• Posted August 8, 2024

More Evidence That an Artificial Sweetener Poses Heart Risk

There's more evidence to suggest that the common artificial sweetener erythritol might pose dangers to consumers' hearts.

The new study, involving 20 healthy adult volunteers, found that at doses commonly found in an erythritol-sweetened soda or muffin, the sweetener was linked to heightened activity of blood platelets, which could make clots more likely.

No such effect was seen with sugar, noted a team led by Dr. Stanley Hazen, chair of cardiovascular and metabolic sciences at the Cleveland Clinic’s Lerner Research Institute.

“Many professional societies and clinicians routinely recommend that people at high cardiovascular risk -- those with obesity, diabetes or metabolic syndrome -- consume foods that contain sugar substitutes rather than sugar,” Kazen explained in a clinic news release.

However, his team's findings "underscore the importance of further long-term clinical studies to assess the cardiovascular safety of erythritol and other sugar substitutes," Kazen said.

The findings were published Aug. 8 in the journal Arteriosclerosis, Thrombosis and Vascular Biology.

The new study comes more than a year after Hazen's team published similar results in the journal Nature Medicine. As reported last year by HealthDay, that study of nearly 1,200 people found those who had large amounts of erythritol in their blood were up to twice as likely to suffer a heart attack or stroke compared to those with the least amounts.

At the time, a lab investigation had hinted that erythritol produced this harmful effect on the heart by stimulating clot-forming platelets.

Erythritol is about 70% as sweet as sugar and is produced commercially by fermenting corn. It’s found in many keto foods and zero-sugar foods, Hazen said, and is an ingredient in some Splenda stevia sweetener products and Truvia.

“It's literally one of the fastest-growing artificial sweeteners in processed foods,” Hazen said when the Nature Medicine study was published. “We make it ourselves in our body, but at an amount that is a thousand to a million-fold less than what it is when we ingest it in an artificially sweetened product that has it.”

In the new study, 20 healthy volunteers were given a dose of erythritol equivalent to that found in a sugarless muffin or can of diet soda.

Blood levels of erythritol rose 1,000-fold soon after, the researchers found, and that was accompanied by a big rise in a blood clot formation among the volunteers.

“This research raises some concerns that a standard serving of an erythritol-sweetened food or beverage may acutely stimulate a direct clot-forming effect,” said study co-author Dr. W. H. Wilson Tang, research director for Heart Failure and Cardiac Transplantation Medicine at Cleveland Clinic. “Erythritol and other sugar alcohols that are commonly used as sugar substitutes should be evaluated for potential long-term health effects, especially when such effects are not seen with glucose itself.”

Erythritol is classified by the U.S. Food and Drug Administration as “generally recognized as safe." According to Hazen's group, that's largely because erythritol is a sugar alcohol found naturally in fruits and vegetables and "a byproduct of glucose metabolism in human tissue, although in small quantities."

However, according to Hazen, the combined data from his team's studies should give weight-conscious consumers pause.

“I feel that choosing sugar-sweetened treats occasionally and in small amounts would be preferable to consuming drinks and foods sweetened with these sugar alcohols, especially for people at elevated risk of thrombosis such as those with heart disease, diabetes or metabolic syndrome,” Hazen advised. “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.”

The study was supported in part by U.S. National Institutes of Health and the Office of Dietary Supplements.

A group representing the sweetener industry questioned the study's methodology.

The findings should be interpreted with "extreme caution," Calorie Control Council President Carla Saunders ‎told CBS News.

She pointed to the limited number of participants and "excessive amount" of erythritol, which she said was "nearly double to triple the maximum amount approved in any single beverage in the United States based on standard 8-16oz serving." 

"Importantly, erythritol levels were only measured once after consumption, and the pilot lacked control over lifestyle factors that may affect the outcome, which could introduce confounding variables and impact the reliability of the findings," the statement continued. "Further, as erythritol levels were only measured at baseline and 30 minutes after consumption, there is no way to demonstrate any lasting effect of excessive consumption on any health outcome. Consumers need to rely on science, and for 30 years, science has shown that erythritol is a proven safe and effective choice for sugar and calorie reduction."

More information

Harvard Health has more on artificial sweeteners.

SOURCES: Cleveland Clinic, news release, Aug. 8, 2024, CBS News