A New Study Connected an Artificial Sweetener with Higher Heart Attack Risk

Erythritol is a fairly common sugar substitute you'll find in some sweetener blends as well as in reduced-sugar products

Leah Goggins, Eatingwell, Mar 1, 2023

Swapping out sugar for an artificial sweetener might not always be a wise decision, a new study suggests. The study published in Nature Medicine tied consuming erythritol-a calorie-free sweetener found in some stevia blends and low-sugar products-to a higher risk for blood clots, heart attacks and strokes.

The study, which looked at data from American and European patients undergoing elective cardiac evaluations, found that folks who have existing risk factors for heart disease were twice as likely to experience a cardiac event or stroke if they also had high levels of erythritol in their blood. (Existing risk factors can include diabetes, high blood pressure and high cholesterol levels, among other conditions.)

"Following exposure to dietary erythritol, a prolonged period of potentially heightened thrombotic risk may occur," the study authors concluded. "This is of concern given that the very subjects for whom artificial sweeteners are marketed (patients with diabetes, obesity, history of CVD and impaired kidney function) are those typically at higher risk for future CVD events."

The study also assessed the sweetener's effect on blood clotting in mice and humans, noting that the individuals who consumed erythritol at a typical level still had the compound lingering in their blood for more than two days. While the first section of the study included more than 4,000 people, the blood clotting portion used data from a much smaller group of eight people. This is worth noting as a smaller sample size can make the results less comprehensive and potentially not applicable to a broader population.

"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," lead author Stanley Hazen, M.D., Ph.D., said in a media release. "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."

Erythritol, which is "generally recognized as safe," or GRAS, according to the Food & Drug Administration (FDA). This label indicates that the FDA used preexisting data to determine that the artificial sweetener was exempt from more rigorous testing requirements before hitting the market.

CBS News medical correspondent David Agus, M.D., noted that there is "certainly enough data to make you very worried" in the study. "Most artificial sweeteners bind to your sweet receptors but aren't absorbed. Erythritol is absorbed and has significant effects, as we see in the study," Agus told CBS.

The study itself determined that more research needs to be done to determine the long-term safety of erythritol, so you can feel free to stick to your low-sugar routine in the meantime-especially if you already consume erythritol rarely. But if you're concerned and want to rethink your approach to artificial sugar, the researchers recommend talking to your doctor or a dietitian to get personalized recommendations that will help you make healthy food choices that you're confident in. If you just want to avoid erythritol for now, our sugar substitutes breakdown lists the ingredients of several popular sweetener blends.

Like the study authors said, the folks most likely to opt for artificial sweeteners instead of sugar-like those with diabetes-are also at a greater risk for cardiac events. If you plan to avoid erythritol while still sticking to a low-sugar eating pattern, you might consider sticking to recipes that get their sweetness naturally, from a touch of honey or the inclusion of fruit. Our Apple Crisp recipe, for example, fits the bill, as do these chilled desserts that are perfect for warmer weather.

The Bottom Line

Erythritol, a sugar substitute found in fermented corn, has been tied to a further increased risk for cardiac events, strokes and blood clotting for folks who already have cardiovascular risk factors, according to a study in Nature Medicine. More comprehensive research that accounts for the influence of preexisting conditions needs to be done before we know conclusively how safe the sweetener is.

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