A recent study from the Cleveland Clinic raises questions about the safety of erythritol, a natural non-caloric sweetener that I have included in some of my recipes. This comes from the laboratory of Dr. Stan Hazen, who has–in my view—released suspect evidence in past regarding the atherogenicity (atherosclerotic plaque-causing) and cardiovascular event-promoting effects of trimethylamino oxide, TMAO. Because TMAO levels increase in the bloodstream with consumption of compounds such as carnitine that originate with animal products such as chicken, fish, and beef, the increased TMAO levels were declared a reason to avoid all animal products. The flaw in this argument is that TMAO is a product of microbes in the gastrointestinal (GI) microbiome. Unfortunately, in these studies, the GI microbiome was ignored, essentially being treated as a black box, despite the fact that GI microbial composition is a major determinant of TMAO levels and cannot be ignored. When this most recent study was released that questions the safety of erythritol, I was therefore skeptical. However, upon closer examination, they have indeed raised some important safety issues.
This comes as a surprise, since erythritol is a naturally-occurring sweetener found in small quantities in fruit, as well as a compound that the human body produces in modest amounts. Naturally-occurring compounds are usually safe to use. Erythritol may therefore be an exception.
Notably, majority of the report is observational, i.e., simply observations among people but not an intervention of, say, erythritol consumption versus placebo. Observational data is nearly always questionable, failing to yield cause-effect relationships. However, in this case, observations that suggest an increase in the incidence of cardiovascular events is 1) dose-related (i.e., the greater the consumption or blood levels, the greater the risk), 2) consistent across different groups of people (cohorts), and 3) potentially explained by their prospective demonstration of platelet activation (that underlies many cardiovascular events such as stroke and heart attack). While not conclusive, it does raise enough suspicion that, I believe, we should limit our exposure to the most minimal amounts or exclude entirely.
Notably, the increase in cardiovascular events appeared to occur in participants with the greatest consumption (fourth quartile) of erythritol. The increase in platelet responsiveness/clotting was provoked with ingestion of 30 grams of erythritol, about 7.5 teaspoons or 2.5 tablespoons.
It is therefore wise to limit consumption of products containing erythritol. This leaves us with stevia in its various forms, monk fruit, and allulose as our sweeteners of choice. Also note that, in our wheat/grain-sugar-free lifestyle, our sensitivity to sweetness is heightened, allowing us to use far less of any form of sweetener. And, of course, many of us lose our “sweet tooths” over time, making the choice of sweetener a non-issue.
New to the Inner Circle! What is the appropriate procedure to ask questions? I have a lipid size lab that I need help interpretating the results.
Thanks for all your help and information!
Kathy Berry wrote: «New to the Inner Circle!»
This is the I.H. Blog and not the I.H. Inner Circle, which is a separate subscription. The Inner Circle site is found here. You don’t need both subscriptions, but if you have both, they don’t share user databases, so it would unusual for the login name and password to be the same on both. I don’t have access to member records there or here, so can’t tell if you have an account on IHIC.
re: «What is the appropriate procedure to ask questions?»
Start a new Topic (thread basenote) in a suitable forum, perhaps Coronary Disease & Cholesterol Protocol
Once logged in there, if the lab results are too extensive, see this article on Forum File Upload.
If you don’t have an IHIC account, and for the benefit of anyone wondering about the difference, this article compares them: Infinite Health Participation Plans
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BP under 120/65 (usually in the teens), HR high 40s-mid 50s.
Dang! Reading this as I drink my morning coffee and eat a keto grain free granola sweetened with guess what! I’ve been grain free and making yogurt for nearly a year now. Stomach issues nearly gone but now having heart palpitations. Heart checks out ok (tho cardiologist put me on Atenolol) so trying increasing magnesium. My biologist brain continues to seek solutions without meds! Onward! Thanks for keeping us informed of new developments! K
Kathy Berry wrote: «Dang! Reading this as I drink my morning coffee and eat a keto grain free granola sweetened with guess what!»
Don’t panic. Just make a note for the next re-order.
Erythritol has been on the approved sweetener list for over a decade, with no reports of Stan Hazen-class adverse outcomes that I recall. I’ve read the paper on this, and exactly none of the studied subjects were what you’d call healthy, based on TG, HDL, and over 20% of them being diabetic.
But the paper did identify a possible biologic pathway, so until further notice, choose one or more of the other sweeteners.
re: «Stomach issues nearly gone but now having heart palpitations. Heart checks out ok (tho cardiologist put me on Atenolol)…»
What’s the actual diagnosis? PVC? PAC? Afib? And now for something, completely different?
That agent’s side effects would prompt me to be darn sure it was necessary. It isn’t usually used in Afib, but if that’s the diagnosis, the Inner Circle site has a protocol for that. The list of triggers for Afib often also applies to PAC & PVC (which latter two are usually considered harmless but annoying).
re: «… so trying increasing magnesium.»
