Common sweetener erythritol tied to higher risk of stroke and heart attack

• Researchers investigated the link between the common artificial sweetener erythritol and cardiovascular risk.
• They found that erythritol is linked to increased cardiovascular risk.
• Further studies are needed to confirm the results.

Individuals with metabolic conditions such as type 2 diabetes and obesity are often advisedTrusted Source to consume products that replace sugars with artificial sweeteners to improve blood sugar levels and facilitate weight loss.

However, there are no long-term clinical trials examining the safety of most sweeteners. Some studies suggest that certain sweeteners may be linked to weight gain, cardiovascular diseaseTrusted Source, and type 2 diabetesTrusted Source.

Erythritol is a commonly used artificial sweetener. Although naturally present in small amounts in fruits and vegetables, it is often added to processed foods in 1,000 times higher quantities.

While some studies show that erythritol may have antioxidant effects in animal modelsTrusted Source of diabetes, others show that it may be linked to increased weight gain in college students, and to the onset of type 2 diabetesTrusted Source.

Further study of the effects of erythritol on cardiometabolic risk could inform healthful dietary practices.

Recently, researchers examined the link between erythritol consumption and cardiovascular risk.

They found that erythritol consumption increases cardiovascular risk, including the risk of a heart attack or stroke, thrombosis (blood clotting), and death related to a cardiovascular event.

The results appear in NatureTrusted Source.

Dr. John Alan Galat, a cardiac surgeon with Novant Health in Charlotte, NC, not involved in the study, commented about its findings to Medical News Today. According to him:

“This article [makes] a convincing argument that one of the more common sugar substitutes — erythritol — may very well increase the risk for heart attack and stroke. [The authors nevertheless] concede that much more investigation needs to be done. The important question is whether the benefits of reduced sugar and caloric intake outweigh the risk of consuming products with these sugar substitutes.”

What the researchers did

The researchers first analyzed blood samples from 1,157 participants. They found multiple compounds linked to cardiovascular risk. However, erythritol had some of the strongest links to the risk of cardiovascular events.

Next, the researchers analyzed blood samples from 2,149 participants from the United States and from 833 European participants. Plasma levels of erythritol were higher among participants with cardiovascular disease.

They also found that participants in the U.S. and European cohorts with the highest 25 percentile erythritol blood levels were 2.5 and 4.5 times more likely to have a cardiovascular event than those in the lowest 25 percentile.

Each micromoleTrusted Source increase in erythritol levels was linked to a 21% and 16% increase in cardiovascular event risk in U.S. and European cohorts, respectively.

Next, the researchers set out to see how erythritol impacted blood clotting. Through multiple tests, they found that increased erythritol levels indicated higher rates of clot formation and increased thrombosis potential.

Lastly, the researchers examined the effects of consuming a snack or drink containing 30 grams (g) of erythritol in eight participants. While erythritol levels were low at baseline, they remained 1,000-fold higher for hours after ingestion.

“It is important that further safety studies are conducted to examine the long-term effects of artificial sweeteners in general, and erythritol specifically, on risks for heart attack and stroke, particularly in people at higher risk for cardiovascular disease,” notes senior author Dr. Stanley Hazen, chairman of the Department of Cardiovascular and Metabolic Sciences in Lerner Research Institute and co-section head of Preventive Cardiology at Cleveland Clinic.

Erythritol and cardiovascular risk

To understand how erythritol might increase heart attack and stroke risk, MNT spoke with Dr. Rigved Tadwalkar, a board-certified cardiologist at Providence Saint John’s Health Center in Santa Monica, CA, not involved in the study.

He noted that erythritol facilitates mechanisms needed for platelet aggregation and thrombosis, which are both key for developing heart attack or stroke.

“As cardiovascular disease is a process that is more complex than platelet aggregation alone, it is possible that erythritol causes other pathophysiologic changes on the molecular level to increase the risk for a cardiovascular event. Complicating matters, it appears that consuming erythritol-sweetened foods increases plasma erythritol levels for days, potentially prolonging cardiovascular effects.”

– Dr. Rigved Tadwalkar

Dr. John Hwa, professor of cardiology at Yale School of Medicine, not involved in the study, also told MNT that indirect mechanisms by which erythritol increases cardiovascular risk may include effects on the microbiome and nutrient absorption and metabolism.