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New research suggests that erythritol, a common artificial sweetener, may increase heart attack and stroke risks. Javier Díez/Stocksy
  • A new study has found a link between the artificial sweetener erythritol and heart attack and stroke.
  • When present in blood, it made it easier for clotting to occur, which might contribute to risk.
  • Erythritol has experienced growing popularity in recent years for patients with obesity and heart disease.
  • While erythritol naturally occurs in plant foods, artificial erythritol is being consumed in larger amounts.
  • Nutritionists advise minimizing sugar intake and making safer substitutions.

New research published in the journal Nature Medicine reports that the popular artificial sweetener erythritol was found to be linked to a greater risk for cardiovascular events like heart attack and stroke.

The researchers also looked at what happened when they added erythritol to whole blood or isolated platelets. Platelets, according to the National Cancer Institute, are small pieces of cells found in the blood that help blood clot and aid in wound healing.

The team found that the presence of the sweetener made it easier for platelets to cause clotting, which might potentially increase risk.

Additionally, they noted that pre-clinical studies confirmed erythritol had the same effect when consumed orally.

Dr. Stanley Hazen and his colleagues at Cleveland Clinic explained in their report that while erythritol is becoming more and more commonplace in foods and other products — to the point that it has even been detected in ground and tap water — little is known about its long-term effects.

Further, people with conditions like obesity and heart disease are often advised to use artificial sweeteners in order to lose weight. However, the authors noted that epidemiological studies have previously found an association between using these artificial sweeteners and the very conditions they are intended to help.

They said that this makes it especially important to determine just how these substances might be influencing people’s risk.

Liz Weinandy, a registered dietitian at The Ohio State University Wexner Medical Center and instructor of practice in medical dietetics, said the first thing we need to consider is that the study did not actually prove that erythritol causes heart disease and stroke.

“There’s a big difference between association and causation,” she explained. “Several aspects of this study were in vitro and in vivo which can provide us with information, but do not necessarily mean they translate into the same effects in humans as seen in the laboratory.”

The authors themselves also acknowledge this limitation in their study, recommending that more studies are needed in order to confirm this effect.

It should also be noted that, even if it increases cardiovascular risk, it may be more a matter of quantity rather than erythritol being inherently dangerous. It is naturally occurring in fruits and vegetables, albeit in much smaller quantities than what is being consumed in artificially sweetened foods.

The human body does a poor job of metabolizing it so any excess is shunted into the bloodstream. It is this excess erythritol that might be problematic, according to the study authors.

Samantha Coogan, Program Director, Didactic Program in Nutrition & Dietetics at the University of Nevada, Las Vegas, reiterated the distinction between naturally occurring erythritol, which is found in foods including grapes, watermelon, mushrooms, and fermented foods like wine, cheese, and soy sauce. It is not necessary to avoid these foods.

She further explained that artificial erythritol is found mostly in chewing gum and zero-sugar sodas, such as Blue Sky.

“If you’re a gum chewer, you can try choosing gums sweetened with xylitol for its added benefit to dental health that can help combat dental bacteria,” said Coogan.

“And instead of diet or zero-sugar soda, try flavored sparkling/mineral water … or make your own ‘spa’ water by infusing whole fruits/cucumbers into water in a water bottle or pitcher.”

Sharon Palmer — registered dietitian, author, and blogger at The Plant-Powered Dietitian — added that it can also be found mixed in with other artificial sweeteners, like aspartame and stevia. Additionally, it can make an appearance in foods and products like candy, protein and nutrition bars, baked goods, fruit spreads, frozen desserts, and even mouthwash.

However, while many foods, drinks, and products do contain added erythritol, it’s actually fairly simple to determine which ones they are. “Reading the ingredients on the food label will clearly tell if a product has erythritol in it or not because it has to be listed by law in the U.S.,” said Weinandy.

For those at risk for heart attack and stroke, Palmer said that sugar substitutes like neotame and stevia appear to be safe.

“Too much of the ‘real’ added sugars isn’t a good idea,” said Palmer, advising that people should keep added sugars like honey, table sugar, maple syrup, and high-fructose corn syrup below 10% of daily calories (50 g on a 2,000-calorie diet).

“This is especially true for people at risk of CVD,” she said, “They should keep their added sugar intake low, as high intake is linked with cardio-metabolic risks.”

Coogan said another good alternative that provides sweetness while aiding heart health and blood sugar balance is substituting spices like cinnamon, nutmeg, allspice, ginger, and cloves in place of sugar.

“They may take a lot of getting used to in beverages . . . but they can all be easily added/substituted for sugar in oatmeal, baked goods, marinades, DIY condiments/dressings, homemade fruit leather, dehydrated fruit, sprinkled over fresh fruit and salads, etc.,” she noted.

Finally, Weinandy said to consider that many foods containing erythritol are not healthy, to begin with; and that using sugar substitutes gives them a “health halo” that they don’t deserve.

She suggests “getting back to the basics” by eating whole, minimally processed foods.

“Keep sweets and desserts that have sugar in them to a limited amount, like a small serving 1 to 2 times a week,” she said. “Try eating a variety of fruits to satisfy a sweet craving.”

Weinandy concluded by noting that plant foods contain many compounds and nutrients — like potassium, vitamin C, and polyphenols — that help lower your risk of heart and stroke.

“There is nothing fake or artificial about that,” she said.


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