I had a patient come into the office on a weight loss program, and she asked me what I thought of the different protein shakes and a protein bar she had purchased. I quickly looked at the Nutrition Facts panel on these products and found they all contained artificial sweeteners. Since artificial sweeteners are associated with abdominal weight gain, Type 2 diabetes, and cardiovascular disease, I told her to stop her current products and use ones without these synthetic chemicals. 

What Are Artificial Sweeteners?

Artificial sweeteners are artificial chemicals added to food and drinks to make them taste sweet without using sugar. They are found in many diet sodas, protein shakes, snack bars, and gum. While they contain little or no calories, they are not always safe. Common examples include:

Aspartame

Acesulfame potassium

Sucralose

What About Erythritol and Xylitol?

Erythritol is another sweetener that’s often used in low-sugar foods. It is known as a sugar-alcohol. It’s found naturally in small amounts in fruits like grapes and melons and is made in tiny amounts by our bodies, so it's sometimes called a natural sweetener. However, newer research has linked erythritol to a higher risk of blood clots and other heart-related events. This has raised concerns about whether erythritol is truly a safe option.

Xylitol is a popular sweetener and is also a sugar-alcohol, and small amounts occur naturally in fruits and vegetables. Moreover, the body does make it as well. Unfortunately, recent research has shown an association with major adverse cardiovascular events, as blood clots may form more easily. However

‍Cardiovascular Risk

Studies continue to emerge demonstrating the detrimental health effects of artificial sweeteners. Another concern with artificial sweeteners is the increased risk of cardiovascular disease. A large study involving more than 100,000 people consuming artificial sweeteners was associated with increased risk of cardiovascular, cerebrovascular, and coronary heart diseases.

The summary of the authors from the British Medical Journal study I referred to in this article had a concise recommendation on artificial sweeteners:

Our results indicate that these food additives, consumed daily by millions of people and present in thousands of foods and beverages, should not be considered a healthy and safe alternative to sugar, in line with the current position of several health agencies.

Safe Natural Sweeteners

 Monk Fruit Extract

• Made from a small fruit grown in Asia.
• Much sweeter than sugar, but has no calories.
• May have antioxidant benefits.

Honey (in small amounts)

• Natural and unprocessed.
• Contains vitamins and antioxidants.
• Still raises blood sugar, so use it in moderation.

Maple Syrup (pure, not processed in small amounts)

• Contains minerals like zinc and manganese.
• Less processed than white sugar.
• Use in small amounts, as it still contains sugar.

Fruit

• When in doubt, use pieces of whole fruit whenever possible for sweetening.

Conclusion

Do not use artificial sweeteners, especially on a regular basis.

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References

Debras C, Chazelas E, Sellem L, Porcher R, Druesne-Pecollo N, Esseddik Y et al. Artificial sweeteners and risk of cardiovascular diseases: results from the prospective NutriNet-Santé cohort BMJ 2022; 378:e071204 doi:10.1136/bmj-2022-071204 

Mazi, T. A., & Stanhope, K. L. (2023). Erythritol: An In-Depth Discussion of Its Potential to Be a Beneficial Dietary Component. Nutrients, 15(1), 204. https://doi.org/10.3390/nu15010204

Witkowski, M., Nemet, I., Alamri, H. et al. The artificial sweetener erythritol and cardiovascular event risk. Nat Med 29, 710–718 (2023). https://doi.org/10.1038/s41591-023-02223-9

Witkowski, M., Nemet, I., Li, X. S., Wilcox, J., Ferrell, M., Alamri, H., Gupta, N., Wang, Z., Tang, W. H. W., & Hazen, S. L. (2024). Xylitol is prothrombotic and associated with cardiovascular risk. European heart journal, 45(27), 2439–2452. https://doi.org/10.1093/eurheartj/ehae244

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