Have you heard about the new study linking erythritol to heart disease including heart attacks, strokes, blood clots, and more? It’s the thing of nightmares for sugar-free eaters and makes you want to do what a lot of memes are telling you to do–toss your low-carb sweetener in the trash.
So–should you? Or is this all just a bunch of ado about nothing?
Let’s find out.
I mean, it’s not fun finding out that your attempts to be healthier might actually be making you MORE sick and you start thinking “So what am I supposed to eat anyhow?!”
And if you’re like me, you might even check out the study to see what’s happening, but your eyes cross looking at control groups and massive amounts of scientific jargon.
I get it.
I admit the study and endless articles on it look very upsetting, but acting when you’re stressed is almost never a good thing.
And stress is linked to heart disease too so…..
Let’s dig in and figure this out together.
What Is Erythritol?
Erythritol is a sugar alcohol (like xylitol, sorbitol, mannitol, and others). It’s found naturally in many fruits and vegetables and also interestingly in humans in a very small amount.
Erythritol has become super popular recently since it has no lingering aftertaste (unlike stevia, though there are ways to make stevia taste better), doesn’t spike blood sugar and typically causes less digestive upset than other sugar alcohols.
You can find erythritol sold on its own, but it’s typically blended with other super sweet sweeteners like stevia extract and monkfruit extract.
Since erythritol isn’t as sweet as sugar, and both stevia and monkfruit are approximately 200 to 400 times sweeter than sugar, adding a little bit of stevia or monk extract to erythritol makes an end product that conveniently substitutes for sugar.
Note: typically people refer to an erythritol/monk blend as “monkfruit sweetener” but really the bulk of the product is erythritol. Basically, if you have a “monk sweetener” that looks like sugar, it’s almost for sure mostly erythritol.
Erythritol has been thought to be safe and even classified on a federal level as being safe for decades, both in the U.S. and in other countries. As a result, many people have been consuming it and enjoying lower carb erythritol sweetened foods without worry–
until this week, that is.
Disclaimer. I’ve been sugar-free for at least 12 years.
I had health issues that were partially a result of eating too much sugar and refined carbs. Hypoglycemia and candida. There were other things going on like undiagnosed lyme, but going off of sugar was a big part of my getting healthier.
I use stevia a lot, but I often use an erythritol/monk blend when baking.
I want to branch out into other alternative sweeteners, but I like blends like Lakanto, and I’m an affiliate.
However, I’m not writing this to say that this whole thing is a nothing burger (or rather a nothing zero calorie soda). I’m here to find the truth, both for me and for you.
For example, when news about stevia potentially not being safe came across my desk, I was scared. But instead of panicking, I researched to figure out if I needed to change things up, and ended up writing this post.
Back to erythritol…
Details About The Study(ies)
The “study” (which is, in fact 3 studies) however, changed that. Here are the details.
- A larger group of “not healthy” people was being studied and researchers noticed that the ones that had cardiovascular episodes in the previous 3 years had higher concentrations of erythritol in their blood. They looked at two more large groups of “unhealthy” people and found the same thing.
- A small (8 people) group of “healthy” people had 30 grams of erythritol daily and had their blood looked at.
- The third study was done in a lab.
Some Concerns With The Study(ies)
I’m not here to say that erythritol is definitely safe, and that you should consume erythritol-sweetened cookies, cakes, candies, and sodas all day long. However, it’s really important that we all CALM DOWN and see what was and wasn’t proven in these studies.
While evaluating all of this, here are some concerns that I have with this study.
The Main “Study” Was Retrospective
The main study cited didn’t set out to study erythritol at all. They merely noticed that the participants who had had a cardiovascular event in the past three years had higher erythritol content in the blood.
They then looked at 2 other groups, and found the same thing.
No Control Group
The researchers looked at the group of people studied and saw a lot of erythritol in the blood. There was no group of people who were not eating erythritol–or more erythritol or some. They had no idea what people were eating–ONLY that they had more erythritol in their blood.
So they couldn’t compare the results to a group of people with similar demographics who weren’t eating erythritol.
Erythritol Wasn’t Popular During The Study
The larger portion of the “study” was done in the early 2000s, (starting in 2001), before erythritol was anywhere near as popular as it is now.
In fact, erythritol was only approved by the FDA to be used as a sweetener in the US in 2001, so it’s quite likely that most of the people whose data was evaluated were not consuming any or much erythritol at all.
Some articles state that erythritol wasn’t approved for most or all of this “study.” I don’t think that’s the case–it merely wasn’t that popular.
To be fair, I was erythritol back in 2014, but I’ve been a bit unusual for awhile now.
The Subjects Were Ill
The study group was a large group of people (3 groups, actually) who were mostly over the age of 60, obese, and male. Most of them (72%) had high blood pressure, most (75%) had a history of cardiovascular disease, nearly half had a previous heart attack, and about a quarter (22%) of them had diabetes.
