Online red sugar substitutes have caused controversy. Can sugar-free beverages be safely consumed

“Zero calorie sugar has always been considered the perfect substitute for added sugar, with no calories, which not only satisfies the craving for sweets, but also eliminates the burden of gaining weight, making sugar-free beverages a new source of happiness for fat homes.”.
But is zero calorie sugar really safe enough?
On February 27th, a new study published in the journal Nature Medicine led to a controversy over erythritol, which has been widely used in sugar-free beverages. The team from the Cleveland Clinic in the United States pointed out that erythritol may not be as perfect – its intake may be associated with an increased risk of adverse cardiovascular events, including death, myocardial infarction, and stroke, and the risk level is not low [1].
How did you come to this conclusion? Can erythritol and other sugar substitutes be safely eaten?
1、 Don’t panic, this research conclusion doesn’t apply to the general population
People who often drink sugarless beverages are not unfamiliar with erythritol.
Erythritol has a very low caloric value and an energy coefficient of only 0.88 kJ/g, making it unique compared to other 10 kJ/g sugar alcohol sweeteners.https://forum.stoneitech.com/
There are few metabolic pathways in humans that actually use erythritol. Erythritol is almost completely absorbed by the small intestine, with 80% to 90% of it entering the blood circulation, but it will not be decomposed by the enzyme system in the human body, and ultimately discharged from the body as the urine is [2]. Lack of metabolism is one of the reasons why it is considered safe.
However, the latest study in the journal Nature Medicine found an association between erythritol and the risk of heart attack and stroke [1].
How did this conclusion come to?
The research team has successively found three groups of experimental populations. About 70% of the participants in the three groups suffer from coronary artery disease or hypertension, more than half of them are obese, about one fifth of them suffer from diabetes, and most of them are between 60 and 70 years old [1].
Focus: The subjects of this study are mainly elderly people with underlying diseases.
The first batch of non targeted metabolomics studies were conducted on 1157 people. After a three-year follow-up, it was initially found that erythritol may be one of the relevant factors affecting major adverse cardiovascular events.
Subsequently, 2149 people from the United States and 833 people from Europe were found, and the results were still valid.
The researchers extracted their blood samples for testing, and found that in the US and European cohorts, subjects with heart disease generally had higher levels of erythritol in their plasma [1].
The figure above shows the levels of erythritol in the plasma of the American and European groups, respectively. In both groups, people at risk for cardiovascular disease (blue legend) have higher levels of erythritol in their plasma [1]
The figure above shows the levels of erythritol in plasma of the American and European groups. In both groups, people at risk for cardiovascular disease (blue legend) have higher levels of erythritol in their plasma [1]
In order to find out the reason behind it, the researchers further conducted in vitro experiments.
Researchers first extracted platelet-rich plasma from healthy people to verify the effect of erythritol on platelet aggregation. The results showed that the higher the concentration of erythritol in plasma, the faster the platelet aggregation. This can directly lead to an increased risk of platelet reactivity and thrombosis.
Subsequently, researchers used a vascular endothelial injury model to simulate the process of thrombosis in the human body, monitoring the rate of clot formation and the time of blood flow cessation. When plasma erythritol levels increase, platelets become more sensitive, resulting in increased adhesion, and a higher rate of clot formation after arterial injury; And the clotting time becomes shorter, and the possibility of thrombosis increases.
Within 3 minutes, platelets in plasma containing high levels of Erythritol rapidly form clots. The fluorescent green spots in the above image are platelet clots [1]
Within 3 minutes, platelets in plasma containing high levels of Erythritol rapidly form clots. The fluorescent green spots in the above image are platelet clots [1]
These clots may fall off and move to the heart, causing a heart attack; Or move to the brain, causing a stroke. A cohort study in the United States also shows that the group with the highest blood erythritol content has a nearly double higher risk of heart disease, stroke, and other diseases than the group with the lowest blood erythritol content.
To sum up, we must clarify two points:
These groups of participants, who are older and have certain underlying diseases, have a relatively higher risk of cardiovascular disease. At best, this experiment suggests that excessive consumption of erythritol may worsen the effects of cardiovascular and cerebrovascular diseases in people who originally suffered from it.
In addition, the experiment only yielded correlations, not causal relationships. Factors such as diet, work and rest habits were not considered in this experiment.
2、 Erythritol is safe for healthy ordinary people
The study, published in the journal Nature Medicine, also tested healthy people, but the sample size was very small, with only 8 people.
These 8 healthy subjects received 300 ml of experimental beverage containing 30 g of erythritol within 2 minutes.
The concentration of erythritol in the blood changes significantly within hours of ingestion. After drinking the experimental beverage for about 30 minutes, the concentration of erythritol in plasma was about 5.85 (4.30 – 7.68) µ m, reaching the highest level, almost 1000 times higher than the baseline level when not drinking. After that, although it fell back, it still maintained a relatively high level. And this impact will last at least 7 days [1].
After subjects ingested erythritol beverages, the concentration of erythritol in their plasma changed over time. The peak value is reached about 30 minutes after ingestion [1]
After subjects ingested erythritol beverages, the concentration of erythritol in their plasma changed over time. The peak value is reached about 30 minutes after ingestion [1]
But there is still a big bug in this experimental design.
