Calorie free sweetener erythritol may clot blood in high risk adults

If you sprinkle erythritol into your coffee, you might be stirring up heart disease.

Erythritol looks like sugar, tastes like sugar, and you can bake with it. It’s nearly calorie-free because it’s metabolized differently than regular sugar. While naturally present in many fruits in minute quantities, it’s now being mass-produced by fermenting corn. Lately, its become the sweetheart of the food industry. It’s practically universal in keto and low-carb products, and also commonly marketed to people with diabetes. And now it looks as though it can cause blood clots in susceptible adults.

If you use Stevia, you might want to double-check the package ingredients. Some brands of Stevia are blended with erythritol.

What is erythritol and how is it calorie-free?

Erythritol is not as caloric as sugar because it’s a category of sugar molecule called a sugar alcohol. Sugar alcohols are not as well absorbed or metabolized as typical sugars.

This article is continued below...(scroll down)

---

It helped. I feel great.

"It’s helped. I feel great."

Kobe Bryant

NBA baskeball player

This has been life changing

"Let me tell you this has been life-changing. I have all of her books, in audible and ebooks! I have gotten rid of all the hateful 8 oils. I have trained my body to eat its own previously toxic body fat. Download that pod it's a game changer!"

Megyn Kelly

Broadcaster / The Megyn Kelly Show

Life changing

Deep Nutrition changed my life.

Jesse Watters

Fox News Primetime host

Saved my life

I would like to thank you for literally saving my life. Back in February, I had to be hospitalized while on vacation in Phoenix with an A1C of 11% and had to start taking 2 types of insulin and 2 other meds. I read the Fatburn Fix in April, and followed the program to a tee, and I’m down by 15 pounds, 6.8 A1C, and only one once weekly diabetes medicine. Prior to reading the book, it was almost impossible for me to lose weight as a diabetic. 

Leontyne Tompkins

I feel free

For the last month, I have really been reading all labels on everything. I have completely remove those 8 oils you talk about. I must tell you, I feel great! I have more energy and I am now 197 lbs (have always been around 205 to 210lbs). I eat potatoes with real butter, grass fed steak, pasta with the right toppings. I eat everything! I seem to crave less sugar. I love it! 

Robert Kirkendall

I feel so much better

I had terrible aches and pains everywhere in my body, my hands, shoulders and knees. I feel so much better and the way I feel is motivating me every day! Thank you

Mike Deb Wootan Burcin

Better than ever

I am an anesthesiologist in Orlando and a huge fan of both of your books! I have been incorporating your principles for the last 10 months and feel that my health is better than ever.

Marnie Robinson, MD

My allergies disappeared

The biggest difference for me (and a surprising one) is that my allergies have almost completely disappeared! This is a big deal for me, because I’ve had allergies most of my life and they have often affected what I do which is a teaching music in [a public school district].  In general, I feel much better and have more consistent energy throughout the day.

Erica Turrell

Heart Palpitations have Stopped

I’ve lost 20+ pounds (also fasting 16-24 hours daily) and haven’t had palpitations except for one occasion — I had a mini bag of Fritos for the first time in July. And, I feel better now on a daily basis than I ever did all through college.

Mike Wright

Deep Nutrition and Fatburn Fix reader

I’ve lost over 50 pounds

I’ve lost over 50 pounds. I’m 56 years old. Cutting processed food and unhealthy fats from my diet was one of the first things I did on my health recovery journey...I went cold turkey off the bad oils. Emptied my pantry into the trash and just started eating real food

Mitzi Wilkinson Champion

Knowledge I didn’t know I needed

Your Fatburn Fix book is amazing, my friend. Thank you! I’m an Functional Nutritional Therapy Practitioner and I know my stuff. This is the extra layer of knowledge I didn’t know I needed. Well done!

Jennifer Dillman

Fatburn Fix reader

Lost a solid 20 lbs and my bloodwork is great

I have lost a solid 20 lbs and my bloodwork (after 3 months of eating your way) was even better! I was metabolically healthy (per your book) before I read your book, but barely. Lowering my weight, sealed the deal! I have been talking about you and your book to anyone who will listen...Thank you for all you’ve done and what you continue to do! You are changing lives for the better!

