One of the most frustrating events at the Kahn Center is to evaluate a patient with a heart attack or stroke history and not find a "major" risk factor like Lipoprotein(a) or a high homocysteine. Of course, all traditional risk factors like smoking are evaluated too.
Stanley Hazen, MD of the Cleveland Clinic has been like "Indiana Jones" by searching in the blood for possible triggers of cardiovascular disease (CVD) previously unknown. Back in 2011, he and his colleagues identified TMAO as a possible contributor to CVD and now there are thousands of research studies supporting the link. Lately, he has been researching sugar alcohols used as sweeteners in various foods and drinks and has raised the question if erythritol and xylitol may put patients at risk by promoting blood clots, specifically platelets. A new study advances the science and concern that this is a real factor.
STUDY
Using a prospective interventional study design, the researchers tested the impact of erythritol or glucose consumption on platelet responsiveness in healthy volunteers (n=10 per group). Erythritol plasma levels were measured. Platelet function at baseline and following erythritol or glucose ingestion was assessed.
RESULTS
Dietary erythritol (30 grams), but not glucose (30 grams), lead to a >1000-fold increase in erythritol plasma concentration. Furthermore, ingesting 30 grams of erythritol triggered platelet activation in all subjects. There were many different measures of platelet activation and they were all triggered.
In contrast, glucose ingestion triggered no significant increases in platelet activation.
CONCLUSIONS
Ingestion of a typical quantity of the non-nutritive sweetener erythritol, but not glucose, enhances platelet reactivity in healthy volunteers, raising concerns that erythritol consumption may enhance thrombosis potential. The amount tested, 30 grams, can be found in drinks, ice creams, and baked goods bought at stores.
The present findings suggest that discussion of whether erythritol should be reevaluated as a food additive. Patients with CVD might choose to avoid erythritol until more data are known.
