Skip to main content
food for thought

Artificial sweeteners are increasingly common food ingredients. They’re added to thousands of “sugar-free,” “low-carb” and “keto-friendly” processed prepackaged foods and beverages.

That’s despite the fact that very little is known about their long-term health effects.

Now, new research from the Cleveland Clinic Lerner Research Institute adds to growing evidence linking the consumption of artificial sweeteners to increased risk for cardiovascular disease.

The findings suggest that a zero-calorie sweetener called erythritol may increase the risk of heart attack and stroke. Here’s what to know.

What is erythritol?

Erythritol belongs to the family of sugar alcohols, or polyols, carbohydrates that occur naturally in certain fruits and vegetables. Small amounts are also synthesized by the body.

Sugar alcohols used as food additives are produced industrially; erythritol, for example, is made by fermenting glucose from corn. Sugar alcohols permitted for use in Canada include erythritol, xylitol, sorbitol, maltitol, mannitol, lactitol and isomalt.

Sugar alcohols have a chemical structure similar to table sugar but they taste less sweet. Erythritol, for example, is about 70 per cent less sweet than sugar.

Erythritol is used to sweeten beverages, chewing gum, chocolate, candies, bakery products, protein bars and other snack foods. It’s also mixed with table-top sweeteners such as stevia and monk fruit to add bulk and a sugar-like texture.

The Cleveland Clinic research

The study, published Feb. 27 online in the journal Nature Medicine, initially set out to identify unknown compounds in the blood that could increase the risk of heart attack, stroke or death in people at risk for cardiovascular disease.

The researchers examined blood samples of 1,157 patients undergoing elective cardiac risk assessment at the Cleveland Clinic and then tracked who had a heart attack or stroke or died over the next three years.

Erythritol was at the top of the list of compounds that predicted cardiovascular risk. Compared to people who had the lowest blood levels of erythritol, those who had the highest were twice as likely to have a heart attack or stroke.

To confirm these results, the researchers analyzed blood samples from two other studies, one conducted in the U.S. and the other in Europe.

In both studies, blood levels of erythritol were higher in people who had cardiovascular disease. Higher levels were also found among participants in the U.S. study who had a heart attack or stroke during the study period.

Further experiments conducted in human blood and mice revealed that erythritol made it much easier for cells called platelets to clump together and form a blood clot. Heightened blood clotting can increase the risk of heart attack and stroke.

As part of the study, researchers recruited eight healthy volunteers to drink 300 ml of a beverage sweetened with 30 g of erythritol, an amount found in a serving of many foods containing erythritol.

Blood levels of erythritol increased by 1,000-fold and remained substantially elevated for more than two days in all participants. Notably, the elevated level of erythritol in the bloodstream was well above that which was observed to enhance blood clotting risk.

These findings are observational and do not prove that erythritol directly causes blood clots. They’re also preliminary.

The researchers emphasized the need for “further safety studies examining the long-term effects of artificial sweeteners in general, and erythritol specifically, on risks heart attack and stroke risk, especially in people already at higher risk for cardiovascular disease.” Initial human safety studies looked only at a four-week erythritol exposure.

Reading labels for sugar alcohols, erythritol

Health Canada, like the U.S. Food and Drug Administration and European Food Safety Authority, considers sugar alcohols, including erythritol, safe to add to foods. Consuming too much of a sugar alcohol, however, can cause bloating, gas and diarrhea. (Erythritol is easier on the digestive system than other sugar alcohols.)

To limit your intake of erythritol, which I recommend you do, read labels. If sugar alcohols are added to a food, their total content (in grams per serving) must the declared on the Nutrition Facts table as “Sugar Alcohols” or “Polyols.”

If a food product contains only one type of sugar alcohol, it can either be declared on the Nutrition Facts table individually by its name (e.g., “Erythritol,” “Xylitol”) or collectively as “Sugar Alcohols” or “Polyols.” However, individual sugar alcohols must be listed by their specific name on the ingredient list.

Leslie Beck, a Toronto-based private practice dietitian, is director of food and nutrition at Medcan. Follow her on Twitter @LeslieBeckRD

Sign up for the weekly Health & Wellness newsletter for the latest news and advice.

Follow related authors and topics

Authors and topics you follow will be added to your personal news feed in Following.

Interact with The Globe