Missy Cramer

FatBurn Fix reader

Lost 20 lbs I could never shed

I love your Fatburn Fix!  Has helped me so so much!  I have had the dreaded weight all my life - 20 or so pounds I could never shed.  I have lost that now. I only eat 2 meals a day lunch and dinner with a glass of milk or cappuccino around 4 to hold me over. No snacking and not bad oils.  It has been the key to unlocking my fatburn.  I work out in the am and believe I am burning fat for energy not from food!

Lauren Smith

http://mcmahonmed.com

I feel great

My waist is four inches smaller. I feel great and many of the minor aches and pains that I had (knees and lower back) are gone. Also, my muscle tone is amazing, even though I have not increased my workout routine.

Richard Janelle

Completed Dr Cate's online course

The go-to for strength and conditioning coaches

Whenever I advise my clients about eating to perform I go straight to what I have learned from Dr. Cate. Her book Deep Nutrition has become the go-to for strength and conditioning coaches across the country.

Kent Matthes

Major League Baseball Agent with WME Sports

Dismantles the lie

Dr. Cate dismantles the lie that seed oils are healthy, which may the biggest lie about nutrition and health because it’s so insidious.  

Ken D Berry, MD

Author of Lies My Doctor Told Me

She knows the chemistry

Dr. Cate alerts us to the harms of seed oils and she’s convincing because she knows the chemistry better than anyone.

Dr. Drew Pinskey, MD

Globally recognized internal medicine and addiction medicine specialist, media personality, LoveLine Host, and New York Times bestselling author

No one is better at communicating nutritional truth

Dr. Cate has had the single greatest impact on how we talk to people about fueling for both performance or durability. While we all are a little unique, the foundational principles of human nutrition are immutable. If you are looking to create a more durable, resilient body, no one is better at communicating nutritional truth than Dr. Cate.

Dr. Kelly Starrett

Physiotherapist coach and New York Times and Wall Street Journal bestselling author

Highly recommend The Fatburn Fix

Dr. Shanahan has had a significant impact on my practice of medicine. I am known as a Low Carb Doctor, but I never really appreciated the negative effects of processed seed oils on the health of my patients. I highly recommend The Fatburn Fix to my patients and have a loaner copy in my waiting room. It is amazing how quickly blood sugars and overall health improves with cutting seed oils. It is not just about the carbs!

Dr. Brian Lenkzes, MD

CEO of LowCarbMD San Diego, co-host of Low Carb MD Podcast and host of Life's Best Medicine Podcast

Respected in the sports world

Dr. Cate reordered my diet when I was with the L.A. Lakers, and the benefits, for me personally, were felt immediately and have served me to this day. I’ve come to take real food so seriously I started a small family farm. I know of no M.D./nutritionist more respected in the sports world than Dr. Cate Shanahan.

Chris Kaman

NBA Player

Brought seed oil issue front and center

Cate brought the seed oil issue front and center. Healthy fats matter. So much so that I created an entire product line to swap out bad fats with good.

Mark Sisson

Founding Father of the Primal/Paleo Movement

Optimal health starts with food

If you want to understand how optimal health starts with food, start with Dr. Cate. Her book Deep Nutrition leaves you with an appreciation of the profound relationship between our genes and the planet, inspiring us to be good shepherds of both.

Dallas Hartwig

Attribution author of The Whole 30

Helped me with endurance

Deep Nutrition really helped me with endurance. I started to feel better as a player. I was able to run more, I was able to be more active …and I just decided to keep going with it to this day.

Dwight Howard

NBA Player

Silver bullet for me

Dr Cate’s teachings helped me lose 60 pounds like it was nothing. It was like a silver bullet for me.

Paul Grewal, MD 

Dr Grewal Internal Medicine, MD, author of Genius Foods

Radically improve your health…

Dr. Shanahan has provided a solid reference that deserves a place in the library of anyone who is seriously interested in nutrition. Her perspective on the vital role that healthy fat has in our diet is novel and, if implemented, can radically improve your health.

