For decades, erythritol was considered a safe, low-calorie alternative to sugar, particularly popular in ketogenic and diabetic-friendly foods. Unlike some other sugar alcohols, it was generally well-tolerated and didn't cause the same level of digestive upset. However, recent research has prompted a crucial reassessment of its long-term health implications, particularly for cardiovascular and neurological systems.
The Cleveland Clinic's Cardiovascular Findings (2023)
In early 2023, a study from the Cleveland Clinic linked higher blood levels of erythritol with an increased risk of heart attack and stroke over a three-year period in a high-risk population. The research also found that consuming a significant amount of erythritol caused blood levels to rise sharply and remain elevated, and that erythritol enhanced blood clot formation by making platelets more sensitive to clotting signals.
Cellular Mechanisms and Brain Health (2025)
Expanding on the 2023 findings, research presented in 2025 delved into erythritol's effects on brain health, focusing on the cells lining the brain's blood vessels. These studies indicated that erythritol exposure led to increased cellular damage due to higher levels of reactive oxygen species. Additionally, it reduced the production of nitric oxide, which is important for blood vessel relaxation, potentially impairing blood flow and increasing stroke risk. The research also suggested that erythritol could hinder the body's natural clot-busting activity, indicating a potential link to ischemic stroke and neurovascular damage.
Erythritol vs. Other Sweeteners: A Comparison
In light of these new findings, many are re-evaluating their choice of sugar substitutes. A comparison between erythritol and other popular sweeteners highlights key differences in their safety profiles and effects.
| Characteristic | Erythritol | Stevia | Monk Fruit | Regular Sugar |
|---|---|---|---|---|
| Sweetness | ~70% of sugar | 200-400x sweeter than sugar | ~150x sweeter than sugar | Reference standard |
| Calories | 0.2 kcal/g | Zero | Zero | 4 kcal/g |
| Blood Sugar Impact | Zero glycemic index | Zero glycemic index | Zero glycemic index | High glycemic index |
| Primary Health Concern | Cardiovascular and neurovascular risk | None reported | None reported | Weight gain, metabolic issues, diabetes |
| Common Use | Keto products, baked goods, bulk filler | Beverages, tabletop sweeteners | Beverages, packaged foods | Universal sweetener |
Scientific Context and Interpretations
The findings linking erythritol to cardiovascular and neurological risks are based on correlational epidemiological data and in-vitro cellular studies. Correlation does not prove causation, and cellular studies may not perfectly replicate conditions in the human body. The Calorie Control Council has stated that these results contradict previous research on erythritol's safety. Scientists involved in the research emphasize the need for larger, long-term human studies to confirm these effects, noting they may be dose-dependent and vary based on individual health.
What This Means for Consumers
For individuals seeking to reduce sugar intake, the emerging research suggests a cautious approach to erythritol is warranted, especially for those with existing risk factors for heart disease or stroke. Reducing overall reliance on sweeteners and focusing on whole foods may be beneficial.
Health experts suggest several prudent steps:
- Minimize Reliance: Decrease your overall consumption of processed foods and beverages containing any added sweeteners.
- Read Labels Carefully: Be aware that erythritol is often used as a bulk filler in other sweetener products, like stevia and monk fruit blends. Look for pure extracts or alternative options.
- Opt for Alternatives: Consider genuinely zero-calorie alternatives like stevia extract or monk fruit extract, which have not been linked to the same cardiovascular concerns in recent research.
- Consult a Professional: Discuss concerns with a healthcare provider or registered dietitian, especially if you have cardiovascular risk factors or are managing a condition like diabetes.
Conclusion
The new research on erythritol presents a challenge to its long-held reputation as a safe sugar substitute. Recent studies highlight potential adverse effects on cardiovascular and neurological function, including increased blood clotting and impaired blood vessel health. These findings encourage caution, prompting consumers and manufacturers to reconsider its use and calling for further research to clarify its long-term safety. Experts recommend moderation and exploring alternatives, particularly for individuals at risk. This evolving scientific understanding underscores the complexity of food science and the importance of ongoing investigation into food additives.
Cleveland Clinic Study: Substitute Erythritol Raises Cardiovascular Risk
