Researchers found a strong link between sugar alcohols, especially erythritol, and a higher risk of heart attacks and strokes.

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Erythritol is a natural sugar substitute made by fermenting corn, called a sugar alcohol. Other sugar alcohols are sorbitol and xylitol. Because they are all natural, the FDA does not consider them to be food additives. Other artificial sweeteners like aspartame and saccharine are made from chemicals in a laboratory. These artificial sweeteners can be up to 700 times sweeter than real sugar.

Erythritol has become a favorite of the food and diet industry because it looks like sugar, tastes like sugar, and it is only 30 percent as sweet as sugar. It can be mixed with an artificial sweetener to give it the texture and the look of sugar without the sickly-sweet taste of the artificial versions. Erythritol makes up the bulk of sugar substitutes like Stevia and monk fruit. It is also in many antioxidant drinks, energy drinks, low calorie ice cream, Splenda, Truvia, Keto foods, and many other processed foods. Foods labeled sugar-free, low carbohydrate, diet, or diabetic commonly contain erythritol.

Read Maltitol: What You Should Know About This Common Sweetener

The Dark Side of Erythritol

In a March 2023 study published in the journal Nature Science, researchers who were looking for unknown chemicals in blood samples of people with heart attack or stroke risk – called cardiovascular disease risk – report an unexpected and worrisome discovery. After three years, they were surprised to find a strong link between sugar alcohols, especially erythritol, and a higher risk of heart attacks and strokes.  Hoping to find clues to identify cardiovascular risk, they had started with 1,157 blood samples in people with risk factors like high blood pressure, heart disease, and diabetes. Most were between the ages of 60 and 70.

To confirm this link, they looked at another 2,149 blood samples from the U.S. and 833 samples from Europe, all with similar risks for cardiovascular disease. In all the samples, erythritol was associated with a higher risk of stroke, heart attack, and death from cardiovascular disease within three years. People with erythritol levels in the lowest 25 percent had an increased risk of about 20 percent, but people in the highest 25 percent had double that risk, an amount of risk that would be about the same as having diabetes.

To find out how erythritol might increases the risk of heart attack and stroke, the research team looked at the effects of erythritol on blood clotting. Blood clots are a major event leading to a heart attack or stroke. They found that erythritol added to laboratory blood samples increased the activity of blood clotting cells called platelets. When erythritol was added to the blood samples, platelets became more active and made bigger clots.

Read Aspartame Side Effects: Recent Research Confirms Reason for Concern

What’s Next for Artificial Sweeteners?

Based on decades of research, the FDA still classifies sugar alcohols GRAS, generally regarded as safe. We know that real added sugar increases cardiovascular risk factors like diabetes, obesity, and high cholesterol. Sugar substitutes may reduce these risks. So, do the benefits still outweigh the risks?

This study and other recent studies have found an association between sugar substitutes and cardiovascular risk, but in research, association may not mean cause. Sugar substitutes have been shown to increase cravings for sweets, so extra calories from sweets may be a cause. People with higher cardiovascular risk factors like obesity or diabetes may use more sugar substitutes, so the risk may already be there. Sugar substitutes are usually added to highly processed foods, which are bad for you, even without the extra sweetness.

Sugar alcohols are naturally found in vegetables and fruits in safe levels, but in processed foods or when used as a sugar substitute in your coffee, you are getting about 1000 times more than the natural sources. According to the researchers and other experts who reviewed this study, people with cardiovascular disease should consider avoiding sugar alcohols like erythritol, and people without risk factors should limit their use until we have more studies.