Dr. Joseph Mercola

Author of Fat for Fuel and Founder of Mercola.com

Pull up a chair…

I have based my work on the idea that getting the right kinds of healthy fats into your body and avoiding the worst fats is essential to optimal health. I've interviewed dozens of the world's top experts about this, and I know of no one who speaks more eloquently on this topic than Dr Cate. If she’s talking fats, pull up a chair. Take notes.

Dave Asprey

Author of the Bulletproof Diet

The key to unlocking my fatburn

I love your Fatburn Fix!  Has helped me so so much!  I have had the dreaded weight all my life - 20 or so pounds I could never shed.  I have lost that now. I only eat 2 meals a day lunch and dinner with a glass of milk or cappuccino around 4 to hold me over. No snacking and not bad oils.  It has been the key to unlocking my fatburn.  

Lauren Smith

Saved my life

I would like to thank you for literally saving my life. Back in February, I had to be hospitalized while on vacation in Phoenix with an A1C of 11% and had to start taking 2 types of insulin and 2 other meds. I read the Fatburn Fix in April, and followed the program to a tee, and I’m down by 15 pounds, 6.8 A1C, and only one once weekly diabetes medicine. 

Leontyne Tompkins

> Tears of joy

 I'm crying tears of joy and appreciation for all you've done for me and my health! Without Deep Nutrition and Fatburn Fix, I would literally still be in the vicious cycle I'd been fighting all my life! In a nutshell - I am no longer a compulsive overeating addict suffering under the crushing 'thumb' of all food and alcohol.     

Penni Wicks

---

 

Alcohol sugars like xylitol and sorbitol are often added to sugarless chewing gum, laxatives, and cough syrups. But these can cause digestive issues when you eat much more than a few grams. That’s because these sugar alcohols don’t get absorbed. When they make their way to the colon, they can promote bloating, diarrhea, and discomfort. Erythritol actually gets absorbed so doesn’t upset the colon. And, after circulating around your bloodstream for a couple of days, your kidneys eliminate it.

In other words, the sweetness comes in and the calories go out.

If you think that sounds too good to be true, you might be right. New research suggests these sugar alcohols have unexpected side effects.

Is using erythritol bad for your heart?

Researchers at the Cleveland Clinic found that higher levels of erythritol in the blood caused a “not modest” increase in the risk of both heart attack and stroke. They performed the analysis 3 times, in 3 different groups of people. Twice in the US, and once in Europe. The groups with the highest levels had 4 to 5 times the risk of the group with the lowest levels.

The timeline was very short, just 3 years. Most risk factors are evaluated over 10 or 20-year periods. So this is pretty sensational.

In the US groups, only 4 percent of people who ate the least erythritol had either a heart attack or stroke, versus 18 percent of the people who ate the most. Both heart attacks and strokes are caused by blood clots that occur on inflamed, atherosclerotic arteries.

In the European group, 10 percent of people eating the least amount of erythritol experienced these problems, while a whopping 45 percent of people eating the most were affected.

Yeah, but is it really all that bad?

The authors were not specifically looking to study erythritol. They evaluated thousands of compounds in people’s blood and the association between erythritol and blood clotting stuck out like a sore thumb. That suggests erythritol is pretty potently bad–in high-risk people eating a lot of it.

What’s more, the risk was manifested after just 3 years. This is much faster than established factors like high blood pressure, obesity, and prediabetes, which typically take 5 to 20 years of study for risks to become apparent.

Risk factors are cumulative too, meaning the more you have the higher your risk. So if you are over 55, and already have a few risk factors, I’d say yes, it’s bad. But of course, more research is needed.

No long-term safety tests were evaluated during the FDA approval.

According to Robert Rankin, executive director of the Calorie Control Council, “The results of this study are contrary to decades of scientific research showing reduced-calorie sweeteners like erythritol are safe, as evidenced by global regulatory permissions for their use in foods and beverages.”

It’s important to recognize that the Calorie Control Council is a trade group for manufacturers of artificial sweeteners. In fact, it’s been called “More like an industry front group than a trade association.” So Robert Rankin is not exactly an impartial observer.

The problem with this particular artificial sweetener is that the FDA designated it “Generally Recognized As Safe (GRAS).” That means there was no requirement for performing long-term studies before releasing it into the food supply.

While there may be an abundance of single-dose and other short-term safety studies, that may not be relevant to a substance used daily for years.

