steviol glycoside from stevia (0.2%). for every 100 grams there are 99 grams of carbohydrate! does that sound right to you???

@dpgedward5947 Год назад

so what about someone who takes Erythritol and also eat garlic, which would stop any blood clots. Impossible to do a study with giving everyone the exact same diet and making other factors equal

@mikerudd4943 9 месяцев назад

You looked a little tired on this one Doc. Thank you for this video on sugar substitutes

@galaxywanderer5945 Год назад

One would think that whenever ANY study to be conducted would have some sort of questioner that ask the participant if they DID CONSUME any Erythritol before during or after the specified study program???? Also they would have a box whether if those people surfers from any chronic diseases/disorder condition or even if they are under any medications or not?! Right?? I mean this is just plain and simple! or if those people HAD or HAVE BEEN consuming Erythritol and if so how much and how frequent!

@nourishedbyscience Год назад

Yes. It was not a good study in many ways, and I think it's unfortunate that it made such huge headlines. Cheers Mario

@creepycrespi8180 Год назад

Tried Erythritol/Stevia mix last year(Pyure brand). It made my tongue go numb. Haven't touched it since.

@nourishedbyscience Год назад

Wow. Haven't heard that one. Cheers Mario

@ronniecampbell7762 Год назад

Fdxddx

@johndoles3713 3 месяца назад

Freak 😅

@user-ft8fg5zw9h Год назад

Thanks a lot.

@damirmogut4038 Год назад

Hallo Mario, great video (as always). One thing made me think. So if there is a metabolicall pathway to change blood glucose into erythritol (some more information needed) than maybe it could also be a additional biomarker for metabolic health? I found a paper from 1994 considering the bioavailability of erythritol - according to them, less than 10% is absorbed (only 5 volunteers). Eur J Clin Nutr. 1994 Apr;48(4):286-92.

@nourishedbyscience Год назад

I think other data suggest that the rate of absoption of erythritol is a lot higher than 10%, but nevertheless you are correct that even before this new Nature Medicine paper, several other papers had suggested that elevated blood erythritol is a marker for poor metabolic health. What is sad to me as a scientist is that these colleagues had been adequately skeptical of their own findings, had not made it into a huge story about dietary erythritol, and as a result got their studies published in much lower impact journals where no one noticed them. The new study really should not have been published in Nature Medicine, and should not have garnered such huge attention on the media. Cheers Mario

@chewiewins Год назад

Thank you. Very reassuring for the small amount I use. Do drink Coke Zero so those soft drink arficifial sweeteners, I would love your views.

@nourishedbyscience Год назад

Much requested topic, so I will cover this at some point. Cheers Mario

@chewiewins Год назад

@@nourishedbyscience Thank you Mario. Found you best health related channel on RU-vid

@tofu-munchingCoalition.ofChaos Год назад

18:43 Couldn't it also be possible that they just wanted to publish more papers? We did that in mathematics because irrationally the number of published papers is very important. So it's better to publish one idea or major finding in several steps. Perhaps something similar is going on here. Or is there a way to say that this is supposed to be the full data of the study they pre-registered?

@nourishedbyscience Год назад

Sadly, 'slicing the salami' is also a big thing in the biomedical/health sciences. It's unfortunate, but the incentives in academia are not aligned with doing the best science. The scientifically rigorous thing to do is to always publish the data on your a priori-defined primary endpoint first (in fact, some journals require this), and then to clearly mark all other analyses as secondary or exploratory. Nature Medicine apparently does not require this, which is dissapointing. If I had been an editor or reviewer on this paper, I would have checked the clinicaltrials.gov entry of the human study right away, and I would have not accepted the paper for publication with data on the a priori-defined primary endpoint missing (particularly given that these data are so critical to making this paper a bit more definitive). Also, imagine you are the main investigator here, wouldn't you want to be somewhat more certain that erythritol actually does increase platelet aggregation in vivo in humans before publishing such a study? Let's assume they did not finish the human study and really didn't have the coagulation data yet, what if they find out in a few weeks that erythritol doesn't do anything to human platelets in vivo? Then they made the whole world crazy with their half-baked paper, for no reason at all. In other words, I would not have published the paper like this. But then, as I stated above, the academic incentive system pushes people to do exactly what we are seeing here (one of the reasons I quit academia).

