Common Artificial Sweetener Linked to Increased Heart Attack Risk in Small Study

The artificial sweetener erythritol may increase people’s risk of blood clots, a small study finds, potentially putting them at an increased risk of heart attacks and strokes. Sugar was not observed to have the same effect.

The findings, published last week in the journal Arteriosclerosis, Thrombosis and Vascular Biology, contribute to a growing body of research suggesting the health impacts of erythritol—which is labeled “generally recognized as safe” by the Food and Drug Administration (FDA)—should be reevaluated.

“This is the first direct head-to-head comparison of the effects of ingesting glucose versus ingesting erythritol on multiple different measures of platelet function,” Stanley Hazen, a co-author of the study and cardiologist at the Cleveland Clinic, tells CNN’s Sandee LaMotte. “Glucose doesn’t impact clotting, but erythritol does.”

“This research raises some concerns that a standard serving of an erythritol-sweetened food or beverage may acutely stimulate a direct clot-forming effect,” W. H. Wilson Tang, a co-author of the study and cardiovascular disease researcher at the Cleveland Clinic, says in a statement from the 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 a sugar alcohol commonly used as a replacement for sugar in low-calorie, low-carbohydrate and ketogenic diet food and drinks. It can be found in baked goods, drinks, gum and candy.

The sweetener naturally occurs in fruits and vegetables, and the human body produces it in small amounts. As such, it can be used in food products without restrictions. But when artificially produced, it’s made in large quantities, writes CNN.

“The amount in sugar substitutes is thousands of folds higher than what is made in our bodies, so to call it ‘natural,’ it’s not,” Hazen tells NBC News’ Caroline Hopkins.

Last year, a study by some of the same authors in the journal Nature Medicine found a link between erythritol and heart problems. People with higher levels of the sugar alcohol in their blood were more likely to experience a heart attack or stroke in the next three years. The study also found that eight people who consumed food and drinks containing erythritol had sharply elevated levels of the sweetener in their blood for several hours afterward.

In the new paper, researchers gave ten healthy people a drink with 30 grams of erythritol, while ten other healthy people received a drink with 30 grams of glucose. The levels of erythritol in the blood of people who drank it rose more than 1,000 times higher than they were before the experiment. Those participants were also significantly more likely to form blood clots, measured by an increase in platelet aggregation.

Meanwhile, the people who consumed glucose did not show a higher risk of blood clots, and their blood glucose levels rose only a small amount, per the Cleveland Clinic.

“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,” Hazen says in the clinic’s statement.

“I would argue it is a safer to drink a [sugar]-sweetened drink than an erythritol-sweetened drink in a patient at risk for clotting and having a heart attack or stroke,” he tells New Scientist’s Grace Wade.

Limitations of the study include its small number of participants and the fact that it only looked at one instance of consuming erythritol or glucose, Valisa Hedrick, a dietitian at Virginia Tech who did not contribute to the findings, says to NBC News. She points out that sustained consumption of glucose can also raise the risk of stroke and clotting.

Future studies should look at the long-term impacts of erythritol and other sugar substitutes on cardiovascular health, per the Cleveland Clinic. The new evidence suggests the FDA should consider reevaluating erythritol’s “generally recognized as safe” label, the study authors write.

“I’m not saying we need to cease using these sugar alcohols immediately, but this line of research certainly begs the question: Are they safe or not?” Andrew Freeman, a cardiologist at National Jewish Health who was not involved in the research, tells CNN.

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Will Sullivan is a science writer based in Washington, D.C. His work has appeared in Inside Science and NOVA Next.