Zero-calorie sweetener linked to blood clots and heart disease risk, study finds

(CNN) — Consuming a beverage containing erythritol — an artificial sweetener used to bulk up stevia and monk fruit and to sweeten low-carb keto products — more than doubled the risk of blood clotting in 10 healthy people, a new pilot study found.

Clots can break away from blood vessels and travel to the heart, causing a heart attack, or to the brain, causing a stroke. Previous research has linked erythritol to an increased risk of stroke, heart attack, and death.

“What’s remarkable is that in every subject, every measure of platelet reactivity (clotting) increased after erythritol ingestion,” said the study’s lead author, Dr. Stanley Hazen, director of the Center for Cardiovascular Diagnosis and Prevention at the Cleveland Clinic. Lerner Research Institute.

Consuming a drink containing an equal amount of glucose, or sugar, did not affect blood platelet activity in another group of 10 people, said Hazen, who is also the Jan Bleeksma Chair in Vascular Cell Biology and Atherosclerosis at the Cleveland Clinic.

“This is the first direct comparison of the effects of glucose versus erythritol ingestion on several different measures of platelet function,” Hazen said. “Glucose does not impact clotting, but erythritol does.”

Although small, the study was “very intriguing and interesting,” said Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver.

“I’m not saying we should stop using these sugar alcohols immediately, but this line of research certainly raises the question: Are they safe or not?” said Freeman, who was not involved in the research.

In response to the study, the Calorie Control Council, an industry association, told CNN that 30 years of science has shown erythritol to be a “safe and effective choice” for reducing sugar and calories.

“Consumers should interpret the results of this pilot project with extreme caution. The limited number of participants, 10 in total, received an excessive amount of erythritol, nearly four times the maximum amount allowed in a beverage in the United States,” council chair Carla Saunders said in an email.

However, the amount of erythritol used in each drink in the study — 30 grams — was about the same as what’s found in regular soda, ice cream or sugar-free muffins, of which people often eat more than one, Hazen said.

“This research raises some concern that a standard serving of an erythritol-sweetened food or beverage may acutely stimulate a direct clot-forming effect,” study co-author Wai Hong Wilson Tang, MD, director of heart failure and cardiac transplantation research at Cleveland Clinic, said in a statement.

What are sugar alcohols?

Like sorbitol and xylitol, erythritol is a sugar alcohol, a carbohydrate naturally present in many fruits and vegetables. The human body also produces erythritol as a byproduct of glucose metabolism, but only in small amounts.

Artificially manufactured in large quantities, erythritol has no lingering aftertaste, does not raise blood sugar, and has less of a laxative effect than some other sugar alcohols. It has about 70% of the sweetness of sugar and is considered calorie-free, experts say.

Erythritol is the largest ingredient by weight in many “natural” stevia and monk fruit products, Hazen said. It looks and tastes like sugar and can be used in baking. It’s also a key ingredient in many keto-friendly products, including ice cream, Hazen said.

“If you look at the nutrition labels on a lot of keto ice creams, you’ll see ‘reducing sugar’ or ‘sugar alcohol,’ which are terms for erythritol,” he told CNN in a previous interview.

“You will find that a typical pint contains between 26 and 45 grams.”

Artificially created erythritol, along with its cousins, is considered “generally recognized as safe,” or GRAS, by the U.S. Food and Drug Administration.

A series of studies show similar results

The study, published Thursday in the journal Arteriosclerosis, Thrombosis, and Vascular Biology, asked 20 participants to fast overnight in preparation for a morning blood draw. Then they were given a drink containing either 30 grams of erythritol or 30 grams of sugar. After 30 minutes, another blood draw was taken.

Blood levels of erythritol increased a thousandfold after consuming a drink containing the substance, while blood sugar increased slightly after consuming a drink containing glucose. However, it was the change in platelet activity that was surprising, Hazen said.

“We saw an improvement in clotting, using measures of how quickly clots block a vessel or stop blood flow, which is similar to a model of a heart attack or stroke,” he said.

Similar results appeared in a 2023 study by Hazen and colleagues in which eight healthy volunteers also consumed the same amount of erythritol and saw a thousand-fold increase in the substance in their blood.

“(Erythritol) remained elevated above the threshold necessary to trigger and increase the risk of clotting for the next two to three days,” Hazen said at the time.

This study also analyzed the blood of more than 4,000 people in the United States and Europe and found that those with the highest levels of erythritol were twice as likely to have a heart attack or stroke.

“What we see with erythritol is that platelets become extremely reactive: a simple 10% stimulant produces 90 to 100% of the clot formation,” Hazen said.

The studies were conducted on healthy people without chronic diseases; however, the study results still apply to the future, Hazen said.

“However, if you look at middle-aged America, the average person has two to three risk factors for heart disease, and 70 percent of us will develop heart disease in our lifetime, so maybe we should all consider taking action,” he said.

When it comes to cardiovascular disease risk, it’s better to occasionally eat small, sugary treats than to consume sugary drinks and foods with sugar alcohols, he added. This is especially true for people at higher risk for blood clotting, heart attack and stroke, such as those who already have heart disease or diabetes.

“Cardiovascular disease develops over time and is the leading cause of death worldwide,” he said. “We need to make sure that the foods we eat are not hidden factors.”

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