A new study from researchers at the Cleveland Clinic — a non-profit medical institute based in Ohio — and published in the European Heart Journal, found that erythritol, a sugar substitute often blended with stevia, was linked to an increased risk of heart attack, stroke and other cardiovascular events.
The study builds upon a growing body of research that has found dangers in consuming large amounts of sugar-alternatives.
Nearly a year ago, the World Health Organization warned that artificial sweeteners like aspartame and stevia (which contains erythritol) — often found in diet sodas — were linked to a greater risk of type-2 diabetes, cardiovascular disease and death in adults. Aspartame was also deemed a “possible” cause of cancer by the World Health Organization. New regulations in Canada published in 2022 mean manufacturers are no longer required to label some artificial sweeteners, like aspartame, on the front of packaging and do not have to disclose the miligram per serving in the list of ingredients.
What is erythritol?
Erythritol is a sugar alcohol found naturally in some foods but is mainly used as a artificial sweetener.
Sugar alcohols are similar to sugar — they are both carbohydrates and have similar structures, but sugar alcohols contain an alcohol molecule and aren’t processed by the body in the same way.
Erythritol, like another well-known artificial sweetener xylitol, is often used as a sugar-free or reduced sugar additive, as it not only has fewer calories, but doesn’t spike blood sugar or insulin to the same extent as added sugar, making it popular for diabetics and those on a Keto diet.
Another study from the Cleveland Clinic released in June found that xylitol was linked to an increased risk of heart attack, stroke and other cardiovascular events.
Is erythritol bad for you?
The study found that erythritol-sweetened drinks more than doubled the risk of blood clotting in ten healthy volunteers who drank a typical portion size, Hazen explained. The study showed that erythritol sweetened drinks made a noticeable difference before and after consumption within volunteers’ bodies, Dr. Stanley Hazen, director of the Cleveland Clinic’s centre for cardiovascular diagnostics and prevention, said.
“This adds to the growing body of evidence that artificial sweeteners in general, but especially sugar alcohols like erythritol, appear to promote or foster an enhanced clotting risk.”
Hazen recommended that anyone with an increased risk of heart disease or blood clotting should avoid sugar alternatives erythritol and xylitol entirely.
In 2022, more than 57,000 Canadians died of heart disease, the second leading cause of death in the country.
Before the study was released on Thursday, the Calorie Control Council — an “international association representing the low- and reduced-calorie food and beverage industry,” released a statement on its website warning consumers against the results of the study, citing the small sample size of the study, the amount of erythritol given to participants and its short time frame. Members of the Calorie Control Council include food and beverage giants like the Coca-Cola Company, PepsiCo Inc and Keurig Dr Pepper.
But, Hazen added that the study looked specifically at healthy volunteers in an attempt to rule out mitigating factors that might interfere with the results, like a diagnosis of diabetes or obesity, hypertension and other factors. The amount of erythritol given to participants was based on levels of erythritol that companies had reported when registering their products with the U.S. Food and Drug Administration.
And, alongside other researchers, Hazen, in February, found that high levels of erythritol in more than 1,000 patients in the U.S. examined had a higher risk of heart attacks and stroke over a time span of three years. A further look at another 3,000 people across the U.S. and Europe confirmed those results.
What should I eat instead?
Instead of artificial sweeteners, Hazen recommends using glucose, sugar, honey or fruit, but “in moderation.”
“I’m trying to sound the alarm,” Hazen said. “We need to look at the safety of this because I’m concerned that, long-term, we’re seeing, unfortunately, adverse consequences for the very people who are trying to reach for a healthy option or healthy alternative.”
“They’re the ones who are most at risk.”
