The sweetener is erythritol, a zero-calorie sugar substitute popular with people who have diabetes. Some patients were being checked for heart disease. Those with more erythritol in their blood had more heart attacks, strokes and other major heart and blood vessel events within three years. And erythritol made platelets clot more easily.
Summary: People with diabetes often use artificial sweeteners in place of table sugar. But new studies show they are not fully safe, mostly when used without limits. Used too much, they can also worsen insulin resistance. They can harm other body chemistry too. The new study shows that one of them, erythritol, may even raise the risk of heart attack and stroke over time. It seems to make platelets clump more.
Fast-absorbing carbs, such as table sugar, are broken down and absorbed quickly. Too much of them can make blood sugar spike. That is a special problem for people with diabetes. They have trouble controlling their blood sugar. Over time, that can lead to many problems. Table sugar, also called sucrose, is a common fast-absorbing carb. The body quickly breaks it into glucose and fructose, which can raise blood sugar. That is a problem for people with diabetes. Their bodies may not make enough insulin to handle the extra sugar. Cutting sugar matters for everyone, but most of all for people with diabetes. Too much sugar can lead to heart disease, nerve damage, and kidney disease over time. To cut sugar, many people turn to sweeteners with no calories. Common ones include aspartame, sucralose, and erythritol. Erythritol is a natural sweetener made from fermented corn or other natural sources. It has no calories and does not spike blood sugar. That makes it popular with people with diabetes. Sweeteners like erythritol can help cut sugar and calories. But they can have side effects. For example, some people get bloating, gas, or diarrhea from them. Some also worry that large amounts over time may raise the risk of some cancers. If you use sweeteners often, know they are not as safe as many believe. Because they taste sweet, they still raise insulin and worsen insulin resistance over time. They also seem to harm gut bacteria, with many bad effects on health. In recent years, researchers have found many side effects of these sweeteners. These are more likely in people who use them too often. Until recently, they were thought to be at least safe for the heart. People thought using them might even improve heart health in people with diabetes. But new studies show that some sweeteners, like erythritol, may not be good for the heart. A new study shows that erythritol may raise the risk of heart disease. The study looked at how erythritol affects heart and metabolic disease over the long run. The researchers ran a series of tests to find the possible risks associated with erythritol consumption. First, they broadly screened the blood of patients being checked for heart risk. They measured several sweeteners in the blood, including erythritol. Higher erythritol levels were linked to a higher risk of major adverse cardiovascular events (MACE) within three years. That means heart attack, stroke and similar events. To confirm this, they ran blood tests in two more groups. These were stable patients having planned heart checkups. Patients with more erythritol in their blood had a significantly higher risk of MACE than those with less. They also ran lab and animal tests to see how erythritol might raise the risk. Erythritol made platelets more reactive in the lab and made clots form more readily in animals. That suggests it may raise the risk of blood clots and heart events. Finally, the researchers ran a small trial in healthy volunteers. They gave the volunteers erythritol and measured their blood levels and platelet reactivity. Eating erythritol caused big, lasting rises in blood erythritol. Those rises came with more reactive platelets and a greater chance of clots. So erythritol may raise the risk of heart events and blood clots. But the researchers stress that more studies are needed on the long-term safety of erythritol and other sugar swaps. They also warn against using sweeteners freely in place of sugar. This matters most for people who already have heart risks.
Swapping foods is rarely enough on its own. That is why diet counseling sits inside a broader medical weight loss program instead of standing alone.
Frequently asked questions
What is erythritol?
Erythritol is a zero-calorie sweetener made from fermented corn or other natural sources. It does not spike blood sugar. That made it a popular swap for table sugar among people with diabetes. It sits on the shelf next to aspartame and sucralose as a common sugar substitute. It is the one this study tied to heart attack and stroke.
Why are people avoiding erythritol?
Some patients were being checked for heart disease. Those with higher blood erythritol had a significantly higher risk of heart attack, stroke and other major heart and blood vessel events within three years. The finding held in two separate groups. In lab and animal tests, erythritol made platelets more reactive and clots form more easily. That points to how the harm happens.
How does erythritol affect blood clotting?
Erythritol makes platelets, the cells that start a blood clot, more reactive. In a small trial, healthy volunteers ate it. Their blood erythritol rose sharply and stayed high. Their platelets became more reactive, with a greater tendency to clot. More clotting is the path to heart attack and stroke.
Can heart patients have erythritol?
The researchers gave a warning. People who already have heart risks should not use sweeteners freely in place of sugar. The higher risk showed up in patients already being checked for heart disease. If your heart is part of your medical picture, erythritol is not the safe free pass it was once thought to be.
Are artificial sweeteners safe for people with diabetes?
Not fully, especially when used heavily. Because they taste sweet, they still raise insulin and worsen insulin resistance over time. They also upset gut bacteria. Some people get bloating, gas or diarrhea. Side effects are more likely in frequent users. Cutting sugar matters, but a sweetener is not a free substitute for it.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
