Should you avoid erythritol? Is there any connection between erythritol and heart attacks,
stroke, and cardiovascular disease? And how can you really be sure of that? Because the body cant
really metabolize erythritol, what happens to it? But doesnt the body create its own
erythritol through the pentose phosphate pathway? So what gives? These questions have really started
only being asked, well, on the 27th of february. When this study came out, it confused a lot of
people who rely on these sugar alternatives, either as part of the keto diet, or are in
need of a sugar that bypasses glucose and insulin pathways. In this video, lets take a good look at
this study, understand erythritol, platelets, and see if you really need to be worried?
If you guys are new here, this channel is all about helping you make informed decisions as well
as be in the know when it comes to your health and wellness, and I would love for you all to gently
tap on that like button down below, and if you really like the content, then consider subscribing
as well. Also, if you guys are on instagram, you can follow me there too. Now without wasting any
more time, lets take a look at the study. Here is the first problem. The people that
are spreading the news on erythritol causing heart attacks really only look at this. Nature Medicine.
The title. Artificial sweetener erythritol and cardiovascular event risk. And lets highlight it.
At physiological levels, erythritol enhanced platelet reactivity in vitro and thrombosis
formation in vivo. Which means not just in a test tube, but also in people, like you and I. But
heres whats funny. This is just the abstract. Its not the full study guys. The full study is
actually 28 pages long and looks like this. And youll be shocked to see whats in it. But before
we get into that. Lets take a look at what really is erythritol and what happens to it in the body.
Erythritol is already made in the body, in fact, it exists naturally in melons, grapes and even
asparagus. But the erythritol that is in food and drinks, is made by fermenting glucose with a yeast
like fungi called monilella pollinis, getting you close to about 70% of the sweetness of table
sugar. Its a 4 carbon sugar, mostly known for not affecting your glucose and insulin in the body.
Now, once you ingest it, Most of it gets absorbed into your bloodstream before it reaches your
colon. It circulates in your blood for a while, until it’s eventually excreted in your urine.
We as humans dont have enzymes to break it down. Which is why its considered safe and to an extent
we can call it biologically inert, since our gut and bacteria dont even like to ferment it. It just
kind of like passes thru us. Exactly why its a sweetener in sugar free gum, because it doesnt
cause tooth decay. But for some reason, it causes platelet aggregation, and cardiovascular events?
Lets take a deeper look. Now the first thing I look at in studies, are the number of people
in the study and what their past medical history was like. Heres what youre thinking. Theres over
1000 people involved in this study, surely its a big sample size. Not so fast. Heres the context,
from 2004-2011, Dr. Hazen and his colleagues were collecting blood samples, as part of a database.
In the first group of about 1,100 people who were undergoing cardiac risk assessments,
from Their blood samples they concluded that The more erythritol in a person’s blood stream,
the higher their chances of suffering a major cardiac event—like a heart attack or stroke would
be—during a three-year period. Now we dont even know the details of their underlying conditions
that already put them at risk for developing complications. You see what im saying. This is the
old correlation does not equal causation fallacy. And to illustrate this , take a look at this graph
that looks at ice cream sales and shark attacks to make sense of it. You see how they are so closely
correlated. So does that mean that consuming ice cream causes shark attacks? No: what it means
is that more people consume ice cream and get in the ocean when it’s warmer outside. Thats all it
means. Plus, the actual volunteers in this study were 8 people. Just 8. 8 is a sample size that is
too small. It reduces the power of the study and increases the margin of error, which can
render the study, hate to say it, meaningless. And to get to the bottom of this to really be
sure. You have to literally get to the bottom. By scrolling down to the bottom. And ill leave the
link to full study below. Scroll down to bottom To this tiny section here. And what do you know. This
study has not minor limitations but SEVERAL. The study itself is telling you there are limitations,
so read them before you get all caught up. What does it say? Measurement of erythritol
in clinical cohort studies was only performed once as an overnight fasting level at the time
of enrollment. So they dont even know if more measurements throughout the day would have changed
their findings. Secondly. Because patients in our observational cohorts were recruited at quaternary
referral centers and show a high prevalence of CVD and traditional risk factors, the translatability
of our findings to the general population needs to be determined. This is huge right here. Were
these volunteers already at risk of cardiovascular disease, and they wanted to use them in order to
get the results they wanted. Moving on. Thirdly, Another limitation of our clinical observational
studies is that by design, these studies can only show association and not causation. Which
we discussed earlier with ice cream sales and shark attacks. Which is exactly what i was saying.
Fourthly. We also recognize the possibility of unmodelled confounding (for example,
diet) that may have (directly or indirectly) impacted our results by factors that are not
included in our models. Basically, its a way of saying, they didnt even account for what else the
volunteers ate throughout the trial that could have skewed results in any which way. Now the
amount they used on those 8 people was 30 grams of erythritol, which is about the amount in a pint of
keto ice cream. And the levels of erythritol apparently, remained 1,000-fold higher for
hours after ingestion and remained substantially elevated for over 2 days. So the real question is,
does that have any clinical ramifications that should concern you. Heres my opinion,
it’s important to know that the appearance of erythritol in the blood before a cardiac event
doesn’t necessarily mean that erythritol is causing that event. Because our bodies produce
erythritol on its own, it introduces a very high likelihood of whats called the “third variable
problem” – in which the observed correlation between two variables, in this case more
eythritol = more cardiovascular events, can actually be explained by a third variable
that hasn’t been accounted for. Which in this case would be the: pentose phosphate
pathway activity that increases as a result of oxidative stress, inflammation, diabetes,
obesity, that also impacts cardiovascular risk. And a good example is the following one,
cities with more fire hydrants tend to also have more dogs right. Thats the correlation.
But there is a third variablethat is causing that correlation which is: the population size of that
city. Of course youre going to have a correlation of more dogs and more fire hydrants, because you
have a larger city thats creating that correlation to begin with. Of course larger cities have more
dogs and more fire hydrants. Its a covariate. Now with that said, and with the study
broken down. I cant tell you to eat or not eat erythritol. Thats entirely up to you. The reason
why i dont like it, is because of the taste. It literally tastes too artificial for me. Which
is why if im looking for a sugar alternative, id start with allulose, xylitol, and monk fruit for
example. But i'm more curious to hear from you. What is your favorite sugar alternative? Do you
have one? Or do you believe everything is fine in moderation? Let me in the comments below. Also,
hit that subscribe button too if you found value in this, and ill see you on the next one.