The Skinny on Erythritol and Other Artificial Sweeteners: How Safe Are They?


For all the popularity of sugar substitutes, in beverages or in food, there are nagging questions about the health risks of sweeteners. Photo: Maria Bell/Getty Images

Sweetness without calories, what’s not to like? On the surface, it seems like a win-win.

For example, cola with artificial sweeteners such as aspartame is a fizzy, tangy, acidic, refreshingly bubbly beverage that adds no calories to your diet no matter how much you drink.

Jennifer Lopez recently revealed that hubby Ben Affleck keeps a soda machine in his office that dispenses both Diet Coke and Diet Pepsi. (Affleck, along with Renée Zellweger, Matt Damon and the late Whitney Houston have appeared in Diet Coke ads, while Lopez and Beyoncé have promoted Diet Pepsi.)

Donald Trump reportedly downed a dozen Diet Cokes each day while in the White House and his predecessor Bill Clinton was frequently photographed with a can of the carbonated cola in his hand.

But for all the popularity of sugar substitutes, in beverages or in food, there are nagging questions about the sweeteners. How safe are they? How much is known about the risks and benefits?

“It’s time to have a conversation about artificial sweeteners,” says Marsha Fenwick, a Toronto clinical nutritionist.

The concern about artificial sweeteners was highlighted recently with a study of erythritol, a calorie-free sugar alcohol sweetener often used to sweeten stevia, monkfruit and keto reduced-sugar products.

Researchers found that erythritol is linked to blood clotting, stroke, heart attack and death. “The degree of risk was not modest,” lead study author Dr. Stanley Hazen, director of the Center for Cardiovascular Diagnostics and Prevention at the Cleveland Clinic, told CNN.

“If your blood level of erythritol was in the top 25 per cent compared to the bottom 25 per cent, there was about a two-fold higher risk for heart attack and stroke, Hazen said. “It’s on par with the strongest of cardiac risk factors, like diabetes.”

The results came as “a little bit of a surprise” to nutritionist Fenwick. She does caution that the limited study shows only that high blood levels of erythritol are associated with cardiac risk but not that they cause it. And the study participants were already undergoing cardiac risk assessments.

“There’s no reason to panic,” she says about erythritol. Nevertheless, she adds, it’s important to read labels and be aware of what you’re ingesting and to keep up with research about artificial sweeteners and additives.

More than 20 products containing erythritol are approved for sale by the government of Canada including cakes, cookies, yogurt drinks, cereals, chewing gum and hard and soft candies. “The information that Health Canada has reviewed to date does not indicate that any of the sweeteners permitted in Canada are unsafe for their permitted use(s),” a representative from the agency told Zoomer in an email.

Erythritol is the largest ingredient by weight in many “natural” stevia and monkfruit products, Hazen noted. Just a small amount is needed because the sugar alcohol is about 200 to 400 times sweeter than sugar. Still, it is possible to find some brands of pure stevia and monkfruit without erythritol. Those are the forms of artificial sweeteners that Fenwick recommends to her clients.

Erythritol isn’t the only sugar substitute that’s come under scientific scrutiny, attracting government regulations and unnerved consumers.

In 1969, Canada banned cyclamates in soft drinks and in all other foods effective Sept. 1, 1970. Then, in 1977, studies linked saccharin with the development of bladder cancer in laboratory rats. As a result, saccharin was not permitted as a food additive in Canada, although restricted use of saccharin as a table-top sweetener has been allowed. Since then, more than 30 human studies found that the effect of saccharin on rats was not the same in humans and the sweetener is no longer considered carcinogenic in humans.

Aspartame entered the Canadian market in 1981 and is commonly found in diet colas. 


Less Calories, but More Weight Gain?


While artificial sweeteners can reduce consumption of sugar and calories, the whole category, including those approved by the government of Canada, may be problematic.

Some research studies suggest that artificial sweeteners may contribute to weight gain and even stimulate sugar cravings.

A University of Manitoba study published in the Canadian Medical Association Journal in 2017 suggested that “non-nutritive sweeteners, such as aspartame, sucralose and stevioside, are widely consumed, yet their long-term health impact is uncertain.”

Consumers may want to think twice about relying on artificial sweeteners, study author Meghan Azad told CBC at the time. 

The Manitoba study reviewed 30 observational studies that followed more than 400,000 people in the general population for about a decade, as well as seven randomized trials of about 1,000 people with obesity who were followed for an average of six months.

While those with obesity were trying to use the artificial or non-nutritive sweeteners to help with weight loss, Azad found no consistent benefits in weight reduction or slimming.

However, the studies did suggest that routine consumption of artificial sweeteners may be associated with cardiovascular disease events such as heart attacks and strokes, Type 2 diabetes and hypertension. Azad admitted her research convinced her to give up diet cola, “There’s no clear benefit and there’s potential for harm, so for me, it’s worth it to just choose water instead.”

However, if you’re still partial to artificial sweeteners, check out this succinct overview on the government of Alberta website.