A recent study conducted by Cleveland Clinic found that erythritol, a commonly used artificial sweetener, is linked to higher risks of heart attack and stroke. The study’s results were published in the journal Nature Medicine.
Cleveland Clinic research showcases the need for further safety studies.
New Cleveland Clinic research showed that erythritol, a popular artificial sweetener, is associated with an increased risk of heart attack and stroke. Findings were published yesterday (February 27, 2023) in the journal Nature Medicine.
Researchers studied over 4,000 people in the U.S. and Europe and found those with higher blood erythritol levels were at elevated risk of experiencing a major adverse cardiac event such as heart attack, stroke, or death. They also examined the effects of adding erythritol to either whole blood or isolated platelets, which are cell fragments that clump together to stop bleeding and contribute to blood clots. Results revealed that erythritol made platelets easier to activate and form a clot. Pre-clinical studies confirmed ingestion of erythritol heightened clot formation.
Erythritol is a type of sugar alcohol that is often used as a low-calorie sweetener in various food and beverage products. It has about 70% of the sweetness of regular sugar, but contains only a fraction of the calories. Erythritol is also often used in sugar-free and diabetic-friendly products, as it does not significantly raise blood sugar or insulin levels.
“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,” said senior author Stanley Hazen, M.D., Ph.D., chairman for the Department of Cardiovascular & Metabolic Sciences in Lerner Research Institute and co-section head of Preventive Cardiology at Cleveland Clinic. “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.”
Artificial sweeteners, such as erythritol, are common replacements for table sugar in low-calorie, low-carbohydrate, and “keto” products. Sugar-free products containing erythritol are often recommended for people who have obesity, diabetes or metabolic syndrome and are looking for options to help manage their sugar or calorie intake. People with these conditions also are at higher risk for adverse cardiovascular events like heart attack and stroke.
New Cleveland Clinic research, led by Dr. Stanley Hazen, showed that erythritol, a popular artificial sweetener, is associated with an increased risk of heart attack and stroke. Credit: Cleveland Clinic
Erythritol is about 70% as sweet as sugar and is produced through fermenting corn. After ingestion, erythritol is poorly metabolized by the body. Instead, it goes into the bloodstream and leaves the body mainly through urine. The human body creates low amounts of erythritol naturally, so any additional consumption can accumulate.
Measuring artificial sweeteners is difficult and labeling requirements are minimal and often do not list individual compounds. Erythritol is “Generally Recognized As Safe (GRAS)” by the FDA, which means there is no requirement for long-term safety studies.
The authors note the importance of follow-up studies to confirm their findings in the general population. The study had several limitations, including that clinical observation studies demonstrate association and not causation.
“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 Dr. Hazen. “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.”
Authors recommend talking to your doctor or a certified dietician to learn more about healthy food choices and for personalized recommendations.
Reference: “The artificial sweetener erythritol and cardiovascular event risk” by Marco Witkowski, Ina Nemet, Hassan Alamri, Jennifer Wilcox, Nilaksh Gupta, Nisreen Nimer, Arash Haghikia, Xinmin S. Li, Yuping Wu, Prasenjit Prasad Saha, Ilja Demuth, Maximilian König, Elisabeth Steinhagen-Thiessen, Tomas Cajka, Oliver Fiehn, Ulf Landmesser, W. H. Wilson Tang and Stanley L. Hazen, 27 February 2023, Nature Medicine.
DOI: 10.1038/s41591-023-02223-9
Disclosures: Dr. Hazen is named as co-inventor on pending and issued patents held by Cleveland Clinic relating to cardiovascular diagnostics and therapeutics.
