Zero-calorie sweetener is increasingly common ingredients in soft drinks, processed foods and personal care products because of the growing obesity epidemic worldwide

Artificial sweeteners are widely used as sugar substitutes, but up until now little has been known about their long-term health risks. No longer.

According to the latest study published in the journal Nature, a sugar replacement called erythritol has been linked to blood clotting, stroke, heart attack and death.

The significant study will have an impact as artificial sweeteners have been widely introduced into the food chain over the past few decades to reduce sugar and calorie intake.

Artificial sweetener is increasingly common ingredients in soft drinks, processed foods and personal care products, because of the growing obesity epidemic worldwide

Patients with metabolic diseases, including type 2 diabetes and obesity, are frequently advised that the use of artificial sweeteners in place of sugar can improve glycemic control and help achieve weight loss.

Erythritol is a sugar alcohol that is commonly used as a sugar substitute. It is naturally present in low amounts in fruits and vegetables, but when incorporated into processed foods, it is typically added at levels 1,000-fold higher. The daily intake of erythritol in the total US population has been estimated to reach up to 30g per day in some participants based on the 2013–2014 National Health and Nutrition Examination Survey data and FDA filings.

Upon ingestion, erythritol is poorly metabolized and mostly excreted in the urine. Consequently, erythritol is characterized as both a ‘zero-calorie’ or ‘non-nutritive’ sweetener and a ‘natural’ sweetener, leading to its rapidly rising popularity and predicted doubling in market share within the sweetener sector in the next 5 years.

But little is known about circulating erythritol levels and cardiometabolic risks.

“However, there is growing epidemiological evidence linking the consumption of artificial sweeteners to adverse cardiometabolic phenotypes, such as weight gain, insulin resistance, type 2 diabetes and cardiovascular disease (CVD), including atherothrombotic complications and cardiovascular mortality,” says the study.

“Following exposure to dietary erythritol, a prolonged period of potentially heightened thrombotic risk may occur. This is of concern given that the very subjects for whom artificial sweeteners are marketed (patients with diabetes, obesity, history of CVD and impaired kidney function) are those typically at higher risk for future CVD events,” the study adds.

It further reveals that the artificial sweeteners saccharin and sucralose were linked to impaired glycemic responses in participants.

“In a population-based prospective cohort study with repeated dietary records, ingestion of multiple artificial sweeteners (for example, aspartame, acesulfame potassium and sucralose) was associated with CVD risk,” the study adds.

The Calorie Control Council – an international association representing the low and reduced-calorie food and beverage industry – says the findings indicate that varying levels of erythritol found in the body were associated with increased risk of cardiovascular events and could contribute to blood clots.

“The results of this study are contrary to decades of scientific research showing reduced-calorie sweeteners like erythritol are safe, as evidenced by global regulatory permissions for their use in foods and beverages, and should not be extrapolated to the general population, as the participants in the intervention were already at increased risk for cardiovascular events,” says Robert Rankin, Executive Director, Calorie Control Council, adding that erythritol is a proven safe and effective choice for sugar and calorie reduction.

“For more than 30 years, (erythritol) has been used in reduced-sugar foods and beverages to provide sweetness, as well as enhance their taste and texture. Along with exercise and a healthy diet, reduced-calorie sweeteners are a critical tool that can help consumers manage body weight and reduce the risk of non-communicable diseases, such as cardiovascular disease,” he adds.

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