Artificial sweetener is linked to higher heart-attack risk, study says
The popular artificial sweetener erythritol, which is used as a sugar substitute in many low-calorie, lowcarb and keto products, has been linked to heightened risk of heart attack, stroke and death, according to a study published in Nature Medicine.
Looking at more than 4,000 people in the U.S. and Europe who were undergoing elective cardiac evaluation, researchers at the Cleveland Clinic found that those who had greater erythritol levels in their blood had a higher chance of experiencing adverse cardiac events. In preclinical studies, they also found evidence that ingestion of erythritol increased blood clot formation.
Researchers caution that more study is necessary and that participants independently had a high prevalence of cardiovascular disease, so the “translatability” of the findings to the general population needs to be determined.
Still, the results offer a significant challenge to product marketing that pitches erythritol as a healthy, natural sugar alternative. And the insights arrive as erythritol has come into vogue, with plant-based, keto and lowcarb diet trends spurring interest in alternative sweeteners sold as “natural.”
According to 2022 reports from research firm NielsenIQ , sales growth for products with erythritol grew 43% over two years, and products that claim to contain “natural sweeteners” grew by 91%. “Sugar-free” products with erythritol are often recommended to individuals with obesity, diabetes or metabolic syndrome — who are already at risk for such cardiovascular health problems, the paper’s authors note.
In a statement about the study, Stanley Hazen, a cardiologist at the Cleveland Clinic, called for more research into alternative sweeteners. “Cardiovascular disease builds over time, and heart disease is the leading cause of death globally,” he said. “We need to make sure the foods we eat aren’t hidden contributors.”
Hazen wrote in an email that his team did not set out to study artificial sweeteners, but was rather looking to find chemicals in the blood that identified “who was at risk for a future heart attack, stroke or dying in the next three years.” The compound that predicted this “ended up being Erythritol.” His team then developed a test for it, independently tested their hypothesis and replicated the findings.
A sugar alcohol that is found in small amounts in fruits and vegetables, erythritol is poorly metabolized, excreted almost entirely in urine and characterized as a “zero-calorie” sweetener. Many foods that claim to be naturally flavored, such as keto cookies and granola, contain erythritol. But when it is artificially added to processed foods, it is seen at levels “1,000 fold higher than endogenous levels,” the researchers wrote.
Greg Neely, a professor of functional genomics at the University of Sydney who has studied artificial sweeteners, said many “natural” labels amount to “misleading marketing,” noting that people assume, “If it occurs in nature, it’s probably not as bad for us.”