Erythritol is added to many low-carb and keto products and low-calorie sweeteners.
CNN —
A sugar replacement called erythritol – used to add bulk or sweeten stevia, monkfruit and keto reduced-sugar products – has been linked to blood clotting, stroke, heart attack and death, according to a new study.
“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 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 Monday 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. It’s on par with the strongest of cardiac risk factors, like diabetes,” Hazen said.
Additional lab and animal research presented in the paper revealed that erythritol appeared to be causing blood platelets to clot more readily. Clots can break off and travel to the heart, triggering a heart attack, or to the brain, triggering a stroke.
“This certainly sounds an alarm,” said Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health, a hospital in Denver, who was not involved in the research.
“There appears to be a clotting risk from using erythritol,” Freeman said. “Obviously, more research is needed, but in an abundance of caution, it might make sense to limit erythritol in your diet for now.”
In response to the study, the Calorie Control Council, an industry association, told CNN that “the results of this study are contrary to decades of scientific research showing reduced-calorie sweeteners like erythritol are safe, as evidenced by global regulatory permissions for their use in foods and beverages,” said Robert Rankin, the council’s executive director, in an email.
The results “should not be extrapolated to the general population, as the participants in the intervention were already at increased risk for cardiovascular events,” Rankin said.
The European Association of Polyol Producers declined to comment, saying it had not reviewed the study.
What is erythritol?
Like sorbitol and xylitol, erythritol is a sugar alcohol, a carb found naturally in many fruits and vegetables. It has about 70% of the sweetness of sugar and is considered zero-calorie, according to experts.
Artificially manufactured in massive quantities, erythritol has no lingering aftertaste, doesn’t spike blood sugar and has less of a laxative effect than some other sugar alcohols.
“Erythritol looks like sugar, it tastes like sugar, and you can bake with it,” said Hazen, who also directs the Cleveland Clinic’s Center for Microbiome and Human Health.
“It’s become the sweetheart of the food industry, an extremely popular additive to keto and other low-carb products and foods marketed to people with diabetes,” he added. “Some of the diabetes-labeled foods we looked at had more erythritol than any other item by weight.”
Erythritol is also the largest ingredient by weight in many “natural” stevia and monkfruit products, Hazen said. Because stevia and monkfruit are about 200 to 400 times sweeter than sugar, just a small amount is needed in any product. The bulk of the product is erythritol, which adds the sugar-like crystalline appearance and texture consumers expect.
An unexpected discovery
The discovery of the connection between erythritol and cardiovascular issues was purely accidental, Hazen said: “We never expected this. We weren’t even looking for it.”
Hazen’s research had a simple goal: find unknown chemicals or compounds in a person’s blood that might predict their risk for a heart attack, stroke or death in the next three years. To do so, the team began analyzing 1,157 blood samples in people at risk for heart disease collected between 2004 and 2011.
“We found this substance that seemed to play a big role, but we didn’t know what it was,” Hazen said. “Then we discovered it was erythritol, a sweetener.”
The human body naturally creates erythritol but in very low amounts that would not account for the levels they measured, he said.
To confirm the findings, Hazen’s team tested another batch of blood samples from over 2,100 people in the United States and an additional 833 samples gathered by colleagues in Europe through 2018. About three-quarters of the participants in all three populations had coronary disease or high blood pressure, and about a fifth had diabetes, Hazen said. Over half were male and in their 60s and 70s.
In all three populations, researchers found that higher levels of erythritol were connected to a greater risk of heart attack, stroke or death within three years.
But why? To find out, researchers did further animal and lab tests and discovered that erythritol was “provoking enhanced thrombosis,” or clotting in the blood, Hazen said.
Clotting is necessary in the human body, or we would bleed to death from cuts and injuries. The same process is constantly happening internally, as well.
“Our blood vessels are always under pressure, and we spring leaks, and blood platelets are constantly plugging these holes all the time,” Hazen said.
However, the size of the clot made by platelets depends on the size of the trigger that stimulates the cells, he explained. For example, if the trigger is only 10%, then you only get 10% of a clot.
“But what we’re seeing with erythritol is the platelets become super responsive: A mere 10% stimulant produces 90% to 100% of a clot formation,” Hazen said.
