They’re sweet — but they’re not sugar. Artificial sweeteners and sugar substitutes are everywhere, but they also come with concerns that they may contribute to health problems down the road. Now, a new study from Cleveland Clinic suggests that the sugar substitute erythritol raises the risk of cardiovascular issues.
Here’s what we know, and what experts say about the findings.
What is erythritol?
Erythritol is a sugar alcohol, a type of carbohydrate that is almost as sweet as sugar. At just 0.24 calories per gram (compared to table sugar’s 4 calories per gram), it’s a popular choice for sweeteners like Splenda and Truvia, as well as products like lower-calorie ice cream such as Halo Top and candies including Lily’s Chocolate.
Erythritol is produced by the human body, but in low levels. Michelle Routhenstein, a dietitian nutritionist, tells Yahoo Life that when erythritol is consumed in food products, it is absorbed into the bloodstream and later excreted through urine. This causes erythritol to have less of an impact on your blood sugar levels.
What did this study say about erythritol?
The Cleveland Clinic study, which was published in the journal Arteriosclerosis, Thrombosis and Vascular Biology, suggests that erythritol may be linked to cardiovascular issues. The research looked at a small sample size of 20 healthy adults and found that ingesting erythritol made their platelets more hyper-responsive. This can raise the risk of blood clots, which, in turn, can lead to serious conditions such as heart attacks and strokes. This effect was not seen when participants ingested glucose, aka sugar.
Study author Dr. Stanley Hazen, who is chair of cardiovascular and metabolic sciences in Cleveland Clinic’s Lerner Research Institute, tells Yahoo Life that this study follows their previous research that linked elevated erythritol levels with a risk for heart attack and stroke, even among those without known heart disease.
“If your loved one has heart disease especially, I strongly recommend you advise them to avoid erythritol, xylitol and other sugar alcohols,” Hazen says.
What experts say
Jamie Alan, an associate professor of pharmacology and toxicology at Michigan State University, tells Yahoo Life that because this study had only 20 participants, it’s possible that the findings would not hold up with a larger population sample. She also acknowledges that platelet activity is not the only risk factor for blood clots.
Alan agrees, however, that there’s reason to be wary of erythritol, especially if you already have risk factors for blood clots. This includes but is not limited to people who are on oral contraceptives with estrogen, those who have atrial fibrillation, smokers and those at higher risk for stroke (such as having high blood pressure).
“Clots and strokes are life-altering events, and so I think it's appropriate for people who are at risk of these things to start using a lot of caution when they're [consuming] this type of sweetener,” Alan says.
Dr. Joyce Oen-Hsiao, a cardiologist at Yale Medicine, tells Yahoo Life that erythritol isn’t the only artificial sweetener to be linked to increased cardiovascular risk, which she says may be an indication that all sugar alcohols should be avoided for people at high risk for clotting. Sugar alcohol xylitol was also linked with an increased risk of heart attack and stroke, according to recent research.
“Unfortunately we are seeing more risks from artificial sweeteners than originally thought — and it seems to be a risk of the class of sweeteners rather than one specific one,” she says. Oen-Hsiao recommends that people limit their intake of artificial sweeteners whenever possible.
Alan says that more studies need to be done on artificial sweeteners and sugar substitutes as a whole. The immediate risks of artificial sweeteners outside of the sugar alcohol family, such as aspartame, can include gastrointestinal distress, she says.
Routhenstein says that for sweeteners like aspartame, some studies have raised concerns about a link to cancer. However, the majority of research, including reviews by the Food and Drug Administration and other health agencies, has found “no conclusive evidence supporting this risk at typical consumption levels,” she says.
Switching to regular sugar isn’t necessarily the answer either. Oen-Hsiao notes that excess consumption of sugar can lead to diabetes, which also increases risk of cardiovascular events. The American Heart Association advises limiting added sugars to 6% of daily calories, which is about 6 teaspoons (25 grams or 100 calories) for women and 9 teaspoons (38 grams or 150 calories) for men. Oen-Hsiao recommends people choose naturally sweet foods, like berries, when they are craving something sweet as opposed to either type of sugar.
The bottom line
Ultimately, Alan says the artificial sweetener concerns are probably not a “panic issue” — that is, if you've enjoyed treats with the sugar substitute erythritol in the past, you don’t necessarily have to be concerned now. However, “if you are at risk where clots may be an issue for you, you should speak to your doctor to have a conversation about it,” she says.
FAQs
The research looked at a small sample size of 20 healthy adults and found that ingesting erythritol made their platelets more hyper-responsive. This can raise the risk of blood clots, which, in turn, can lead to serious conditions such as heart attacks and strokes.
Is the artificial sweetener erythritol bad for you? ›
More research is needed to further understand possible health risks of erythritol. In addition to increasing your risk of heart attack and stroke, erythritol can cause mild to severe digestive issues if you consume large amounts of it. That includes bloating, cramping, excess gas, and diarrhea.
