Is Erythritol (the zero calorie sweetener found in Truvia, Stevia, Splenda, etc.) Dangerous for Migraineurs?

You may have seen lots of articles on erythritol being linked to heart attack and stroke in the past few days:

We know that women with migraine with aura have an increased risk of stroke by about 50% so erythritol may be a serious concern for this subgroup of patients who are more cautious around hormonal oral contraceptives due to the increased stroke risk.

Well, let’s take a minute and see what this study shows before throwing out our Stevia, Splenda and Truvia.

The study, published by Nature Medicine by the Center for Cardiovascular Diagnostics and Prevention at the Cleveland Clinic Lerner Research Institute, looked at the serum erythritol- that is the amount of this sugar alcohol in the blood- in 3 different cohorts.

The study noticed an association between the plasma levels of erythritol in the blood and the likelihood that these participants had serious cardiovascular events like heart attack or stroke.

It also found that those participants with the highest levels of erythritol in the blood have double the risk of having a heart attack or stroke. 

Erythritol is naturally occurring. It has been isolated from fruits like pears, grapes, and melons. It was found in mushrooms, and in alcoholic drinks including beer, wine, and sake. Fermented food like soy sauce and miso bean paste also contains erythritol. It is not only found in zero calorie sweetener.

Even more interestingly, erythritol is naturally produced in our bodies via the pentose phosphate pathway and has been found in eye lens tissue, serum, plasma, urine, and even fetal fluid.

Furthermore, we don’t even know if the high levels of erythritol is the result of what the participants are consuming or if their body naturally produces high levels of erythritol, which may have an unknown link to the promotion of clots. We don't know because, for some odd reason, the researchers never bothered to ask about their dietary consumption of erythritol. 

Remember, a causation was not found, just an association. For example, people with Fordyce spots have a higher risk of colorectal cancer, but Fordyce spots do not cause colorectal cancer.

Even more bizarre is that they measured fasting levels of erythritol and erythritol reaches max serum levels in 30 minutes after consumption and is quickly excreted out in the urine in 24 hours.

You would have to consume an inordinate amount of erythritol to maintain elevation of serum erythritol for more than a day. We are talking about 15 packets or a pint of some keto ice cream. The latter seems more do-able, but, again, we don’t know what that means. 

So how much did the participants in this study consume? We have no idea. Again, they didn’t measure it. Therefore, the conclusion that it’s erythritol consumption is not factual nor is it based in science. It may be related to why these participants produce more serum erythritol than the average person and not the erythritol levels themselves.

In fact, we know that oxidative stress increases erythritol levels and we also know that oxidative stress also increases the risk of a major cardiovascular event. Again, it has nothing to do with erythritol, but the underlying cause of both phenomena.

Moreover, over 70% of the participants had coronary artery disease and were around 65 years old so it is not a surprise that they may have had higher erythritol due to oxidative stress and that they were more likely to have a higher rate of mortality.

So, while it is possible erythritol does increase the risk of a major cardiovascular event, it certainly has not been proven. These sensationalist articles are not good for anyone, and the FDA continues to recognize erythritol as generally recognized as safe (GRAS).

For now, do not throw away your erythritol products and discuss this study with your physician.