“For people who are at risk for clotting, heart attack and stroke – like people with existing cardiac disease or people with diabetes – I think that there’s sufficient data here to say stay away from erythritol until more studies are done,” Hazen said.
Oliver Jones, a professor of chemistry at RMIT University in Victoria, Australia, noted that the study had revealed only a correlation, not causation.
“As the authors themselves note, they found an association between erythritol and clotting risk, not definitive proof such a link exists,” Jones, who was not involved in the research, said in a statement.
“Any possible (and, as yet unproven) risks of excess erythritol would also need to be balanced against the very real health risks of excess glucose consumption,” Jones said.
Healthy volunteers
In a final part of the study, eight healthy volunteers drank a beverage that contained 30 grams of erythritol, the amount many people in the US consume, Hazen said, according to the National Health and Nutrition Examination Survey, which examines American nutrition each year.
Blood tests over the next three days tracked erythritol levels and clotting risk.
“Thirty grams was enough to make blood levels of erythritol go up a thousandfold,” Hazen said. “It remained elevated above the threshold necessary to trigger and heighten clotting risk for the following two to three days.”
Just how much is 30 grams of erythritol? The equivalent of eating a pint of keto ice cream, Hazen said.
“If you look at nutrition labels on many keto ice creams, you’ll see ‘reducing sugar’ or ‘sugar alcohol,’ which are terms for erythritol. You’ll find a typical pint has somewhere between 26 and 45 grams in it,” he said.
“My co-author and I have been going to grocery stores and looking at labels,” Hazen said. “He found a ‘confectionery’ marketed to people with diabetes that had about 75 grams of erythritol.”
There is no firm “accepted daily intake,” or ADI, set by the European Food Safety Authority or the US Food and Drug Administration, which considers erythritol generally recognized as safe (GRAS).
“Science needs to take a deeper dive into erythritol and in a hurry, because this substance is widely available right now. If it’s harmful, we should know about it,” National Jewish Health’s Freeman said.
Hazen agreed: “I normally don’t get up on a pedestal and sound the alarm,” he said. “But this is something that I think we need to be looking at carefully.”
FAQs
Are artificial sweeteners linked to heart attack? ›
Key findings: Artificial sweeteners were linked to a 9% higher risk of any type of cardiovascular problem (including heart attacks) and an 18% greater risk of stroke.
What artificial sweetener is linked to heart attack and stroke? ›New Cleveland Clinic research showed that erythritol, a popular artificial sweetener, is associated with an increased risk of heart attack and stroke.
Do artificial sweeteners increase risk of stroke? ›Overall, artificial sweeteners were associated with a 9 percent higher risk of any type of cardiovascular disease event and an 18 percent greater chance of stroke, according to results published in The BMJ.
Does erythritol cause heart problems? ›Sugar Substitute Erythritol May Increase Risk for Blood Clotting and Stroke. A preliminary study showed that consuming erythritol, found in many keto-friendly foods — including the sweetener Truvia — can significantly increase heart disease risks.
What is the 2022 study of artificial sweeteners? ›In 2022, the NutriNet-Santé cohort study reported that adults who consumed higher amounts of aspartame were slightly more likely to develop cancer overall (1.15 times the risk), breast cancer (1.22 times the risk), and obesity-related cancers (1.15 times the risk) than those who did not consume aspartame (4).
Can zero calorie sweeteners raise your risk for cardiovascular disease? ›A study published this month in BMJ, the British Medical Journal, reported that people who consumed significant amounts of artificial sweeteners had an 18% higher risk for stroke and cerebrovascular incidents, and a 9% increase in risk for cardiovascular disease.
What is the most harmful artificial sweetener? ›The worst of the worst culprits include aspartame (found in Equal and NutraSweet), sucralose (found in Splenda), and Saccharin (found in Sweet 'N Low). Many people who cut artificial sugars out of their diets report the improvement of many health problems including migraines, depression, IBS, weight gain, and more.
How does stevia affect the heart? ›The study found stevia lowered total cholesterol, LDL (“bad”) cholesterol, and triglycerides with no negative side effects. It also increased HDL (“good”) cholesterol. What's more? It is associated with reduced heart disease risk.
Does aspartame increase risk of stroke? ›The results showed that participants who consumed large amounts of aspartame — found in the tabletop sweeteners Equal and NutraSweet as well as cereals, yogurt, candy and diet soda — had a higher risk of stroke than people who didn't consume the sweetener.
