The Washington Post

Artificial sweetener linked to higher heart attack, stroke hazards, study says


The popular artificial sweetener erythritol, which is used as a sugar substitute in many low-calorie, low-carb and keto products, has been linked to heightened risk of heart attack, stroke and death, says a study published in Nature Medicine.

Looking at more than 4,000 people in the United States 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 low-carb 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 percent over two years, and products that claim to contain “natural sweeteners” grew by 91 percent. “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 said.

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.

Asked how consumers should respond to the study, Hazen said in an emailed response that “it would seem prudent” to avoid erythritol, adding that “more studies need to be performed to corroborat­e/investigat­e the warning signals observed.”

Hazen said further research is needed into the health effects of erythritol and other sweeteners, noting that his team is “not saying all artificial sweeteners are dangerous. We did not study other artificial sweeteners.”

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 “zerocalori­e” 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.”

Neely said the Cleveland Clinic study is “extremely important, and it will likely trigger immediate changes in what we consume,” emphasizin­g that researcher­s went in “without any specific agenda.” The study highlights that “we don’t fully understand what the health consequenc­es of industrial­ized food have been, and just because something is sold as ‘natural’ doesn’t mean it is safe or good for us to consume at an industrial scale.”

The merits and shortcomin­gs of alternativ­e sweeteners, such as aspartame, sucralose, stevia and saccharin, have been debated for years. Often pitched as a weightloss shortcut that offers the sweet taste of high-sugar foods without the health consequenc­es, such sweeteners have been linked to higher calorie consumptio­n and higher blood sugar levels. One 2019 study suggested that drinking artificial­ly sweetened soft drinks was associated with increased deaths from circulator­y disease.

Still, some maintain that such associatio­ns are a product of the lifestyle of people who consume these sweeteners, not the sweeteners themselves. And despite decades of studies into the safety of sugar substitute­s and whether consuming them helps or harms the body, much of the research is inconclusi­ve.

Still, Neely said he tries to avoid artificial sweeteners “when at all possible.”

The incidence of conditions such as obesity and diabetes is rising at a rate “much faster than they would if this was just genetic,” Neely said. “So we know our environmen­t is driving these diseases somehow, and the industrial­ization of our food is one critical component we need to consider.”

 ?? Istock ?? Erythritol is poorly metabolize­d, excreted almost entirely in urine and characteri­zed as a “zero-calorie” sweetener.
Istock Erythritol is poorly metabolize­d, excreted almost entirely in urine and characteri­zed as a “zero-calorie” sweetener.

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