Monday, May 29, 2023
Support Our Journalism
HomeFeaturesIs erythritol safe? This US study has confused India’s wellness community

Is erythritol safe? This US study has confused India’s wellness community

In India, erythritol has birthed a thriving industry of low-calorie, protein-infused and ‘guilt-free’ pleasures such as ice creams, cookies and chocolates.

Text Size:

Metabolic health coach Shashi Iyengar switched to plant-based sweeteners when he was diagnosed with diabetes. When whipping up a batch of chocolates and baked goods at home, he turns to zero-calorie erythritol, a sweetener popularly marketed as a safe weight loss and diabetes solution.

But a new study questioning its safety has become the cause of much confusion. The February 2023 study, published in Nature Medicine, linked erythritol consumption to blood clots, heart attacks and strokes.

It’s been seven years since Iyengar switched to erythritol and started enjoying the benefits of this ‘guilt-free’ delight.

“The low-carb or keto community that I closely work with is splintered. Half of them say we need to steer clear from this, and the other half has completely dismissed the findings of the study,” says Iyengar.

The study’s findings are especially relevant to India, given the high incidence of diabetes, our love affair with all things sweet, and the pervasiveness of erythritol. The sweetener can be easily bought online, on sites such as Amazon, for as little as Rs 235 for 250 grams under various brands.

“India is often referred to as the ‘diabetes capital of the world’, as it accounts for 17 per cent of the total number of diabetes patients. There are currently close to 80 million people with diabetes in India,” says Dr Cyriac Abby Philips, a researcher and specialist in hepatology and liver transplant medicine at Kerala’s Rajagiri Hospital.

“This indicates that the consumption of such sweeteners or alternative food options that are low in sugar may be on the rise,” adds Philips.

The US Food and Drug Administration (FDA) labels erythritol “generally recognised as safe”. According to studies, the currently defined safe and tolerable dose of erythritol in men and women is up to one gram per kilogram of body weight per day in diet and drinks.

Also read: What foods can ensure you don’t gain weight this winter? Start with this lentil-vegetable soup

‘The next-generation sweetener’

Erythritol is not just an additive—it is also found naturally in some plants and fruits such as pear, watermelon, peach and grape. The human body also produces it through the pentose phosphate pathway (PPP). This metabolic pathway regulates cellular metabolism and can also be manufactured industrially through the fermentation of glucose.

In India, erythritol has birthed a thriving industry of low-calorie, protein-infused pleasures such as ice creams, cookies and chocolates. These new products are part of a wave of guilt-free consumption and dietary consciousness.

Erythritol is sometimes mixed with popular sugar substitutes such as aspartame and stevia, often marked obscurely on packaging labels and promoting uninformed consumption.

“A lot of people may be buying and consuming erythritol-based sweeteners unknowingly,” says Philips. He cites one sweetener brand that is marketed as stevia but contains only 7 per cent stevia glycosides; the remaining 93 per cent is erythritol.

The study also discovered that people with existing risk factors for heart disease, such as diabetes, were twice as likely to experience a heart attack or stroke if they had the highest levels of erythritol in their bloodstream.

But Iyengar and Philips both agree that there is no reason to panic.

“This study is in no way a strong and solid conclusion for anyone to stop using erythritol. It provides insights into erythritol effects, which need to be confirmed in larger and better-designed trials. However, the study does inform the public at large regarding changes in options,” says Philips.

Iyengar, too, does not think that this is a “full-proof” study. “There is nothing negative about erythritol, and nothing has been conclusively proven yet,” he says.

Also read: A gallbladder-friendly diet? Yes, your nutrition can prevent stone formation

No cause and effect established

The researchers sought to assess erythritol levels in the human body, which may have been naturally produced in participants due to underlying health conditions.

Blood samples of over 4,000 participants, analysed between 2004 and 2011, revealed that all had major risk factors for heart disease.

It was found that an active PPP and the participants’ own illnesses contributed to the high levels of erythritol in their bodies, and that their sweeteners of choice were not to blame. But that was lost in the pandemonium that ensued after they released their findings.

“In the 4,000 subjects studied, the majority of erythritol levels are likely from what they made on their own. But, our animal model studies show direct provision of erythritol provokes heightened clotting potential,” Stanley L Hazen, one of the study’s authors from the Lerner Research Institute in Cleveland, told ThePrint.

This factor might have been misunderstood among the scientific community and diabetes patients, raising alarm. Dr Libin Abraham, a scientist from Canada, is also cautious about the findings.

“Without dietary recall, it is not possible to say that consumption of erythritol causes stroke and cardiac events. Moreover, the sample population they took is very sick, including people who are obese, diabetics, and have a history of heart attack,” says Abraham, who specialises in cancer immunotherapy and is a member of the Mission for Ethics and Science in Healthcare in India.

Also read: Your modern diet is contributing to climate change — but here’s how you can fix it

Small sample, high dose

In the second part of the study, eight volunteers who were given 30 grams of erythritol for consumption showed “prolonged elevation of erythritol after ingestion” in their system.

But to some experts such as Iyengar and Abraham, this sample size is too small to generalise any findings. Moreover, such high consumption of the additive was due to “high doses”, making the study’s methodology “flawed”. While the study is unable to give a final verdict on the safety of erythritol, it does show a correlation between stroke and the substance in question.

“In my professional opinion, stevia is the best sweetener out there. And now, after this study, it is better if people with heart disease abstain from erythritol and switch to stevia, says Dr Nishith Chandra, principal director of interventional cardiology at Fortis Escorts Heart Institute and Research Centre.

However, Chandra says that erythritol can be consumed in moderation by those who can tolerate it well. “This study has educated people that not all sweeteners are safe and that they should read the label carefully,” he adds.

Iyengar, for one, is not planning to give up the small quantities of erythritol he consumes now and then. It allows him to have the (occasional) cake and eat it too.

(Edited by Zoya Bhatti)

Subscribe to our channels on YouTube & Telegram

Support Our Journalism

India needs fair, non-hyphenated and questioning journalism, packed with on-ground reporting. ThePrint – with exceptional reporters, columnists and editors – is doing just that.

Sustaining this needs support from wonderful readers like you.

Whether you live in India or overseas, you can take a paid subscription by clicking here.

Support Our Journalism

Most Popular