Artificial sweeteners are increasingly common food ingredients. They’re added to thousands of “sugar-free,” “low-carb” and “keto-friendly” processed prepackaged foods and beverages.
That’s despite the fact that very little is known about their long-term health effects.
Now, new research from the Cleveland Clinic Lerner Research Institute adds to growing evidence linking the consumption of artificial sweeteners to increased risk for cardiovascular disease.
The findings suggest that a zero-calorie sweetener called erythritol may increase the risk of heart attack and stroke. Here’s what to know.
What is erythritol?
Erythritol belongs to the family of sugar alcohols, or polyols, carbohydrates that occur naturally in certain fruits and vegetables. Small amounts are also synthesized by the body.
Sugar alcohols used as food additives are produced industrially; erythritol, for example, is made by fermenting glucose from corn. Sugar alcohols permitted for use in Canada include erythritol, xylitol, sorbitol, maltitol, mannitol, lactitol and isomalt.
Sugar alcohols have a chemical structure similar to table sugar but they taste less sweet. Erythritol, for example, is about 70 per cent less sweet than sugar.
Erythritol is used to sweeten beverages, chewing gum, chocolate, candies, bakery products, protein bars and other snack foods. It’s also mixed with table-top sweeteners such as stevia and monk fruit to add bulk and a sugar-like texture.
The Cleveland Clinic research
The study, published Feb. 27 online in the journal Nature Medicine, initially set out to identify unknown compounds in the blood that could increase the risk of heart attack, stroke or death in people at risk for cardiovascular disease.
The researchers examined blood samples of 1,157 patients undergoing elective cardiac risk assessment at the Cleveland Clinic and then tracked who had a heart attack or stroke or died over the next three years.
Erythritol was at the top of the list of compounds that predicted cardiovascular risk. Compared to people who had the lowest blood levels of erythritol, those who had the highest were twice as likely to have a heart attack or stroke.
To confirm these results, the researchers analyzed blood samples from two other studies, one conducted in the U.S. and the other in Europe.
In both studies, blood levels of erythritol were higher in people who had cardiovascular disease. Higher levels were also found among participants in the U.S. study who had a heart attack or stroke during the study period.
Further experiments conducted in human blood and mice revealed that erythritol made it much easier for cells called platelets to clump together and form a blood clot. Heightened blood clotting can increase the risk of heart attack and stroke.
As part of the study, researchers recruited eight healthy volunteers to drink 300 ml of a beverage sweetened with 30 g of erythritol, an amount found in a serving of many foods containing erythritol.
Blood levels of erythritol increased by 1,000-fold and remained substantially elevated for more than two days in all participants. Notably, the elevated level of erythritol in the bloodstream was well above that which was observed to enhance blood clotting risk.
These findings are observational and do not prove that erythritol directly causes blood clots. They’re also preliminary.
The researchers emphasized the need for “further safety studies examining the long-term effects of artificial sweeteners in general, and erythritol specifically, on risks heart attack and stroke risk, especially in people already at higher risk for cardiovascular disease.” Initial human safety studies looked only at a four-week erythritol exposure.
Reading labels for sugar alcohols, erythritol
Health Canada, like the U.S. Food and Drug Administration and European Food Safety Authority, considers sugar alcohols, including erythritol, safe to add to foods. Consuming too much of a sugar alcohol, however, can cause bloating, gas and diarrhea. (Erythritol is easier on the digestive system than other sugar alcohols.)
To limit your intake of erythritol, which I recommend you do, read labels. If sugar alcohols are added to a food, their total content (in grams per serving) must the declared on the Nutrition Facts table as “Sugar Alcohols” or “Polyols.”
If a food product contains only one type of sugar alcohol, it can either be declared on the Nutrition Facts table individually by its name (e.g., “Erythritol,” “Xylitol”) or collectively as “Sugar Alcohols” or “Polyols.” However, individual sugar alcohols must be listed by their specific name on the ingredient list.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
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