Can artificial sweeteners trigger atrial fibrillation? ›Artificial sweeteners did not affect heart rate or atrial effective refractory period. However, the artificial sweeteners caused some electrophysiological abnormalities with a prolonged PR interval and a tendency of increased atrial fibrillation (AF) inducibility in rats.
Can artificial sweeteners cause blood clots? ›
After an average followup of nearly 12 years, the scientists found that women who drank two or more artificially sweetened drinks a day had a 23% higher risk of having any type of stroke, and a 31% increased risk of having a stroke due to clotting in brain blood vessels, compared to women who reporting drinking fewer ...
What is erythritol sweetener dangers? ›Erythritol side effects can include diarrhea, headache, and stomachache in some people, particularly when consumed in large doses. We recommend you eat only a small amount of erythritol when you first try it. That way, you can screen out an allergy or negative reaction before it is serious.
Should you avoid erythritol? ›Overall, erythritol appears to be very safe. Multiple studies on its toxicity and effects on metabolism have been performed in animals. Erythritol has been found safe for both human and animal consumption (2). However, there is one major caveat to most sugar alcohols: They can cause digestive issues.
Is erythritol safe for heart patients? ›Erythritol is added to many low-carb and keto products and low-calorie sweeteners. A sugar replacement called erythritol – used to add bulk or sweeten stevia, monkfruit and keto reduced-sugar products – has been linked to blood clotting, stroke, heart attack and death, according to a new study.
What is the most controversial sweeteners in the world? ›The artificial sweetener aspartame has been the subject of several controversies since its initial approval by the U.S. Food and Drug Administration (FDA) in 1974.
What do doctors say about artificial sweeteners? ›Some research on long-term, daily use of artificial sweeteners suggests a link to a higher risk of stroke, heart disease and death overall. But other things people do, or healthy habits that people don't do, may be the cause of the higher risk.
How does the brain react to artificial sweeteners? ›Aspartame (α-aspartyl-l-phenylalanine-o-methyl ester), an artificial sweetener, has been linked to behavioral and cognitive problems. Possible neurophysiological symptoms include learning problems, headache, seizure, migraines, irritable moods, anxiety, depression, and insomnia.
Which artificial sweeteners can cause heart problems? ›New Cleveland Clinic research showed that erythritol, a popular artificial sweetener, is associated with an increased risk of heart attack and stroke.
Which artificial sweetener is linked to cardiovascular disease risk? ›The study also reports that one artificial sweetener, aspartame, was more closely linked to an increased risk of stroke, whereas the sweeteners sucralose and acesulfame potassium were more strongly linked to coronary heart disease.
What is the medical news today about artificial sweeteners? ›Now the new study, published this month in the peer-reviewed British Medical Journal, links consumption of artificial sweeteners to a 9 percent higher risk of cardiovascular disease – heart and blood vessel harm that's the leading cause of death in the U.S. and globally.
What is the least harmful artificial sweetener? ›
Acesulfame-K — "safe
It's a good artificial sweetener to bake with, because it can retain its sweetness even at high temperatures. And it's 200 times sweeter than sugar. According to the FDA, more than 90 studies suggest that Acesulfame-K is safe for general use.
- Stevia. Stevia is a very popular low calorie sweetener. ...
- Erythritol. Erythritol is another low calorie sweetener. ...
- Xylitol. Xylitol is a sugar alcohol with a sweetness similar to that of sugar. ...
- Yacon syrup. Yacon syrup is another unique sweetener. ...
- Monk fruit sweetener.
“Stevia leaf extract is safer than many other sugar substitutes, especially aspartame and sucralose,” Lefferts says. Research has linked sucralose, aspartame, and saccharin with cancers.
What are the dangers of using stevia? ›- Kidney damage. Stevia is considered a diuretic, meaning that it increases the speed at which the body expels water and electrolytes from the body in urine. ...
- Gastrointestinal symptoms. ...
- Allergic reaction.
- Hypoglycemia or low blood sugar. ...
- Low blood pressure. ...
- Endocrine disruption.
