Artificial sweeteners and sugar substitutes directly linked to heart attacks and strokes

Sugar substitutes and artificial sweeteners show up in many diets and “low-calorie” products, promoted as a way to help people enjoy sweet flavors without the usual calories.

Some folks pick them to help manage weight goals or reduce daily sugar intake. Others look for sugar-free snacks to limit changes in blood glucose.

Their popularity reflects a common desire to avoid sugar-related pitfalls. Yet concerns continue to surface about how these substances may affect overall health.

Senior and corresponding author Stanley Hazen, M.D., Ph.D., from Cleveland Clinic’s Lerner Research Institute, addresses these questions through new findings on certain sugar substitutes.

Sugar substitutes – the basics

There are many forms of “sugar substitutes,” also known as artificial sweeteners. Aspartame, sucralose, saccharin, and sugar alcohols such as erythritol and xylitol are available in various items labeled “diet” or “low-calorie.”

They offer sweetness in small amounts because many are far sweeter than table sugar. Saccharin, for example, is typically hundreds of times sweeter than sugar, so only a tiny dose is required.

They also appeal to those trying to manage their weight. Some people believe replacing sugar with these products helps them avoid extra calories.

Others rely on them to reduce sudden spikes in blood sugar, which can be appealing to individuals with conditions like diabetes.

Divide in the scientific community

Several regulatory agencies consider many of these sugar substitutes acceptable at certain daily intake levels. Some nutritional guidelines encourage their use when people need to cut back on simple carbohydrates.

“Many professional societies and clinicians routinely recommend that people at high cardiovascular risk – those with obesity, diabetes, or metabolic syndrome – consume foods that contain sugar substitutes rather than sugar,” Dr. Hazen explained.

“These findings highlight the importance of further long-term clinical studies to assess the cardiovascular safety of erythritol and other sugar substitutes.”

Though these products are labeled “Generally Recognized as Safe,” the way individuals actually consume them raises questions that may not have been fully covered in past research.

Some experts would like to see broader and longer studies on potential effects beyond weight management.

Sugar substitute called Erythritol

Over time, scientists wondered if all sugar substitutes behave the same way in the body. A Cleveland Clinic team looked at erythritol, a sugar alcohol found in sugarless items such as gum and certain snack products.

During an intervention study with healthy volunteers, they noticed a pattern that prompted follow-up.

“This research raises some concerns that a standard serving of an erythritol-sweetened food or beverage may acutely stimulate a direct clot-forming effect,” said study co-author W. H. Wilson Tang, M.D., research director for Heart Failure and Cardiac Transplantation Medicine at Cleveland Clinic.

“Erythritol and other sugar alcohols commonly used as sugar substitutes should be evaluated for potential long-term health effects, especially when such effects are not seen with glucose itself.”

Xylitol also has issues

Those same scientists saw that xylitol, another sugar alcohol, displayed similar behavior in the bloodstream.

Individuals with higher xylitol levels appeared to have an increased likelihood of experiencing serious cardiac-related events over the following few years.

Since these trends emerged in people already facing cardiovascular issues, the question has become whether these substances could pose added risks.

Some products are marketed as keto-friendly, which has further boosted the reputation of sugar alcohols for those on very low-carb diets.

While xylitol and erythritol fit the profile for reduced-calorie sweetening, this latest work suggests that they merit deeper research to see how they interact with blood and overall heart function in various groups.

Balancing sweetness and safety

In light of the new data, there are suggestions for caution, particularly if a person has conditions linked to thrombosis or other cardiac complications.

“I feel that choosing sugar-sweetened treats occasionally and in small amounts would be preferable to consuming drinks and foods sweetened with these sugar alcohols, especially for people at elevated risk of thrombosis, such as those with heart disease, diabetes, or metabolic syndrome,” Dr. Hazen advises.

“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.”

Manufacturers often include sugar substitutes in a range of drinks and snacks. Some individuals like them simply because they believe they promote better control of caloric intake.

Yet researchers suggest that people who already have heart-related issues or metabolic conditions pay special attention to how often they rely on these sweeteners.

Why does any of this matter?

One reason experts remain cautious is the fact that sweetener consumption can vary widely from person to person. Some drink several diet beverages a day or frequently snack on sugar-free treats.

Guidelines about upper intake levels were developed when long-term cardiovascular outcomes were less clear.

Now, these studies may prompt new evaluations of how all sugar alcohols behave in those at high risk for blood clots.

Whether someone chooses sugar alternatives for weight management or portion control, these details introduce fresh reasons to check in with a healthcare provider.

An individual plan that considers medical history and personal risk factors can be valuable when figuring out how often to use products sweetened with substances like erythritol or xylitol.

What’s next for sugar substitutes

Opinions differ about whether these sugar substitutes fully serve their intended purpose. Some see them as helpful for limiting sugar.

Others consider them a source of unintended problems when used regularly, especially in people with a history of heart disease or metabolic disorders.

As new information continues to emerge, discussions may lead to fresh guidelines or label requirements that highlight potential cardiovascular considerations.

For now, moderate consumption and a balanced diet remain popular approaches. Artificial sweeteners may fit into certain meal plans, but the recent research from Cleveland Clinic invites extra thought about possible drawbacks.

Reading labels and talking with trusted healthcare professionals can help people figure out the best mix of sweet options in daily life.

That awareness may allow many to avoid unwelcome surprises while still keeping their favorite flavors on the menu.

The full study was published in the journal Arteriosclerosis Thrombosis and Vascular Biology.

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