Low-sugar and sugar-free diets can help boost your health, but a new study suggests that replacing sugar with artificial and low-calorie sweeteners may have the opposite effect. That’s because erythritol, a sugar alcohol found in stevia and monk fruit, has been linked to an increased risk of stroke, heart attack, and mortality.
The study, published in February in the journal Nature Medicine, investigated the risk of atherothrombotic disease associated with multiple polyol sweeteners. The researchers concluded that erythritol causes blood platelets to clot, which can trigger a heart attack if the blood clot travels to the heart or a stroke if it travels to the brain.
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“The degree of risk was not modest,” Stanley Hazen, MD, PhD, lead study author and director of the Center for Cardiovascular Diagnostics and Prevention at the Cleveland Clinic Lerner Research Institute, recently told CNN.
In fact, the subjects who had a blood level of erythritol in the top 25 percent had a two-fold higher risk for heart attack and stroke compared to the bottom 25 percent. “It’s on par with the strongest of cardiac risk factors, like diabetes,” Hazen said.
Hazen said the researchers were surprised by the findings while speaking with the outlet.
“We never expected this. We weren’t even looking for it,” he explained. “We found this substance that seemed to play a big role, but we didn’t know what it was. Then we discovered it was erythritol, a sweetener.”
However, the research is not without precedent—previous studies have reached similar conclusions about the effects of sugar alternatives, including xylitol, which has been linked to long-term heart health consequences.
“Many artificial sweeteners have been studied and historically have been sold as healthy alternatives to sugar, but they have often been found to have significant side effects,” says Bradley Serwer, MD, an Interventional Cardiologist and Chief Medical Officer at VitalSolution.
“There have been other studies showing that erythritol increases platelet activity which leads to abnormal blood clot formation,” he tells Best Life. “Hopefully this data will cause the FDA to reevaluate the safety of erythritol.”
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Serwer adds that there may be other adverse health outcomes associated with erythritol.
“In addition to increasing risk of cardiovascular events from increasing platelet activity, these artificial sugars often trick the body into producing more insulin. Insulin increases sweet cravings, so people crave more sugar after eating artificial sweeteners, thus causing a negative impact which leads to metabolic syndrome,” he explains.
Hazen added while speaking with CNN that erythritol is increasingly found in pre-packaged foods, meaning you may be consuming it even if you avoid adding artificial sweeteners to your food and beverages.
“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 told the news outlet. “Some of the diabetes-labeled foods we looked at had more erythritol than any other item by weight.”
Carefully checking food labels can help reduce your chances of consuming erythritol or other artificial sweeteners without realizing it. Experts from Johns Hopkins Medicine suggest reducing your overall sugar consumption and opting for natural sources, including fruit juice, honey, molasses, and maple syrup, all of which “contain natural sugar and have some nutritional benefits.”
Serwer says that as a cardiologist, he often recommends a healthier diet and lifestyle to his patients, which frequently means looking for alternatives to high-calorie, sugary foods.
“It is important to inform them that it may be better to avoid these sugar alcohols altogether,” the cardiologist says.
