Criticism and Impact
Critics have suggested the 30-gram dose of erythritol ingested by study participants is unrealistic. Dr. Hazen said that it’s not.
Erythritol is often recommended as a one-to-one sugar replacement. And you could top 30 grams with a few servings of erythritol-sweetened ice cream or soda, Dr. Hazen said.
“The dose that we used, it’s on the high end, but it’s well within a physiologically relevant level,” he said.
Still others say the results are only relevant for people with preexisting heart trouble. But Dr. Hazen said they matter for the masses.
“I think there’s a significant health concern at a population level that this work is underscoring,” he said.
After all, heart disease risk factors like obesity, hypertension, diabetes, and smoking are common and quickly add up.
“If you look at middle-aged America, most people who experience a heart attack or stroke do not know that they have coronary artery disease, and the first recognition of it is that event,” Dr. Hazen said.
For now, Dr. Hazen recommends eating real sugar in moderation. He hopes future research will reveal a nonnutritive sweetener that doesn’t activate platelets.
The Bigger Picture
The new research adds yet another piece to the puzzle of whether nonnutritive sweeteners are better than sugar.
“I think these results are concerning,” said JoAnn E. Manson, MD, chief of the Division of Preventive Medicine at Brigham and Women’s Hospital and a professor of medicine at Harvard Medical School, both in Boston, Massachusetts. They “ may help explain the surprising results in some observational studies that artificial sweeteners are linked to an increased risk of cardiovascular disease.”
Dr. Manson, who was not involved in the new study, has conducted other research linking artificial sweetener use with stroke risk.
In an upcoming randomized clinical study, her team is comparing head-to-head sugar-sweetened beverages, drinks sweetened with calorie-free substitutes, and water to determine which is best for a range of cardiometabolic outcomes.
“We need more research on this question,” she said, “because these artificial sweeteners are commonly used, and many people are assuming that their health outcomes will be better with the artificial sweeteners than with sugar-sweetened products.”
A version of this article first appeared on Medscape.com.