Yes, more and more people these days are sick (it’s so terrible) but when studying sick people, you have to keep in mind, that illness can throw testing results off for many reasons–choice of foods, body metabolism results, and more.
Untargetted Metabolomics–What’s That?
Dr. Peter Cicero (a Ph.D. OrthoMolecular Organic Chemist, NPD, and R&D executive for over 35 years) has this concern about the measurements used in the study.
In the present studies, they used an untargeted metabolomics approach as a discovery platform to identify circulating metabolites associated with incident CVD event risk. Untargeted metabolomics is only qualitative in nature, yet these results were used to state that erythritol is linked to heart issues!… It means that they used second class unreliable testing methods to prove their theory. Several advanced quantitative testing methods exist which would better prove or disprove the researcher’s theory.
Also, the level of erythritol in your blood is always changing. The largest amount of evidence shows the body completely rids itself of consumed erythritol within 24-hours, 90% from urination and 10% from colon. To be able to quantify a reliable level of erythritol in your blood that could cause heart issues is next to impossible since the level is always changing. For some reason, the study failed to use these advanced testing methods and neglected consideration of the body’s flux in erythritol levels.
I reached out to Dr. Cicero to get more information about this, but haven’t heard back yet.
Our Bodies Make Erythritol
The main study that cited a lot of erythritol in the blood of the cohorts did mention that some of the erythritol was endogenous (having an internal cause or origin)–meaning, it occurs naturally in the body.
Now, our bodies don’t make that much erythritol, but they do make it (as part of the pentose phosphate pathway [PPP] [source]), and that fact should be noted.
I don’t think it’s the case, but I wonder if people with certain health issues might make more erythritol in their bodies than others. This is quite possibly a non issue, but it’s something that should be studied before making this kind of claim.
**Update: Since the publishing of this post, I’ve learned more about this. See the next section for more information.
At the end of the study, this statement was made:
This is of concern given that the very subjects for whom artificial sweeteners are marketed (patients with diabetes, obesity, history of CVD and impaired kidney function) are those typically at higher risk for future CVD events.
I don’t know about you, but have you seen marketing of artificial sweeteners to people with impaired kidney function? Then again, I don’t watch TV, but I see it being marketed mostly to diabetics and those who want to lose weight.
Incorrect Information About Marketing
I get their point, but I disagree with the last part of that statement. That doesn’t mean that the whole study is unreliable, but I thought it was worth pointing out.
Measurements Might Not Have Been Accurate
Dr. Cicero claimed that the measurements weren’t accurate–I haven’t sorted out that claim yet.
If that’s the case, however, then none of the other hypotheses are valid. I am assuming that they are for now.
Initial Questions: Where Else Could the Erythritol In the Blood Be Coming From?
When this study first came out, I didn’t know what to think. I mean, yes there are some concerns with the study, BUT the point remains--there was more erythritol in the blood for people who had a history of really bad health.
WHY was there a lot of erythritol in these people’s blood and should we be concerned about it?
It made me nervous! It seemed possible that erythritol is really deadly and that we should stay 100% away from it.
But I just wondered…something wasn’t sitting right with me.
Could something else be causing the elevated levels of erythritol in the blood?
Here were some of my thoughts.
Cardiac Events Might Lead to More Erythritol In the Blood
How the body makes erythritol is complicated. Is it possible that people who’ve had cardiac events end up with more erythritol in their blood on an ongoing basis?
Cardiac Events Might Prevent Removal of Erythritol From the Blood
Is it possible that people who have had cardiac events are less able to clear erythritol from their blood and so it builds up at least for some period of time following the event?
People Who Have Cardiac Events Might Eat (a Lot) More Erythritol
It’s possible that those people who had the cardiac events were super addicted to sweets and were more motivated to make a change to their diets and therefore ate more erythritol filled foods than other people.
As a result, their blood could have had higher erythritol levels.
Erythritol Soda (Alone) Could Possibly Be the Bad Guy
It’s possible that the subjects with high blood erythritol levels were drinking a lot of erythritol sweetened drinks alone while those in the “erythritol is good for you” study consumed the drink with something else. If that’s the case, it’s possible that drinking zero calorie sweetened beverages that are sweetened with erythritol might drive blood sugar erythritol levels up higher than other types of ingestion.
I don’t know enough about that latter study and that issue, and of course we know nothing about erythritol consumption at all in the large study, but it’s possible. Not likely given the time frame of the study and how erythritol wasn’t that popular then, but it’s a possibility.
Erythritol Might Have Made Their Blood Labs Better
This doesn’t talk about where the erythritol might have come from, but it’s important to mention. While we don’t know for sure that the subjects were consuming erythritol, it’s possible that their blood work was actually worse before they had higher levels of erythritol in their blood, and so the levels of erythritol in the blood weren’t as much of a concern as they seem to be.
