| By now, you’ve probably seen the new erythritol study. It was a big study with a lot of layers. First, they looked at a big group of people, tracked the levels of blood erythritol, and compared that to the incidence of major heart events. Those with higher levels of erythritol in their blood were at a greater risk of heart attacks and other serious outcomes. Lots of people jumped on this part of the study because for one it was observational and two because it could just as easily be reverse causality. After all, we naturally endogenously produce erythritol in our body in response to oxidative stress. In fact, it can often precede metabolic syndrome, almost as a forecast of sorts. Were these people showing high levels of blood erythritol because they were unhealthy or because they were eating a bunch of it? They didn't test that. Of course, they did "control for" all the health variables they could think of that would capture and mitigate the problem of reverse causality and the relationship between erythritol levels and heart attacks persisted, but you can't control every variable. Then they did a human study of 8 individuals. They drank 30 grams of erythritol—a fairly realistic dose—then looked at platelet aggregation. What is platelet aggregation? It's the tendency of platelets to "stick together." It normally increases when blood has to clot, such as after an injury. Abnormal aggregation can also cause heart attacks, stroke, and atherosclerosis. It's an important process but, like most things in our bodies, can also go wrong and harm us. After the 30 grams of erythritol, blood levels went up 1000x (and stayed elevated for days) and platelet aggregation increased. Normally after a meal, platelet aggregation decreases—whether the meal is high or low carb. This is worrisome. The observational part of the study I can dismiss. Have done it a hundred times before when the mechanistic in vivo follow-up research falls flat. But this time the follow-up in vivo human research actually looks pretty bad. I’ve never been a huge fan of sugar alcohols. So many of them aggravate digestive issues in people. Diarrhea, flatulence, constipation, upset stomach—these aren’t minor issues to just ignore. And although xylitol is acutely harmless in most mammals, it will kill a dog in hours. Strange stuff, you know? At the same time, the data up until now suggested that erythritol was safe, so I never had reason to believe that people should avoid it if it didn't cause them acute digestive distress. Even this study doesn't definitively mean that erythritol is bad per se, but it does give me pause about using it in my own diet or as a sweetener in products that our customers might be using every day. I hope this study leads to more research that can provide more concrete answers. What about you? Let me know in this week's New and Noteworthy. | 