The Bitter Truth About Sugar-Free Sweeteners and Your Heart

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Picture this: You’re scanning the aisles of your favorite grocery store, determined to make healthier choices. You skip the regular soda for a “zero sugar” version, swap your favorite chocolate bar for one labeled “keto-friendly,” and toss a few “sugar-free” protein bars into your cart. You’re proud of yourself for dodging the evils of sugar.

But what if those swaps come with a hidden cost? Believe it or not, there are red flags about certain “no-sugar” sweeteners—especially erythritol—linking them to higher risks of stroke and heart attack.

For those who reach for these products to cut calories, manage blood sugar, or protect heart health, the findings are sobering. You may want to reconsider once you know the truth of these supposedly healthy swaps.

Read on to learn about the latest science, which sweeteners may be of concern, and tips for navigating the modern sweetener landscape more safely.

Erythritol: The Sweetener Under the Microscope

Erythritol is a type of sugar alcohol that occurs naturally in small amounts in some fruits and fermented foods. In the food industry, it’s prized for its sugar-like taste, bulk, and low calorie count. You’ll find it in “sugar-free” ice cream, keto baked goods, protein bars, and even some toothpastes.

Until recently, erythritol was considered safe.

However, recent research challenges that assumption. An article published in the National Library of Medicine states, “Artificial sweeteners are widely used sugar substitutes, but little is known about their long-term effects on cardiometabolic disease risks. … In initial untargeted metabolomics studies in patients undergoing cardiac risk assessment, circulating levels of multiple polyol sweeteners, especially erythritol, were associated with incident (3-year) risk for major adverse cardiovascular events (MACE; includes death or nonfatal myocardial infarction or stroke).”

In other words, the association between erythritol and cardiovascular events is not a good one.

Those with the highest erythritol levels had twice the risk of experiencing a major adverse cardiovascular event—such as heart attack, stroke, or death—within three years.

As the National Institutes of Health explains it, “People with the highest erythritol levels (top 25%) were about twice as likely to have cardiovascular events over three years of follow-up as those with the lowest (bottom 25%).”

Erythritol’s link to dangerous clots that can block arteries is something to consider before you spring for a sugar-free option, thinking you’re helping your health by swearing off the dangers of sugar.

New Evidence From 2025: A Deeper Look at Stroke Risk

In July 2025, a University of Colorado Boulder study published in the Journal of Applied Physiology shed more light on how erythritol may affect blood vessels in the brain.

The University of Colorado reports, “the popular sugar substitute and specialty food additive comes with serious downsides, impacting brain cells in numerous ways that can boost risk of stroke.”

The study found that erythritol exposure:

* Damaged the cells lining the brain's blood vessels

* Reduced nitric oxide (a natural chemical that helps vessels relax)

* Increased endothelin-1 (which causes vessels to constrict)

* Impaired the body’s ability to break down clots naturally

This combination—narrower blood vessels and more clotting—creates a perfect storm for stroke risk.

And here’s the catch: the people most likely to choose “sugar-free” products—those with diabetes, obesity, or metabolic syndrome—are often the same people already at higher cardiovascular risk.

That makes the findings even more concerning. Going sugar-free is not the health-conscious option it seems to be.

Consumers think they’re doing a good thing when they see “sugar-free” on the label, but in reality, that choice could be worse than the real thing in all its sugary glory.

Beyond Erythritol: The Bigger Sweetener Picture

If you’ve ever been out to a restaurant or diner that serves coffee, you know that erythritol isn’t the only player in the “no-sugar” game. There are always packets in a variety of colors waiting in that little dish on the table. Other non-nutritive sweeteners (NNS) include:

* Aspartame (Equal, NutraSweet)

* Sucralose (Splenda)

* Saccharin (Sweet’N Low)

* Stevia

* Monk fruit extract

Many people reach for Splenda or Sweet’N Low, thinking they’re making a good decision for their health. But while erythritol has the strongest emerging evidence for cardiovascular risks, there’s also a link between high consumption of some other NNS—especially in diet sodas—to increased risk of stroke, heart disease, type 2 diabetes, and gut microbiome changes.

As a study in the National Library of Medicine reports, “Several NNS compounds are now hypothesized to affect human physiology by modulating the gut microbiome, though the mechanism for this action remains unclear.”

In other words, scientists know these compounds are changing us at a cellular level and affecting our gut health; they’re not sure exactly how yet, but it’s not looking good.

Of course, it’s important to note that association doesn’t equal causation. Many studies are observational, meaning they can’t prove that sweeteners directly cause these outcomes.

Still, the research into erythritol is beginning to reveal possible cause-and-effect mechanisms, and that’s raising awareness and sounding alarm bells for conscious consumers.

How to Navigate the “No-Sugar” Landscape

If this news has you eyeing your pantry and your grocery cart with suspicion, that’s probably a good thing.

Information is power. Here’s how to make smarter, safer choices:

1. Read Labels Diligently: Erythritol often hides in plain sight; it’s no secret. You can spot it on ingredient lists for protein powders, “diet” snacks, and keto desserts, so always scan labels carefully before buying.

2. Prioritize Whole Foods: The safest no-sugar approach isn’t about swapping one sweetener for another; it’s about reducing your reliance on ultra-processed foods entirely. Build your meals around veggies, fruits, lean proteins, legumes, nuts, and seeds instead of packaged foods.

3. Rethink “Diet” Drinks: Diet sodas and artificially sweetened energy drinks are among the most significant NNS sources. Try sparkling water with a slice of citrus, unsweetened iced tea, or plain water infused with cucumber or berries instead.

4. Sweeten Naturally and In Moderation: When you need a touch of sweetness, you can add small amounts of raw honey, pure maple syrup, date paste, or even whole fruit. While these do contain natural sugars, they’re not the same harmful chemical compounds and also come with beneficial compounds like antioxidants and vitamins when consumed in moderation.

5. Talk to Your Healthcare Provider: If you have heart disease, diabetes, or other metabolic conditions, discuss your sweetener use with your doctor or a registered dietitian. They can help you evaluate your overall diet and risk factors.

The Bottom Line: No-Sugar Doesn’t Mean No Risk

The promise of “no sugar” can be misleading. While cutting added sugar remains an important health goal, replacing it with certain sweeteners—especially erythritol—may come with its own set of risks.

The science is still evolving, but it’s becoming increasingly clear that we need to approach non-nutritive sweeteners with the same scrutiny we give to sugar, if not more. By making informed choices and leaning toward whole, unprocessed foods, you can enjoy sweetness without compromising your long-term heart or gut health.

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