Who should worry about erythritol causing a heart attack or a stroke?

If you’re healthy, you’re probably not endangering your health very much, but it’s really too early to know.

The people in the study were very high risk, hardly your average man on the street, however, so it’s likely these findings don’t apply to most of us. Everyone in the study was in the hospital being evaluated for possible heart disease. In the US, the average age was 65, with a range of 44 to 72, and even older in Europe. Many people had diabetes, high blood pressure, heart failure, or a history of a heart attack.

On the other hand, if you are an erythritol enjoyer over 55, and have any of these risk factors, you might want to think about how much you’re getting.

How much erythritol is a safe amount?

It’s too early to really know.

The researchers did not have the ability to ask any of the study participants about their diets. So instead they checked blood levels. The folks at the lowest risk all had levels lower than 3.75 micromoles. The folks at the highest risk all had levels above 5.97 micromoles. A micromole of erythritol translates to about 10 millionths of a gram.

These numbers will become more meaningful when you read the next paragraph. The researchers themselves had no idea what a normal level was, so they designed another study.

How much does Keto ice cream bump your erythritol?

About 1000x. 8 healthy people were given 30 grams of erythritol, which is about 2 Tablespoons or the amount in a pint of keto ice cream. Within 30 minutes, erythritol levels in their blood shot up from around 4 micrograms to between 3,000 and 8,000 micrograms, after that peak it started declining but stayed well over baseline for 2 to three days.

In a press release, the lead author, Dr. Hazen, warned that these “markedly elevated levels in the blood are…well above those observed to enhance clotting risks.

How does erythritol cause heart attacks and strokes?

Erythritol causes tiny particles called platelets in the blood to clump together, forming a clot. When blood clots in your heart, that’s a heart attack. When it clots in your brain, that’s a stroke.

What I find concerning is that the dose required to cause this clotting effect is only 45 micrograms. The 8-person test group I just mentioned showed that after that single 30-gram test dose, the equivalent of a minor ice cream binge, blood levels stayed well above the 45 microgram threshold for nearly 2 days.

Would other sugar alcohols do the same thing?

None have been tested but if I had to bet money I would put it on YES, they would. In fact, according to some studies, other artificial sweeteners outside of the sugar alcohol category seem to have at least some pro-clotting effect on platelets. This may be related to how they process serotonin, the pleasure chemical that makes us crave sweet taste—but that’s just a speculative guess.

What should you substitute?

As research comes out striking down just about every artificial sweetener, I’m going to say just eat sugar. If you’re worried about calories, glycation, or your insulin levels, then just eat less sugar. LOL.

On a serious note, I think this hopeless search for sweetness without side effects is nature’s way of telling us that something is wrong.

I thought I was cursed with a sweet tooth from birth and would never be able to resist chocolate candies and dried fruits if any found their way into my house. But as I write about in Deep Nutrition, that was a product of sugar’s ability to blunt your taste for everything else.

And more than that, it’s a byproduct of the metabolic effects of seed oils. I write about how seed oils drive the most powerful kinds of sugar addictions in The FATBURN FIX.

So what is the bottom line on erythritol?

Putting everything from this new study in Nature together, here’s what I think.

The people in the highest risk group were more likely to be consuming enough erythritol that their level would go really high periodically. In other words, chronic daily use with some periodic binges. So if you are over 55 with risk factors, I’d suggest limiting erythritol-sweetened indulgences to maybe a few times a year.

On the other hand, if you’re under 55 with normal blood pressure, fasting blood sugar, and no prior history of cardiovascular disease, getting just a few grams maybe 2-3 times a week is less likely to be a problem.

Keep in mind, anything sweet can deaden your sense of taste, depriving you of deriving enjoyment from other flavors.

What are other people saying?

This doctor wrote up his thoughts and he has included key images from the study. I agree with most of what he’s saying. However, where I differ is his thinking that the dose is too high. He points out that the average person gets 13 grams of erythritol every day, and concluded that the 30 mg dose was too high. But I disagree. f someone is getting 13 grams a day on average that most likely means some days they get much less and some days they get much more. And I think it’s those spikes on top of regular consumption that might really represent a problem.