Popular sweetener erythritol, found in Truvia, linked to heart risk, new study says

A new study finds a link between erythritol – a common artificial sweetener also used as a filler in stevia and monk fruit sweeteners and some keto products – and risk of harm to the heart and blood vessels, including clotting, stroke, heart attack and even death. The study suggests erythritol is concerning for the people it’s marketed to, who are already at risk for cardiac problems. 

Erythritol is “on par with the strongest of cardiac risk factors, like diabetes,” the lead author writes. The peer-reviewed research was published this week in the journal Nature Medicine.

Found naturally in some types of fruits and fermented foods, erythritol is added as an artificial sweetener to processed foods at levels 1,000 times higher than the amounts than would be otherwise be found in those food, sometimes making up over half of the weight of the item.

It's popular partly because its aftertaste doesn’t linger. About 70 percent as sweet as sugar, erythritol “looks like sugar, it tastes like sugar, and you can bake with it,” says the study’s lead author, Dr. Stanley Hazen, a cardiologist at the Cleveland Clinic. Erythritol adds bulk to the widely used artificial sweeteners stevia and monk fruit. 

The new study isn’t the first to question the safety of artificial sweeteners. They’ve been under fire for years. Last year a large study showed a connection to heart disease and stroke, and earlier research connected them to Type 2 diabetes and cancer.

Despite these increasing concerns, there is no accepted daily intake of erythritol set by the Food and Drug Administration, which considers it generally recognized as safe, or GRAS. Nearly all food chemicals introduced since 2000 were greenlighted by the food and chemical industry rather than the FDA, using a GRAS loophole that lets companies decide substances are safe.

Erythritol is often used instead of table sugar by home bakers in no-sugar-added food, which is especially desirable for people, such as diabetics, who are trying to control their sugar intake. It’s become more popular in recent years, in part as a result of its use in processed foods consumed as part of a keto – low carb and high fat – diet. Keto diets are criticized by some as more of a quick fix for some health conditions than a safe and tested long-term food plan.

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Study’s accidental findings

The study’s authors stumbled on the link between erythritol and heart problems by chance. They were researching blood samples from people at risk for heart disease, seeking characteristics that might predict heart problems, and found erythritol to be a common factor. 

Further research confirmed their findings – a link between the artificial sweetener and a tendency for the blood to clot: Among 4,000 people in Europe and the U.S., those with higher levels of erythritol in their blood had a higher risk of a major heart-related event. 

As the study’s own authors point out, most participants already had coronary disease, high blood pressure or diabetes, which may skew the results. 

Heart disease is the leading cause of death globally.

Then, as a final part of the research, they asked eight healthy volunteers to consume a drink containing 30 grams of erythritol, about the amount in a pint of keto ice cream or a can of artificially sweetened soda. Their blood levels of the chemical went up a thousandfold and stayed elevated for days. As the lead author explains it: “If your blood level of erythritol was in the top 25% compared to the bottom 25%, there was about a two-fold higher risk for heart attack and stroke. It’s on par with the strongest of cardiac risk factors, like diabetes.”

The study’s authors call for further study on the safety of artificial sweeteners. The higher clotting risk after exposure is concerning, they say, because the people to whom artificial sweeteners like erythritol are marketed – those with diabetes, obesity, history of cardiovascular disease and reduced kidney function – are typically already at higher risk. 

What you can do

It’s up to the federal government to protect shoppers from food chemicals, such as artificial sweeteners and sugar substitutes, whose safety has not been established. In the meantime, some states are stepping up to fill the gap. 

For instance, legislation has been introduced in the bellwether state of California to ban or restrict the use of five common highly toxic food chemicals. And EWG is helping lead the fight on Capitol Hill against harmful chemicals in our food. 

Until harmful chemicals are banned from our food supply, here are steps you can take:

  • Study ingredient labels. Try to avoid food products with ingredients whose names you can’t pronounce. 
  • Eat fewer processed foods, such as those sweetened by erythritol. They’ve been shown to have a negative association with good health. Choose foods that are not processed or have been processed very little, such as whole grains and fresh fruits and vegetables.
  • Consult EWG’s Food Scores database to find out which foods are more and less healthy for you. It includes thousands made with erythritol. 
  • Download EWG’s Guide to Food Additives for quick tips to reduce your exposure to questionable chemicals in our food:
Get Your Free Guide: EWG's Guide to Food Additives
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