Many people turn to artificial sweeteners to cut back on sugar and slim down. But in the past 10 years, they’ve become a topic of hot debate.

Previous research has linked these sugar substitutes with obesity, diabetes, high blood pressure, and even cancer. And a recent study suggests artificial sweeteners may raise the risk of cardiovascular disease too.

This article will break down the link between artificial sweeteners and heart disease and how to choose the best sweetener for you.

Risks of Artificial Sweeteners

Artificial sweeteners may seem like a smart move when you’re trying to lose weight or manage your blood sugar. But according to a recent study, they may be bad news for your heart.

The study, published in the BMJ, followed 103,388 French citizens for over a decade. The average age of participants was 42 and roughly 80% were women.

Volunteers kept detailed food logs over various 24-hour periods, tracking all foods and beverages consumed. Physical activity and health habits were also tracked.

Over a third (37.1%) of participants used artificial sweeteners. On average, these participants consumed about 42 mg of artificial sweeteners a day (roughly the same as 3.4 ounces of diet soda or one packet of sweetener).

They found that consuming artificial sweeteners was linked with a 9% higher risk of cardiovascular disease. What’s more, those that used artificial sweeteners faced an 18% higher risk of stroke.

Keep in mind, this link is not proof that artificial sweeteners cause stroke or heart disease. Just that people who consume them have a higher risk of these problems. Other lifestyle and health issues may also play a role.

For example, those who used artificial sweeteners also had a higher BMI, were less physically active, and were more likely to be on a weight loss diet.

Still, the study authors concluded, “Our results indicate that these food additives, consumed daily by millions of people and present in thousands of foods and beverages, should not be considered a healthy and safe alternative to sugar.”

Which Artificial Sweeteners to Avoid

In the study, three sweeteners were the most problematic: aspartame, acesulfame potassium, and sucralose.

Aspartame was linked with a 17% increased risk of stroke. This sweetener, sold under the brand names Equal and Nutrasweet, is often used to sweeten diet sodas and other low-calorie food products.

Acesulfame potassium and sucralose were linked with a 40% higher risk of coronary heart disease. Acesulfame potassium is sold under the brand names Sweet One and Sunett, while sucralose is included in the popular sweetener Splenda.

With the safety of artificial sweeteners under scrutiny, many are turning to other sugar alternatives, like erythritol. Yet research shows this sweetener may pose problems as well.

Is Erythritol Safe?

Erythritol is a type of sugar alcohol that’s about 80% as sweet as sugar with only 5% of the calories. Because of this, it’s often used to replace sugar in many low-calorie, low-carb, or keto products.

But a study published in the journal Nature Medicine suggests that erythritol is linked with a greater risk of cardiovascular events.

The study looked at the erythritol levels of over 4,000 people in the U.S. and Europe. They found that those with higher erythritol levels had a greater risk of stroke, heart attack, and death.

Further lab research in the study suggests that erythritol may increase the formation of blood clots. While more research is needed, it may be wise for those with heart issues to limit erythritol for now.


Healthiest Sugar Substitutes

So, if artificial sweeteners are off the menu, what are the safest (and healthiest) alternatives to sugar?

It all depends on your health situation. Whole food sources of sugar, such as fruit, are the most nutritious option.

Fruit is rich in vitamins, minerals, and antioxidants. Yes, fruit does have natural sugars. But it’s also packed with fiber, which slows digestion and helps prevent blood sugar spikes.

That said, if you’re diabetic, you’ll want to limit your fruit intake or stick to low-glycemic fruits like berries.




Other wholesome natural sweeteners include honey and maple syrup. Both of these liquid sweeteners contain vitamins, minerals, and antioxidants.

However, honey and maple syrup do come with some calories and can spike your blood sugar. So while they’re healthier than sugar, it’s best to not go overboard.


If you’re diabetic, on a low-carb diet, or watching your calories, here are a couple of zero-calorie sweeteners to consider:

  • Stevia: This natural sweetener comes from the South American plant Stevia rebaudiana. With zero calories and zero carbs, it’s a favorite among the keto and low-carb crowd. And unlike artificial sweeteners, stevia is free of nasty side effects. It’s between 200 to 400 times sweeter than sugar, so a little goes a long way.
  • Monk fruit extract: Another darling of the keto community, monk fruit is roughly 100 to 250 times sweeter than sugar. Like stevia, it’s also free of calories and doesn’t affect your blood sugar levels.



The safety of artificial sweeteners remains controversial. The FDA maintains these calorie-free sweeteners are safe when used within recommended amounts. Yet, research shows artificial sweeteners are linked with an increased risk of cardiovascular disease. Even newer artificial sweeteners, such as erythritol are linked with a higher risk of heart attack and stroke. While more research is needed, sticking to more natural sources of sugar is a safer bet.