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Some sugar alcohols, like erythritol and sorbitol -- commonly used as sweeteners -- can cause cancer, according to research at Upstate.
Some sugar alcohols, like erythritol and sorbitol -- commonly used as sweeteners -- can cause cancer, according to research at Upstate.

Liver cancer – the potential side effect of sugar substitutes


Commonly used sweeteners can cause cancer in the liver, according to Upstate research published recently in the journal Nature Metabolism. The work also shows that medication may prevent the growth of this cancer.

“We should avoid using sugar alcohols such as erythritol and sorbitol as sweeteners,” says Andras Perl, MD, PhD. “They are causing liver cancer, there’s no doubt.”

Erythritol is added to many sugar substitutes, such as stevia, Truvia and other products. Sorbitol sweetens products like chewing gum, ice cream and mints.

Because it is a naturally occurring compound, erythritol is “generally recognized as safe” by the federal Food and Drug Administration, but the quantities used in foods are generally much higher than the body typically creates, Perl says. “Normally the level in the body is very low, undetectable.”

He is a rheumatologist and a SUNY Distinguished Professor who also oversees a laboratory at Upstate.

Perl designed a study of liver cirrhosis that progresses to liver cancer in mice with a genetic mutation that is also found in humans. Previously, his team of scientists determined mice with a specific mutation were much more likely to develop cancer.

Researchers found that sugar alcohols accumulated in subjects with the genetic defect, which caused a lack of the enzyme transaldolase, known as TAL. Subjects that were missing TAL had a 216-fold increase of erythritol.

The production of sugar alcohols depends on another enzyme, aldose reductase, Perl explains. He says medication can inhibit that enzyme, and “when you block the formation of the sugar alcohol, there’s no cancer.”

His study focused on sugar alcohols created by the body, but they are chemically identical to the sugar alcohols found in many popular sweeteners on the market.

“When we treat cancer cells with sweeteners, it causes the proliferation of cancer cells. They grow much more rapidly,” Perl describes. “In contrast, when we treat cancer cells with inhibitors of aldose reductase, it blocks their proliferation.”

Perl says this is the first study to show the link between sugar alcohols and liver cancer. The next step is to study the rates of cancer in patients who consume sweeteners containing sugar alcohols.

In the meantime, he says this data is strong enough for people to consider avoiding sweeteners that contain erythritol and sorbitol. “These studies are quite definitive that these sweeteners cause cancer.”

 This article appears in the summer 2023 issue of Cancer Care magazine.