A Common Low-Calorie Sweetener May Raise Blood Clotting Risk

• A recent study found a connection between the artificial sweetener erythritol and an increased risk of blood clots.
• After consuming erythritol, participants showed a sharp spike in platelet activity, indicating a greater chance of blood clot formation.
• While the findings align with previous research, further studies are needed to fully understand the potential health risks of erythritol.
• As a precaution, experts advise avoiding erythritol and opting for small amounts of natural sweeteners like 100% stevia or pure maple syrup.

A new study from Cleveland Clinic researchers suggests that consuming a 30-gram serving of erythritol, a popular artificial sweetener, could rapidly raise the risk of blood clots.

The findings were published August 8 in Arteriosclerosis, Thrombosis and Vascular Biology .

Erythritol is commonly found in diet, low-calorie, and sugar-free food and drink products, particularly those marketed for keto diets . It is often blended with stevia and monk fruit sweeteners to enhance their bulk.

In the study, researchers examined the effects of erythritol or regular sugar on blood platelets, which play a crucial role in blood clotting. They found that typical amounts of erythritol appear to significantly increase platelet activity, raising potential concerns about an elevated risk of blood clots. Sugar did not have this effect on platelets.

Blood clots form within a blood vessel and may travel to the heart, causing a heart attack, or to the brain, potentially resulting in a stroke. A blood clot can also travel to the lungs, leading to a pulmonary embolism.

The findings from this new study echo the research team’s 2023 findings linking erythritol with a higher risk of heart attack and stroke . This concerning data suggests it may be time to reevaluate erythritol’s safety as a food additive.

Popular sweeteners like Truvia and certain Splenda products contain erythritol as a key ingredient. Both Splenda (Heartland Food Products Group) and Truvia declined Healthline’s request to comment on these new findings.

The Calorie Control Council (CCC), which represents the low- and reduced-calorie food and beverage industry, told Healthline the findings were “misleading.”

“For more than 30 years, global authorities have repeatedly confirmed the safety and efficacy of erythritol and other low and no-calorie sweeteners,” the CCC representative said.

Erythritol linked to blood clots

The new study looked at healthy people with normal kidney function. It involved 20 volunteers, averaging about 30 years old, including both males and females.

After fasting overnight, 10 participants drank water mixed with 30 grams of sugar (glucose), while the other 10 had water with 30 grams of erythritol. Blood samples were taken before they drank and again 30 minutes later.

In those who consumed erythritol, blood levels of erythritol rose dramatically — over 1000 times higher than initial levels. These participants also showed a significant increase in platelet aggregation (clumping) when exposed to certain triggers and an increase in specific markers released from platelets.

There were no changes in platelet reactions after glucose consumption, emphasizing erythritol’s unique effect on platelet function.

Although the study was small and examined the effects of only one dose shortly after consumption, it raises concerns about erythritol’s potential to increase the risk of blood clot formation when consumed in typical daily amounts.

These results follow another recent study by the same researchers, which found that xylitol , another artificial sweetener , may similarly increase blood clotting risk in healthy adults.

This highlights the need for further research into the long-term health effects and cardiovascular safety of sugar alcohols like erythritol and xylitol, especially for those at higher risk of blood clots.

Is erythritol safe?

Erythritol is commonly marketed as a natural and healthy alternative to traditional sugar because it is calorie-free and naturally occurs in small amounts in some fruits and vegetables.

However, erythritol is also commercially manufactured through a fermentation process and used in larger amounts as a food additive than would naturally occur in foods.

While many sweetener products contain erythritol as a primary ingredient, it is also found in many other processed foods and drinks, including:

• sugar-free gum
• energy bars
• some diet sodas
• protein shakes

The amount of erythritol used in the present study (30 grams) reflects the typical daily amount that people consume from food and drinks based on data from the 2013 to 2014 National Health and Nutrition Examination Survey and FDA calculations from 2001.

However, given the steady rise in artificial sweetener use , daily intakes of erythritol may have increased since these estimations were made.

Once consumed, erythritol is not digested. It enters the bloodstream through the intestine and is primarily excreted through urine, remaining unchanged.

The body naturally produces small quantities of erythritol, but any extra intake from the diet can build up in the blood, as seen in the current study.

Even though there is growing evidence questioning its safety, the FDA still considers erythritol as “ generally recognized as safe (GRAS) .” This means that erythritol is deemed safe for the general population to consume in typical daily amounts from food and drink products.

Should you avoid erythritol?

Erythritol has previously been recommended as a sugar alternative for people with chronic conditions like obesity, diabetes, and heart disease.

While erythritol is widely used and remains classified as GRAS, experts are now urging caution and advising against its use.

“The GRAS designation relies on the assumption that a substance is safe based on existing research and historical use, but this approach may not always account for long-term or cumulative risks,” Thomas M. Holland, MD , a physician-scientist and assistant professor at the RUSH Institute for Healthy Aging, RUSH University, College of Health Sciences, not involved in the study, told Healthline.

“While the FDA requires safety parameters to be established and data to be publicly accessible, this does not eliminate the need for consumers to stay informed and cautious,” he warned.

Holland suggested that people should “err on the side of caution” regarding artificial sweeteners like erythritol, especially for individuals at risk of cardiovascular issues or with conditions related to an increased risk of blood clots.

Kiran Campbell , a registered dietitian nutritionist at Dietitian Insights, echoed this sentiment, urging the FDA to reconsider erythritol’s safety.

She told Healthline that consumers should avoid erythritol as a precaution until we know more, especially because nearly half the adult population “has some form of heart disease, including stroke, and may be taking antiplatelet medications.”

Campbell also highlighted the World Health Organization’s (WHO) updated 2023 guidelines , which advise against using non-nutritive (zero-calorie) sweeteners for weight loss or chronic disease prevention.

What is a good substitute for erythritol?

Holland emphasized the importance of being cautious with food additives and prioritizing natural, whole foods , as these don’t contain harmful additives and instead offer recognized health benefits.

Both Holland and Campbell also advised that, in small amounts, minimally refined natural sugars and sweeteners could be safer alternatives to artificial sweeteners like erythritol. These include:

• pure grade A honey
• pure maple syrup
• dates
• coconut sugar
• 100% stevia extract (calorie-free)
• 100% monk fruit extract (calorie-free)

“While a diet low in added sugars is ideal, occasional consumption of natural sugars is likely safer than relying on artificial alternatives, given the current evidence,” Holland said.

“However, even natural sugars should be consumed sparingly to prevent long-term negative effects , such as metabolic disorders ,” he cautioned.

Takeaway

A new Cleveland Clinic study shows that a 30-gram serving of erythritol, a common artificial sweetener, might significantly raise the risk of blood clots.

The research highlights that even substances considered safe by regulatory bodies could pose potential risks, especially for individuals with existing health issues.

As evidence mounts against erythritol and other artificial sweeteners, experts advise consumers to avoid these products as a precaution and consider choosing natural sugar and sweetener alternatives in moderation.