Common Sweetener Linked to Increased Clotting and Cardiovascular Risk

According to a study published in Nature Medicine, elevated levels of erythritol in the blood are linked with an increased risk of cardiovascular events, including heart attack and stroke.

Sweet beginnings

Erythritol belongs to a group of artificial sweeteners called sugar alcohols. Less sweet than sugar but lower in calories, these sweeteners are an attractive option for those trying to lose weight, manage their diabetes or avoid tooth decay. Other examples include xylitol (a likely ingredient in your chewing gum) and sorbitol.

Erythritol is a popular sugar substitute as it has a similar flavor profile, “mouthfeel” and texture to table sugar, however it can pass through the body without being metabolized because humans lack the enzymes required to break down such sugar alcohols.

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Don’t sugarcoat it

In the current study, researchers from the Cleveland Clinic investigated the association between higher circulating levels of erythritol in patients who experienced major adverse cardiac events (MACE), including stroke, non-fatal heart attack or death.

Of the sugar alcohols that exist, erythritol is of interest because manufacturers tend to add increased quantities of it in foods due to its reduced sweetness. It is also used to “bulk” out other sweeteners, as it adds a weight and volume, similar to sugar. Individuals who may be eating or drinking products containing erythritol to manage conditions such as obesity or diabetes are already at higher risks for adverse cardiovascular events like heart attack and stroke.

After confirming an association between blood erythritol levels and incident MACE risks using over 4,000 subjects in both the US and Europe, the researchers, led by Dr. Stanley Hazen, MD, examined the effects of adding erythritol to either whole blood or isolated platelets. The latter are cell fragments that clump together to stop bleeding and contribute to blood clots that cause stroke and heart attack.

The study revealed that erythritol made platelets easier to activate and form a clot. “Our findings reveal that erythritol is both associated with incident MACE risk and fosters enhanced thrombosis,” the authors write. Thrombosis is the formation of a blood clot – also known as a “thrombus”.

“Our studies show that when healthy volunteers consumed an artificially sweetened beverage with an amount of erythritol observed in many processed foods, markedly elevated levels in the blood are observed for days – levels well above those observed to enhance clotting risks,“ Hazen said “The question is whether it's safe for some of us to be consuming this much erythritol – and for an extended period of time.”

The research supports launching further investigation to determine the long-term effects of sugar alcohols. “Sweeteners like erythritol, because they appear naturally, had minimal requirements to pass through the regulatory process, but there needs to be more in-depth research into long-term effects,” said Hazen,

“Cardiovascular disease builds over time, and heart disease is the leading cause of death globally. We need to make sure the foods we eat aren’t hidden contributors.”

Reference: Witkowski M, Nemet I, Alamri H, et al. The artificial sweetener erythritol and cardiovascular event risk. Nat Med. 2023:1-9. doi: 10.1038/s41591-023-02223-9

This article is a rework of a press release issued by the Cleveland Clinic. Material has been edited for length and content.