A Journey with Artificial Sweeteners and Heart Disease

When I was diagnosed with heart disease last year, I was also told that I was at risk for developing diabetes. I was advised to avoid sugar and to switch to products with sugar substitutes to satisfy my ever-present sweet tooth. It has been a journey to find healthy sugar alternatives.

So, I started eating products such as Chobani Zero Sugar and Oikos Triple Zero yogurts, drank Zetia sweetened iced tea, and Swerve brown sugar substitute went into my heart-healthy oatmeal. These use sugar alcohols that are sweeter than sugar, so much less is used. My understanding was that except for possible unpleasant gastrointestinal side effects, they were safe, and additionally, didn’t cause a spike in blood sugar like other artificial sweeteners.

However, recently, a study came out in the medical journal, Nature Medicine, that consuming erythritol, a common sugar alcohol (Stevia) was associated in a 2x fold increase in adverse cardiac events, including heart attacks, strokes and even death. The study has potential limitations – as the people studied had a history of heart disease – and further research is needed, but the findings were unexpected. This raised concerns for me.

I’m old enough to remember the pink Sweet ’n Low packets that contained saccharin. But then, studies came out showing that it caused bladder cancer in mice (not people), and it was mostly banned, (except for dire-hard Tab drinkers) only to be replaced by aspartame (Nutri-Sweet) in those blue packets. But aspartame, was later considered to be possibility carcinogenic and fell out of favor only to be replaced with those yellow packets of sucralose (Equal). However, some people find that it has a bitter aftertaste, so then Stevia in green packets came out and grew in popularity. That it was from a plant, and not from a laboratory, reassured people that it was ‘natural’ and thus safe.

The problem with artificial sweeteners however is two-fold. One, when your brain receives signals that you are eating or drinking something sweet, it sends signals to your pancreas to increase insulin production, which can still cause blood sugar levels to spike. Many studies support that consuming artificial sweeteners then can still lead to diabetes and weight gain. Second, because those sweeteners are no-calorie, the increase in insulin and subsequent blood sugar crash will leave many hungrier than before and more likely to eat more calories overall. In my experience, I feel far less satisfied after eating a triple-zero yogurt than I would with low-fat yogurt sweetened with actual sugar, or better yet, fresh fruit.

So what should I do? While more studies are needed, I decided that, as a woman with heart disease, it’s not worth taking any chances with my heart. I immediately returned a box of Triple Zero yogurt to my local Costco (who happily accepted it) and donated my packets of Stevia and Swerve to my office coffee bar. I plan to return to eating small quantities of sugar—and to consume most of it through fresh whole fruits – while allowing myself a treat now and then. To quote Michael Pollan, author of the book In Defense of Real Food, the best recourse may be simply to “Eat food. Mostly plants. Not too much.”

Keep those hearts beating strong!

Dr. Sherri Hansen is psychiatrist in Madison, WI and a Champion from the class of 2022.

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