Artificial sweetener erythritol could elevate heart disease risk, new researches say

Recent studies have brought to light potential health risks associated with erythritol, a widely used artificial sweetener. Originally lauded for its low-caloric content and lack of impact on blood glucose levels, erythritol has gained popularity among individuals seeking healthier alternatives to sugar. However, emerging research suggests that this seemingly innocuous sweetener may be linked to an increased risk of cardiovascular disease. This revelation prompts a reevaluation of the safety and long-term implications of consuming artificial sweeteners in general.

The pivotal study published in a prominent medical journal examined the effects of erythritol on cardiovascular health by analyzing data from over 4,000 participants. Researchers discovered that elevated levels of erythritol in the bloodstream were associated with a higher incidence of heart attack and stroke. Furthermore, animal studies corroborated these findings, revealing that erythritol can promote platelet activation—a critical factor in blood clot formation—thereby exacerbating cardiovascular risk factors. These insights challenge the prevailing notion that artificial sweeteners are devoid of adverse health effects.

“The degree of risk was not modest,” said lead study author Dr. Stanley Hazen, director of the Center for Cardiovascular Diagnostics and Prevention at the Cleveland Clinic Lerner Research Institute.

People, including many with existing risk factors for heart disease, such as diabetes, were twice as likely to experience a heart attack or stroke if they had the highest levels of erythritol in their blood, according to the study, published February 27 in the journal Nature Medicine.

“If your blood level of erythritol was in the top 25% compared to the bottom 25%, there was about a two-fold higher risk for heart attack and stroke,” Hazen said. “It’s on par with the strongest of cardiac risk factors, like diabetes.”

Erythritol is a common artificial sweetener. Low amounts occur naturally in fruits and vegetables. It is also made inside our cells as part of normal metabolism. But when used as a sweetener, erythritol levels are typically more than 1,000-fold greater than levels found naturally in foods. Erythritol is in an ingredient category called “sugar alcohols,” which are not required to be listed individually on Nutrition Facts labels. 

An NIH-funded research team led by Dr. Stanley Hazen at the Cleveland Clinic examined the relationship between erythritol and heart attacks and stroke. In an initial study with more than 1,000 people, the team looked for compounds in blood whose levels were linked to future cardiac risk. They tracked major adverse cardiovascular events over three years, including death and nonfatal heart attack or stroke. Results appeared in Nature Medicine on February 27, 2023.

While there have been many headline-making instances of coworkers pregnant at the same time over the years, doctors say there is no way to medically explain the phenomenon.

The question on everyone's minds: Could there really be something in the water at these workplaces?

"More likely, I think it's people who are around the same age, going through the same thing, and they see people getting pregnant and being able to handle it," Dr. Joanne Stone, director of maternal-fetal medicine at Mount Sinai Hospital, told ABC News previously, when 11 labor and delivery nurses were pregnant at the same time at an Ohio hospital. "It's more of an atmospheric thing than there's any medical reason for it."

Zero-calorie non-sugar sweeteners have not been shown to help with weight loss long-term in children or adults, and their use may bring side effects like increased risk of cardiovascular diseases, Type 2 diabetes and death in adults, the WHO said at the time.

When looking for sugar substitutes like Stevia, check for raw or extract. "Stevia labeled" products and "all-purpose non sugar" sweeteners are combined with other agents like erythritol as a bulking agent.

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Sarah H

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