CLEVELAND — The Calorie Control Council, an international association representing the low-calorie food and beverage industry, defended the safety of erythritol, a polyol used in reduced-sugar formulations, after a published study revealed an association between the sweetener and an increased risk of heart attacks and strokes.

Researchers from the Cleveland Clinic studied over 4,000 consumers in the United States and Europe and found those with higher blood erythritol levels were at an elevated risk of experiencing an event such as heart attack, stroke or death. The study, which was published Feb. 27 in Nature Medicine, also investigated the effects of adding erythritol to either whole blood or isolated platelets, discovering that erythritol made platelets easier to activate or form a blood clot.

“Our study shows that when participants consumed an artificially sweetened beverage with an amount of erythritol found in many processed foods, markedly elevated levels in the blood are observed for days — levels well above those observed to enhance clotting risks,” said Stanley Hazen, MD, PhD, an author of the study and co-section head of preventive cardiology at Cleveland Clinic. “It is important that further safety studies are conducted to examine the long-term effects of artificial sweeteners in general and erythritol specifically on risks for heart attack and stroke, particularly in people at higher risk for cardiovascular disease.”

The National Institutes of Health partially funded the study, which noted the US Food and Drug Administration considers erythritol as Generally Recognized As Safe (GRAS) for use in foods and beverages.

“The results of this study are contrary to decades of scientific research showing reduced-calorie sweeteners like erythritol are safe, as evidenced by global regulatory permissions for their use in foods and beverages, and should not be extrapolated to the general population, as the participants in the intervention were already at increased risk for cardiovascular events,” said Robert Rankin, executive director of the Calorie Control Council. “Erythritol is a proven safe and effective choice for sugar and calorie reduction and, for more than 30 years, has been used in reduced-sugar foods and beverages to provide sweetness, as well as enhance their taste and texture.”

Participants in the study consumed 30 grams of erythritol dissolved in 300 milliliters of water within 2 minutes while a serving is closer to 8 grams of erythritol based on the FDA approval for erythritol, according to the council. Other factors to consider on the study, according to the council, were including only consumers who already were at an increased risk for cardiovascular events and not controlling other factors such as overall diet and physical activity.

More than 50 countries have approved the use of erythritol for use in foods, according to the council. Erythritol, which is found in fruit and other foods, has a high digestive tolerance and is non-glycemic, meaning it is safe for consumers with diabetes, according to the council, which added it does not promote tooth decay. Erythritol is about 70% as sweet as sugar, according to the Cleveland Clinic, which added it may be produced by fermenting corn.