Artificial sweetener may be linked to heart attack, stroke

Artificial sweetener may be linked to heart attack, stroke

While cutting sugar from your diet isn’t always easy, the increased popularity and availability of foods containing artificial sweeteners is creating a new concern. According to research published in Nature Medicine, consuming one type of artificial sweetener may not be the safest way to curb cravings.

The study reveals that erythritol, a zero-calorie artificial sweetener, has been linked to heart attack and stroke. Erythritol is found naturally in many vegetables and fruits such as watermelon, pears and grapes. It can also be added to processed foods, drinks, frozen desserts and homemade baked goods.

Study participants with high levels of erythritol in their bloodstream were twice as likely to have a heart event, such as a heart attack or stroke, compared to those with the lowest levels of erythritol. Researchers think high levels of erythritol are triggering the formation of blood clots.

“You may not have any signs or symptoms of an impending blood clot around your heart,” explains Heather Klug, a registered dietitian with the Karen Yontz Women’s Cardiac Awareness Center at Aurora St. Luke’s Medical Center in Milwaukee, Wis.

Klug says when signs of a blood clot do show, the most common are severe pain in the chest or arm, sweating, and trouble breathing. A blood clot in the brain may present problems with vision or speech, seizures, or general feelings of weakness.

Why is erythritol popular?

Erythritol has increased in popularity, in part, because of the keto diet. The artificial sweetener is found in many keto products lining grocery store shelves. Additionally, erythritol is often paired with stevia to offset a bitter aftertaste without increasing a consumer’s blood sugar levels.

Unlike other sugar alcohols, erythritol is recommended to patients because it doesn’t lead to digestive issues like gas, bloating, diarrhea and stomach cramps. Klug says that recommendation may be changing with this latest research.

“It should be noted that this study doesn’t prove cause and effect — it provides associations,” explains Klug. “The study’s subjects were over the age of 60 and either had existing heart disease or were at higher risk for heart disease, which may have skewed the numbers. Until we know more, limiting the amounts of erythritol and other artificial sweeteners are my best words of advice.”

Klug’s advice is consistent with recent guidance from the World Health Organization, advising against the use of non-sugar sweeteners to control weight or reduce risk of noncommunicable diseases.

To satisfy cravings, Klug suggests eating healthy foods that contain natural sugar and nutrients, such as colorful fruits and small amounts of dark chocolate. Sweet spices like cinnamon, nutmeg and allspice can also be used in foods like oatmeal and yogurt. If more sweetness is desired, try adding unrefined sugars like honey, pure maple syrup or date sugar.

“There are still calories attached to these sugars, so don’t go on a sugar binge,” warns Klug. “Like many things in life – moderation is key. If you use artificial sweeteners, keep the amount as small as possible and limit how often you consume them.”

Want to learn more about your risk for heart disease? Take a free online quiz to learn more. 

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  1. From my research, the all-around safest “natural sweetener” is pure Stevia. ALL artificial sweeteners including the alcohol-based are highly processed and border on toxic. Some sweeteners labelled STEVIA are as much as 99% maltodextrin which is harmful to diabetics. The downside to Stevia is that it stimulates the “hunger hormone” and causes cravings that must be resisted.

    • Hi James. Thank you for your comment. At this time, raw stevia does appear to be the safest substitute for sugar. While studies show that maltodextrin can increase blood glucose levels, the actual amount contained in a stevia mixture is small unless someone is using large amounts. The amount recommended for most stevia/maltodextrin products is 1/4 teaspoon, which equals the sweetness of two teaspoons of sugar (the amount of maltodextrin in the 1/4 teaspoon is less than one gram, which shouldn’t increase blood glucose levels substantially). Blood glucose levels will also be better regulated if stevia/maltodextrin is consumed with a meal that contains protein and fat. The bigger concern would be consuming stevia/maltodextrin in commercially bought drinks such as sports drinks and also sugar-free desserts since the amounts would be much larger. Adding a small amount of stevia with maltodextrin to coffee or tea shouldn’t be a concern unless using large quantities of it.

      I couldn’t find research to corroborate your statement that stevia stimulates the hunger hormone. Research seems to support the opposite per the two studies below. Cravings occur for multiple reasons: stress, feeling overwhelmed, boredome, the sight of food, the smell of food, etc… Every body is different though. Most cravings come on quickly and dissipate within 10-15 minutes. Drink water and distract yourself with a non-food related activity to help the craving pass.,intake%20and%20postprandial%20glucose%20levels.

