A 2023 study sent shockwaves through the sugar-substitute world. Researchers at the Cleveland Clinic found that people with higher levels of erythritol in their blood had nearly twice the risk of heart attack, stroke, and cardiovascular death over three years. Headlines warned people to ditch their erythritol-sweetened products immediately. At Hallelujah Diet, we had erythritol sweetener in one of our protein powder products, which we reformulated because of this study, just to be on the safe side.
The topic came up again because “we” (actually, one of my daughters) were considering making low-sugar jam with a stevia sweetener that also contained erythritol. I had remembered this study and was wondering more about it.
So, should you just avoid erythritol completely? Or is there more to the story than those headlines suggested?
It seems that the media lives on controversy, but it’s not very helpful to us. It gets them clicks, but it doesn’t give us clear direction. We get yanked back and forth.
Here’s what I found when I dug into this a bit further.
What the Headline-Making Study Actually Found
Marco Witkowski, Stanley Hazen, and colleagues published their findings in Nature Medicine in February 2023. Their team measured blood metabolites in thousands of patients who were already undergoing cardiac evaluation. They found that erythritol levels in the blood correlated with a higher risk of cardiovascular events.
They also showed that erythritol could enhance platelet clumping in lab and animal studies, a mechanism that could theoretically promote dangerous blood clots.
That sounds alarming. They also had data showing that when you ate erythritol, your blood erythritol levels went up for days.
But here’s what the study did not find: it did not measure what these patients were eating. No one tracked their erythritol consumption. And there’s a very good reason why that matters.
Key Point: Your Body Makes Erythritol
Erythritol is not just a commercial sweetener. Your body manufactures it. It is a natural byproduct of glucose metabolism via the pentose phosphate pathway.
Katie Hootman and colleagues at Cornell University demonstrated this clearly in a 2017 study published in the Proceedings of the National Academy of Sciences. Using isotope tracers, they confirmed that the human body synthesizes erythritol directly from glucose. And they found something striking: people who gained central body fat had 15 times higher blood erythritol than those who stayed stable. People with higher blood sugar levels had 21 times more.
That is a massive difference. And it was driven by the body’s own production — not by eating erythritol.
The Oxidative Stress Connection
A 2022 study from Cornell and the Technical University of Braunschweig added another piece. Semira Ortiz and Martha Field found that erythritol synthesis increases when cells are under oxidative stress. When the antioxidant response system is activated, as it is in metabolic syndrome, diabetes, and heart disease, erythritol production goes up.
In other words, elevated blood erythritol may be a symptom of metabolic dysfunction, not a cause of heart disease.
What a 2025 Review Concluded
A comprehensive 2025 review published in Cardiovascular Research by Bettina Wölnerhanssen and colleagues pulled together the full body of evidence. Their conclusion: Mendelian randomization studies, which use genetics to test cause-and-effect questions, do not link sugar alcohols to significant cardiovascular risk.
Studies on critically ill patients who received large intravenous doses of erythritol also did not find cardiovascular harm.
The review noted that endogenous erythritol production under conditions of metabolic stress is not fully understood, but the direction of evidence does not support dietary erythritol as the culprit.
What This Means for You
Above, we showed that your body makes erythritol. And if you have central body fat or high blood sugar, you have much higher levels.
So high blood Erythritol looks like a warning signal. It’s a metabolic red flag that glucose is overflowing its normal pathways. You have high levels of oxidative stress, and your metabolic health needs attention.
These are reasons to take your blood sugar seriously, not to avoid erythritol sweetener. Erythritol has a 50-year safety record in the food supply. That’s not the problem.
The goal is still the same: lower your blood glucose, reduce inflammation, protect your metabolic health. It probably includes losing weight, but by improving your diet, you can make changes that will reduce inflammation today.
High blood erythritol may be your body’s warning signal — a metabolic red flag that glucose is overflowing normal pathways, oxidative stress is elevated, and metabolic health needs attention.
That is a reason to take your blood sugar seriously. It is not necessarily a reason to avoid a sweetener that has no glycemic effect, zero calories, and a 50-year safety record in the food supply.
The goal is always the same: lower your blood glucose, reduce inflammation, and protect your metabolic health. Do that, and your body may have much less reason to manufacture erythritol in the first place.
If you’ve been struggling with low energy, weight that won’t go away, or feeling your body just isn’t keeping up with you anymore, then your metabolism may be trying to tell you something. I offer metabolic lab testing to help you find out what’s going on inside. We look at the numbers together, and we stop guessing. You get a clear picture of your metabolic health (what’s working well and what you need to improve on), so you can take action with confidence.
Learn more about metabolic lab testing here.
References:
- Witkowski M, Nemet I, Alamri H, Wilcox J, Gupta N, Nimer N, Haghikia A, Li XS, Wu Y, Saha PP, Demuth I, König M, Steinhagen-Thiessen E, Cajka T, Fiehn O, Landmesser U, Tang WHW, Hazen SL. The artificial sweetener erythritol and cardiovascular event risk. Nat Med. 2023;29(3):710–718. https://doi.org/10.1038/s41591-023-02223-9
- Hootman KC, Trezzi JP, Kraemer L, Burwell LS, Dong X, Guertin KA, Jaeger C, Stover PJ, Hiller K, Cassano PA. Erythritol is a pentose-phosphate pathway metabolite and associated with adiposity gain in young adults. Proc Natl Acad Sci USA. 2017;114(21):E4233–E4240. https://doi.org/10.1073/pnas.1620079114
- Ortiz SR, Heinz A, Hiller K, Field MS. Erythritol synthesis is elevated in response to oxidative stress and regulated by the non-oxidative pentose phosphate pathway in A549 cells. Front Nutr. 2022;9:953056. https://doi.org/10.3389/fnut.2022.953056
- Wölnerhanssen BK, Meyer-Gerspach AC, Arduini A, D’Alessandro A, Gronda E, Carugo S, Bonomini M, Gallieni M, Masola V, Angelillo-Scherrer A, Prosdocimi T, Lopaschuk GD. Sweeteners: erythritol, xylitol and cardiovascular risk — friend or foe? Cardiovasc Res. 2025;121(9):1319–1329. https://doi.org/10.1093/cvr/cvaf091
