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By Miriam Raftery

Photo by Thomas Kniess, CC 4.0 via Wikipedia

March 6, 2023 (San Diego) – Erythritol, an artificial sweetener, substantially increases the risk of death from heart attacks and strokes caused by blood clots, according to a study by the Cleveland Clinic’s Lerner Research Institute published in the journal Nature Medicine.

Erythritol is not required to be listed on food labels, so consumers may not be aware when they are choosing products that contain it.  It’s used as a sugar replacement and is also added to bulk up stevia and monkfruit, two other sweeteners. It’s been found in high levels in some products for diabetics and in low-sugar keto products.

“The degree of risk was not modest,” said Dr. Stanley Hazen, lead author of the study and director of the Center for Cardiovascular Diagnostics and Prevention at the Cleveland Clinic Lerner Research Institute.

Those with the highest levels of Erythritol in their blood and who had risk factors for heart disease, such as diabetes, were twice as likely to have a heart attack or stroke as those who had not consumed Erythritol, the study found.

Even in healthy people, the study found that consuming 30 grams of Erythritol jacked up blood levels of the substance by 1,00% percent, and that the levels remained above the thresholds that can increase blood clots for up to three days.

“This certainly sounds an alarm,” Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver, told CNN. He suggests limited erythritol in people’s diets at least until further studies are done.   

But Robert Rankin, executive director of an industry association,  the Calorie Control Council, contends that the study results are contrary to past research showing reduced-calorie sweeteners to be safe, with regulatory permissions for their use in many countries, CNN reports.

So how can you avoid Erythritol, which looks and tastes like sugar, and may not be listed on food or beverage labels?

Sugar is one option. If you have want  a sugar alternative, there are several natural alternatives.

One is Xylitol, or birch sugar. But this is a bad idea if you have pets, since even small amounts of Xylitol can be deadly if a dog ingests it. Xylitol can also have a laxative effect.

Another option is Agave, a plant-derived sweetener that tastes similar to honey. But it has a high fructose content, so it’s not the best option for diabetics or those on diets.

Coconut blossom sugar has a low glycemic index, so it might take more to produce sweetness.

Maple syrup has lower glycemic index than cane sugar, so can be a good alternative if you’re watching your blood sugar levels and is also very tasty, as anyone who enjoys maple syrup on pancakes can attest. 

Avoid Truvia, Splenda, Stevia and Monk Fruit in the Raw, since these can contain Erythritol. However Stevia in the Raw does not contain Erythritol, according to a report published by in Green Matters.

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Should One Trust One Study on Erythritol?

As a long-time vegan, I have been using a protein powder sweetened with erythritol. I put one scoop on my cereal in the morning and one scoop on strawberries for evening dessert together with a no sugar added soy milk. I also use probably 1/4 or less scoop with coffees and teas, so my total is 10 grams or less per day. I don’t use any sugar, thus have a low sugar diet. And I am a regular blood donor, usually give one unit plasma and one unit platelets every four weeks and being in my late 70s, everything is as perfect as I could want it. What is extremely upsetting is that newspapers and other media have jumped on this paper without any careful scientific analysis. Unfortunately, I could only find the Abstract online since I am a retired researcher and would have liked to do my own analysis of the paper; but I found the following:

“This study is made up of several small studies using varying methodologies with their own inherent flaws,  to draw correlations that do not establish causality, do not represent real-world erythritol consumption, and cannot be extrapolated to the general public. Some additional key factors to consider include: 

The authors only included individuals who were already at increased risk for adverse cardiovascular events. 
The authors did not control for overall diet, physical activity and other important factors that are known to be associated with cardiovascular disease risk. 
The authors conducted in-vitro studies, which cannot mimic the complex physiological environment of the human body which includes absorption, metabolism, and excretion.  
As most commercial products containing erythritol usually contain a very small amount, which are usually blended with other sweeteners, the subjects of the study consumed excessive amounts (30 g of erythritol dissolved in 300 ml water within 2 minutes) which does not reflect a typical real-world serving (which is closer to 8 g per serving based on the U.S. Food and Drug Administration approval for erythritol).  
The authors incorrectly referred to erythritol as an artificial sweetener. While erythritol may be commercially produced from glucose, it exists naturally in a variety of fruits and fermented foods.  

For more than three decades, erythritol has been commercially produced and added to foods and beverages to provide sweetness, as well as enhance their taste and texture. In addition to providing zero calories, erythritol is well-tolerated, does not affect blood serum glucose or insulin levels and does not cause tooth decay. The safety of erythritol as a food ingredient under conditions of its intended use is substantiated by human and animal safety studies, including short- and long-term feeding, multi-generation reproduction and teratology studies. The FAO/WHO Joint Expert Committee on Food Additives (JECFA) has reviewed the safety of erythritol and established an acceptable daily intake level of “not specified,” the highest safety category possible. It is approved for use in foods in more than 50 countries, including the United States, Canada, Brazil, Mexico, Australia, New Zealand, and the European Union.”  Calorie Control Council. CCC Statement on “The Artificial Sweetener Erythritol and Cardiovascular Event Risk Available at:

“The first issue to jump out here is that all of the people studied already had metabolic issues of some sort. So it's at least unclear that these results would generalize to populations without these issues.
Another red flag (raised by a neurobiology Ph.D. student on Twitter) is that the people in the highest quartile of erythritol levels look quite different than the people in the lowest quartile. In the first part of the study, for instance, those in the lowest quartile had an average age of 59.8, while those in the highest quartile had an average age of 70.2. The highest quartile had about a point heavier BMI, was less likely to be male, and was significantly more likely to have diabetes (36.7 percent versus 14.8 percent in the lowest quartile). They were more likely to have a history of heart attack and heart failure, and had significantly higher blood triglyceride levels, among other things. And similar differences can be seen in the U.S. and European study cohorts.

The researchers say they adjusted for these factors. But it's difficult to adjust for such a wide range of differences and all the complex metabolic processes that they entail.

Perhaps the biggest issue in the study—noted by University of Oxford researcher Nicola Guess—is that human bodies produce some erythritol naturally, and yet the researchers didn't control for endogenous versus exogenous erythritol.”
Elizabeth Nolan Brown (2023 Mar 2). Be Skeptical of the New Artificial Sweetener Scare. Reason Magazine. Available at: