Study Links Common Low-Calorie Sweetener to Increased Heart Risks

Researchers at the Cleveland Clinic found that erythritol, unlike regular sugar, may lead to adverse heart effects.

The research compared erythritol to regular sugar and found that only erythritol caused concerning cardiovascular effects.

Although the study was limited in size, it marks the first direct comparison of blood levels in individuals after consuming erythritol versus sugar (glucose).

"We compared the results, and glucose caused none of the problems," said Dr. Stanley Hazen, a cardiologist at the Cleveland Clinic and the study's lead author. The study was published Thursday in the journal Arteriosclerosis, Thrombosis, and Vascular Biology.

Erythritol is one of several nonsugar sweeteners increasingly used in low-calorie and sugar-free foods.

Sugar alcohols like erythritol and xylitol are sweet but contain far fewer calories than sugar. Erythritol is often combined with stevia, while xylitol is commonly found in gum, mouthwash, and toothpaste.

Previous studies from Hazen’s lab, including one from last year and another in June, suggested that sugar alcohols might increase the risk of heart attacks and strokes.

The research indicated that sugar alcohols could make blood platelets more likely to stick together, potentially leading to clotting that could block veins or arteries, contributing to heart attacks and strokes.

In the latest study, Hazen’s team analyzed the heart effects of erythritol and regular sugar—specifically glucose—by studying two groups of healthy middle-aged male and female volunteers: one group consumed erythritol, and the other consumed sugar.

After fasting overnight, the volunteers had their blood drawn to measure platelet activity.

The participants then drank water mixed with either 30 grams of glucose or 30 grams of erythritol. Hazen noted that this amount of erythritol is typical of what is found in erythritol-sweetened foods.

Approximately 30 minutes after consuming the sweetened drinks, their blood was drawn again and retested.

Researchers observed increased platelet aggregation, a sign of clotting, in those who consumed erythritol.

Conversely, those who drank the sugar solution showed no change in platelet aggregation.

The study recorded a 1,000-fold increase in blood erythritol levels in participants who consumed the erythritol drink.

No such changes were observed in those who drank glucose, whose blood glucose levels only slightly increased.

Hazen noted that the amount of erythritol in sugar substitutes is "thousands of folds higher than what is made in our bodies," questioning its classification as a natural substance.

"Your best recommendation is to avoid sugar substitutes, and sugar alcohols in particular, because there’s an acute increase in the likelihood of clotting events once you ingest them," Hazen advised.

The US Food and Drug Administration (FDA) currently considers artificial sweeteners, including erythritol and xylitol, as GRAS (Generally Recognized As Safe).

However, Hazen hopes that mounting evidence on sugar alcohols might prompt the FDA to reevaluate the data.

Internationally, concerns about erythritol have also gained attention among food regulators.

For instance, last year, the European Food Safety Authority recommended that the European Commission request data on erythritol levels in food to better understand the potential risks.

Regarding whether erythritol is worse than high-calorie sugar, Valisa Hedrick, a registered dietitian at Virginia Tech, cautioned that a diet high in sugary foods can lead to elevated blood glucose levels, which are also linked to stroke and clotting risks. Hedrick was not involved in the Cleveland Clinic study.