Reacción a "Reactions to study linking sweetener consumption with increased cardiovascular risk"

There is an ongoing discussion of the safety of sweeteners – partly because some studies show an increased risk for chronic diseases among those who consume sweeteners, especially in soft drinks.

It is therefore important to investigate the physiological effect of sweeteners, and this has been done in this study.  Unfortunately, the authors decided to use an amount of sweetener that is – at least in the UK and Europe – unrealistic.  The sweetener concentration they used was 10-fold higher than the permitted amount in drinks and the single dose they use was more than most of us would eat during an entire day.

The authors also find other physiological effects of erythritol but mainly at plasma concentrations that are higher than those found in the study cohort and presumably also the general public.

These results suggest a potentially adverse effect of erythritol when consumed a amounts above what is generally consumed in Britain or the EU – and this is one of the reason why regulators set limits for the use of food additives in sweeteners: to protect the public and ensure intake is in a safe range.

In contrast to these data in this new study, observational studies can provide much more reliable data about links between sweetener intake and health as they reflect normal diet.  In this context, those studies measure actual intake which provides much better information on actual intake.  Unfortunately, even those studies are affected by confounding and an association between high sweetener intake and ill health might not establish a casual relationship.

Unfortunately, the authors do not provide any information about the erythritol concentration found in the study populations and this makes an interpretation difficult.  The study’s findings are surprising as only the group with the highest plasma erythritol concentration has a higher risk of disease – but not the others.  This group also has the oldest participants, and when the authors adjust for this, the observed association with risk becomes much smaller.

The interesting question here is the origin of plasma erythritol, as this could potentially explain some of the results: erythritol is not only used in foods but also other products such as tooth paste and drugs.  Especially the latter might affect the observed results as higher plasma concentrations could indicate that participants receive different medical treatments.

The press release is very cautious in making a bold claim, and I agree that the information is interesting and useful, but definitely not suitable to cause anyone to worry.

(The paper claims that erythritol has 'generally regarded as safe' [GRAS] status in Europe and this is incorrect.  EFSA does not have a GRAS system.)