Erythritol

Treat erythritol-sweetened products as occasional, not staples. If you have heart disease, a past stroke, atrial fibrillation or a high risk of clots (including anyone on antiplatelet drugs), don't use it as an everyday sweetener.

What it is

Erythritol is a sugar alcohol (polyol) and very low in calories. Most of it is absorbed and then passed unchanged in urine, so it barely touches blood sugar — its glycemic index is zero, against 65 for table sugar.^[1] It turns up mainly in keto baking, sugar-free sweets and low-carb protein bars. Your body also makes some itself from glucose, and that matters for everything below.

The heart signal

A Cleveland Clinic group measured blood erythritol in people having heart check-ups: a US cohort of 2,149 adults and a European one of 833. People in the top quarter had roughly double the three-year risk of a heart attack, stroke or cardiovascular death — about 80% higher in the US group and about 120% higher in the European one. In the lab, erythritol made platelets more prone to clotting at levels people actually reach, and a single typical sweetener dose of around 30 g kept blood levels above that threshold for more than 48 hours.^[2]

A third study, of 4,006 older adults, replicated only part of this. Erythritol tracked with heart failure, cardiovascular death and death from any cause, but not with heart attack or stroke — the two events that carried most of the weight in the original finding.^[3]

Pooling six blood-level studies of sugar alcohols, the highest levels carried about 26% more cardiovascular events. The studies disagreed a lot, and smaller studies that found nothing may be missing from the record.^[4]

Cause, or a marker of poor metabolic health?

This is the open question. Because the body makes more erythritol from glucose under metabolic stress, high blood erythritol may partly flag underlying cardiometabolic disease rather than cause harm.

• Genetic studies haven't settled it. These use inherited differences in erythritol levels to get around confounding. The largest found no causal effect on coronary heart disease;^[5] two smaller ones found effects that were statistically positive but very small. A 2026 analysis linking erythritol to stroke used the same small set of genetic markers as those, so it is not independent confirmation.
• A weight-loss trial fits the marker reading. In an observational analysis of a two-year weight-loss trial, people whose blood erythritol fell saw their estimated ten-year heart risk fall slightly. That is consistent with erythritol as a marker, but it cannot rule out a direct effect.^[6]
• The platelet work is what keeps the dietary worry alive. The clotting effect at levels a single serving produces is the load-bearing piece of the case, more than the risk figures alone.

What hasn't been tested

There is no trial on heart attacks or strokes. The human challenge evidence is an eight-person study with no comparison group. The one randomised trial of regular intake gave 42 adults with obesity 36 g of erythritol (or 24 g of xylitol) a day for five weeks and found no effect on artery stiffness, belly fat or glucose tolerance — reassuring, but short and small, and not designed to catch clots.^[7]

A separate line of evidence points the same way. In a Brazilian study of 12,772 adults followed for about eight years, erythritol was one of three sugar alcohols individually linked to faster decline in memory and thinking, in adults under 60 only.^[8] Different population, different outcome, different research group. The paper has since been corrected twice, once after a full re-analysis, so trust the direction more than any single number.

Your gut, and the official limit

Erythritol is the best-tolerated sugar alcohol, because most of it is absorbed before it reaches the colon. It is not exempt from the rules, though. EU law requires a laxative warning on any food with more than 10% added sugar alcohols, erythritol included,^[9] and the European Food Safety Authority (EFSA) refused an industry request for an erythritol exemption in 2023. It set an intake limit of 0.5 g per kilogram of body weight a day — about 35 g for a 70-kg adult — and estimated that high consumers, especially children, may already exceed it, though it considered its own estimates to be on the high side.^[10] The "typical sweetener dose" of around 30 g used in the platelet experiments is not far below it.

Like other sugar alcohols, it doesn't feed tooth decay.

What to do

1. Keep erythritol occasional. A sugar-free sweet now and then is a different exposure from erythritol as the base of daily baking and drinks.
2. If you have cardiovascular disease or a high clotting risk, avoid it as a routine sweetener. The evidence is not proof of harm, but the downside falls on exactly this group.
3. For baking, allulose is the better-evidenced swap; for drinks, stevia. The wider comparison is on Sugar substitutes.

Further reading

• Witkowski M et al. The artificial sweetener erythritol and cardiovascular event risk. Nature Medicine 2023.^[11]
• Abushamat LA et al. Erythritol, erythronate, and cardiovascular outcomes in older adults in the ARIC study. JACC Advances 2025.^[12]
• Khafagy R et al. Erythritol as a Potential Causal Contributor to Cardiometabolic Disease: A Mendelian Randomization Study. Diabetes 2024.^[13]
• Bordier V et al. Effects of a 5-week intake of erythritol and xylitol on vascular function, abdominal fat and glucose tolerance in humans with obesity: a pilot trial. BMJ Nutrition, Prevention & Health 2023.^[14]
• Younes M et al. Re-evaluation of erythritol (E 968) as a food additive. EFSA Journal 2023.^[15]
• Livesey G. Health potential of polyols as sugar replacers, with emphasis on low glycaemic properties. Nutrition Research Reviews 2003.^[16]