In a peer-reviewed paper published in the scientific journal Nature Medicine on Monday, experts from universities in the U.S., Germany, Saudi Arabia and the Czech Republic noted that little was known about the long-term effects of common artificial sweeteners on cardiovascular health.

The research team investigated the impact that erythritol, a commonly used sugar substitute, was having on people’s health.

Their findings suggested that the consumption of vast amounts of the sweetener could have severe consequences—to the point of putting people’s lives at risk.

In the preliminary stage of the study, the team analyzed blood samples from more than 1,100 people that were collected between 2004 and 2011. They found that high levels of erythritol in the blood was linked to experiencing a heart attack, stroke or death within the next three years.

Scientists went on to test blood samples from 2,149 people in the U.S. and 833 people in Europe, confirming the link between higher levels of erythritol and increased risk of heart attack, stroke or death.

In a third round of testing, the research team found that ingesting high levels of erythritol increased the likelihood of developing blood clots—which can be life-threatening if left untreated.

“Our findings suggest the need for further safety studies examining the long-term effects of artificial sweeteners in general, and erythritol specifically, on risks for heart attack and stroke, particularly in patients at higher risk for [cardiovascular disease],” they said in the paper.

However, they noted that their study had a number of limitations. These included the fact that many of their participants had underlying health issues, meaning the relevance of their findings to the general population remained to be determined.  

“However, in our sensitivity analyses, it should be noted that the clinical prognostic value of erythritol was widely observed, including numerous lower-risk subgroups,” they added.

What is erythritol?

Erythritol is a food additive and sugar substitute that, unlike sugar itself, contains zero calories.

The substance is one of the most widely used artificial sweeteners in food, and has become increasingly prevalent thanks to its presence in processed and keto-reduced-sugar foods.

Erythritol is not a new or manmade substance, occurring naturally in low amounts in fruits and vegetables. However, when it is used to sweeten processed foods, it is often added at levels 1,000-fold higher than the levels at which it is found naturally.

In the U.S., however, the FDA does not require disclosure of erythritol in food or drink—which the researchers working on the study said made it difficult to track its levels in food as an additive.

They also noted that although the FDA and the EU deemed the sweetener safe, most of the existing studies on the substance looked at its short-term effects on human health.

Artificial sweeteners, although having been linked to type 2 diabetes, cancer and obesity in the past, have become increasingly common in recent decades, being used in yogurt, candy, breakfast cereals and a slew of other foods and beverages.

A previous study found that the consumption of low-calorie sweeteners had jumped by 200% in U.S. children between 1999 and 2012, while research published in 2020 showed Americans were eating less sugar but far more artificial sweeteners.