New research carried out by the Cleveland Clinic has associated erythritol, a popular artificial sweetener, with an increased risk of heart attack and stroke.

To carry out the study, researchers analysed over 4,000 people in the US and Europe, finding that those with higher blood erythritol levels were at an “elevated risk of experiencing a major adverse cardiac event such as heart attack, stroke or death”.

Additionally, the researchers examined the effects of adding erythritol to either whole blood or isolated platelets (cell fragments that clump together to stop bleeding and contribute to blood clots). The results revealed that erythritol made platelets easier to activate and form a clot. In fact, the researchers have added that pre-clinical studies confirmed ingestion of erythritol heightened clot formation.

“Sweeteners like erythritol, have rapidly increased in popularity in recent years but there needs to be more in-depth research into their long-term effects,” said Dr Stanley Hazen, Senior Author of the study, Chairman for the Department of Cardiovascular & metabolic Sciences in Lerner Research Institute and Co-Section Head of Preventive Cardiology at Cleveland Clinic.

“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.”

While artificial sweeteners, such as erythritol, can be used in replacement of table sugar in low-calorie, low-carbohydrate and “keto” products, the sweetener can be found in other products too.  The researchers have noted that sugar-free products containing erythritol are “often recommended for people who have obesity, diabetes or metabolic syndrome and are looking for options to help manage their sugar or calorie intake”.

“People with these conditions also are at higher risk for adverse cardiovascular events like heart attack and stroke,” explained the study authors.

Noting the difficulties that come with analysing sweeteners, the researcher expressed that “measuring artificial sweeteners is difficult and labelling requirements are minimal and often do not list individual compounds”. However, the US Food and Drug Administration (FDA) have said that erythritol is “Generally Recognized As Safe (GRAS)”, meaning there is no requirement for long-term safety studies.

Going forward, the study authors have said that follow-up studies will be important to confirm their findings in the general population because, as it stands, the study “has several limitations, including that clinical observation studies demonstrate association and not causation”.

“Our study shows that when participants consumed an artificially sweetened beverage with an amount of erythritol found in many processed foods, markedly elevated levels in the blood are observed for days – levels well above those observed to enhance clotting risks,” said Dr. Hazen.

“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,” concluded Dr Hazen.