Erythritol Linked to Increased Cardiovascular Risk

Researchers investigated the link between the common artificial sweetener erythritol and cardiovascular risk. They found that erythritol is linked to increased cardiovascular risk. Further studies are needed to confirm the results.

Individuals with metabolic conditions such as type 2 diabetes and obesity are often advised to consume products that replace sugars with artificial sweeteners to improve blood sugar levels and facilitate weight loss.

However, there are no long-term clinical trials examining the safety of most sweeteners. Some studies suggest that certain sweeteners may be linked to weight gain, cardiovascular disease, and type 2 diabetes.

Erythritol is a commonly used artificial sweetener, consumption increases cardiovascular risk, including the risk of a heart attack or stroke, thrombosis (blood clotting), and death related to a cardiovascular event. The results appear in Nature.

The researchers first analyzed blood samples from 1,157 participants. They found multiple compounds linked to cardiovascular risk. However, erythritol had some of the strongest links to the risk of cardiovascular events.

Next, the researchers analyzed blood samples from 2,149 participants from the United States and from 833 European participants. Plasma levels of erythritol were higher among participants with cardiovascular disease.

They also found that participants in the U.S. and European cohorts with the highest 25 percentile erythritol blood levels were 2.5 and 4.5 times more likely to have a cardiovascular event than those in the lowest 25 percentile.

Each micromole increase in erythritol levels was linked to a 21% and 16% increase in cardiovascular event risk in U.S. and European cohorts, respectively.

Next, the researchers set out to see how erythritol impacted blood clotting. Through multiple tests, they found that increased erythritol levels indicated higher rates of clot formation and increased thrombosis potential.

Lastly, the researchers examined the effects of consuming a snack or drink containing 30 grams (g) of erythritol in eight participants. While erythritol levels were low at baseline, they remained 1,000-fold higher for hours after ingestion.

“It is important that further safety studies are conducted to examine the long-term effects of artificial sweeteners in general, and erythritol specifically, on risks for heart attack and stroke, particularly in people at higher risk for cardiovascular disease,” notes senior author Dr. Stanley Hazen, chairman of the Department of Cardiovascular and Metabolic Sciences in Lerner Research Institute and co-section head of Preventive Cardiology at Cleveland Clinic.

“As cardiovascular disease is a process that is more complex than platelet aggregation alone, it is possible that erythritol causes other pathophysiologic changes on the molecular level to increase the risk for a cardiovascular event. Complicating matters, it appears that consuming erythritol-sweetened foods increases plasma erythritol levels for days, potentially prolonging cardiovascular effects.”, says Dr. Rigved Tadwalkar.

“Although compelling, the studies are preliminary, and findings indicate an association between erythritol and heart attacks and strokes rather than a causal relationship,” noted Dr. Hwa.

“Longer term studies are needed, measuring both erythritol levels and markers of platelet activation in the same patients, particularly those that had heart attacks and strokes,” he added.

Dr. Tadwalkar further cautioned that although “adjustments were made in this study for traditional risk factors that are known to be implicated in cardiovascular disease, including age, smoking status, blood pressure, and cholesterol levels […] it is possible that unmeasured confounders may be present, such as diet, which could have affected the results.”

“Nutritional metabolism is complex and sometimes unpredictable,” Dr. Hwa pointed out. “Even though erythritol is a naturally occurring substance and made in some cells in the body, if taken in excess may lead to platelet dysfunction.”

“If proven with further studies, caution should be taken in cardiovascular risk patients who may already be prone to ‘extra-sticky’ platelets such as [people with diabetes]. Consultation with one’s own medical practitioner may then be necessary before considering erythritol,” he noted.


Witkowski, M., Nemet, I., Alamri, H. et al. The artificial sweetener erythritol and cardiovascular event risk. Nat Med (2023). DOI 

Annie Lennon on March 1, 2023. Common sweetener erythritol tied to higher risk of stroke and heart attack. MedicalNewsToday. Retrieved March 3, 2023 from 

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