Does Erythritol Increase Heart Disease Risk?

Erythritol, an FDA-approved low-calorie sweetener, may be associated with increased heart disease risk, according to a study published last week in Nature Medicine.

Researchers said higher levels of blood erythritol were found in people with an elevated risk for heart attack or stroke after examining blood samples from over 4,000 individuals in Europe and the United States.

The researchers also found that erythritol may make it easier for blood clots to form, but some health experts pointed out that the data only came from research on mice and a small cohort of eight humans.

This wasn’t the only concern some experts had about the Nature Medicine study.

In a Twitter thread, Nicola Guess, RD, MPH, PhD, a dietitian based in London specializing in the prevention and management of type 2 diabetes, pointed out that the researchers did not attempt to control or assess exposure to erythritol that’s naturally produced in the body. She argued that erythritol in the blood can be an indicator cardiometabolic dysfunction rather than a cause.

Maya Vadiveloo, PhD, RD, FAHA, an associate professor in nutrition and food sciences at the University of Rhode Island, who was not affiliated with the study, said that the association between blood erythritol levels and heart disease risk could be due to participants incorporating more sugar substitutes in their diets to lower their health risks.

“Without a comprehensive examination of dietary patterns—both before and after disease development—it is difficult to know whether there is some reverse causation,” Vadiveloo told Verywell in an email.

Should You Stop Using Erythritol?

Erythritol, a sugar alcohol that is produced naturally in some fruits and commercially by food scientists, doesn’t seem to have the same negative effect on blood sugar or dental hygiene as regular sugar, and contains almost zero calories. But the study researchers are cautious about the long-term impact of consuming erythritol.

“Cardiovascular disease builds over time,” Stanley Hazen, MD, PhD, a co-author of the study, said in a press release. “We need to make sure the foods we eat aren’t hidden contributors.”

A review published earlier this year in Nutrients concluded that long-term clinical studies on the effects and safety of erythritol are lacking.

Sugar substitutes, including erythritol, saccharin, and sucralose, are often considered helpful in weight loss because of their presence in low or zero-calorie products. But some research suggests that artificial sweeteners may actually have an unintended effect on metabolism and lead to weight gain.

“I have seen many patients develop unhealthy eating habits and patterns when using non-nutritive sweeteners,” Nancy Farrell Allen, MS, RDN, a spokesperson of the Academy of Nutrition and Dietetics in Fredericksburg, VA, told Verywell in an email.

Farrell Allen said that certain sugar substitutes can contribute to overeating because people might not feel as satiated after consuming foods made with non-nutritive sweeteners so they end up eating more.

“My advice is to be mindful and use non-nutritive or natural sweeteners sparingly,” Farrell Allen said.