Common artificial sweeteners linked to higher rates of heart attack and stroke

Research showcases the need for further safety studies.


Artificial sweeteners are widely used sugar substitutes, but little is known about their long-term effects on cardiometabolic disease risks. 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. 

A new Cleveland Clinic study examined the risk of commonly used sugar substitute erythritol and atherothrombotic disease. 

It suggests that erythritol, a popular artificial sweetener, increases the risk of heart attack and stroke.

Almost 4,000 persons were evaluated in the U.S. and Europe. It was discovered that those with greater blood erythritol levels were more likely to die from a major adverse cardiac event such as a heart attack, stroke, or death. Scientists also looked at the effects of adding erythritol to isolated platelets or whole blood, which are fragments of cells that clump together to stop bleeding and help form blood clots. The outcomes showed that erythritol promoted platelet activation and clot formation. Pre-clinical research proved erythritol consumption increased clot formation.

Senior author Stanley Hazen, M.D., Ph.D., chairman of the Department of Cardiovascular & Metabolic Sciences at Lerner Research Institute and co-section head of Preventive Cardiology at Cleveland Clinic, said, “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. Cardiovascular disease builds over time, and heart disease is global’s leading cause of death. We need to make sure the foods we eat aren’t hidden, contributors.”

Erythritol is made by fermenting corn and is around 70% as sweet as sugar. The body poorly metabolizes Erythritol after consumption. Instead, it enters the bloodstream and primarily exits the body through urine. Because the human body typically produces only little amounts of erythritol, any additional consumption might accumulate.

Artificial sweeteners are challenging to measure, and the basic labeling requirements frequently do not list particular compounds. As erythritol is “Generally Recognized As Safe (GRAS),” according to the FDA, long-term safety studies are unnecessary.

The authors note the importance of follow-up studies to confirm their findings in the general population. The study had several limitations, including that clinical observation studies demonstrate association and not causation.

Dr. Hazen said“Our study shows that when participants consumed an artificially sweetened beverage with 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. 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.”

Journal Reference:

  1. Witkowski, M., Nemet, I., Alamri, H. et al. The artificial sweetener erythritol and cardiovascular event risk. Nat Med (2023). 10.1038/s41591-023-02223-9


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