A sugar-free sweetener you might eat daily was just found to raise the risk of heart attacks

A new study indicates that erythritol, a sugar substitute you might find in various products or use to sweeten homemade drinks and food, can increase the risk of blood clotting. Erythritol seems to increase the activity of platelets, a type of blood cells involved in clotting. Cardiovascular events like heart attacks and strokes can occur when clotting happens inside blood vessels.

Cleveland Clinic researchers found last year that cardiac patients with high erythritol levels were twice as likely to experience a major cardiac event in the next three years compared to those who had low levels of erythritol in their bloodstream. A new study builds on that research.

This time, the scientists compared 20 healthy subjects who were divided into two groups. One group was given erythritol, while the other got glucose-sweetened drinks. The people in the first group showed a big spike in blood erythritol, which might impact the formation of clots. Blood sugar didn’t show a similar increase in the glucose group, nor did the activity of the platelets.

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The 20 participants fasted overnight and had blood drawn the following morning. They were then given 30 grams of erythritol or 30 grams of sugar. The researchers drew blood 30 minutes after the participants ingested the two substances.

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The average erythritol level rose over 1,000 times in the erythritol group compared to initial levels. The researchers also observed a significant increase in blood clot formation in the erythritol group compared to the participants who got glucose.

The Calorie Control Council told CNN that 30 years of science back the idea that erythritol is a “proven safe and effective choice” for reducing sugar and calorie intake.

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The council also said that the study participants were given “an excessive amount of erythritol,” or quadruple the maximum amount approved for beverages in the US. Dr. Stanley Hazen, the study’s senior author, said the 30 grams given to one person is the equivalent of what is included in typical sugar-free sodas, ice cream, or muffins. He added that people often eat more than one.

Erythritol is about 70% as sweet as sugar and is produced by fermenting corn. It is considered a safe sugar replacement and might be recommended in diets that reduce calorie intake. The US Food and Drug Administration (FDA) and the European Food Safety Authority classified erythritol as a GRAS (“generally recognized as safe”) ingredient, which is why it’s used as a sugar substitute.

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However, the body does not efficiently metabolize erythritol. It enters the bloodstream and then leaves the body via urine. The human body also creates erythritol as a byproduct of glucose metabolism, but in much smaller quantities. You’d also consume erythritol from fruit and vegetables.

The presence of erythritol in the bloodstream increases the activity of platelets, which can lead to clot formation. If that happens in the heart or brain, a person risks experiencing a heart attack or stroke. Clotting can also occur in blood vessels in other organs.

“I feel that choosing sugar-sweetened treats occasionally and in small amounts would be preferable to consuming drinks and foods sweetened with these sugar alcohols, especially for people at elevated risk of thrombosis such as those with heart disease, diabetes or metabolic syndrome,” Hazen said in a statement . “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.”

Again, this is a limited study involving only 20 people who were observed for a short period. Even the authors say that further clinical studies are needed to assess the long-term cardiovascular safety of erythritol.

That said, the researchers point out that another study from earlier this year that was focused on another sugar substitute offered similar results. Xylitol was also found to increase the risk of heart attack and stroke.

That said, sugar substitutes alone aren’t the only potential risks for cardiovascular events in our food. Unhealthy diets, excess sugar, and lack of exercise are bigger dangers. They can lead to obesity, diabetes, and cardiovascular events. You probably should not reduce the use of sugar substitutes or replace them with more sugar before talking to your doctor.

The new study is available in the journal Arteriosclerosis, Thrombosis, and Vascular Biology .

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