What is the concept of 30 g erythritol? The addition amount of erythritol in common beverages sold on the market is about 1.5g-2g/100ml [3]. A 300ml can of sugar-free beverage only contains 4.5g-6g. At least 5-7 bottles should be poured vigorously for a short time to reach the experimental dose.
Given the dose and sample size of the experiment, this study is not sufficient to conclusively determine the safety of erythritol.
In fact, there have been a large number of studies on the safety of erythritol internationally. Similar papers are published every year. Despite controversy, the vast majority of current studies point to its safety.
The Food and Drug Administration (FDA) has reviewed existing data on the absorption and metabolism of erythritol, various toxicity, animal carcinogenicity, and clinical research, and found no significant safety issues. Finally, erythritol obtained FDA’s GRAS certification in 1997, which is “generally recognized as safe” and can be safely used [4].
China also has strict regulations and certification for the use of food additives such as sweeteners. According to GB 2760-2014 “National Food Safety Standard for the Use of Food Additives” issued in 2014, erythritol belongs to the category of “food additives that can be used in an appropriate amount in various types of food according to production needs.” There is no specific amount of use value, as long as the amount is added in an appropriate amount according to production needs, it is safe and feasible [5].
In addition, erythritol has also passed the safety assessment of multiple international authoritative organizations and multinational regulatory authorities such as the Codex Alimentarius Commission (CAC), the European Union Scientific Committee on Food (SCF), the Food Standards Australia New Zealand (FSANZ), and so on.
Therefore, without further evidence and complete causal chain studies, ingesting a reasonable dose of erythritol is safe for most healthy ordinary people.
Sugar-free drinks can be safely consumed.
3、 The right amount is the key
The human pursuit of sweetness is engraved in DNA. Adding sugar is not only high in calories, but also more likely to cause obesity and tooth decay; As a result, sugar substitutes (i.e., sweeteners), which also give food a sweet taste but are healthier, emerged as the times require.
Sugar substitutes can be divided into two broad categories based on whether they generate calories: nutritional sweeteners and non nutritional sweeteners.
Generally speaking, the former often has a certain amount of calories, while the latter is what we call “zero calorie sugar.”.
The erythritol mentioned above is relatively special. Although it is a type of nutritional polyols, its calories can be almost negligible.
Non nutritive sweeteners are no stranger to us. For example, stevioside and Arhat fruit glycoside extracted from natural plants; Or artificial saccharin, acesulfame, cyclamate, aspartame, neotame, sucralose, etc. [6], which are common “zero calorie sugars.”.
These sugar substitutes are low in calories and are often considered to be more blood sugar and insulin friendly. But that doesn’t mean you can consume large amounts with impunity.
These glycosides may affect the intestinal flora, and their stimulation of blood sugar and insulin may vary from person to person.
Most artificial sweeteners pass through the gastrointestinal tract but are not digested by the host, so they can directly confront the intestinal microbiota. As early as 2014, a study published on Nature by the Weizmann Scientific Research Institute team in Israel found that feeding mice with artificial sweeteners such as saccharin, sucralose, and aspartame for one week can lead to changes in the composition and function of intestinal microbiota, leading to glucose intolerance [7].
Similar conclusions have been reached in short-term small sample experiments in humans.
A team from the Weizmann Scientific Research Institute in Israel also found that a study published on Cell last year found that sugar substitutes may also increase blood sugar [8].
The study selected 120 volunteers who had never eaten sugar substitutes and divided them into six groups, including two control groups and four experimental groups. Each day, the experimental group was given a smaller amount of aspartame, saccharin, sucralose, and stevia glycosides than the daily recommended standard; The control group received the same amount of glucose or no additional additives.
The study found that there were changes in the composition of intestinal microorganisms in the experimental group, especially in the fecal samples of volunteers who ingested saccharin and sucralose. There were significant changes in microorganisms in the other experimental groups, too. This can further alter the body’s response to blood sugar, affecting the glucose tolerance of healthy adults. Although everyone’s response varies due to individual gut specificity, in general, the human body’s blood sugar response will significantly increase during the two consecutive weeks after ingestion of a substitute.
Compared to the intake of aspartame, stevia glycosides, and glucose, Figure E and F represent the intake of saccharin and sucralose, which have a more significant impact on human blood sugar
Compared to the intake of aspartame, stevia glycosides, and glucose, Figure E and F represent the intake of saccharin and sucralose, which have a more significant impact on human blood sugar
In order to demonstrate the causal relationship more strictly, the researchers also transplanted the intestinal microbiome of volunteers into sterile mice, using mice without their own microbiome, to ensure the accuracy of the experimental results. In the end, it was found that after the intestinal microbiota of the experimental group participants were transplanted to sterile mice, the mice also had similar changes in blood sugar, while the control group had no changes.
Based on the experimental results, it may be prudent to assume that artificial sweeteners are not as inert as we thought. Their impact on human health requires more long-term clinical observation.
Of course, this does not mean that sugar substitutes are more harmful than added sugars. The advantages of low calorie, sugar free foods are still evident compared to the “blood sugar shock” brought about by adding sugar. While satisfying our cravings, it can help us control our weight and protect our blood sugar to a certain extent.
However, for some special populations, such as patients with cardiovascular disease, obesity, and the elderly, it is best to wait and see again. If you really don’t trust me, barley tea, tea leaves, plain boiled water, and coconut water are all better choices than sugarless drinks.
I have to say that most straight men have long understood the true meaning of life: drink plenty of hot water and never go out of style.