What I Learned Later: Where Erythritol in the Blood Comes From
Since the original publishing of this post, I found more information that backed up some of what I was thinking and seems to put to rest most of the alarm about this “study.”
Now, this doesn’t mean that erythritol definitely doesn’t cause heart issues, but it’s solid research about where the increase in blood erythritol could very well be coming from–and it’s super interesting.
When I first wrote this posts, I wondered if it could be that the participants weren’t eating a lot of erythritol, but their blood was making it anyway.
Yes, it could be–and in fact, that’s likely the case.
In this 2017 study, it was found that humans make erythritol endogenously (inside their own bodies) via the pentose phosphate pathway (PPP; not to be confused with the PPP loans), as a result of eating glucose and fructose. Note, by the way that this study is entitled “Mammalian metabolism of erythritol: a predictive biomarker of metabolic dysfunction.”
So since the subjects in this “study”(ies) were ill, they likely were consuming larger than normal amounts of glucose and fructose, leading to larger amounts of endogenously produced erythritol.
Ill or not, people in the U.S. and Europe consume really high amounts of sucrose (which is converted to glucose) as well as glucose and fructose so it makes a lot of sense that this could be the cause of the high blood erythritol content.
This paper from 2020 discusses the conversion.
Here’s a graph showing how the body makes erythritol from glucose, fructose, and starches. People eating a poor diet full of these things would definitely have more erythritol in their blood as a result.
The PPP (which results in erythritol being made in the body and showing up in the blood) is a way for the body to moderate insulin sensitivity and inflammation from obesity. (source)
The PP Pathway is not controlled well for those who are obese or have metabolic disorders. So it only make sense that those who had worse health would have more erythritol in their blood. (source)
This study showed that the PPP is upregulated (increased) in mice and rats that suffered from obesity, hyperglycemia, and hyperinsulinemia.
We know that those who had the worst health in this study had HIGHER levels of erythritol in their blood, but we don’t know that the health issues caused the higher levels–we only know that they were related.
Taking this above information into account, it seems totally plausible that these issues were the cause of, or at least significantly contributed to the higher levels.
This study shows that oxidative stress causes the body to make more erythritol. And severe illness, including heart disease [source], causes the body to have a higher level of erythritol in the blood.
More Important Information
Previous Conflicting Erythritol Heart Study
This current “study” comes after decades of studies showing erythritol’s safety, including one in particular that studied erythritol’s affect on cardiac issues.
This study of 24 people with diabetes showed that erythritol had a beneficial effect on blood vessels. It’s a small study, but interesting.
If the conclusions are true, then it really doesn’t seem to be the case that erythritol causes heart disease.
Were the Study’s Subjects Eating Crazy Amounts of Erythritol?
The point I’m making here doesn’t support the “erythritol is AOK” argument, but it’s important to share.
It’s well known that often in this type of study, participants are often given / fed a much larger than normal amounts of the item in question. For example, if a study made people drink 10 gallons of water a day and then said that water wasn’t good for you, that wouldn’t be valid because no one drinks that amount of water normally.
In the 8 person section of the study participants were asked to eat 30 grams of erythritol.
Some people in the “erythritol is totally fine and this is a flawed study” camp are claiming that this is a ridiculous amount of sugar-free food to eat, since many keto treats have only a few grams of erythritol per serving.
I don’t know about you, but I can easily eat a pint of sugar-free ice cream in one sitting. It’s a bit heavy but I can sure come close. And let’s face it–some sugar-laden ice creams. And I’ve been known to eat more than one serving of a keto treat.
And this soda has 14 grams in one can.
Some people drink TONS of soda daily, so I don’t see drinking two cans of sugar-free soda being out of the reach of most people.
Conflicts Of Interest
This may or may not be an issue but for the record…
Hazen (the main person behind the study) is connected with Cleveland Clinic in a cardiovascular role, was a paid consultant for Procter and Gamble and currently with Zehna Therapeutics. He’s received funds from Roche Diagnostics, and is eligible to receive funds from Cleveland HeartLab, a subsidiary of Quest Diagnostics, Procter and Gamble and Zehna therapeutics. Tang’s been a consultant for Sequana Medical A.G., Owkin Inc., Relypsa Inc. and PreCardiac Inc., has received an honorarium from Springer Nature, and is related to the American Board of Internal Medicine.
What Should You Do?
- Don’t Panic: Just don’t. Again, this isn’t a conclusive study at all, and since I learned more, it seems like it really is a nothing cookie (had to use a sweet treat instead of calling it a nothing burger, LOL.) More investigation should happen but this time by feeding people a certain amount of erythritol.
