Popular Artificial Sweetener Linked to Increased Risk of Stroke, Heart Attack: Study

Artificial sweeteners should be chosen carefully. AS photo family/Shutterstock

A popular artificial sweetener called erythritol is associated with an increased risk of heart attack, stroke, and death, according to a new study published on Monday.

The study, published in the journal Nature Medicine, was led by Dr. Stanley Hazen, who chairs the department of cardiovascular and metabolic sciences at the Cleveland Clinic.

Researchers studied over 4,000 individuals in the United States and Europe, analyzing small molecules, commonly known as metabolites, within their bloodstream and found that those with higher levels of erythritol in their bloodstream were at an increased risk of experiencing a major adverse cardiac event such as heart attack, stroke, or death within three years.

In preclinical studies, they also found evidence that ingestion of erythritol increased blood clot formation.

Specifically, researchers began by analyzing 1,157 blood samples in people at risk for heart disease collected between 2004 and 2011.

That analysis found a link between high levels of erythritol and an increased risk of major adverse cardiac events, prompting them to conduct further studies among 2,100 people in the United States and 833 samples in Europe through 2018.

Both cohorts included individuals with coronary disease or high blood pressure and diabetes, and over half were male and in their 60s and 70s. The follow-up study confirmed the findings from the initial study, researchers said.

Artificial sweeteners are displayed in New York on Sept. 17, 2014. Jenny Kane/AP Photo

‘Heightened Risk of Blood Clots’

The study also found that when a group of eight healthy volunteers consumed a beverage sweetened with 30 grams of erythritol, there were “heightened” periods of thrombotic risk, or blood clotting risks.

Further animal and lab studies on mice reinforced the suggestion that erythritol promotes blood clots, the authors said.

“Following exposure to dietary erythritol, a prolonged period of potentially heightened thrombotic risk may occur. This is a concern given that the very patients 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,” study authors wrote, referring to cardiovascular disease.

However, the study authors noted that because patients who participated in the study were recruited at quaternary referral centers and show a high prevalence of cardiovascular disease and traditional risk factors, “the translatability of our findings to the general population needs to be determined.”

They also acknowledge other limitations, including that clinical observation studies demonstrate association and not causation.

The study was partially funded by the National Heart, Lung, and Blood Institute and the Office of Dietary Supplements, both part of the National Institutes of Health (NIH).

“Sweeteners like erythritol, have rapidly increased in popularity in recent years but there needs to be more in-depth research into their long-term effects,” Hazen said in a news release. “Cardiovascular disease builds over time, and heart disease is the leading cause of death globally. We need to make sure the foods we eat aren’t hidden contributors.”

The study shows that when participants consumed an artificially sweetened beverage with the amount of erythritol found in many processed foods, they had markedly elevated levels of the sweetener in their blood for days, and these were “well above those observed to enhance clotting risks,” Hazen continued.

“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,” he said.

Additional Studies on Erythritol

Hazen is named as co-inventor on pending and issued patents held by the Cleveland Clinic relating to cardiovascular diagnostics and therapeutics.

Erythritol is an artificial sweetener commonly used as a replacement for sugar in low-sugar and sugar-free foods, although it is also found naturally in some foods such as grapes, mushrooms, and pears.

The zero-calorie sweetener was approved for safe use as a sweetener in food and beverage products by the World Health Organization (WHO) in 1999, and declared “Generally Recognized As Safe (GRAS)” by the Food and Drug Administration in 2001, meaning there is no requirement for long-term safety studies.

Owing to the fact that erythritol is low in calories, it is widely used in low-carbohydrate and “keto” products and is often recommended in diets for people with obesity or diabetes to help manage sugar intake.

However, erythritol is poorly metabolized by the body and is predominantly excreted almost entirely in the urine.

While the researchers recommend individuals at risk for heart disease talk to their doctors regarding personalized dietary recommendations, Oliver Jones, a professor of chemistry at RMIT University in Victoria, Australia, noted that the study had only shown a correlation, not a relationship of cause and effect.

“As the authors themselves note, they found an association between erythritol and clotting risk, not definitive proof such a link exists,” Jones, who was not involved in the research, said in a statement to CNN. “Any possible (and, as yet unproven) risks of excess erythritol would also need to be balanced against the very real health risks of excess glucose consumption.”

Other studies have found that erythritol is less irritating to the human digestive tract and also has a lower rate of adverse reactions than xylitol, another low-calorie sugar substitute.

An array of natural alternatives to refined sugar also exist, such as date syrup and yacon syrup.

Erythritol has also not been found to be harmful in multiple other human studies.