This Zero-Calorie Sweetener Was Just Linked to Heart Attack and Stroke

What you need to know about erythritol, a common sugar replacement used in low-calorie, low-carbohydrate and keto products.

If you’re a fan of artificial sweeteners, you might want to reconsider using them moving forward. New research suggests that a popular artificial sweetener is linked to an increased risk of heart attack and stroke. Read on to find out which one, and what you need to know.

What artificial sweetener is linked to heart attack and stroke?

The artificial sweetener in question is called erythritol. A new study by the Cleveland Clinic, published this week in Nature Medicine, found that those with higher levels of erythritol in their blood were at an elevated risk of experiencing a major adverse cardiac event such as heart attack, stroke or death. The study also suggests that erythritol may cause blood clotting.

The news came as a surprise to scientists. “We never expected this. We weren’t even looking for it,” Stanley Hazen, a researcher at Cleveland Clinic and lead author of the study, told CNN. Erythritol, Hazen said, has “become the sweetheart of the food industry,” and is a very popular additive to keto and other low-carb products—and is even found in foods marketed to people with diabetes.

Researchers studied over 4,000 people in the United States and Europe. The study shows that in participants who consumed an artificially sweetened beverage with a typical amount of erythritol found in many processed foods, markedly elevated levels in the blood are observed—and continue to be elevated for days. “Levels well above those observed to enhance clotting risks,” said Hazen.

Artificial sweeteners are widely used sugar substitutes, but little is known about their long-term effects on heart disease risks. “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,” said Hazen, who added that further studies to examine the long-term effects of the artificial sweetener are necessary.

What is erythritol and what products is it in?

Erythritol is a type of carbohydrate called a sugar alcohol that people use as a sugar substitute. It has about 70% of the sweetness of sugar and is considered zero-calorie. At low levels, it’s found naturally in fruits and vegetables such as grapes, mushrooms, pears and watermelon and also fermented things like cheese, wine and beer.

The issues appear to be when erythritol is used in processed foods and drinks, such as those targeting people on a keto diet. Erythritol is in alternative sweeteners such as stevia and monk fruit products.

Should I avoid products with erythritol?

While more research needs to be done, some suggest limiting the intake of products with erythritol. For now, research suggests that 30 grams of the substance are enough to make blood erythritol level spike to a dangerous level. Thirty grams is roughly the equivalent of eating a pint of keto ice cream, Hazen told CNN.

Other researchers suggest cutting it from your diet completely. “At the current knowledge we have, I would not recommend people use it,” Karsten Hiller, a biochemist and specialist in human metabolism at the Braunschweig Institute of Technology in Germany, told USA Today.

What can I use instead of erythritol sweeteners?

Los Angeles-based, board-certified holistic nutritionist Katie Bressack, INHC, AADP recommends that if you’re looking to cut erythritol sweeteners completely, you can try using natural sugars, like maple syrup (in mindful doses!) or honey—in fact, check out the recent study that discovered honey may help lower cholesterol and blood sugar.

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