Erythritol, the zero-calorie sweetener found in everything from keto protein bars to sugar-free sodas, is facing intense scrutiny after a series of groundbreaking studies linked it to significantly increased risks of heart attack and stroke. Once hailed as a safe alternative for weight loss and diabetes management, this popular sugar substitute is now at the center of a health debate that could change how millions approach sugar-free eating.
Breaking Research: How Erythritol Increases Cardiovascular Risk
A comprehensive study from the Cleveland Clinic, published in August 2024, revealed that erythritol consumption makes platelets—the blood cells responsible for clotting—more active, dramatically increasing the risk of dangerous blood clots. Dr. Stanley Hazen, the study's senior author and a specialist in preventive cardiovascular medicine, explained that this effect isn't minor. "It wasn't a modest effect. It was a very large effect that we were seeing reproduced across multiple groups and across geographies," he emphasized.
The research showed that a single serving of erythritol-containing "keto-friendly" processed foods can increase blood levels of the sweetener by 1,000-fold, well above the threshold linked to enhanced clotting risks. This elevated clotting potential can persist for several days after consumption, creating a window of increased vulnerability to cardiovascular events.
From 2023 to 2025: The Growing Evidence Against Erythritol
The timeline of erythritol research reveals a consistent pattern of concern. In March 2023, NIH Research Matters highlighted a study finding that higher blood levels of erythritol were associated with increased risk of heart attack and stroke. The Cleveland Clinic's 2024 intervention study provided mechanistic evidence, showing how erythritol directly affects platelet function.
Then, in July 2025, University of Colorado Boulder researchers published a study in the Journal of Applied Physiology demonstrating that even small amounts of erythritol can harm brain blood vessel cells. The study found that erythritol-treated cells produced less nitric oxide (which relaxes blood vessels) and more endothelin-1 (which constricts them), while also showing reduced ability to break down blood clots.
"Big picture, if your vessels are more constricted and your ability to break down blood clots is lowered, your risk of stroke goes up," explained Auburn Berry, the study's first author and a graduate researcher at CU Boulder.
Inside the Bloodstream: How Erythritol Triggers Dangerous Changes
The mechanisms behind erythritol's harmful effects are becoming increasingly clear. When erythritol enters the bloodstream, it triggers several physiological changes that collectively increase cardiovascular risk:
- Platelet Activation: Erythritol makes platelets more "sticky," lowering the threshold for clot formation and increasing the likelihood of dangerous blood clots that can cause heart attacks and strokes.
- Blood Vessel Constriction: The sweetener reduces production of nitric oxide while increasing endothelin-1, leading to narrower blood vessels and reduced blood flow.
- Impaired Clot Breakdown: Cells exposed to erythritol show "markedly blunted" production of t-PA, the body's natural clot-busting compound.
- Increased Inflammation: Erythritol-treated cells produce more reactive oxygen species (free radicals), which damage cells and promote inflammation in blood vessel walls.
These effects are particularly concerning because erythritol is often consumed by people already at higher cardiovascular risk—those with obesity, diabetes, or following ketogenic diets for weight management.
Where We Stand: Regulatory Responses and Expert Recommendations
Despite the growing evidence, erythritol remains classified as "Generally Recognized as Safe" (GRAS) by the U.S. Food and Drug Administration. However, researchers involved in these studies argue that regulatory agencies should reevaluate this classification given the new findings.
Dr. Christopher DeSouza, senior author of the University of Colorado study, advises consumers to be cautious: "Given the epidemiological study that inspired our work, and now our cellular findings, we believe it would be prudent for people to monitor their consumption of non-nutrient-sweeteners such as this one."
Healthcare professionals increasingly recommend reading food labels carefully, looking not just for "erythritol" but also for "sugar alcohol" listings, which indicate the presence of this and similar sweeteners.
The Future of Sweeteners: Safer Alternatives and Consumer Choices
For those seeking sugar alternatives, experts suggest several options that currently appear safer than erythritol:
- Stevia (pure leaf extract): Plant-based sweetener without the sugar alcohol structure of erythritol
- Monk Fruit: Another natural sweetener that doesn't contain sugar alcohols
- Small amounts of natural sweeteners: Honey, maple syrup, or coconut sugar in moderation
- Gradual reduction: Training your palate to enjoy less sweetness overall
It's important to note that some stevia and monk fruit products on the market are blended with erythritol to improve texture and bulk, so checking ingredient lists remains crucial.
Key Takeaways: What You Need to Know About Erythritol
The evidence against erythritol is mounting, with multiple studies across different research institutions converging on similar concerning conclusions. While more human trials are needed to fully understand the long-term effects, the current research suggests that this popular sweetener may pose significant cardiovascular risks that outweigh its benefits for many consumers.
If you regularly consume keto-friendly, low-carb, or sugar-free products, taking a closer look at their sweetener content could be an important step in protecting your heart and brain health. As with any dietary change, consulting with a healthcare professional about your individual risk factors and sweetener choices is always recommended.
