Consuming the commonly used artificial sweetener erythritol may increase the risk of cardiovascular problems such as heart attacks and strokes because it contributes to the formation of blood clots.
New research from the Cleveland Clinic reveals that eating foods with erythritol, a popular artificial sweetener, increases the risk of cardiovascular events such as heart attacks and strokes. The findings, from a new study in healthy volunteers, show that erythritol activates platelets (a type of blood cell) more, which may increase the risk of blood clots forming. This effect was not seen with sugar (glucose).
The research adds to growing evidence that erythritol may not be as safe as it is currently classified by food regulatory agencies, and should therefore be re-evaluated as an ingredient. The study was conducted by a team of researchers at the Cleveland Clinic as part of a series of investigations into the physiological effects of common sugar substitutes, and their findings have been published in Arteriosclerosis, Thrombosis and Vascular Biology.
“Many professionals and clinicians routinely recommend that people at high cardiovascular risk – those with obesity, diabetes or metabolic syndrome – consume foods with sugar substitutes instead of sugar,” said Stanley Hazen, MD, chair of Cardiovascular and Metabolic Sciences at the Cleveland Clinic Lerner Research Institute and senior author. “These findings underscore the importance of conducting long-term clinical studies to evaluate the cardiovascular safety of erythritol and other sugar substitutes.”
Erythritol and other artificial sweeteners are common sugar substitutes in low-calorie, low-carb, and keto-friendly products. Erythritol is about 70% as sweet as sugar and is produced by fermenting corn. After being ingested, erythritol is inefficiently metabolized by the body, remaining in the bloodstream and being excreted primarily through urine. The human body produces small amounts of erythritol naturally, so additional consumption can add up.
Increase in blood clots after erythritol consumption
Erythritol is classified by the U.S. Food and Drug Administration (FDA) and the European Food Safety Authority (EFSA) as a GRAS (“generally recognized as safe”) ingredient, allowing its unrestricted use in food products. This is primarily because it is a sugar alcohol found naturally in fruits and vegetables and is a byproduct of glucose metabolism in human tissues, albeit in small amounts. However, recent studies by Dr. Hazen’s group have found evidence that erythritol, in the amounts typically consumed, may increase cardiovascular risk.
The current research expands on a previous study by the team, published last year in Nature Medicine, which found that heart patients with elevated levels of erythritol were twice as likely to suffer a major cardiac event in the following three years, compared with those with low levels. The study also found that adding erythritol to patients’ blood or platelets increased clot formation. These findings were confirmed by preclinical studies.
The new human intervention study was designed to look more directly at the effects on platelets following ingestion of erythritol at a dose typically contained in a sugar-free soda or muffin. In 20 healthy volunteers, researchers found that erythritol levels on average increased more than 1,000-fold after consuming erythritol, compared to their baseline levels. The results also revealed a significant increase in blood clot formation after consuming erythritol, while no change was seen after consuming glucose.
“Erythritol and other sugar alcohols should be evaluated for their potential long-term health effects, especially when these effects are not seen with glucose.”
“This research raises concerns that a standard serving of an erythritol-sweetened food or beverage may acutely stimulate a direct effect on clot formation,” said study co-author Dr. W.H. Wilson Tang, director of research for Heart Failure and Cardiac Transplant Medicine at the Cleveland Clinic. “Erythritol and other sugar alcohols, commonly used as sugar substitutes, should be evaluated for their potential long-term health effects, especially when these effects are not seen with glucose.”
He added that the results of this study are especially notable as they follow another recent study from this research group that showed that xylitol, another common artificial sweetener, produced similar increases in plasma levels and affected platelet aggregation in healthy volunteers in the same way. As with erythritol, the xylitol studies also included large-scale observational studies that showed that high levels of xylitol were associated with an increased risk of heart attack, stroke or death within three years.
The authors note that further clinical studies evaluating the long-term cardiovascular safety of erythritol are needed. “I believe that occasionally choosing sugar-sweetened sweets in small amounts would be preferable to consuming beverages and foods sweetened with these sugar alcohols, especially for people at increased risk of thrombosis, such as those with heart disease, diabetes, or metabolic syndrome,” Dr. Hazen advised. “Cardiovascular disease develops over time, and heart disease is the leading cause of death worldwide. We need to make sure that the foods we eat are not contributing in hidden ways to these problems.”
This research is part of Dr. Hazen’s ongoing investigation into factors that contribute to residual cardiovascular risk. His team follows patients over time and finds chemical signatures in the blood that can predict future development of cardiac and metabolic diseases. He has made pioneering discoveries in atherosclerosis and inflammatory disease research, including the seminal discovery linking gut microbial pathways to cardiovascular and metabolic diseases.
