Take Sugar Studies With a Grain of Salt, Part 2
A poor study gets even worse media coverage. Here's the reality.
“To click or not to click, that's the trillion dollar mental health question in the internet age.” ― Abhijit Naskar
Last week, we talked about a study that cast a completely natural sugar (erythritol) in a bad light. The study was less than stellar, but the news media, hungry for clicks, made it even worse. The mangled message could cause people — especially those with diabetes or obesity — to give up a very successful sugar substitute that may be saving their lives.
Widespread Media Coverage
The study, from the Cleveland Clinic, had little to say about actual consumption of erythritol—except in large doses—and even that is speculative without a control group. That hasn’t stopped the click-baity news coverage.
Fox News said, “A new Cleveland Clinic study shows that a popular artificial sweetener, erythritol, is associated with an increased risk of heart attack and stroke.” The first thing to note is that erythritol, which occurs naturally, is labeled "artificial" both by the study and the press. However, it is a natural sugar alcohol found in many foods, including pears, grapes, watermelon, mushrooms, cheese, soy sauce, beer, sake, and wine. It’s also worth noting that erythritol has been affirmed as safe by the U.S. Food and Drug Administration (FDA), the World Health Organization, and the EFSA (the European version of the FDA). Second, they imply that the observational study looked at consumption. Unfortunately, as mentioned in part 1, consumption data wasn’t available.
The study has also gone global. The Indian Express chose the bold headline: “Does your artificial sweetener have Erythritol? Study says it raises risk of heart attack and stroke.“ The Indian Express is hardly a medical journal, but it should know the difference between an association and a causal risk.
According to many other scientists, there is not enough here to worry about. Robert Rankin, executive director of the Calorie Control Council, disputed the findings, saying, “The results of this study are contrary to decades of scientific research showing reduced-calorie sweeteners like erythritol are safe.” He added that the results “should not be extrapolated to the general population, as the participants in the intervention were already at increased risk for cardiovascular events.” That may be true, but many of those people are the prime demographic for sugar substitutes.
The Calorie Control Council represents the low-cal food and beverage industry, so they have a vested interest in sweeteners, but other scientists concur and decry the lax press coverage. Kevin Klatt, a metabolism researcher at UC Berkeley Metabolic Biology, says that “Erythritol is a great example of something that is in the diet but can also be made endogenously, where we are not sure if it is causally linked to disease but there is [speculation] that it might be, so the media and influencers will run with headlines about it.” So, don’t panic just yet.
What to Do While Awaiting Follow-Up Research
But until follow-up studies are done, you might want to keep your consumption of erythritol below 30 grams at one sitting. There are other natural sweeteners available, such as allulose and tagatose. Switch them up to ensure you don’t get too much of any one of them. These sugar substitutes have been used for decades with great results for people trying to reduce their blood sugar.
There was a time when we didn’t have access to so much refined sugar. Amazingly, people were still happy. There is joy to be found in sweet fruits, and we should reconnect with them. And maybe we don’t need donuts, candy bars, sodas, and ice cream with every meal. It’s a bitter pill to swallow, but perhaps dessert should be a treat, not a staple.
References
Witkowski, Marco, Ina Nemet, Hassan Alamri, Jennifer Wilcox, Nilaksh Gupta, Nisreen Nimer, Arash Haghikia, et al. “The Artificial Sweetener Erythritol and Cardiovascular Event Risk.” Nature Medicine, February 27, 2023, 1–9.
Ortiz, Semira, Doletha Szebenyi, and Martha Field. “Endogenous Synthesis of Erythritol, a Novel Biomarker of Weight Gain (P15-016-19).” Current Developments in Nutrition 3, no. Suppl 1 (June 13, 2019): nzz037.P15-016-19.
Ortiz, Semira R., and Martha S. Field. “Elevated Plasma and Urinary Erythritol Is a Biomarker of Excess Simple Carbohydrate Intake in Mice.” bioRxiv, December 4, 2022.