A popular artificial sweetener, erythritol, could raise the risk of heart attack and stroke, a new study from the Cleveland Clinic revealed.
Researchers evaluated more than 4,000 people in the U.S. and Europe. Those who consumed high amounts of erythritol had a greater risk of developing major adverse cardiovascular events, which could include stroke, heart attack or death.
The study, published in Nature Medicine, found that erythritol may contribute to the formation of blood clots, a major trigger for cardiac events.
However, there were also some caveats.
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Erythritol is a carbohydrate called a sugar alcohol, which has about half the calories of regular sugar, per WebMD.
It is an ingredient in both Truvia and Splenda, two popular zero-calorie sugar substitutes. The sweetener is also found naturally in some foods, including grapes, watermelon, pears, mushrooms and fermented cheese.
“Our study shows that when participants consumed an artificially sweetened beverage with an amount of erythritol found in many processed foods, markedly elevated levels in the blood are observed for days — levels well above those observed to enhance clotting risks,” said Stanley Hazen, M.D., PhD, in a press release on Cleveland Clinic’s website.
He is co-section head of preventive cardiology at Cleveland Clinic and lead author of the study.
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The U.S. Food and Drug Administration (FDA) approved erythritol for safe consumption in 2001. The World Health Organization (WHO) approved it in 1999.
Erin Palinski-Wade, R.D., a New Jersey-based dietitian with a focus on diabetes and nutrition, said erythritol has a sweetness level similar to sugar, making it easy to swap out in recipes in equal amounts.
“Because it is not metabolized in the gut, erythritol has a limited impact on blood glucose levels, unlike other sugar alcohols,” Palinski-Wade told Online News 72h Digital in an email.
“This sweetener also has no aftertaste and only 0.24 calories per gram, making it an appealing choice as a sugar replacement.”
Palinski-Wade, who was not involved in the new study, said erythritol is also added to a variety of foods, including low-carb ice creams, protein powders, low-carb snacks, desserts and some beverages.
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“Sweeteners like erythritol have rapidly increased in popularity in recent years, but there needs to be more in-depth research into their long-term effects,” said Hazen of Cleveland Clinic.
“Cardiovascular disease builds over time, and heart disease is the leading cause of death globally. We need to make sure the foods we eat aren’t hidden contributors.”
Palinski-Wade was surprised by the findings of the study.
“Most previous research on erythritol has been quite positive, as it contains beneficial antioxidants and has no impact on blood glucose levels or insulin,” she said.
“More research and longer-term studies are needed to fully understand the impact of erythritol on long-term health.”
Palinski-Wade added that the study shows an association, not causation.
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“More research and longer-term studies, including research on individuals without current risk factors for cardiovascular disease, are needed to fully understand the impact of erythritol on long-term health,” she said.”
Hazen also recognized the need for further research.
“It is important that further safety studies are conducted to examine the long-term effects of artificial sweeteners in general, and erythritol specifically, on risks for heart attack and stroke, particularly in people at higher risk for cardiovascular disease,” he said.
The study’s limitations
The new study had some limitations that are important to know.
Kim Kulp, a registered dietitian in San Francisco, California, who was not involved in the study, pointed out that while there was an increase in cardiovascular events after having higher levels of erythritol in the blood, the people involved in the study were already at a higher risk for heart disease and other health problems.
“Since those who choose to use sugar substitutes are often overweight or have diabetes, this puts them at a greater risk for heart problems to begin with,” she told Online News 72h Digital in an email.
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“The results of this same study could be different if the subjects were all healthy individuals.”
Palinski-Wade said the best strategy is to follow the recommendation of the Dietary Guidelines of Americans (from the U.S. Department of Health and Human Services) to limit added sugars to less than 10% of total daily calories — and to use all sweeteners, both caloric and non-calorie, in moderation.
“Working to limit added sweeteners in the diet while boosting our intake of foods containing naturally occurring sugars, such as whole fruit, is the best strategy when it comes to improving long-term health,” she said.
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“Based on the findings of this study, people with risk factors for cardiovascular disease should speak to their physician to see if erythritol is right for them.”