Sugar is a known health risk for several metabolic diseases, including diabetes, obesity, and cardiovascular diseases. But are sugar substitutes risk-free?

Adding more evidence to the increased risk associated with sugar substitutes, researchers of a recent study have identified that erythritol, a common low-calorie sweetener, could raise the risk of heart attacks and strokes.

A team of Cleveland Clinic researchers came across startling findings while they were investigating the physiological effects of common sugar substitutes. Based on the study results published in the journal Arteriosclerosis, Thrombosis, and Vascular Biology, the researchers now caution that erythritol might not be as safe as food regulatory agencies currently classify it, calling for a reevaluation of its use.

Erythritol is a naturally occurring sugar alcohol found in fruits and vegetables and is a byproduct of glucose metabolism in human tissue. Since it is a low-carbohydrate sweetener, it is used in many "keto" products. Both the U.S. Food and Drug Administration (FDA) and the European Food Safety Authority classify erythritol as GRAS, (generally recognized as safe). This classification allows its unrestricted use in food products.

The new study points to the cardiovascular risk associated with erythritol, suggesting that even a standard serving size of the sweetener could raise blood clot risk.

"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. These findings underscore the importance of further long-term clinical studies to assess the cardiovascular safety of erythritol and other sugar substitutes," senior and corresponding author Dr. Stanley Hazen said in a news release.

In a study conducted last year, it was found that cardiac patients with high erythritol levels were twice as likely to experience a major cardiac event within the next three years compared to those with lower levels. Additionally, the study revealed that adding erythritol to patients' blood or platelets increased clot formation.

To further investigate the effects of erythritol on blood platelets, researchers used a human intervention study that tested its use on 20 healthy individuals. The participants ingested erythritol in the form of a standard "sugarless" soda or muffin and compared the results with glucose consumption.

The researchers then noted that after consumption of erythritol products, the level of erythritol in the blood increased by over 1,000 times compared to before. Additionally, the study showed that blood clotting increased after consuming erythritol, but this effect was not seen after consuming glucose.

"This research raises some concerns that a standard serving of an erythritol-sweetened food or beverage may acutely stimulate a direct clot-forming effect. Erythritol and other sugar alcohols that are commonly used as sugar substitutes should be evaluated for potential long-term health effects, especially when such effects are not seen with glucose itself," said study co-author Dr. W. H. Wilson Tang.

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