From what current intake? If you are already at program intake levels (which is basically high end of RDA), as confirmed by RBC-Mg, I’m not sure that increasing it is helpful. There are, of course multiple electrolytes to consider, as well as vagal/microbiome involvement, circadian matters, thyroid, hydration, food/beverage timing, excess adiposity, and other factors.
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Thanks so much for your reply!
Re :”palpitations – racing hr upon minimal exercise ie doing dishes”
Then a bunch more stuff!
14 day Zio monitor- dr says was fine, though I was on Atenolol throughout it.
Dr. says everything fine, basically normal and when I asked if I could stop Atenolol (which has been helping with symptoms), he said why if I feel better. When I asked what was causing my symptoms he said that I needed to chill, have fun and that it’d be helpful to smoke a joint. Then said Mg,electrolytes, continuing the vagal exercises might help. He suggested upping Mg to 1000mg 2xdaily. Really wants me to start statin as my LDL 196, HDL 83, Trig 67. I talked him into a NMR fractionizatuon test (only positive in my appointment with him). Haven’t received results yet. He hasn’t done any labwork other than the NMR that I requested.
I asked him about possible thyroid (I have Hashimoto’s), adrenal, etc. and he just states that he’s a cardiologist and doesn’t do anything else.
I’ve decreased my thyroid. Last TSH 2.46. Staying asleep issues blah blah blah! Seeing new PCP and endocrinologist soon.
I’m 64, BMI 21, exercise regularly and all symptoms started after very high stress time. Lost my stepson suddenly at 40 to an undiagnosed heart issue then within 4 months sold our family home (and 3 other land lots) and moved to another state. Whew.
Kathy Berry wrote: «…”palpitations – racing hr upon minimal exercise ie doing dishes”…»
Even if I had some expertise on this, a quick search suggests a huge number of usual suspects, including MVP, hyperthyroid (or over-treated hypo), and some genetic factors. The low hanging fruit would be to restore ancestral health, and see what happens.
re: «…EF 60%…»
That appears to be welcome news, being in the upper half of the normal range.
re: «…Trileaflet AV…»
The Inner Circle site actually has a protocol for avoiding aortic valve stenosis, and in reviewing that, I’m wondering if you got a report or aortic valve area (how open the valves get)? In any event, the core program, esp. the Vitamin D at stock program levels, could help head off any developing future AV problems.
re: «Then said Mg,electrolytes, continuing the vagal exercises might help.»
The Inner Circle also has a protocol for A-fib, and the forum discussion for that includes a long checklist of things (including numerous electrolytes) useful in managing AF, PCV, PAC. The big problem with electros these days is that RDA might be all that most people need, but most people aren’t getting RDA.
re: «He suggested upping Mg to 1000mg 2xdaily.»
With an absorbable form of Mg (even Mg-bcarb from Mg-water), there’s an upper limit to how much one can absorb. Any excess is either going to result in excess motility, or will be just spilled in urine. Program target for Mg is only slightly above RDA, and I’ve not seen any cardiac argument for increasing it. In case it arises, potassium needs to not exceed RDA (which may be too high).
re: «Really wants me to start statin as my LDL 196, HDL 83, Trig 67.»
Sounds like a coin-operated dogma dispenser. That “LDL” is presumably one of the fictional values. Has your LDL actually been measured yet, with NMR Small LDL-P being the marker of interest?
The TG is a bit elevated on program goals, with carbs being the usual suspect. The HDL is already in program range.
re: «I asked him about possible thyroid (I have Hashimoto’s), adrenal, etc. and he just states that he’s a cardiologist and doesn’t do anything else.»
Silo medicine; it appears that back when Dr. davis had an active practice, a significant part of dealing with non-zero coronary calcium scores involved getting thyroids optimized. Anyway, with the Hashi’s, I presume you are not supplementing iodine to program levels? Sometimes it can be done, but it can also cause flares that might include tachycardia.
re: «I’ve decreased my thyroid. Last TSH 2.46.»
Decreased what? If dose, dose of what, and from what to what? The TSH is still suggestive of under-treated hypo, but any interpretation would need to consider fT3, rT3, fT4, and why not: current TPOab & TGab status if not checked lately.
re: «Staying asleep issues blah blah blah!»
re: «I’m 64, BMI 21, exercise regularly and all symptoms started after very high stress time.»
Not to mention the late great epidemic and possible cardiac effects from both the virus and some of the novel interventions developed for it.
re: «BP under 120/65 (usually in the teens), HR high 40s-mid 50s»
No suspects there. But in closing, let me observe that this blog/comment format is clearly no an ideal place for lengthy discussions about wide-ranging case details.
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