Another research is raising concerns about the safety of erythritol, a low-calorie sugar alternative commonly found in “keto-friendly” meals, baked goods, and sweets. Researchers at the Cleveland Clinic compared erythritol to regular sugar and discovered that only erythritol had adverse cardiovascular consequences.

Despite its modest size, the study is the first to compare people’s blood levels after consuming items containing erythritol or sugar.

“We compared the results, and glucose caused none of the problems,” said Dr. Stanley Hazen, a cardiologist at Cleveland Clinic and principal author of the study, which was published Thursday morning in the journal Arteriosclerosis, Thrombosis, and Vascular Biology.

Erythritol is one of an increasing number of nonsugar sweeteners included in low-calorie and sugar-free products. Erythritol and xylitol are sugar alcohols that taste sweet like sugar but have significantly fewer calories. People often combine erythritol with another sweetener, stevia, and commonly find xylitol in gum, mouthwash, and toothpaste.

Earlier investigations from Hazen’s team, one published last year and the other in June, discovered possible correlations between sugar alcohols and an elevated risk of heart attacks and strokes. According to the study, both sugar alcohols may make blood platelets stickier, making them more prone to clotting and clogging veins or arteries, contributing to heart attacks and strokes.

For the latest study, Hazen’s team compared the cardiac effects of erythritol and conventional sugar—in this case, simple glucose—by recruiting two sets of healthy middle-aged male and female volunteers: 10 who ingested erythritol and ten who consumed sugar.

Both groups fasted overnight. To determine their platelet activity levels, we collected their blood in the morning. Then, half of the participants drank glasses of water with 30 grams of glucose, while the other half drank glasses of water with 30 grams of erythritol. According to Hazen, 30 grams of erythritol is the normal quantity used to sweeten dishes.

Blood was collected and examined approximately 30 minutes after each group ingested the sweetened beverages. Researchers discovered that patients who took erythritol had higher platelet aggregation, which means their blood was more prone to clotting. Adults who had the standard sugar drink experienced no changes in platelet aggregation.

The researchers observed a 1,000-fold rise in blood erythritol levels in the group that received the erythritol drink. Those who drank glucose water saw no changes in blood erythritol levels, and their blood glucose levels were only marginally elevated. The discovery stood out to Hazen because it significantly exceeded the minimal amounts of erythritol found naturally in the blood.

He told CNN, “The amount in sugar substitutes is thousands of times higher than what our bodies make, so to call it ‘natural’ isn’t accurate.” “Your best recommendation is to avoid sugar substitutes, and especially sugar alcohols, because there’s an acute increase in the likelihood of clotting events once you ingest them.”

The Food and Drug Administration classifies artificial sweeteners like erythritol and xylitol as GRAS, or generally regarded as safe. Hazen believes that growing evidence regarding sugar alcohols will prompt the FDA to look more closely at the facts.

Outside the United States, food agencies have expressed alarm. Last year, for example, the European Food Safety Authority advised that the European Commission obtain data on how much erythritol is present in food, which might help clarify the hazards.

Do the data suggest that erythritol is worse than high-calorie sugar? Valisa Hedrick, a registered dietitian at Virginia Tech, asserts that a high-sugar diet can elevate blood glucose levels, thereby increasing the risk of stroke and clotting. Hedrick was not participating in the Cleveland Clinic study.

The study has some significant drawbacks. Aside from the limited number of participants, it examined the effects of erythritol and glucose at a single moment rather than across months or years of constant ingestion, according to Hedrick.

The sugar water contains roughly 30 grams of glucose, equivalent to approximately 120 calories of sugar. Sugary drinks, such as juices and sodas, typically contain more sugar.

For example, a 12-ounce can of Coca-Cola has 39 grams of sugar, but 12 ounces of Mountain Dew have 46 grams.

Michael Goran, a pediatrics professor at the University of Southern California’s Keck School of Medicine, suggested comparing erythritol to fructose and glucose. According to him, sugary drinks and sodas are more likely to contain fructose and glucose than glucose alone. Goran was not part of the current study.

Hazen’s study focused solely on glucose.

Although the Cleveland Clinic study found no detrimental impacts from sugar consumption, the experts concurred that the findings do not prove sugar is safe. Higher sugar levels may have comparable platelet consequences, particularly for diabetics who are unable to adequately manage high blood glucose.

Hazen’s study focused on healthy persons rather than diabetics.

It may also be necessary to investigate the effects on heart change when patients drink erythritol-containing food versus water, according to Dr. Michelle Pearlman, a gastroenterologist and CEO and co-founder of the Prime Institute in Miami.

“Factors such as protein, fat, fiber, and other nutrients might influence this response,” she told me.

Finally, Hedrick of Virginia Tech stated that the current study highlights the need for future research comparing the health consequences of sweeteners and sugar.

Hazen and his colleagues concluded their study by advocating for more investigation into erythritol’s cardiac concerns, particularly in patients who are already at a higher risk of strokes and clots.