@qasimsiddique9581 Год назад

How about monk fruit natural sweetener?

@nourishedbyscience Год назад

Commercial monk fruit sweeteners often is a mixture of monk fruit extract and erythritol, so if you decide to play it safe and stay away from erythritol for now, you'd need to find a monk fruit extract without erythritol. Also, we have very few data on the safety of monk fruit. It's been used traditionally in some regions for a long time, but scientific data are sparse: pubmed.ncbi.nlm.nih.gov/32626208/ Hope this helps. Cheers Mario

@senterprise8392 Год назад

I’m not a scientist but it does make me wonder about the fact that why do a study on people that might already be sick and/or with co-morbidities. Surely if you were going to do such a study, it would be more valuable to be done on healthy people, so that the effects and risk could be more clearly determined. If erithritol is also made by the body, then the study becomes even less convincing. It’s beginning to seem like these studies are simply being done for studies sake. A numbers game. They don’t produce clearly determined results and merely end up creating fear and confusion for the general public. Is it any wonder people are losing trust in this type of science. The mere fact that a study like this raises more questions than answers makes it problematic.

@nourishedbyscience Год назад

Totally agree. At the very least, this should never have been published in such a top journal, and it should never have been discussed in the public until we have much higher-quality evidence.

@tanyasydney2235 Год назад

100% agree.

@realimagevanity2289 Год назад

"It’s beginning to seem like these studies are simply being done for studies sake." CORRECTION

@nourishedbyscience Год назад

@@realimagevanity2289 I wouldn't say most studies are this bad. In this particular case though, I think you are correct, and it's disheartening that it got published in such a high impact journal and got so much press. Cheers Mario

@Sophal27 Год назад

The group with the highest erythritol has a much poorer metabolic health. Their statistical ajustements can not correct such large difference at base line.

@nourishedbyscience Год назад

Yes, I agree. There is very high potential for what we would call residual or unmeasured confounding, or even reverse causation. Cheers Mario

@Sophal27 Год назад

@@nourishedbyscience I agree. Great video by the way.

@seitanbeatsyourmeat666 Год назад

I never liked it, and I really don’t think you can fool the body. I think it encourages bad eating habits in general so avoid it, and other fake/processed “foods”

@liliana1036 11 месяцев назад

That means you prefer sugar ?

@MJYouAreNotAlone1 Год назад

🙏❤️

@jeffrey4577 9 месяцев назад

👍‼️

@advertiserfriendlyusername5362 Год назад

No.

@tofu-munchingCoalition.ofChaos Год назад

More like we don't know. Both is plausible, possible and not one answer is clearly more likely. Or do you have additional data?

@nourishedbyscience Год назад

The paper has so many glaring issues, I can understand why some people discount it entirely. I don't think that's justified though. I agree with how you stated it, Tofu, that it's still possible that dietary erythritol may increase CVD risk. What I wanted to emphasize with this video though is that the paper doesn't link dietary erythritol to CVD in a conclusive or definitive way.

@advertiserfriendlyusername5362 Год назад

@@tofu-munchingCoalition.ofChaos 1.) The people known unto you as your parents are your parents. 2.) Buster Baxter and Fluttershy (after each of them was 18 years old, at least) are your parents. You don't know. Both 1 and 2 are equally plausible, possible and neither 1 nor 2 are are more likely than the other. Or do you have additional data?

@tofu-munchingCoalition.ofChaos Год назад

@@advertiserfriendlyusername5362 Yes, I have additional data that 1) is more likely obviously.

@advertiserfriendlyusername5362 Год назад

@@tofu-munchingCoalition.ofChaos Okay, I was just curious how credulous you are, i.e. if every new hypothesis you encounter has a perfect 50/50 probability of being true.