Consumers of sugar-free treats were in for a shock when a study began circulating last month noting that the use of erythritol ― a popular sweetener used in everything from cereal to sugar-free sodas ― is associated with an increased risk for heart issues. This could prompt people to reevaluate many kitchen items, from coffee sweeteners to granola bars to baking sugar substitutes.
This isn’t the first study that has linked artificial sweeteners to health problems ― research has called them out for many possible side effects. So is it time to ditch them entirely?
As with anything nutrition-related, there are factors you should take into consideration (like how often you consume artificial sweeteners, for example). We spoke with experts about what to know about the new study and previous research, plus got their tips on alternative ways you can sweeten your food if you’re looking to make a switch.
The recent erythritol study analyzed the amount of the sugar alcohol in the blood of around 4,000 people, mostly over the age of 60. Those with high levels were said to be at a higher risk of having a heart attack or stroke.
The research also showed that higher levels of erythritol in the body were likely to make it more prone to blood clots. Some participants in the study had preexisting heart issues, which experts say may have impacted the results. But the clotting risk has been enough for Leah Groppo, a clinical dietitian at Stanford Health Care.
Groppo noted that sugar alcohols like erythritol have a better flavor profile than pure monk fruit and stevia, which are also used as sweeteners. This means that in addition to being added to foods on its own, erythritol is commonly found in blends of monk fruit and stevia.
There is debate as to whether consuming artificial sweeteners causes cancer, but some research suggests there may be a link.
The biggest indicator comes from a large cohort study of 102,865 French adults. The research found that those who consumed higher amounts of aspartame had 1.15 times the risk of developing cancer overall compared to those who did not. Those who consumed higher amounts of the sweetener acesulfame-K had 1.13 times the risk of cancer.
That said, other studies have shown there isn’t a consistent association between artificial sweeteners and cancer, according to the National Cancer Institute.
There may be some evidence that artificial sweeteners could have an effect on the brain over time. One 2017 study found that artificially sweetened drinks were associated with a higher risk of both strokes and dementia. Additional research has linked aspartame to mood disorders, depression and mental stress. Sweeteners also have been linked to headaches and dizziness.
Some research has suggested that certain artificial sweeteners may alter the gut microbiome in both mice and humans who eat foods containing them. Studies also show that non-nutritive sweeteners could impair glucose tolerance. And some sugar alcohols may cause digestive upset.
“While we don’t know the long-term effects from consuming non-nutritive sweeteners, we do know some sugar alcohols such as sorbitol and xylitol can cause digestive distress such diarrhea and bloating,” explained Melissa Hooper, a registered dietitian nutritionist and founder of Bite-Size Nutrition.
So What Should We Be Using To Sweeten Things?
Groppo said that while some of these studies may cause panic, the key is everything in moderation. She noted that the research that suggests artificial sweeteners may alter the gut microbiome is confusing to navigate.
“The hard part about that is we don’t have strong markers to say, ‘these ratios of gut bacteria in your gut biome leads to this health.’ So we give people a lot of artificial sweeteners. And then we change their gut biome. We’re assuming it’s changing into a negative, but we don’t know if that change means it’s necessarily bad,” she said.
Ultimately, Groppo recommended consuming artificial sweeteners on occasion if they’re in something you enjoy. If you’re using a packet in your coffee occasionally, that’s probably OK, she said. But if you notice you’re regularly eating foods sweetened artificially, it may be time to make some changes.
Groppo recommended prioritizing the occasional use of pure monk fruit and stevia, or blends that don’t contain sugar alcohols like erythritol. Coconut and date sugar can have a slightly lower glycemic index than sugar and may be a good alternative, she said. And honey, maple syrup and agave will spike your blood sugar, but are more natural than some of the artificial sweeteners we know less about.
It’s also worth remembering that if a product seems too good to be true, it just may be. “When we do look at these new artificial sweeteners, they’re fast to come on the market, and perhaps there is not very good in-depth research around what they potentially could do inside of our bodies,” Groppo explained. She advocated for getting as close to Mother Nature as possible when looking for something to sweeten your food with.
“At this point, I think in general, when it comes to artificial sweeteners, less is going to be better,” added Hannah Wolf, a registered dietitian at the Frances Stern Nutrition Center at Tufts Medical Center.
If you have any preexisting conditions like cardiovascular disease, you may want to cut back on artificial sweeteners more than the average person, Wolf added. She also advocated for reading labels of the foods you’re eating to take inventory of how many artificial sweeteners you may be ingesting in a day.
“Products marketed as being keto, low-carb diet friendly, sugar-free … all likely contain artificial sweeteners,” she said. “Pretty much anything that says it’s sugar-free but still tastes sweet will contain them.”
Another issue with artificial sweeteners is they can be anywhere from a hundred to a thousand times sweeter than regular table sugar, Wolf said. “So my concern comes in where peoples’ taste buds become desensitized to the sugar, but they feel like they need that taste,” she said. This and the fact that sugar seems to be in everything these days ― from chips to ketchup and beyond ― may cause us to crave more sugar than normal.
Groppo said to try cutting back on the sugar in your coffee, eventually getting it closer to black. “You could add a small amount of honey or coconut sugar, or even just a splash of vanilla almond milk,” she said. Use frozen berries to sweeten smoothies and oatmeal. And try substituting sugar for applesauce, smashed-up bananas or dates in baked goods.
“A small quantity of real sugar or fructose in fresh or frozen fruit is far superior than processed or artificially sweetened drinks or foods,” said Dr. Denise Sorrentino, a cardiologist at MercyOne Medical Center in Des Moines, Iowa.
Spices like cinnamon, nutmeg and vanilla extract are another great way to help to give foods more of a natural sweetness. You can use these ingredients when baking, over oatmeal, in coffee or even blend them into smoothies.
“My strong recommendation would just be looking at all of the things that we’re adding sugar to and thinking about how we can reduce those food products,” Wolf said. That includes artificial sweeteners.