It seems like we are always trying to find new ways to cut sugar out from our diets. In our never-ending quest to be healthier and make better choices, sometimes sugar substitutes that we once thought were miracles for the dreaded sweet tooth can have dangers that we are just beginning to uncover. 

In decades past, how many parents didn’t start their day with a cup of coffee and their beloved pink and blue packets—sometimes Equal, sometimes Sweet'N Low or Splenda? Life was sweet until we got hit with the news that those packets of saccharin sweetness could have a link to bladder cancer, only for the FDA to retract that warning label in 2001. It turned out that it actually doesn’t have a link to cancer, yet the use of saccharin products remains a debate amongst the professional masses.

According to the FDA, the following sweeteners are currently approved as food additives: Saccharin, Aspartame, Acesulfame potassium (Ace-K), Sucralose, Neotame and Advantame.

“In addition to the six high-intensity sweeteners that are FDA-approved as food additives, the agency has received and has not questioned GRAS (Generally Recognized as Safe) notices for three types of plant/fruit based high-intensity sweeteners: certain steviol glycosides obtained from the leaves of the stevia plant (Stevia rebaudiana (Bertoni) Bertoni) or fermentation-based processes, extracts obtained from Siraitia grosvenorii Swingle fruit, also known as Luo Han Guo or monk fruit, and thaumatin, produced by a plant-based process.”

During the holidays, I came across a sugar substitute that uses erythritol. Common artificial sweeteners that use erythritol can be found in products to sweeten stevia, monk fruit, and keto-friendly items. Erythritol, created from corn that has been fermented, has risen in use and popularity.

The current FDA status of erythritol is “Generally Recognized as Safe (GRAS).” When tasting the sugar substitute, it tastes remarkably like sugar—and with zero calories, it would delight any person with a sweet tooth. 

But a new study published in Nature Medicine and founded by Stanley Hazen, M.D., Ph.D., chairman for the Department of Cardiovascular & Metabolic Sciences at the Lerner Research Institute and co-section head of Preventive Cardiology at Cleveland Clinic, has brought some concerns regarding this popular sugar substitute to light.

According to Dr. Hazen, “Our study shows that when participants consumed an artificially sweetened beverage with an amount of erythritol found in many processed foods, markedly elevated levels in the blood are observed for days—levels well above those observed to enhance clotting risks. It is important that further safety studies are conducted to examine the long-term effects of artificial sweeteners in general, and erythritol specifically, on risks for heart attack and stroke, particularly in people at higher risk for cardiovascular disease.”

The Cleveland Clinic does stress that more research and long-term studies are “needed to confirm these latest findings.” In addition, more long-term studies are needed to really weigh the risks vs the benefits of such products.

On May 15, 2023, the World Health Organization (WHO) has taken its stance against non-sugar sweeteners (NSS) a bit further by issuing a “recommendation against the use of NSS to control body weight or reduce the risk of noncommunicable diseases (NCDs). The recommendation applies to all people except individuals with pre-existing diabetes and includes all synthetic and naturally occurring or modified non-nutritive sweeteners that are not classified as sugars found in manufactured foods and beverages or sold on their own to be added to foods and beverages by consumers.” 

Moreover, the World Health Organization stated that not only does NSS fail toward helping people achieve weight loss goals but could escalate the risk of developing Type 2 diabetes, cardiovascular disease (CVD), and premature loss of life. The World Health Organization is instead encouraging consuming fruits as a “natural sugar source” and water and other food sources that do not contain sugar.

The Calorie Control Council has also put out a statement that it “strongly disagrees with this recommendation and reaffirms the documented health benefits and longstanding safety of non-sugar sweeteners, also known as low- and no-calorie sweeteners, for consumption by all populations, including those living with non-communicable diseases such as obesity and diabetes. Low- and no-calorie sweeteners have been proven to assist in body weight and blood glucose management, promote oral health as well as facilitate the reduction of calorie and sugar intake.”  

It is important to note that the WHO recommendation is designated as “conditional, which means the evidence around the benefits and risks of an intervention is less certain.” Also, the WHO recommendation doesn’t include non-food items, such as toothpaste, skin cream, and medications, or to low-calorie sugars and sugar alcohols (polyols), which are sugars or sugar derivatives containing calories and are therefore not considered NSS.”

Findings like these reiterate the need to always consult with your doctor or a registered dietitian when you use a new product or supplement to make sure it is the best fit for you. As with anything, moderation is key. Staying informed and keeping your doctors in the loop is the best way to navigate through the studies and choices and stay on an optimal pathway to health and wellness.