  2. So is anything artificial. At least this one is natural and taste good. I hate Stevia. It taste so bad.

    • Hi Janet. Yes, erythritol does taste good. If you plan to continue consuming it, just use small amounts to reduce the risk of blood clots as discussed in the article. Like many things, it’s the dosage/amount that’s the problem. Stevia does have a bitter aftertaste that takes a little getting used to. Everyone has different taste buds and it sounds like it’s hitting the bitter taste buds on your tongue. If you do decide to consume stevia, stick to smaller amounts to reduce bitterness. The bitter aftertaste can be offset some by using vanilla extract and sweet-tasting spices such as cinnamon. When I make coffee, I add cinnamon or homemade pumpkin pie spice to the coffee grounds and add just a small amount of raw stevia (about 1 tsp) to the brewed coffee.

      • Mars A Caulton May 21, 2023 at 5:04 pm

        Great recommendation, Heather. Bakers often put a dried vanilla bean in their sugar jar. I’m a concerned stevia-only user, and maybe the vanilla bean trick in my stevia jar will help me cut down. Thanks!

  3. Briefest summary on the erythritol finding from the blood study, thank you. Somehow I had not remembered the over 60 and high risk participants info which until more studies are done with younger healthier participants and looking beyond the causal relationship (unexpected finding) we don’t know enough except to assume if we likely should reduce/avoid or use in moderation.. Personally I will try to avoid as I am closer to participants age/risk and have had a mild stroke.

    Anyone know of any health concerns about allulose? I guess my concern is everyone thought erythritol was naturally occurring and safe until this studies surprise findings. Why would. Not be surprised if allulose also a naturally occurring in some foods we eat is also found to surprise concerns if we consuming at lever many times the amount we could ever eat from some whole fruits.

    My go to ‘natural’ sweeteners are monk fruit concentrate and allulose (rare sugar naturally accruing in small amounts in some fruits like figs). I’m not a big fan of the taste ‘cooling effect’ or general taste of erythritol except as medium to carry more concentrated sweeteners like stevia & monk fruit. I find stevia too bitter, and intolerable in hot drinks, but I like allulose and monk fruit in hot and cold drinks.

    Though I find stevia (STV / reb A) products too bitter but due like the reb M (sweetest of stevia compounds with one company (purecane) making it commercially from fermented sugarcane). Less bitter than stevia products but like many stevia products attached to erythritol crystals, but can be less erythritol than many stevia products. I like reb M best with fruit flavored items, and my second favorite in coffee, but it is also its products are made with erythritol.

    My favorite ‘natural’ sugar replacements is allulose and monk fruit used together which I use daily in my mornings coffee replacing decades old of sugar use. I assume it is just how I taste things, of the traditional chemical artificial sweeteners I much prefer sucralose, but hate it’s taste hot.

    • Thank you for reading the article. To answer your question on allulose and health concerns. Based on the current studies, allulose seems to be fine in small amounts, but in large amounts (>30 grams per day), it causes gastointestinal issues such as diarrhea, bloating, and cramps. For people with IBS, it can especially cause these issues.

      Food labels won’t always list allulose (or other low-calorie sweeteners for that matter) since they aren’t required to do so by the FDA, so if you see it listed in the ingredient list, use in small amounts. One teaspoon of allulose is 4 grams.

  4. Charlotte Serazio May 18, 2023 at 12:25 pm · Reply

    I have been using Stevia for the past nine years and it did take some getting used to insofar as it being extremely sweet, but I got over that and just brought down the amount used to replace actual sugar. Stevia has helped me lose weight and I have no side effects whatsoever. I recommend it wholeheartedly. People should also note that
    Aspartame is used in the “Sugar Free” form of Metamucil which I would not use and go for the Metamucil with the Sugar…it is a small amount of sugar in comparison to the long term effects of Aspartame.

    • Hi Charlotte. I just wanted to mention that Metamucil also makes a version with stevia in place of aspartame. Otherwise the original version made with regular sugar is fine, too. It’s only 5 calories more per teaspoon vs the versions with aspartame or stevia.


    • I agree with you agree Laylah. There’s a strong connection between what we eat & drink and our health. For everyone, the best option is for optimal health is to eat foods closest to their natural state (vegetables, fruit, beans, whole grains, nuts, seeds, etc…). I don’t see the FDA changing their position on food additives that are designated generally recognized as safe (GRAS). The good thing is that each of us are in control of what we buy and decide to put in our mouth. The more people write/email the FDA about these additives, the more they may change their mind. Until then, vote with your wallet by buying whole foods and limiting processed foods.

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About the Author

Danielle Mandella
Danielle Mandella

Danielle Mandella, health enews contributor, is a public affairs coordinator in Greater Milwaukee, Wis.