What is the safest sugar substitute without erythritol? ›
Plant- and fruit-based sweeteners stevia, monk fruit and thaumatin are also deemed safe by the FDA.
Which is healthier, stevia or erythritol? ›
While both Erythritol and Stevia have zero calories, Stevia is associated with more health benefits such as lowering blood pressure and fewer potential side effects. Erythritol can cause nausea and digestive issues for some people while Stevia is known to have no harmful impact on your gut.
What is the safest and most common alternative of sugar? ›
5 Natural Sweeteners That Are Good for Your Health
- Stevia. Stevia is a very popular low calorie sweetener. ...
- Erythritol. Erythritol is another low calorie sweetener. ...
- Xylitol. Xylitol is a sugar alcohol with a sweetness similar to that of sugar. ...
- Yacon syrup. Yacon syrup is another unique sweetener. ...
- Monk fruit sweetener.
Natural sweeteners offer a healthy alternative without sacrificing the sweet taste. Sweeteners like fresh fruit, monk fruit extract, raw honey, pure maple syrup, coconut sugar, and blackstrap molasses can help satisfy a sweet tooth while providing other nutritional benefits.
What artificial sweeteners should I avoid? ›
The worst of the worst culprits include aspartame (found in Equal and NutraSweet), sucralose (found in Splenda), and Saccharin (found in Sweet 'N Low). Many people who cut artificial sugars out of their diets report the improvement of many health problems including migraines, depression, IBS, weight gain, and more.
Which sugar is healthiest? ›
You can opt for coconut sugar, honey, maple syrup, and agave nectar, which are some good and healthy options. Another good option is shakkar, an unprocessed sugar rich in nutrients like zinc, iron, potassium, and magnesium.
Which stevia has no erythritol? ›
Stevia In The Raw® does not contain any added flavors or preservatives. Does Stevia In The Raw® contain erythritol? No, none of our packet, bulk or tablet products contain erythritol.
What sweetener is in co*ke Zero? ›
We sweeten co*ke Zero Sugar in our bottles and cans with a blend of aspartame and acesulfame potassium (or Ace-K). Together, they create a great taste with zero sugar and zero calories. Yes. Diet co*ke in our bottles and cans is sweetened with aspartame.
Erythritol is used in some Splenda Brand Sweetener products. Splenda Original Sweeteners do not contain erythritol. Splenda yellow packets and Splenda yellow granulated sweeteners do not contain erythritol. Below is a list of Splenda products with and without erythritol.
What is a healthy substitute for sugar? ›
Sweeteners like fruit juice, honey, molasses and maple syrup contain natural sugar and have some nutritional benefits. Fruit has fiber, vitamins and antioxidants. Even raw honey and maple syrup can contain antioxidants and minerals like iron, zinc, calcium and potassium.
What sweetener is linked to strokes? ›
June 7, 2024 – High levels of xylitol, a low-calorie sweetener used in many reduced-sugar foods as well as gum and toothpaste, are linked to an increased risk of heart attacks, strokes, and death, says a new study published in the European Heart Journal.
Why was stevia banned? ›
Though stevia was initially banned in the U.S. because some studies suggested it may be linked to cancer, it's no longer prohibited. In fact, in 2008, stevia was granted GRAS status by the FDA - which stands for "Generally Recognized As Safe."
Is honey healthier than sugar? ›
So is there a definitive answer to which is healthier, honey or sugar? Both should be consumed in limited amounts. Honey may have a slight edge, but excess consumption of either is more dangerous to your health than the advantage of choosing one over the other.
What is the most harmful type of sugar? ›
Overall, fructose might have the most harmful effects — when it's an added sugar and you have large quantities.
Is erythritol in stevia or Splenda? ›
Erythritol is used in some Splenda Brand Sweetener products. Splenda Original Sweeteners do not contain erythritol. Splenda yellow packets and Splenda yellow granulated sweeteners do not contain erythritol. Below is a list of Splenda products with and without erythritol.
Which is safer sucralose or erythritol? ›
While many sugar alcohols can cause digestive issues, Erythritol is often a kinder, gentler alternative. A study published in the Nutrients journal in 2021 found that, when compared to other sugar alcohols, Erythritol is less likely to cause gastrointestinal symptoms.
What processed foods contain erythritol? ›
Foods that contain erythritol
Some familiar items that contain erythritol include Truvia®, Splenda®, Vitamin Water Zero®, and Halo Top Ice Cream®, but any chewing gum, jelly, chocolate, hard candy, ice cream, yogurt, diet drink or flavored water could contain this ingredient.
What is a safe daily amount of erythritol? ›
Since erythritol can cause digestive side effects if you eat too much of it, it's important to know the accepted limits and then find out what yours are. In general, it's OK to take in about 0.66 grams per kilogram (g/kg) of body weight a day for men and 0.80 g/kg of body weight a day for women.
