What to Know About the Study Linking a Popular Artificial Sweetener to Cardiovascular Disease

A team says erythritol, a keto-friendly sweetener, may be linked to a higher risk of strokes and heart disease, but more research is needed.

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A new study suggests that a popular artificial sweetener may not be as harmless as thought. The researchers say they found evidence in both animals and humans that the sugar alcohol erythritol, commonly included in keto diets, can raise certain people’s risk of cardiovascular disease. Importantly, however, the study only demonstrates a correlation, not a direct cause-and-effect relationship, and more research will be needed to untangle any possible link.

The Erythritol and Heart Disease Study

The work was led by researchers from the Cleveland Clinic. According to the authors, they were simply looking for any hidden risk factors in a sample of patients undergoing cardiac exams when they first noticed the connection. Patients who had higher levels of sugar alcohols in their blood circulation, especially erythritol, seemed to have a later higher risk of major adverse cardiovascular events, such as heart attacks and stroke. Curious, they looked through other datasets of patients in the U.S. and Europe and found the same association.

They subsequently conducted studies in the lab and on animals, finding that exposure to erythritol seems to change the behavior of platelets, which then appears to raise the risk of clotting. And finally, in a very small study of human volunteers (eight in total), the researchers found that people who ingested erythritol went on to have higher and sustained (over two days) levels of erythritol circulating in their blood.


“Our findings reveal that erythritol is both associated with incident [major adverse cardiac events] risk and fosters enhanced [clotting],” the authors wrote in their paper, published Tuesday in Nature Medicine.

The different lines of research are a strength of the study. And the scientists do lay out a plausible mechanism for how erythritol can be raising people’s risk of strokes and heart disease. At the same time, their theory is still built on circumstantial evidence—not definitive proof. It’s also possible that any such risk might only affect people vulnerable to cardiovascular disease in the first place, since the researchers first found the association in people who were already at risk for these problems.

What Is Erythritol?

Erythritol and other sugar alcohols are common sugar substitutes, either used alone or in combination with other types of sweeteners. It’s become more popular with the rise of keto diets. Erythritol is also produced by the body and is naturally found in many fruits and fermented foods. Eating too many of these sugar alcohols at once can cause stomach pain and other gastrointestinal problems, though it seems to be less of a risk with erythritol in particular. This study appears one of the first to suggest a risk of more serious health issues from erythritol.

Interestingly enough, at least one small study has suggested that erythritol might actually improve the blood vessel health of people with diabetes and thus protect them from cardiovascular disease. One major caveat, though, that study was funded by Cargill, a producer of erythritol.


This current research certainly seems worth taking seriously, but it’s only the start. More work, ideally from other research teams, will have to try to verify what these scientists have found, hopefully sooner than later.

“Studies assessing the long-term safety of erythritol are warranted,” the authors wrote.