A growing body of research indicates a potential link between the consumption of various artificial sweeteners and an elevated risk of cardiovascular diseases, including heart attacks and strokes. A comprehensive study found that overall intake of artificial sweeteners was associated with a 9% higher risk of cardiovascular problems and an 18% greater risk of stroke.
Specific sweeteners have been singled out for particular associations. Aspartame, for instance, has been linked to a higher risk of stroke and cerebrovascular events. Both acesulfame potassium and sucralose have been associated with an increased risk of coronary artery disease. Among sugar alcohols, erythritol has shown a strong association with an increased risk of cardiovascular events such as heart attack and stroke; individuals with the highest erythritol levels were twice as likely to experience these events over a three-year period. Xylitol, another sugar alcohol, has also shown an association with major adverse cardiovascular events and an increased potential for blood clot formation.
Proposed biological mechanisms suggest how these sweeteners might contribute to cardiovascular issues. These include triggering inflammation, altering metabolism, disrupting the gut microbiome, and impacting blood vessels. Such changes can contribute to conditions like type 2 diabetes, unhealthy cholesterol levels, and high blood pressure. Aspartame is believed to contribute to atherosclerosis, or arterial plaque formation, by stimulating insulin release, which can lead to chronic hyperinsulinemia and the upregulation of inflammatory signals. Erythritol has been observed to promote blood clot formation by increasing the reactivity of platelets, which are essential for clotting. Long-term consumption of sucralose may negatively affect vascular health, potentially making blood vessels less flexible and more prone to blockages, and can also compromise the brain’s protective barrier.
Medical experts emphasize that while these studies indicate associations, the full health effects of artificial sweeteners are not yet completely settled, and other lifestyle factors may also play a role. The World Health Organization (WHO) advises against using non-sugar sweeteners for weight control or disease prevention, citing a lack of long-term benefits and potential risks, including increased cardiovascular disease and mortality. This WHO guidance applies to most individuals, excluding those with pre-existing diabetes, and does not specifically include sugar alcohols like erythritol and xylitol in this recommendation.
Regulatory bodies and professional organizations hold varied perspectives. The U.S. Food and Drug Administration (FDA) generally considers approved sweeteners safe when used as intended, though the safety classification of erythritol is currently being re-evaluated in light of new research. Conversely, the Academy of Nutrition and Dietetics currently supports the use of non-nutritive sweeteners, including aspartame, within accepted daily limits, pending further evidence. The American Diabetes Association (ADA) suggests that certain artificial sweeteners, such as sucralose, aspartame, stevia, and xylitol, can be useful for reducing sugar and calorie intake.