If you’re adopting new eating habits to help control your blood pressure, chances are that part of the program involves cutting back on added sugar. Substitutes offer one way to still enjoy your favourite treats, but do you need to worry about these sweetener’s effects on your blood pressure?
The relationship between sugar substitutes and blood pressure has been the subject of ongoing research and, in this article, we will explore any potential correlations between the two.
Understanding sugar substitutes
Sugar substitutes, also called non-nutritive sweeteners, include:
- Aspartame
- Sucralose
- Saccharin
- Acesulfame potassium (aka Acesulfame K)
- Monk fruit
- Stevia
- Sugar alcohols, like xylitol, erythritol, and others
One of the purported benefits of these substances is that they can provide sweetness but without the caloric content of sugar, making them attractive for weight control. In addition, they don’t affect blood sugar levels because they aren’t based on carbohydrates, therefore they can be used within a sugar-controlled diet, for example when managing diabetes. However, their potential impact on cardiovascular health, particularly blood pressure, has raised concerns. For example, a recent study in the BMJ has suggested a relationship between higher artificial sweetener consumption (especially aspartame, acesulfame potassium and sucralose) and increased cardiovascular disease risk.
Potential mechanisms affecting blood pressure
Several theories have been proposed regarding how sugar substitutes might affect blood pressure.
Gut microbiome
Some studies suggest that they could influence the gut microbiome, which plays a crucial role in metabolism and overall health. This is important, as disruptions in the gut microbiome balance have been linked to metabolic disorders like insulin resistance, obesity, and increased blood pressure.
Vascular Health
Research undertaken on rodents indicates that sugar substitutesmay affect the inner lining of blood vessels, known as the endothelium, which plays a critical role in regulating blood pressure through release of paracrine signaling molecules, such as nitric oxide (NO) and prostacyclin.Disruption of endothelial function could therefore increase the risk of cardiovascular disorders relating to blood pressure.
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What do the studies say?
In 2023, a study raised concerns about the safety of erythritol, a sugar alcohol commonly used as a sweetener. It found that higher levels of erythritol in the blood were associated with an increased risk of major cardiovascular events such as heart attacks and strokes. This is due to increased platelet reactivity (leading to a higher risk of clotting) instead of changes in blood pressure. There are also studies that suggest high consumption of sugar-sweetened and artificially sweetened beverages leads to increased blood pressure. Finally, rodent models have shown that long term consumption of sugar substitutes does not directly impact upon cardiovascular health. However, it can cause electrophysiological abnormalities, such as a tendency towards increased atrial fibrillation inducibility. That said, more research is needed, and it should be stressed that this study was completed on rodents and not humans.
Yet, there are also research papers suggesting that sugar substitutes have minimal impact upon the body. For instance, though it is well known that stress has an adverse effect on our cardiovascular system, a recent study has shown no difference in blood flow through vessels during stress tests after the consumption of water, artificially sweetened water or sucrose-sweetened water. Individual differences matter
The fact that there is a large body of evidence simultaneously showing that sugar substitutes do and do not affect the body suggests that the answer is not clear-cut, and more research is needed.
One reason for the conflicting data on substitutes and blood pressure may lie in individual differences. Factors such as age, sex, genetics, and overall health may influence how the body responds to them. For example, people with pre-existing metabolic conditions, such as obesity or type 2 diabetes, may respond differently to sugar substitutes when compared with healthy individuals. Another aspect that influences results is lifestyle, and, it has been noted that differences in health habits can affect health outcomes. For example, patient interventions such as cutting back on sodium and regularly exercising can have a positive impact upon the body, whereas being sedentary and having a poor diet can have a negative impact.
Should you be concerned about sugar substitues’ effect on blood pressure (BP)?
Current evidence suggests that the effects of sugar substitutes on blood pressure are minimal for most people, with no conclusive evidence that they directly raise BPin healthy individuals. However, for some people, such as those who consume large amounts of substitutes, there may be a small risk of elevated blood pressure or adverse coronary events. In addition, the impact upon the body may also be related to the identity of the sweetening agent. There is evidence suggesting that aspartame may be closely linked to an increased risk of stroke, whereas sucralose and acesulfame potassium could be more strongly linked to coronary heart disease. However, more work is needed.
As with many dietary components, moderation is key. While sugar substitutes can be a useful tool for reducing sugar intake and managing weight, more research is needed to fully understand their long-term impact on blood pressure and overall cardiovascular health.
Disclaimer: This article is for educational purposes only and does not contain, nor replace, medical advice. Consult your doctor before making any changes to your diet or lifestyle.
Sources:
Sugar, sweeteners and diabetes. Diabetes UK, November 26, 2024 – https://www.diabetes.org.uk/living-with-diabetes-eating-carbohydrates-and-diabetes-sugar-sweeteners-and-diabetes
Artificial sweeteners: No help, possible harm? Harvard Health Publishing, November 1, 2017 – https://www.health.harvard.edu/heart-health-artificial-sweeteners-no-help-possible-harm
Artificial sweeteners and risk of cardiovascular diseases: results from the prospective NutriNet-Santé, BMJ, September 7, 2022 – https://doi.org/101136-bmj2022071204
Ten-Week Sucralose Consumption Induces Gut Dysbiosis and Altered Glucose and Insulin Levels in Healthy Young Adults. MDPI, September 21, 2024- https://doi.org/103390-microorganisms10020434
Gut microbial carbohydrate metabolism contributes to insulin resistance. Nature, December 2, 2024 – https://doi.org/101038-s4158602306466x
Gut microbiota in obesity. BPG, July 7, 2021 – https://doi.org/103748-wjgv27i253837
The gut microbiome and hypertension. Nature Reviews Nephrology, January 11, 2023 – https://doi.org/101038-s41581022006540
Artificial sweeteners impair endothelial vascular reactivity: Preliminary results in rodents. NMCB, May 7, 2020 – https://doi.org/101016-jnumecd202001014
Increased Vascular Contractility in Hypertension Results From Impaired Endothelial Calcium Signaling. AHA, September 23, 2019 – https://doi.org/HYPERTENSIONAHA
The artificial sweetener erythritol and cardiovascular event risk. Nature Medicine, February 27, 2023- https://doi.org/101038-s41591-023022239
Prospective association of sugar-sweetened and artificially sweetened beverage intake with risk of hypertension. Archives of Cardiovascular Diseases, April 14, 2024 – https://doi.org/101016-jacvd201510005
Long-term consumption of artificial sweeteners does not affect cardiovascular health and survival in rats. Peer J, March 9, 2022 – https://doi.org/10.7717/peerj.13071
Effect of nutritive and non-nutritive sweeteners on hemodynamic responses to acute stress: a randomized crossover trial in healthy women. Nutrition Diabetes, January 2, 2020- https://doi.org/101038-s413870190104y
Are artificial sweeteners safe? British Heart Foundation, September 14, 2022 – https://www.bhf.org.uk/heart-matters-magazine-behind-the-headlines-are-artificial-sweeteners-safe
