Artificial sweetener erythritol linked to heart attack and stroke, study finds

Erythritol, a zero-calorie sugar substitute used to sweeten low-cal, low-carb and "keto" products, is linked to higher risk of heart attack, stroke and death, according to a new study.

Researchers at the Cleveland Clinic studied over 4,000 people in the U.S. and Europe and found those with higher blood erythritol levels were at elevated risk of experiencing these major adverse cardiac events. The research, published Monday in the journal Nature Medicine, also found erythritol made blood platelets easier to form a clot. 

"Our study shows that when participants consumed an artificially sweetened beverage with an amount of erythritol found in many processed foods, markedly elevated levels in the blood are observed for days — levels well above those observed to enhance clotting risks," said Dr. Stanley Hazen, senior author of the study and chairman for the department of cardiovascular and metabolic sciences at Cleveland Clinic, in a press release.

Sugar-free products containing erythritol are often recommended for people with obesity, diabetes or metabolic syndrome as ways to manage sugar and calorie intake. Erythritol is one ingredient in the common calorie-free stevia sweetener Truvia, for example. 

People with these conditions are already at higher risk for adverse cardiovascular events such as stroke. 

In response to the study, Robert Rankin, executive director of the Calorie Control Council, an international association representing the low- and reduced-calorie food and beverage industry, told CBS News the results are "contrary to decades of scientific research showing low- and no-calorie sweeteners like erythritol are safe, as evidenced by global regulatory permissions for their use in foods and beverages, and should not be extrapolated to the general population, as the participants in the intervention were already at increased risk for cardiovascular events." 

While the study doesn't definitively show causation, CBS News medical contributor Dr. David Agus says there's "certainly enough data to make you very worried."

"Most artificial sweeteners bind to your sweet receptors but aren't absorbed. Erythritol is absorbed and has significant effects, as we see in the study," Agus explains.

Sweeteners like erythritol have "rapidly increased in popularity in recent years," Hazen noted, and the researchers say more in-depth study is needed to understand their long-term health effects.

"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," he said.