Artificial sweetener in diet drinks and protein bars may increase risk of heart attack

Cleveland Clinic's latest research shows that erythritol, a seemingly less harmful alternative to sugar, can cause cardiac problems

Erythritol is increasingly used as a ‘less harmful’ alternative to sugar. Getty
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Hidden artificial sweeteners used in sugar-free products and diet drinks could lead to increased risk of a heart attack or stroke, US researchers said.

Erythritol is a naturally occurring substance in many fruits such as peaches, grapes, pears and watermelons, but is also added as a sweetener to food and drinks.

Commonly found in diet foods, frozen desserts, protein bars, chewing gum and fruit spreads, erythritol has become increasingly used as a ‘less harmful’ alternative to sugar by providing sweetness without triggering a spike in blood glucose.

But the research found it can make platelets in the blood more likely to “activate” — release molecules into the blood — and form a clot.

Cardiovascular disease builds over time, and we need to make sure the foods we eat aren’t hidden contributors
Dr Stanley Hazen of Cleveland Clinic

As erythritol is low on the glycemic index, it is ideal for diabetics and people following low-carb diets and is much lower in calories than regular sugar.

Cleveland Clinic researchers studied 4,000 people to assess the health impact of erythritol and published the results in the Nature Medicine journal.

The study found those with higher blood erythritol levels were at elevated risk of experiencing a major adverse cardiac event such as a heart attack, stroke or death.

“Cardiovascular disease builds over time, and heart disease is the leading cause of death globally,” said Dr Stanley Hazen, chairman of the department of cardiovascular and metabolic sciences at Lerner Research Institute and co-section head of preventive cardiology at Cleveland Clinic.


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“We need to make sure the foods we eat aren’t hidden contributors.

“Our study shows that when participants consumed an artificially sweetened beverage with an amount of 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.”

He encouraged further research into the long-term effects of erythritol.

Researchers examined the effects of adding erythritol to either whole blood or isolated platelets, which are cell fragments that clump together to stop bleeding and contribute to blood clots.

Results revealed that erythritol made platelets easier to activate and form a clot, while preclinical studies confirmed ingestion of erythritol heightened clot formation.

Erythritol is about 70 per cent as sweet as sugar and is produced through fermenting corn.

It is often recommended to people looking for an alternative to sugar to manage body weight.

Erythritol is generally recognised as safe by the US Food and Drug Administration which means there is no requirement for long-term studies into its effects, despite the recommendation from doctors.

“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,” said Dr Hazen.

Updated: February 28, 2023, 8:32 AM