Why Is the Sugar Substitute Erythritol Risky?

Everyone on the planet may already know that sugar is bad for our health. Excessive sugar contributes to cavities in teeth and pimples on skin. It adds pounds and displaces more nutritious foods like produce or whole grains. Nutrition experts suspect that people who consume a lot of sugar are at greater risk for metabolic syndrome or even diabetes. Despite this, many people still crave sweetness. Consequently, some have embraced sugar substitutes. Unfortunately, many artificial sweeteners carry their own risks. Now we learn that is also true of a natural sugar substitute, erythritol.

A Red Flag on Erythritol:

Erythritol is a popular sugar substitute presented as a natural low-calorie sweetener. Many energy drinks, snack bars and protein supplements rely upon it for their taste appeal. It does not raise blood sugar or insulin like table sugar does. However, studies have suggested that it may have some undesirable effects.

A few years ago, researchers at the Cleveland Clinic found that people with measurable levels of erythritol circulating in their bloodstreams were more likely to experience serious cardiovascular events such as stroke or heart attack in the following three years (Nature Medicine, March 2023). They found that blood platelets reacted to erythritol in test tubes, becoming more likely to clump together. Animal studies showed that the sweetener increased the chance of blood clots. Moreover, healthy volunteers ingesting erythritol had blood levels well above the levels that produced reactions in experiments. These scientists called for long-term safety studies of the sweetener.

Could This Be True?

Needless to say, this alarming finding was controversial (Frontiers in Nutrition, May 23, 2023). Some of the researchers who had conducted the original studies responded to criticism by examining another natural compound used as a sugar substitute, xylitol. They found it too, like erythritol, is associated with an elevated risk of blood clots and cardiovascular complications (European Heart Journal, Nov. 20, 2024).

The scientists also compared the effects of erythritol and glucose in healthy volunteers (Arteriosclerosis, Thrombosis, and Vascular Biology, Sep. 2024). They found that dietary erythritol in a typical dose greatly increased plasma concentrations of the compound. What’s more, platelet reactivity was much higher with erythritol but not glucose, a compound found in table sugar.

They conclude

“the present findings suggest that discussion of whether erythritol should be reevaluated as a food additive with the Generally Recognized as Safe designation is warranted.”

Recent Research Raises New Concerns about Erythritol:

Now a different group of investigators has found that platelets are not the only cells to respond badly to erythritol. Endothelial cells line the blood vessels and contribute to their contraction and dilation. The scientists are reporting to the American Physiology Summit (Baltimore, MD, April 25, 2025) that exposure to erythritol impairs the ability of endothelial cells to produce nitric oxide.

Nitric oxide is an important compound that helps blood vessels dilate, lowering blood pressure and increasing blood flow. The cells the researchers used in their experiments were derived from tiny blood vessels in the brain. After exposure to erythritol, these cells registered higher levels of oxidative stress.

The lead author of the study noted,

“While erythritol is widely used in sugar-free products marketed as healthier alternatives, more research is needed to fully understand its impact on vascular health. In general, people should be conscious of the amount of erythritol they are consuming on a daily basis.”

We endorse that sentiment, and we suggest reading labels carefully. Although presenting research at a conference like the American Physiology Summit is not the same as publishing it in a peer-reviewed journal, having two possible mechanisms for cardiovascular harm is worrisome. That’s underscored by epidemiological data showing that Finns with high levels of erythritol in their blood were more likely to die of heart disease or cancer (Nutrients, Sep. 17, 2024).  Older Americans also were more likely to suffer heart failure, coronary heart disease and cardiovascular death if they had elevated levels of erythritol and its metabolite, erythronate (JACC Advances, March 2025).