The artificial sweetener erythritol has been linked to a higher risk of heart attacks and strokes, according to a study published Monday in the journal Nature Medicine.
Erythritol is a sugar alcohol found naturally in low amounts in fruits and vegetables but added at much higher levels to processed foods, according to the study. It’s widely used in sugar-replacement and reduced sugar products. Due to its ubiquity, some people now have higher-than-normal levels of erythritol in their blood, per New Scientist’s Clare Wilson, which might be leading to an increased risk of blood clots.
Some experts say other factors beyond erythritol might be at play, while others argue that artificial sweeteners are not as bad as added sugars. Regardless, some researchers advise consumers to be aware of what they’re eating.
“Obviously, more research is needed, but in an abundance of caution, it might make sense to limit erythritol in your diet for now,” Andrew Freeman, a cardiologist at the hospital National Jewish Health who did not contribute to the study, tells CNN’s Sandee LaMotte.
Recently, erythritol has become more common in food products. A 2022 report from NielsenIQ found that sales of foods containing the sweetener grew 43 percent over the previous two years. While artificial sweeteners are generally considered safe by regulatory agencies, little is known about their long-term health effects, the study authors write.
“We have work to do on every single one of the artificial sweeteners,” Kimber Stanhope, a research nutritional biologist at the University of California, Davis, who did not contribute to the paper, tells Stat News’ Matthew Herper. “It’s ridiculous how understudied they are.”
In fact, studying artificial sweeteners was not the original goal of the new research. The team was looking for compounds linked to a greater risk of cardiovascular health problems. They studied the blood of 1,157 people undergoing cardiac risk assessment and tracked them for three years to record any heart attacks, strokes or deaths. They found that erythritol was “at the very top of the list,” of compounds tied to these events, Stanley Hazen, a co-author of the study and a physician scientist at the Cleveland Clinic, tells USA Today’s Karen Weintraub.
To confirm this finding, they looked at the blood of 2,149 participants in the U.S. and 833 participants in Europe who were undergoing elective cardiac evaluation. Again, they found that erythritol was linked to adverse health outcomes: After accounting for other factors, the risk of heart attack or stroke over the next three years was about twice as high for people in the top 25 percent of erythritol levels compared to those in the bottom 25 percent, according to New Scientist.
Of the participants in these two studies, about 75 percent had coronary disease or high blood pressure, and about 20 percent had diabetes, Hazen tells CNN.
In a final study, eight participants at a low risk of heart attack or stroke consumed food and drinks containing 30 grams of erythritol. The level of the sweetener in their blood rose one thousandfold and stayed elevated for several hours. The researchers also conducted lab experiments in which erythritol seemed to cause blood clotting and increase the risk of clotting in genetically engineered mice.
“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 tells CNN.
The research didn’t prove that higher erythritol levels were causing heart attacks and strokes—it merely found an association between the two. Multiple experts note to Stat News that instead, conditions causing heart disease might have led to high levels of erythritol, which is produced naturally by the body.
Despite the possible risks of erythritol, some scientists say it might be the lesser evil—consuming products with added sugar could be worse for you than consuming low-sugar products. “If you’re a diabetic and you have a choice between eating sugar and eating this, I would put my bets on this,” Karen Aspry, a clinical cardiologist at Brown University who was not involved in the research, tells Stat News.
But until further studies are conducted, others recommend exercising caution with erythritol for the time being. “At the current knowledge we have, I would not recommend people use it,” Karsten Hiller, a biochemist at the Braunschweig Institute of Technology in Germany, tells USA Today.