Study reveals the risks of a common artificial sugar substitute on the heart

A new study shows that eating foods containing erythritol, an artificial sugar substitute, increases the risk of cardiovascular diseases, such as heart attack and stroke.

The results of the study conducted by the Cleveland Clinic on healthy volunteers showed that erythritol makes platelets (a type of blood cell) more active, which may increase the risk of blood clots. Sugar (glucose) did not have this effect.

The findings, published in the journal Arteriosclerosis Thrombosis and Vascular Biology, add to growing evidence that erythritol may not be as safe as food regulatory agencies currently classify it and should be re-evaluated.

The study was conducted by a team of researchers at the Cleveland Clinic as part of a series of investigations into the physiological effects of common sugar substitutes.

“Many professional societies and clinicians routinely recommend that people at risk for cardiovascular disease — those with obesity, diabetes or metabolic syndrome — eat foods containing sugar substitutes instead of sugar,” said Stanley Hazen, MD, chief of the Division of Cardiovascular and Metabolic Sciences at Cleveland Clinic’s Lerner Research Institute, co-chief of the Division of Preventive Cardiology, and the study’s lead author. “These findings underscore the importance of further long-term clinical studies to evaluate the cardiovascular safety of erythritol and other sugar substitutes.”

Erythritol and other artificial sweeteners are popular sugar substitutes in low-calorie, low-carb, and keto products.

Erythritol is about 70% as sweet as sugar and is produced by fermenting corn. After ingestion, erythritol is poorly metabolized by the body, entering the bloodstream and leaving the body primarily in the urine.

The human body produces small amounts of erythritol naturally, so any additional consumption can add up.

Erythritol is classified as generally safe by the US Food and Drug Administration and the European Food Safety Authority, allowing its unrestricted use in food products. This is primarily because it is a sugar alcohol that occurs naturally in fruits and vegetables and is a by-product of glucose metabolism in human tissues, albeit in small amounts.

However, recent studies by Dr. Hazen's group have found evidence that erythritol in typically consumed amounts may increase the risk of cardiovascular disease.

The current study builds on a previous study by the same team, published last year in Nature Medicine, which found that heart patients with high levels of erythritol were twice as likely to experience a major cardiac event in the next three years compared to those with low levels.

The study also found that adding erythritol to patients' blood or platelets increased clot formation. These findings have been confirmed by preclinical studies.

“This study raises some concerns that a standard serving of erythritol-sweetened food or beverage may acutely potentiate the direct clot-forming effect,” said study co-author W.H. Wilson Tang, MD, director of research in the Division of Heart Failure and Transplantation at Cleveland Clinic. “Erythritol and other sugar alcohols that are commonly used as sugar substitutes should be evaluated for potential long-term health effects, especially when such effects are not seen with glucose itself.”

The researchers stress that further clinical studies are needed to evaluate the long-term cardiovascular safety of erythritol.

The doctor advises choosing foods sweetened with sugar from time to time and in small quantities because this will be better than consuming drinks and foods sweetened with these sugar alcohols, especially for people at risk of strokes, such as those with heart disease, diabetes or metabolic syndrome.