A study by researchers at the Cleveland Clinic reveals that the popular artificial sweetener erythritol increases the risk of heart attack and stroke. The findings were published today in Nature Medicine.

The researchers studied over 4,000 people in the U.S. and Europe and found that individuals with higher levels of erythritol in their bloodstream had an elevated risk of experiencing a major adverse cardiac event such as heart attack or stroke. They also examined the effect of the artificial sweetener on whole blood and isolated platelets, cell fragments that stop bleeding and can clump together to form blood clots. Pre-clinical studies confirmed that consuming erythritol does increase clot formation.

“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 senior author Dr. Stanley Hazen, chairman for the Department of Cardiovascular & Metabolic Sciences in the Lerner Research Institute and co-section head of Preventive Cardiology at Cleveland Clinic. “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.

According to a news release from the Cleveland Clinic, erythritol is 70% as sweet as sugar and is made through fermenting corn. The artificial sweetener is poorly metabolized by the body and instead travels into the bloodstream, leaving the body mainly through urine. Since the human body naturally produces low amounts of erythritol, any additional consumption can accumulate.

The Food and Drug Administration lists erythritol as “Generally Recognized as Safe (GRAS)”, which means there is no requirement for long-term studies. Also, the amount of artificial sweeteners in particular foods are not always listed on food labels.

Artificial sweeteners are common replacements for table sugar for individuals with obesity, diabetes or metabolic syndrome or anyone who is looking for ways to manage their sugar or calorie intake.  People with these conditions are also at higher risk for cardiovascular events. You will also find erythritol in low-calorie, low-carbohydrate and “keto” products, says Cleveland Clinic.

The authors of the new study emphasize the importance of follow-up research to determine if erythritol is causing the heart problems or there is just an association between the artificial sweetener and heart disease.

“Our study shows that when participants consumed an artificially flavored beverage with an amount of erythritol found in many processed foods, markedly elevated levels in the blood are observed for days —levels well above those observed to enhance clotting risks,” said Hazen. “It is important that further safety studies are conducted to examine the long-term effects of artificial sweeteners in general, and erythritol specifically, on risks for heart attack and stroke, particularly in people at higher risk for cardiovascular disease.”