A New Study Links a Popular Zero-Calorie Sweetener to Blood Clots and Heart Disease. Here’s What a Cardiologist Wants You to Know

If you’ve ever tried to cut back on your sugar intake with zero-calorie swaps, you’ve most likely had erythritol. It’s a sugar alcohol often used to sweeten up things like baked goods, ice cream, sodas, candy, and even protein bars without adding extra calories.

Erythritol's safety has been an ongoing debate among doctors and consumers. It’s previously been linked to a higher risk of stroke and heart attacks, but according to the FDA, it’s GRAS (generally recognized as safe) to eat.

Here, a cardiologist weighs in on the new research and breaks down the risk.

A closer look at the study

The study, published in the journal Arteriosclerosis, Thrombosis, and Vascular Biology, had an extremely limited sample size—only 20 people. Some participants were given water sweetened with 30 grams of erythritol, while others drank water sweetened with 30 grams of regular sugar. Thirty minutes afterward, everyone had their blood drawn. The participants who drank the erythritol-sweetened beverage showed high levels of blood platelet activity (clotting), but there was no change for the participants who drank sugar water.

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“Erythritol is poorly metabolized by the body, meaning that it is hard for your body to get rid of it, especially if you consume it in large quantities," says Nikki Bart, MD, a heart failure and heart transplant cardiologist at the Victor Chang Cardiac Research Institute. "There is an emerging signal here that it may not be as safe as previously believed.”

But, Dr. Bart adds: “The results should be taken with the caveat that the total number of people studied is small." However, this isn't the first study to link erythritol with problematic effects. "The same group published a population-based study last year linking higher levels of erythritol to cardiovascular events in 4,000 people,” she notes.

Dr. Bart says given how limited the study is, more research linking erythritol to cardiovascular events is necessary. It’s also important to note that the study participants were given a lot of erythritol in one sitting (more than you would typically get from drinking one zero-sugar soda or eating one erythritol-sweetened protein bar), which likely affected the results.

What does this mean for people who monitor their blood sugar and choose zero-sugar options?

Although more research needs to be done to draw any firm conclusions, it may be best to limit erythritol and other artificial sweeteners in your diet, especially if you live with chronic conditions like diabetes, high blood pressure, and heart disease.

In general, “sugar and sugar substitutes should be limited and avoided where possible,” Dr. Bart says. “Sugar substitutes themselves have been linked to obesity, diabetes, and other health conditions. Plus, they are artificial and can be pro-inflammatory.”

The best option to sweeten foods, she says, is fruits and vegetables, which have added nutritional benefits.

What can people do to lower their risk of blood clots?

Beyond limiting erythritol and other artificial sweeteners, Dr. Bart says maintaining a healthy weight is most important for reducing blood clot risk.

According to the Mayo Clinic, blood clot risk can also be lowered by doing the following:

• Avoid sitting for long periods of time
• Practice daily movement, even if it’s just a light walk
• Stay hydrated
• If you have high blood pressure, take steps to lower it
• Stop smoking

The bottom line is, there’s a lot we still don’t know about the body’s response to erythritol. As a general rule of thumb, though, whole, unprocessed foods like fresh fruits and vegetables are undisputedly better than anything chemically made. But more investigating has to be done to determine the long-term effects of artificial sweeteners on health.

—reviewed by Jennifer Gilbert, MD, MPH