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Artificial sweeteners, including those advertised as natural, are under new scrutiny after a report from the Cleveland Clinic linking one such substance, erythritol, with an increased risk of heart attack and stroke.

Erythritol is a sugar alcohol that’s 70% as sweet as sugar, with few calories and little impact on blood sugar. Due to this, it has gained purchase as a sweetener in low-carb, sugar-free and ketogenic diet products, although it is not required to be listed on a product’s ingredient label.

The Cleveland Clinic report released Monday in the journal Nature Medicine studied over 4,000 Americans and Europeans and found that higher blood erythritol levels corresponded to the higher heart risks.

The research team was initially looking to see which, if any, chemicals in the blood could be tied to a future risk of a patient heart attack.

“We were not looking to study artificial sweeteners at all. We were looking to find chemicals in the blood in patients that identify who was at risk for a future heart attack, stroke or dying in the next three years. And then this compound in the blood that predicted the future development of a heart attack, stroke or death ended up being erythritol,” Dr. Stanley Hazen, author of the study, told U.S. News & World Report.

Figuring out if erythritol is heart safe is particularly important due to its consumer base: obese and diabetic people looking to keep their sugar and calorie intake low. 

“Sweeteners like erythritol have rapidly increased in popularity in recent years, but there needs to be more in-depth research into their long-term effects. Cardiovascular disease builds over time, and heart disease is the leading cause of death globally. We need to make sure the foods we eat aren’t hidden contributors,” Dr. Hazen said.

Industry advocates dispute the study’s claims.

“The results of this study are contrary to decades of scientific research showing reduced-calorie sweeteners like erythritol are safe,” Robert Rankin, executive director of the Calorie Control Council, a trade group representing the diet beverage and food industry, told USA Today.

German biochemist Karsten Hiller, who has also researched erythritol, said governments should intervene so scientists can determine whether the substance is safe for food.

“At the current knowledge we have, I would not recommend people use [erythritol],” Mr. Hiller told USA Today.

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