Consumption of Oral Artificial Sweeteners on Platelet Aggregation and Polyol Excretion

Not Applicable

Active, not recruiting

Conditions: Cardiovascular Risk Factor

Registration Number: NCT04731363

Lead Sponsor: The Cleveland Clinic

Brief Summary: The principal goal for the study is to examine whether ingestion of a beverage containing artificial sweeteners alters in vitro platelet aggregation.

Because of the increasing number of cardiometabolic diseases, such as diabetes mellitus, in the population, the use of artificial sweeteners to replace free sugars has been gaining popularity. Two popular artificial sweeteners are erythritol and xylitol. Erythritol and xylitol are both naturally occurring polyols found in fruits and vegetables. They are potent artificial sweeteners with a higher sweetening intensity and lower calorie content than table sugar.

Previous research has shown that the higher levels of sugar alcohols, like those used as artificial sweeteners, in the blood are related to a higher risk of cardiovascular complications, like heart attacks and strokes, and death. This may be because higher levels of sugar alcohols in one's blood may increase the activity of platelets, which would then increase the risk of heart attack and stroke. The investigators therefore want to find if consuming a single beverage that contains an artificial sweetener can raise the levels of sugar alcohols in the blood and if it can alter platelet function or aggregation.

Detailed Description: The purpose of this study is to examine if drinking a single beverage that contains an artificial sweetener can perceptibly alter the activity of platelets in the body. Platelets are a component of blood that are primarily responsible for helping to stop bleeding and repair damaged blood vessels by grouping together, a process known as aggregation, to form clots.

Artificial sweeteners are popular because they have a lower calorie content than table sugar while still making food and beverages sweet. Their use as a sugar substitute is especially attractive for people with heart disease or diabetes, or for people who are trying to lose weight.

Two popular artificial sweeteners are erythritol and xylitol. Erythritol and xylitol are both naturally occurring polyols, also called sugar alcohols, found in fruits and vegetables. They are potent artificial sweeteners with a higher sweetening intensity and lower calorie content than table sugar.This makes them attractive for the use as sugar substitutes or alternatives, particularly for patients with type 2 diabetes.

Up to now, there is no prospective data available about polyols with respect to their impact on event outcomes in cardiovascular patients, despite their extensive use in the food industry. Moreover, little is known about plasma levels and metabolic changes following food intake of artificial sweeteners, in particular polyols.

The investigators have previously measured fasting levels of various polyols in a large clinical cohort of cardiovascular patients and found that some candidate polyols are related to a higher risk of cardiovascular complications and death. In vitro data using human platelets revealed that the polyols xylitol and erythritol at the levels observed in fasting patients induce platelet aggregation potential. The investigator's data shows that erythritol and xylitol impact platelet function and may, therefore, contribute to cardiovascular mortality.

In preliminary studies the investigators found that when ingesting either erythritol or xylitol, the levels of these sweeteners in the plasma rise within the first hour after consumption. With this study the investigators wish to examine whether the postprandial levels are capable of altering platelet function in vitro. The investigators hypothesize that postprandial polyol concentrations following ingestion increase platelet aggregation in the blood.

Recruitment & Eligibility

Status: ACTIVE_NOT_RECRUITING

Sex: All

Target Recruitment: 50

Inclusion Criteria

Age 18 years or above.
Willing and able to sign the consent form.

Cohort 1

Exclusion Criteria

Use of anti-platelet medications within 14 days of study enrollment.
Active infection or received antibiotics within 1 month of study enrollment.
Use of over-the-counter probiotic within 1 month of study enrollment.
Diabetes mellitus
Ulcerative colitis, Crohn's disease, or other chronic gastrointestinal disorder.
Past history of bariatric procedures or surgeries (e.g. gastric banding or bypass).
Pregnancy.
Significant chronic illness.

Cohort 2 Inclusion Criteria:

Men and women age 18 years or above.
Able to provide informed consent and comply with study protocol.
Diabetes Mellitus Type II

Cohort 2 Exclusion Criteria:

Use of anti-platelet medications within 14 days of study enrollment.
Active infection or received antibiotics within 1 month of study enrollment.
Use of over-the-counter probiotic within 1 month of study enrollment.
Ulcerative colitis, Crohn's disease, or other chronic gastrointestinal disorder.
Past history of bariatric procedures or surgeries (e.g. gastric banding or bypass).
Pregnancy.
Any condition that, in the judgment of the Investigator, would place a subject at undue risk by being enrolled in the trial or cause inability to comply with the trial.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
Platelet Aggregation After Polyol Ingestion	30 minutes	Measuring platelet function 30 minutes after polyol ingestion, using established in vitro platelet assays. Platelet aggregation responses, based on changes in light transmission after adding different concentrations of the agonists ADP and TRAP6 are reported. A higher percentage of light transmission indicates an increased aggregation response, with maximum amplitude (100%) indicating total aggregation.
Change From Baseline in Platelet Aggregation at 30 Minutes Post Polyol Ingestion	Baseline and 30 minutes post ingestion of polyol intervention	Measuring changes in platelet function before versus after xylitol or erythritol ingestion, using established in vitro platelet assays. Platelet aggregation responses, based on changes in light transmission after adding different concentrations of the agonists ADP and TRAP6 are reported. A higher percentage of light transmission indicates an increased aggregation response, with maximum amplitude (100%) indicating total aggregation.
Change From Baseline in Urinary Polyol Levels at 30 Minutes Post Polyol Ingestion	Baseline and 30 minutes post ingestion of polyol intervention	Measuring changes in levels of urinary polyols before versus after xylitol or erythritol ingestion, using established techniques by mass spectrometry. Xylitol was measured, and is reported below, in the two xylitol intervention arms and erythritol was measured, and is reported below, in the erythritol and glucose intervention arms.
Plasma Polyol Levels After Polyol Ingestion	30 minutes	Measuring plasma levels (uM) of polyols (xylitol or erythritol) 30 minutes after xylitol or erythritol ingestion, using established techniques by mass spectrometry. Xylitol was measured, and is reported below, in the two xylitol intervention arms and erythritol was measured, and is reported below, in the erythritol and glucose intervention arms.
Change From Baseline in Plasma Polyol Levels at 30 Minutes Post Polyol Ingestion	Baseline and 30 minutes post ingestion of polyol intervention	Measuring changes in levels of plasma polyols before versus after xylitol or erythritol ingestion, using established techniques by mass spectrometry. Xylitol concentrations are reported in the two xylitol intervention arms. Erythritol concentrations are reported in the erythritol and glucose intervention arms.
Urinary Polyol Levels After Polyol Ingestion	30 minutes	Measuring the urinary levels of polyols (xylitol or erythritol) 30 minutes after xylitol or erythritol ingestion, using established techniques by mass spectrometry. Xylitol was measured, and is reported below, in the two xylitol intervention arms and erythritol was measured, and is reported below, in the erythritol and glucose intervention arms.

Secondary Outcome Measures

Name	Time	Method
Change From Baseline in Plasma Lipid Profile at 1 Day Post Polyol Ingestion	Baseline and 1 day post ingestion of polyol intervention	Measuring changes in lipid levels as markers of changes in metabolism before versus after xylitol or erythritol ingestion.