Not So Sweet: The Effects of Artificial Sweeteners

"Zero sugar" artificial sweeteners, are they a healthy choice? Some common calorie-free sweeteners might be better for a slimmer waistline than heart health. It is easy to believe that foods labeled "zero sugar" are better for us; however, little is known about its long-term effects. Artificial sweeteners are widely used sugar substitutes, the most common being erythritol. A new research study published on February 27, 2023, in Nature Medicine shows that a particular artificial sweetener, erythritol, significantly increases the risk of heart attack, stroke, and CVD (Cardiovascular Disease). Over the last few years, erythritol has grown increasingly popular as it is used in many "low-carb" and processed foods.

So, what is erythritol? Erythritol belongs to a group of carbohydrates called sugar

alcohols. Erythritol is used in Truvia and Swerve, two very popular sweeteners. There are many other choices for sugar substitutes, including xylitol (Sweet'N Low), sorbitol, and mannitol, but they are used less. Because of how sugar molecules are structured, they stimulate a sweet taste on the tongue receptors. Although erythritol has been manufactured, it can also be found naturally in certain fruits and vegetables. Erythritol is a low-nutritive sweetener. This means it is processed using a type of yeast to ferment glucose from wheat or corn starch. After this process, the finished product looks like powdery white crystals. The human body does not produce the enzymes needed to break down erythritol; instead, the molecule is excreted in the urine in its original state. Erythritol differs from other artificial sweeteners because it contains fewer calories than other commonly used sweeteners. Listed below are some popular sweeteners and the number of calories in each.

Based on the numbers above, erythritol provides only 6% of the calories found in an equal amount of table sugar; however, it still contains 70% of the sweetness. This explains why erythritol is so widely popular; because of its low-calorie content, many people use it as a sweetener.

So far, all these things about erythritol sound good, but it also has a not-so-sweet side. The recent multi-part study published in Nature Medicine shows that erythritol is linked to major cardiovascular events, including heart attack, stroke, and CVD. In this three-part study, researchers discovered the following:

1. Researchers found that 1,157 patients undergoing cardiac assessment had an increased risk of cardiovascular events due to high erythritol levels.

2. Researchers also found that adding erythritol to whole blood or isolated platelets led to blood clots.

3. The study shows that ingesting 30 grams of an erythritol-sweetened drink (such as a soda or keto ice cream) led to elevated and prolonged levels of erythritol in plasma.

This is not the first study showing that artificial sweeteners have been linked to cardiovascular events. Last September, in 2022, a large-scale study found that artificial sweetener intake from all sources, including aspartame (Equal and NutraSweet), acesulfame potassium (Sunett and Sweet One), and sucralose (Splenda), was associated with an overall increased risk of cardiovascular and cerebrovascular disease (stroke or mini-stroke). Intake of aspartame was particularly associated with an increased risk for cerebrovascular events, whereas acesulfame potassium and sucralose were associated with an increased risk of coronary heart disease.

While erythritol may be a good sugar substitute in terms of calories, it may not be a risk worth taking when it comes to inadvertently increasing the risk of cardiovascular events. Before purchasing a product, check the ingredient list and watch out for the terms erythritol or "sugar alcohol" to avoid any potential risks. Avoiding artificial sweeteners seems to be the sweeter choice for overall heart health.

References

“Trending Clinical Topic: Artificial Sweetener Safety.” Medscape, 10 Mar. 2023, reference.medscape.com/viewarticle/989122. Accessed 20 Mar. 2023

Busko, Marlene. “Artificial Sweetener in Keto-Related Foods Tied to CV Risk.” Medscape, 2 Mar. 2023, www.medscape.com/viewarticle/988861. Accessed 20 Mar. 2023

BSc, Kris Gunnars. “Erythritol — Like Sugar Without the Calories?” Healthline, 13 Mar. 2023, www.healthline.com/nutrition/erythritol. Accessed 20 Mar. 2023

Witkowski, Marco, et al. “The Artificial Sweetener Erythritol and Cardiovascular Event Risk.” Nature Medicine, vol. 29, no. 3, Nature Portfolio, Feb. 2023, pp. 710–18. doi.org/10.1038/s41591-023-02223-9. Accessed 20 Mar. 2023