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A new study says a widely-used artificial sweetener may cause heart problems

The back of a red snack bag showing the nutritional label.
Erythritol is 1st Ingredient on Monk Fruit Bag in March 2023 in Chicago. The sugar substitute is now linked to risk of blood clots, heart attack, and stroke.

Erythritol is used as a sugar substitute in a variety of foods. Dr. Brandie Williams, a cardiologist with Texas Health Stephenville, told KERA’s Sam Baker consuming large amounts may lead to serious problems.

About the study results

Increased amounts, when they were studied, showed an increased level of platelets in the blood. This makes it easier to form clots which can then lead to heart attack and stroke. I think more studies are going to need to be done, but it looks like this is a very good study with a lot of people involved.

We're talking about something other than the little pink, blue, and yellow packets we've been opening for years?

Erythritol can be in common artificial sweeteners such as equal, but it can also be in Stevia, monk fruit, and Truvia, and all of these are currently being used a lot by patients who are trying to lose weight or on what we call a keto diet.

Is erythritol what is being referred to on food labels as a sugar substitute? 

Sugar substitutes or no sugar added is a common phrase. Sugar alcohol is another phrase to watch for.

This has been in use for some time. It's not something that manufacturers have just started using.

No, I think it's been in use for a while and FDA has approved it. But I think this study shows that we need further investigation before, quote-unquote, calling it safe.

In the meantime, though, if this is as dangerous as it might be implied, hasn't the damage already been done?

It could have. I think it's important for people who have taken in large amounts of Stevia, Truvia, or Equal that they follow up with their primary care physicians or get referred to a cardiologist for some further cardiovascular testing.

Have you encountered it, though, in your own practice? 

I haven't specifically encountered it, but I have had patients that I've asked to reduce the amount of artificial sweetener in their diets and later, for a healthier lifestyle, eating more fruits and vegetables, substituting soda for water, and things like that.

I guess that would be an alternative, maybe to avoid problems, to maybe begin making your own food.

That could be. We also say maybe a tip for cutting down on sugar is to try to decrease that sugar amount by half and then wean down. You could also use fruit for your cereal or honey for your coffee or teas instead of using sugars.

What do you say, though, to patients who wonder how to avoid all of this? I mean, isn't it (erythritol) very widespread in the use of producing food? 

Well, I think reading the labels, being knowledgeable about the foods that you're eating, and what the side effects of those foods are, is important.

You know, you can't cut out sugars completely. It's in our American diet. But I think that you can limit the amount that you take in. Nine teaspoons or 36 grams for men or six teaspoons or 25 grams for women. That equals about 100 calories of sugar. So that's why reading the labels is important.

And to those who say that's why I was using artificial sweeteners, to maybe cut down on sugar and maybe to help me avoid excess weight?

Well, I mean, I think that's true. Trying to be health conscious and avoid sugars is one way to decrease the risk of diabetes or heart disease or stroke. Small amounts of sugar based on the American Heart Association are okay. But we want to be careful with any labels such as non-sugar, sugar-free, and artificial sweeteners and make sure that these aren't causing any ill side effects.


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Interview highlights were lightly edited for clarity.

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Sam Baker is KERA's senior editor and local host for Morning Edition. The native of Beaumont, Texas, also edits and produces radio commentaries and Vital Signs, a series that's part of the station's Breakthroughs initiative. He also was the longtime host of KERA 13’s Emmy Award-winning public affairs program On the Record. He also won an Emmy in 2008 for KERA’s Sharing the Power: A Voter’s Voice Special, and has earned honors from the Associated Press and the Public Radio News Directors Inc.