Even though many people are reporting to have consumed stevia minus any evident changes in their health condition, a percentage of individuals have reported suffering unwanted side effects from consuming the sweetener. Among these side effects are heart palpitations and trouble with digesting food.
What are the controversial health issues regarding the use of stevia? ›Stevia is a natural, low-calorie alternative to sugar that can help you manage and lose weight. Stevia is healthy for you as long as you consume it in moderation, according to dieticians. However, too much Stevia may cause gas, nausea, and inflammation in the kidney and liver.
Does Splenda cause strokes? ›Neither intake of total sugary beverages nor sugar-sweetened soft drink were associated with the risks of stroke. Cumulative consumption of artificially-sweetened soft drinks and event-free survival of incident (a) all stroke and (b) all-cause dementia.
Does Coke Zero raise blood pressure? ›ANSWER: It's unlikely that the diet soda you drink is causing your high blood pressure. A number of studies have examined this topic, and there is no evidence to suggest a link between regularly drinking diet soda and an increase in blood pressure.
Does aspartame mess with your heart? ›Aspartame intake was associated with increased risk of cerebrovascular events, and acesulfame potassium and sucralose were associated with increased coronary heart disease risk. Our results suggest no benefit from substituting artificial sweeteners for added sugar on CVD outcomes.
What are the side effects of zero calorie sweeteners? ›The side effects of artificial sweeteners may include: digestive issues, increased blood sugar levels, a higher risk of cancer, increased blood pressure and adverse effects on those with pre-existing mood disorders. Artificial sweeteners may also have an effect on some people's immune systems.
Which is worse real sugar or artificial sweeteners? ›
Both sugar and artificial sweetener are addictive. But artificial sweeteners may be likelier to make you get hungry, eat more throughout the day and develop diabetes. Sugar is OK in limited amounts and in the context of a healthy diet. (Eating a cookie you've made yourself is fine.
Should you avoid artificial sweeteners? ›Overall, the use of artificial sweeteners poses few risks and may even have benefits for weight loss, blood sugar control, and dental health. These sweeteners are especially beneficial if you use them to decrease the amount of added sugar in your diet.
What vitamins can cause AFib? ›vitamin D is an emerging risk factor of AF, and is implicated in the pathophysiology of atrial fibrillation. It has been established that this vitamin is extensively involved in the regulation of both the renin angiotensin aldosterone system and the immune system.
What naturally controls atrial fibrillation? ›- Avoid stimulants.
- Get your nutrients.
- Stay hydrated.
- Supplements.
- Cut out gluten.
- Exercise and stress relief.
- Q&A.
"But poor sleep is just one of many triggers for Afib," said Ghannam, noting alcohol, excessive exercise, dehydration, stress and consuming large meals as some of the more common ones.
Does Coke Zero cause strokes? ›Other than being observational in nature, this study had serious statistical limitations, which limit its applicability. So no, “diet soda causes strokes and dementia” is not accurate.
Is Diet Coke linked to stroke? ›A published paper from the Boston University School of Medicine suggests that people who consume a large quantity of artificially sweetened soft drinks may be up to three times more likely to suffer from a stroke or dementia.
What popular drink is linked to clotting in small arteries? ›Diet drinks, such as Diet Coke and diet fruit juice, are linked to an increased risk for stroke, and are particularly associated with blood clots of the small arteries, according to a new study published today in Stroke.
Is erythritol worse than stevia? ›In short, this means it feels and tastes the same as sugar to your mouth (which means no aftertaste, woo!). Other than that, erythritol has many of the same benefits as stevia. It also doesn't cause blood sugar spikes or insulin response, and nor does it have calories or nasty side-effects.
Which is safer xylitol or erythritol? ›So, which one is healthier? A study in Caries Research found that erythritol might be better for tooth health than xylitol. And compared to xylitol, erythritol can be fully absorbed by our bodies, causing less digestive distress. Plus, erythritol doesn't raise blood sugar at all, while xylitol has a small impact.
Why does monk fruit have erythritol? ›
During the production of monk fruit sweeteners, monk fruit extract is often blended with erythritol in order to taste and look more like table sugar. Erythritol is a type of polyol, also referred to as a sugar alcohol, that contains zero calories per gram.
What are the dangers of monk fruit sweetener? ›In the case of monk fruit sweeteners, there are no known side effects. The Food and Drug Administration has deemed monk fruit “generally recognized as safe (GRAS)” for everyone, including pregnant women and children.
