Does Erythritol Cause Strokes and Heart Attacks? Science Says No

“Is erythritol bad for you?”

This would have seemed like a silly question not long ago, but a new study making the rounds seems to show that it can increase your risk of heart attack and stroke. 

As is their wont, corporate media has taken up this sensationalist incantation:

“Zero-calorie sweetener linked to heart attack and stroke, study finds” (CNN)

“Common sweetener erythritol tied to higher risk of stroke and heart attack” (Medical News Today)

“Artificial sweetener erythritol linked to heart attack and stroke, study finds” (CBS)

“Erythritol sweetener linked to heart attack, stroke risk, study finds” (Washington Post)

Erythritol is found in thousands of products ranging from chewing gum to pancake syrup to health supplements and pre-workout powder, and is probably consumed by tens of millions of people every day.

Should we all be worried? 

Surely our hallowed health chaperones in the media aren’t misleading us for the sake of advertising clicks, like they’ve done with red meat, sitting, alcohol, saturated fat, cholesterol, creatine, adrenal fatigue, exercise and weight loss, and high-protein dieting . . .  

. . . right?

Let’s find out. 

What Is Erythritol?

Erythritol is a sugar alcohol, an organic compound found naturally in foods such as wine, beer, mushrooms, pears, grapes, and soy sauce. It’s also produced industrially using glucose and endogenously (in the body) during glucose metabolism via a process called the pentose-phosphate pathway.

It contains significantly fewer calories than sugar and other sugar alcohols by weight. For example, table sugar contains ~4 calories per gram, sorbitol contains ~2.6 calories per gram, and xylitol contains ~2.4 calories per gram. In contrast, erythritol contains 0.2 calories per gram.

Despite containing fewer calories, erythritol sweetener is 60-to-70% as sweet as sugar, which is why food producers and supplement manufacturers regularly use erythritol as a lower-calorie substitute for sugar or other sugar alcohols.

Is Erythritol Safe?

Until recently, erythritol had an almost flawless safety record, with multiple studies showing it’s well-tolerated by humans and perhaps confers health benefits. 

It only seemed to cause unwanted side effects when eaten in vast quantities or paired with other sugar alcohols, provided you consumed larger-than-normal doses of both. Even then, reports of erythritol’s side effects weren’t cause for concern; most people reported minor stomach upset and little else.

This changed in February 2023, when a study published in the journal Nature Medicine made headlines after suggesting erythritol increases your risk of heart attack and stroke. 

This unsettled many people who regularly eat products containing erythritol, including Legion’s greens supplement Genesis and Pulse pre-workout, because they feared that the foods and supplements they were consuming to promote better health were in fact undermining it.

Almost every major media outlet eagerly embroidered the results, writing derivative articles based on their tried-and-tested “common ingredient is secretly killing you” formula. 

When you unravel the actual study, though, it’s clear this is much ado about nothing.

In this study, scientists at the Lerner Research Institute first looked at blood data from 1,157 overweight and obese people with poor cardiovascular health and found that many had high levels of erythritol.

Spurred by this finding, they took blood samples from another 2,149 overweight and obese people to investigate how much erythritol each had in their blood and how many suffered cardiovascular issues over a 3-year period.

The results showed that high blood levels of erythritol and poor cardiovascular health were correlated. What’s more, their association seems to have a dose-response relationship. That is, the higher your blood levels of erythritol, the stronger the association with bad heart health becomes.

The researchers did two further experiments: First, they added erythritol to blood platelets in a petri dish and found that erythritol negatively impacted platelet function. Then, they gave 8 people food containing 30 grams of erythritol and found that the people’s blood levels of erythritol remained elevated for 2 days.

If higher levels of erythritol are associated with poor cardiovascular health . . . and erythritol meddles with platelet function in a lab . . . and erythritol sticks around in your bloodstream for 48 hours . . . well, by golly, it must wreak havoc on your ticker and increase your chances of heart attack and stroke. Yay for science!

Of course, simply explicating their line of reasoning exposes a number of fallacious conclusions and logical leaps.  

First, the only data showing a link between erythritol and poor cardiovascular health is observational, which means it can only show two things correlate, not that one causes the other.

Second, the researchers never measured how much erythritol each participant ate, only how much erythritol was in their blood. That is, their data didn’t show that these people consumed large amounts of food containing erythritol, only that, for whatever reason, their blood contained a lot of erythritol (which could be influenced by factors other than their food choices).

This is significant because the study’s participants were very unhealthy: all were overweight or obese, ~22-to-28% had diabetes, 70-to-80% had high blood pressure, ~13-to-17% smoked, ~69-to-75% had coronary artery disease, 17-to-19% had heart failure, and 40-to-50% had already had a heart attack.

Research also shows that unhealthy people—especially those with obesity, diabetes, and cardiovascular disease—produce more erythritol via the pentose-phosphate pathway than healthy folk, regardless of how much they get from food.

In other words, there’s a good chance that the association is the result of reverse causation: these people aren’t becoming unwell because they have high blood levels of erythritol; they have high blood levels of erythritol because they’re unwell.

Moreover, it’s likely that their blood level of erythritol will increase as they get sicker, which explains why there appears to be a dose-response relationship between erythritol levels and cardiovascular issues.

Third, much of the researcher’s conclusion rests on evidence from an in vitro (outside the body) experiment in which the scientists mixed erythritol with blood platelets in a petri dish. However, unusual things routinely occur in experiments of this kind, which makes it impossible to know whether we can extrapolate the findings to living humans.

In other words, mixing substances with isolated human cells will always give you some fireworks, but it’s impossible to extrapolate exactly what effect this will have in the body. 

Fourth, only eight people participated in the “intervention” part of the study, where the researchers measured blood erythritol levels after people ate erythritol.

This is an extremely small sample size to begin with (fewer participants means a lower chance the results are valid), but it’s how these participants were selected that’s even more suspect. 

The authors noted that they pulled the data for these people from a completely separate, non-randomized study involving 40 participants (that’s still ongoing). They also neglected to mention this in the actual text of the study, and instead tucked it away in the supplementary material (which most people don’t read).  

While it wouldn’t be fair to assume they cherry picked the 8 people who’s results aligned with the conclusion they were gunning for, it’s plausible, and this casts a shadow of doubt over the rest of the study.

Finally, as part of the “intervention” trial, the researchers fed people 30 grams of erythritol, since they claimed that some folks consume up to this amount in the United States. 

While this is technically true, it’s also misleading.

According to the FDA, most erythritol users eat ~13 grams in an entire day and only 10% eat as much as 30 grams daily. Basically no one eats 30 grams in a single sitting, and 90% of people who eat erythritol eat less than 30 grams per day.

For example, you’d need to eat ~8 servings of Legion’s greens supplement Genesis or Pulse pre-workout to consume this much erythritol, and all in one sitting. 

You’d think that the mediacrats covering this story would touch on some of these glaring holes.

Instead, most recite vaguely ominous warnings about the dangers of erythritol, padded with speculative opinions from prevaricating doctors to lend credibility to their half-baked scaremongering. 

This bush-league reporting betrays the fact that the journalists and “experts” in question either didn’t pick up on any of these obvious flaws or bother to read the study.  

Conclusion