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Not so sweet: Study links artificial sweeteners to increased risk of stroke, heart attack

Different types of sugar spread out on a wooden table.
New Africa
Erythritol, an artificial sugar commonly found in low-calorie, low-carb and keto products, has been linked to a higher risk of thrombotic events such as heart attacks and strokes, according to a study published by the Cleveland Clinic on Monday, February 27, 2023.

An artificial sweetener commonly found in dietary product may be linked to an increased risk of heart attack and stroke, according to a Cleveland Clinic study published Tuesday.

Erythritol, a sugar alcohol, is found in the body and in fruits and vegetables at low levels. It is also commonly used as a replacement for table sugar in low-calorie, low-carbohydrate and keto products.

The Cleveland Clinic published findings from a new study Monday revealing links between artificial sweeteners with erythritol and an increased risk of heart attack and stroke when consumed consistently and in high amounts.

“Erythritol lowers the threshold for triggering clotting,” senior author of the study and chairman for the Department of Cardiovascular & Metabolic Sciences in Lerner Research Institute Dr. Stanley Hazen said. “It makes it much more likely to provoke a thrombotic event, and that's what a heart attack or stroke is.”

Research and findings

Researchers began looking for potential causes for an increased risk of cardiovascular events, like heart attacks and strokes, other than common factors like cholesterol, blood pressure and diabetes.

In fact, even when monitoring and treating those three factors, Hazen said risk levels remain high.

“It turns out that if one treats cholesterol, treats blood pressure, diabetes, all of the existing risk factors, you still end up experiencing heart attack, stroke, cardiovascular death,” he said. “In fact, with even the most aggressive of preventive efforts, we only at best reduce heart attack and stroke risk by 30 to 50%.”

The team then began working to identify researching to find out what other factor could be leading to that high risk. They studied blood samples from cardiology patients over a three-year period to see who experienced a heart attack, stroke or death.

Hazen was able to come up with a list of compounds identified in the blood samples that could predict a risk of a future cardiovascular event.

“In the beginning, we didn't know what the top of that very priority list was, and it turned out to be -- once we figured out its structure – Erythritol,” he said. “That's literally when we recognized Erythritol as the top compound [and] that's what really focused our attention on it.”

Additional studies looked at samples from 4,000 people in the U.S. and Europe and found those with higher levels of erythritol were more at risk of blood clots, heart attack and stroke than those with lower levels, and animal testing further confirmed a correlation between high erythritol levels and an increased risk for cardiovascular disease.

“The animal model studies,” Hazen said, “the studies where we added Erythritol to blood, we added Erythritol platelets when we gave erythritol to animal models of vascular disease and saw a worsening of the clotting -- those all are very concerning and make you think that, okay, maybe we need to kind of take a step back and avoid this.

The rise of sugar alternatives

Because of its similar taste and texture, sugar-free products containing erythritol have become more popular over the last 10 years, Hazen said, and are often recommended for people who have obesity, diabetes or metabolic syndrome as a way to manage or limit their sugar and calorie intake. But, people with these conditions also are at higher risk cardiovascular events like heart attacks and strokes.

“What we were most concerned about is that the very group that is most likely to be ingesting this are the ones who will be most vulnerable to experiencing the heart attack or stroke or developing cardiovascular disease,” Hazen said, “the very things that we're worried about erythritol helping to enhance susceptibility to develop.”

Currently, the Food and Drug Administration categorizes erythritol as Generally Recognized and Safe, which means products containing the erythritol are not required to list it as an ingredient.

But Hazen emphasized that more research and political backing could motivate the FDA to change that categorization, and better allow consumers to make informed decisions for themselves.

A doctor’s recommendation

Hazen said he has been recommending his patients avoid erythritol and other sugar alternatives until more research can be done.

“It's not surprising in retrospect that something can't be is really all that good as we had hoped,” he said. “It's disappointing, but it unfortunately, I think that there's enough compelling evidence here that there's a warning signal that says we should stay away from erythritol until more studies are done.”

Instead, he said to turn to natural sugar, but in moderation and to eat more fresh fruits and vegetables.

“I know it's easier said than done,” he said, “but I would just argue to use [whole] foods, natural things from the produce section, not this artificial approach, because we just don't know … enough at the present time.”

Zaria Johnson is a reporter/producer at Ideastream Public Media covering the environment.