What is the downside of erythritol? ›Erythritol side effects typically include digestive problems and diarrhea. It may also cause bloating, cramps, and gas. Additionally, erythritol and other sugar alcohols frequently result in more water in the intestines, causing diarrhea. Nausea and headaches may occur as well.
Which is worse sugar or erythritol? ›sugar. If you're looking at the health benefits, erythritol has sugar beat. Fewer calories per gram allow you to eat more sweet treats than you normally could without the weight gain.
Is stevia safe for heart patients? ›There's concern that raw stevia herb may harm your kidneys, reproductive system, and cardiovascular system. It may also drop blood pressure too low or interact with medications that lower blood sugar.
Is erythritol a hormone disruptor? ›In conclusion, acute ingestion of erythritol and xylitol stimulates gut hormone release and slows down gastric emptying, whereas there is no or only little effect on insulin release.
Is Truvia an erythritol? ›Erythritol is also an ingredient in the sweetener Truvia. Though many sweeteners provide intense flavor and need to be used in small concentrations, erythritol's sweetness is close to that of sugar, so it can be used as a substitute in baking.
What are the dangers of artificial sweeteners? ›Studies dating back to the 1970s linked the artificial sweetener saccharin to bladder cancer in rats. Since then, research has shown that those findings don't apply to people. Some research on long-term, daily use of artificial sweeteners suggests a link to a higher risk of stroke, heart disease and death overall.
What is the new warning about artificial sweeteners? ›Now the new study, published this month in the peer-reviewed British Medical Journal, links consumption of artificial sweeteners to a 9 percent higher risk of cardiovascular disease – heart and blood vessel harm that's the leading cause of death in the U.S. and globally.
Is Splenda linked to heart disease? ›Aspartame intake was associated with increased risk of cerebrovascular events, and acesulfame potassium and sucralose were associated with increased coronary heart disease risk. Our results suggest no benefit from substituting artificial sweeteners for added sugar on CVD outcomes.
How do artificial sweeteners harm the body? ›
Besides its benefits, animal studies have convincingly proven that artificial sweeteners cause weight gain, brain tumors, bladder cancer and many other health hazards. Some kind of health related side effects including carcinogenicity are also noted in humans.
What are the dangers of stevia? ›and Warnings. When taken by mouth: Certain chemicals in stevia, including stevioside and rebaudioside A, are likely safe when used as a food sweetener. Side effects might include bloating, nausea, dizziness, and numbness.
Why artificial sweetener is worse for you than sugar? ›"Like sugar, sweeteners provide a sweet taste, but what sets them apart is that, after consumption, they do not increase blood sugar levels," she says. It's been suggested that the use of artificial sweeteners may have a stimulating effect on appetite and, therefore, may play a role in weight gain and obesity.
What sweetener is in Coke Zero? ›Yes. We sweeten Coke Zero Sugar in our bottles and cans with a blend of aspartame and acesulfame potassium (or Ace-K). Together, they create a great taste with zero sugar and zero calories.
What does the FDA say about Splenda? ›Sucralose is sold under the brand name Splenda®. Sucralose is about 600 times sweeter than sugar. FDA approved sucralose for use in 15 food categories in 1998 and for use as a general purpose sweetener for foods in 1999, under certain conditions of use.
What is the best sweetener for heart patients? ›- Erythritol. Erythritol is another low calorie sweetener. ...
- Xylitol. Xylitol is a sugar alcohol with a sweetness similar to that of sugar. ...
- Yacon syrup. Yacon syrup is another unique sweetener. ...
- Monk fruit sweetener.
- Stevia. Stevia is a plant leaf extract. ...
- Agave. Agave is a plant nectar. ...
- Coconut Sugar. Coconut sugar comes from the sap of coconut trees. ...
- Date Sugar. ...
- Monk Fruit. ...
- Fruit Puree. ...
- Honey. ...
- Maple Syrup.
Aspartame (α-aspartyl-l-phenylalanine-o-methyl ester), an artificial sweetener, has been linked to behavioral and cognitive problems. Possible neurophysiological symptoms include learning problems, headache, seizure, migraines, irritable moods, anxiety, depression, and insomnia.