low-calorie and sugar-free food products,
Artificial sweeteners, present in thousands of food and beverage sold worldwide, and widely available online, remain a controversial topic. When consuming popular artificial sweeteners, it is best to do it with caution. Image Credit: Gulf News | Screengrabs


  • Artificial sweeteners remain a contetious topic. Two huge studies have found a link between consumption of popular artificial sweeteners (AS) and cardiovascular events.
  • Persons with higher blood erythritol levels have an “elevated risk” of cardiac event — a recent study on 4,000 people found.
  • Another team of researchers, using vast amounts of data from 100,000 people, found increased risk of heart attack and stroke with high-AS consumption.

From their inception, new sugar substitutes have been promoted as effective alternatives to curb the body-wasting effects of sugar. They satisfy our cravings.

Problem solved. Everybody happy.

Then, a method to extract the protein praseine, a sugar alternative touted as “2,000 times sweeter” and is “most likely nontoxic”, has kicked up even more excitement.

Problem really solved. End of story. Or so it seems.

Researchers, however, threw in a cautionary note: The safety profile of these sweeter-than-sugar alternatives should be further investigated.

Two new research using huge data sets, however, bear out the need for caution.

Cleveland Clinic study

Cleveland Clinic published a study showing erythritol, a derivative of corn fermentation and is around 70 per cent sweeter than sugar, is linked to heart disease and stroke.

The study was published in February in the highly respected journal Nature Medicine. It is timely: The market for the popular sweetener — frequently used as a sweetener in foods with fewer calories, candies, or bakery goods — is on the rise.

An estimated $444.1 million worth of the erythritol was sold across the world in 2020, a number seen growing by 5.5 per cent annually until 2028, according to Grand View Research.


Data from 4,000 people

The study dissected data from nearly 4,000 participants in the US and Europe. The result, in a nutshell, revealed an “elevated risk” of cardiac event — such as a heart attack, stroke, or death.

In particular, the study checked the effects of adding erythritol to either whole blood or isolated platelets — the cell fragments that “clump together” to stop bleeding and contribute to blood clots.

They found that erythritol made platelets easier to activate and form a clot. This confirms earlier pre-clinical studies confirmed ingestion of erythritol heightened clot formation.

○ Blood clots are gel-like collections of blood that form in your veins or arteries when blood changes from liquid to partially solid.

○ It happens when your blood thickens. This can be dangerous when clots form in the arteries or veins.

What’s the problem with blood clots?

In general, blood clots that form in the veins in your legs, arms, and groin can break loose and move to other parts of your body, including your lungs.

That’s why the study’s senior author, Dr Stanley Hazen, chairman for the Department of Cardiovascular & Metabolic Sciences in Lerner Research Institute and co-section head of Preventive Cardiology at Cleveland Clinic, advise caution, at the very least. He argues their findings warrant confirmatory studies.

“Cardiovascular disease builds over time, and heart disease is the leading cause of death globally. We need to make sure the foods we eat aren’t hidden contributors,” he was quoted as saying by Cleveland Clinic’s in-house publication.

“Sweeteners like erythritol, have rapidly increased in popularity in recent years but there needs to be more in-depth research into their long-term effects,” he added

Aspartame, acesulfame potassium, sucralose study

The Nature Medicine study follows a previous study that came out in the highly respected British Medical Journal (BMJ) on July 1, 2022.

In that study, it looked closely into the associations between artificial sweeteners from all dietary sources (beverages, but also table top sweeteners, dairy products, etc), overall and by molecule (aspartame, acesulfame potassium, and sucralose), and risk of cardiovascular diseases (overall, coronary heart disease, and cerebrovascular disease).

There were 103, 388 participants, with an average of age of 42.2 of whom nearly 80 per cent are female.

The data, based on the NutriNet-Santé study Dietary, assessed the intakes and consumption of artificial sweeteners through repeated 24-hour dietary records, including brand names of industrial products.

Study highlights

In a nutshel, the total artificial sweetener intake was associated with increased risk of cardiovascular diseases, resulting in 1,502 “events”. Above the gender-specific median, the study found an “absolute incidence rate” of 346 per 100,000 in people who recorded to have consumed higher amounts of the sweeteners.

For non-consumers of artificial sweeteners, the “absolute incidence rate” was 314 per 100, 000 persons.

It also found the following:

Artificial sweeteners were more particularly associated with cerebrovascular disease risk (777 events) — with incidence rates at 195 per 100, 000 person years in people with higher consumption. For non-consumers, it was 150 per 100,000 persons.


Aspartame intake was associated with increased risk of cerebrovascular events — equivalent to an incidence rate of 186 per 100,000 years for high AS consumption crowd.

For non-AS consumers, it was 151 per 100, 000 person.

Acesulfame potassium

Acesulfame potassium was associated with increased coronary heart disease risk (730 events per 100,000 person years) for high-AS consumer group, versus 164 per 100,000 person years for non-AS group.

READ: Aspartame is 'possibly' carcinogenic, yet safe at common use levels, says WHO


Sucralose was also associated with increased coronary heart disease risk. With absolute incidence rates of 271 per 100,000 person years for high-consumption group, vs 161 per 100,000 for non-AS consumer group.


While erythritol is generally considered safe for consumption, some studies have reported potential negative effects of consuming erythritol in high amounts. Here are some findings from studies on the negative effects of erythritol:

  • Digestive symptoms: Some people may experience digestive symptoms such as bloating, gas, and diarrhea when consuming large amounts of erythritol. This is because erythritol is not fully absorbed by the body and passes through the digestive system largely intact.
  • Headache and migraine: A study published in the journal Food and Chemical Toxicology reported that consuming high amounts of erythritol may trigger headaches and migraines in some people.
  • Allergic reactions: While rare, some people may have an allergic reaction to erythritol. Symptoms of an allergic reaction may include rash, itching, swelling, and difficulty breathing.
  • Metabolism: A study published in the European Journal of Clinical Nutrition reported that erythritol may have an impact on the metabolism of certain amino acids, which could potentially affect protein synthesis.
  • Heart disease/stroke: New findings from large-scale studies show high consumption of erythritol could trigger a re-evaluation by regulators and health authorities.
Image Credit: Gulf News

These studies, though extensive and statistically significant, do not have the final word on the subject matter. The clinical observation studies only show “association” rather than “causation”. A definitive causation study could be the next logical step in research on the subject. 


Previous studies have already raised concerns over how sugar substitutes increase insulin resistance and glucose intolerance. Experts say it is best to ‘train’ the mind to deal with sugar cravings.