- Don’t Revert to Sugar: Returning to white sugar isn’t a great answer because there’s plenty of proof that sugar causes inflammation, heart issues, diabetes, and more. (source)
- Speak With Your Doctor: As with anything, though I think this “study” really shows no concerns at all about erythritol, if you have concerns about your heart health and/or consuming erythritol, you can of course speak with your doctor. I mean, you could even talk about how the conclusions in the media don’t seem to add up. Of course, discussing the link between diabetes and overconsumption of sugar, corn syrup, and other refined carbs while you’re at it would be a good idea too. Some doctors don’t know about this.
- Use Other Sweeteners: Even thought I think this study doesn’t point to any real problem with erythritol, I think it’s great to vary your sweetener use. One of the first practitioners I worked with had the habit of using some stevia, some xylitol, and some erythritol. Her thinking was that if it ever came out that there were serious concerns about any of them, at least she wouldn’t have overdone it with any of them. Good advice!
- Consider Eating Fewer Sweets: I have a lot of sugar-free sweet recipes on my site (like these Sugar-free Snickers, this Amazing Sugar-free Coffee Cake, and how about these Sugar-free Fudge Pops?) but that’s not because we eat a lot of sweets. Desserts, etc. are often the hardest things for people to give up, so I like providing recipes for them.
But you could just opt out and instead of eating sugar or some other sweetener. I’m not saying you have to, but it’s an option.
What Am I Going to Do?
I’m going to keep on doing what I’m doing.
I use a lot of stevia extract in drinks, make occasional treats using erythritol, xylitol, erythritol monk blend, and some raw honey.
After the updates published here on April 2, 2023, it seems to me that there are many other reasons for the elevated erythritol levels in the blood, so I’m not going to change my sweetener habits.
I like monk/erythritol blends. I don’t do a bunch of baking these days, but I’m still going to include it as one of the things I use for both baking and no bake treats like this delicious Keto Coffee Cake, this Chocolate Avocado Ice Cream, and Keto Mounds Bars.
Other Low-carb Sweetener Options
If you still want to avoid erythritol for whatever reason (or you want to take my former practitioner’s advice about mixing things up a bit or you aren’t a fan of processed sweeteners–which by the way is great advice even if you just think that stevia tastes bad), don’t panic–there are other options for sweetening without sugar.
Here are some options you might enjoy.
Stevia Extract – While it doesn’t have bulk needed for baking, it’s great for beverages and also for adding sweetness to any alternative sweetener that’s less sweet than sugar. It also allows you to cut other sweeteners, while keeping the same sweetness level in your recipe.
Monk Extract – As with stevia, there’s no bulk here, but again it’s great for beverages or for increasing the sweetening power of your sweetener.
Xylitol – While it’s not completely low-calorie or keto, and it is highly processed, however xylitol works well in a lot of applications. It also crystallizes nicely in applications like these Toasted Coconut Chips. It’s extremely toxic to dogs, however, so not recommended if you have pooches in the home. Side note, xylitol’s been accused of nasty things too, but you can read this post about xylitol and tumors before tossing it to the curb.
BochaSweet – One of the new kids on the block, it works great in a lot of applications.
I’m sure you’ll find something you like–or why not try all of them?
Bottom line–this “study,” connecting erythritol and heart attacks (and more), is being promoted as refuting many years of research that established erythritol’s safety.
It hasn’t proven causation, just correlation. More studies should definitely be done but I think it’s clear that the issue is with the PPP and how the body makes erythritol. Any future studies should focus on tracking what people are eating and how long their bodies are making extra erythritol after cardiac events.
Also, keep in mind, there are a lot of other things that definitely cause heart issues. Like sugar. And corn syrup (source). And other things in the news these days. Just saying.
If, and as more information comes out about this, I’ll try to keep you updated on this very important topic.
In the meantime, I’m sure in the wake of all of this that erythritol companies are struggling.
I’m not telling you again that you should eat a lot of it, but if you’re thinking it’s not a big deal (like I am), then you could support them by adding some to your shopping cart on Amazon, or at Lakanto. And code WHOLENEWMOM gets you a discount too.
You can also support Swerve by buying some here.
Again, I’m not at all writing this to sell erythritol, so if you’re worried about that being my motivation, simply don’t use my affiliate link or code. (Not that I make much from Amazon anyhow, but every little bit helps.).
It’s of course appreciated if you do, but I don’t want anyone to think that I wrote this post to make a commission off of erythritol.
I 100% did not.
It’s all about truth.
More Posts About Things That Needed Debunking (or at Least a LOT of Research)
Here are some other posts that you might like if you like digging in to find out what’s true and what’s not.
Is Glycerin Bad for Your Teeth? – is it really preventing your teeth from remineralizing? And if so, WHY is it in toothpaste?
Is There Paint Thinner in Cereal? – and if so, why?
Is Stevia Safe? – or it it causing hypoglycemia, infertility, and more?
How about you? What do you think about all of this / what will you do?