Ralph: (growling) Where's my morning coffee?
Alice: Here you go Ralph
Ralph: (sipping) That tastes terrible!
Alice: We ran out of sugar
Ralph: One of these days, Alice. One of these days.
Alice: Try this new artificial sweetener
Ralph (sipping) How sweet it is!
If you are of a certain age, you can identify these characters from the 1950’s television show "The Honeymooners" and you’ll recognize the Ralph Kramden/Jackie Gleason catchphrase, "How sweet it is!". So how sweet are artificial sweeteners? Depending on the agent, artificial sweeteners are 200 to 600 times sweeter than sugar. However, are they healthier than sugar? Are there any heart issues with artificial sweeteners?
Sugar seems to be the new bad guy on the block, not without reason. Everyone likes a sugary snack every now and then, but can it be limited to just one snack? Sugar triggers a reaction in our brain and makes us crave more. Sugar begets sugar. So, instead of stopping at one serving, more sugar is desired and before you know it, the whole candy bar is gone. All that sugar consumption adds empty calories, resulting in obesity, diabetes and heart disease. Even natural sweeteners, such as honey or molasses are a form of added sugar and add calories to the diet. To counteract the health effects of sugar, artificial sweeteners were developed and have been available for decades. Artificial sweeteners taste sweet like sugar but have no or few calories. They allow people to enjoy the sweetness of foods and drinks but without excess calories. In this way, artificial sweeteners can help with weight loss. US and European health agencies have deemed artificial sweeteners safe in limited amounts and extensive research has not shown a higher risk of cancer. It had been felt that these sugar substitutes do not cause serious health problems. Until now.
Recent research on artificially sweetened beverages has shown a link to heart disease. A French study started in 2009 and including 104,000 participants found that people who drank 6 ounces or more per day of artificially sweetened beverages had a higher risk for cardiovascular disease. Artificial sweetened beverages included drinks that contained aspartame (also used in NutraSweet, Equal) and sucralose (found in Splenda). Another study of 9000 participants followed for 10 years showed that those who drank greater than two liters per week (about 10 ounces per day) of an artificially sweetened beverage had an increased risk for atrial fibrillation. One last study followed 2,888 participants and found artificially sweetened drinks to be associated with a higher risk of stroke and dementia. So, these beverages may not be a healthy substitute for sugary soft drinks.
The data on two artificial sweeteners, both from the sugar alcohol category, seems especially troubling. Erythritol is a no calorie sugar substitute used in many products including protein bars, yogurt, cookies and ice cream. It occurs naturally in melons and grapes. It is also the primary sweetener in the low carbohydrate high fat keto diet. A 2023 study of 1100 people found that high levels of erythritol in the blood was associated with an increased risk of heart attack, stroke and death. A more recent study may explain why. Twenty healthy volunteers were given drinks sweetened with a typical amount of erythritol or a drink with sugar. When given erythritol, the blood platelets were activated putting people at risk for blood clotting, heart attack or stroke. The same platelet effect was not seen when consuming a sugar drink. Another sugar alcohol artificial sweetener, xylitol, has similar data. Xylitol is found naturally in fruit and vegetables. It is also used to sweeten gum and toothpaste. In a study of 3000 people in the US and Europe, those with the highest level of xylitol in the blood were more likely to have heart or blood vessel problems. Another study followed 1100 people for three years. Xylitol was associated with major adverse cardiac events and was shown to activate platelets, similar to erythritol.
As daunting as this data is, experts have not declared any artificial sweetener a cardiac risk. However, more and better research is needed on these agents, especially the potential cardiovascular effects. Before you declare “How sweet it is!” and consume artificial sweeteners with impunity, keep an eye out for future research on the safety of these agents. For now, using them in small, limited quantities seems to be safe.
