Sugar substitutes are popular and commonly found in many foods and drinks we consume. They provide the taste of sugar without the sugar- and fewer calories. Some have no calories at all. But it’s not all good news. Some people may experience side effects from consuming sugar substitutes- ranging from headaches and digestive upset- to the alarming finding of one new study- heart attack and stroke. The sugar substitute linked to the increased risk is Erythritol, a sugar alcohol.
Other sugar substitutes include:
- agave nectar
- date sugar
- sorbitol (commonly found in sugar-free foods and drinks)
- mannitol (similar in taste/flavor to sugar)
- xylitol (often found in chewing gums)
- hydrogenated starch hydrolysates (HSH)
artificial sweeteners (FDA approved varieties)
- Acesulfame potassium (Ace-K)
- Luo Han Guo fruit extracts
- High-purity steviol glycosides (Stevia rebaudiana)
While there are many options, erythritol is widely used in the food industry. “Erythritol looks like sugar, it tastes like sugar, and you can bake with it,” said Hazen, who also directs the Cleveland Clinic’s Center for Microbiome and Human Health.
“It’s become the sweetheart of the food industry, an extremely popular additive to keto and other low-carb products and foods marketed to people with diabetes,” he added. “Some of the diabetes-labeled foods we looked at had more erythritol than any other item by weight.”
The new study, published in Nature Medicine shows that erythritol has been linked to blood clotting, stroke, heart attack and death.
“The degree of risk was not modest,” said lead study author Dr. Stanley Hazen, director of the Center for Cardiovascular Diagnostics and Prevention at the Cleveland Clinic Lerner Research Institute.
People with existing risk factors for heart disease, such as diabetes, were twice as likely to experience a heart attack or stroke if they had the highest levels of erythritol in their blood, according to the study.
“If your blood level of erythritol was in the top 25% compared to the bottom 25%, there was about a two-fold higher risk for heart attack and stroke. It’s on par with the strongest of cardiac risk factors, like diabetes,” Hazen said. In fact, the study revealed that the sugar alcohol was causing blood platelets to more easily clot. If those clots break off, they can result in a heart attack or stroke.
How does the study translate to everyday life?
Prior to this study, the American Heart Association (AHA) and American Diabetes Association (ADA) had given a cautious nod to the use of sugar substitutes in place of sugar to combat obesity, metabolic syndrome, and diabetes, all risk factors for heart disease. According to the National Cancer Institute and other health agencies, there’s no sound scientific evidence that any of the artificial sweeteners approved for use in the United States cause cancer or other serious health problems. Numerous studies confirm that artificial sweeteners are generally safe in limited quantities, even for pregnant women. But it cannot be denied that the most recent findings are alarming- especially considering the prevalence of the sweetener in the food market.
The researchers highlight that their findings, while alarming, do require additional research to determine if the data goes beyond the association of erythritol and blood clotting. While the correlation is there, additional studies can better outline the level of risk to our health. However, “For people who are at risk for clotting, heart attack and stroke – like people with existing cardiac disease or people with diabetes. . .there’s sufficient data here to say stay away from erythritol until more studies are done,” Hazen said.
Other factors to consider
Sugar substitutes are typically far more potent than table sugar and high-fructose corn syrup. A small amount produces a sweet taste comparable to that of sugar, without the calories. But, over stimulation of sugar receptors from frequent use of these sweeteners may limit tolerance for more complex tastes, researchers say. That means people who routinely use substitutes may start to find less intensely sweet foods, such as fruit, unappealing and less sweet foods, such as vegetables won’t seem appealing at all.
This is less than ideal if you’re turning away from healthy foods that provide nutritional value you need. Fruits and veggies are high in nutrients, low in glycemic load, and high in fiber, while also providing a bit of natural sugar. All those factors benefit our health. Artificial sugars increase blood glucose levels, cause inflammation and free radicals, and can increase the risk for serious health concerns like diabetes and cardiovascular disease.
Sugar substitutes may also prevent us from associating sweetness with caloric intake, leading us to crave more sweets and potentially gain weight. Participants in the San Antonio Heart Study who drank more than 21 diet drinks per week were twice as likely to become overweight or obese as people who didn’t drink diet soda.
To top it all off, it has also been discovered that sweeteners alter your gut microbiota, sometimes leading to glucose intolerance, and an increased risk for diabetes. Healthy bacteria within the gut is targeted as “food” for unhealthy bacteria, leading to an imbalance of bacteria due to some sweeteners not being absorbed. This can wreak havoc on your body- as you’ll read here, where we discuss the importance of gut health.
It sounds great. Change real, high calorie sugars for artificial, zero-calorie options. But sadly, like everything else in life, there is no quick fix. Even though the current studies are constantly being attacked as just “observational” in need of more scientific evaluation, these well-meaning alternatives are showing they too may have alarming consequences. Studies define a large amount of sweetener as around 77 milligrams per day, which is a little less than two packets of tabletop sweetener. In small quantities, sugar substitutes may be acceptable, but sticking with naturally sweetened fruits, vegetables, foods and especially water, are still the best options.