Is erythritol safe? Current research has raised a question about cardiovascular risk, but it has not shown that eating erythritol causes heart attacks or strokes. The most concerning human findings link higher erythritol levels in blood with later cardiovascular events. Those studies could not tell whether the erythritol came from food or from the body’s own production.
What The 2023 Study Found—and What It Measured
In a 2023 study in Nature Medicine, Marco Witkowski and colleagues examined blood samples from people undergoing cardiac evaluations. The discovery group included 1,157 patients; two additional groups included 2,149 people in the United States and 833 in Europe. These were not representative samples of the general public: participants were being assessed for heart risk, and cardiovascular disease and risk factors were common.
Across the groups, people in the highest quarter of blood erythritol levels had more major cardiovascular events over three years than those in the lowest quarter. The combined outcome included death, heart attack, or stroke. The association remained after the researchers adjusted for several known risk factors. That makes the finding worth investigating, but it does not establish that erythritol caused the events—or that eating it was the source of the blood levels.
The distinction matters because the body can make erythritol from glucose as well as absorb it from food. The researchers did not have dietary-intake information that could separate these sources. As EFSA noted in its 2024 assessment, a high blood level may also reflect metabolic conditions associated with cardiovascular risk. A blood-level association is therefore not the same as evidence that a sweetener in your diet raises your risk.
Is Erythritol Safe? The Mechanism Is A Clue, Not Proof
The 2023 study also tested how erythritol might affect blood clotting. In laboratory experiments, it increased platelet activity; in animal models, it increased clot formation. Platelets help blood clot, so these results offer a possible biological explanation for the cohort findings. They do not show that people who consume erythritol have more heart attacks or strokes.
In a small intervention, eight healthy volunteers drank a beverage containing 30 grams of erythritol. Their blood levels rose and stayed elevated for more than two days. This confirms that a substantial dose can change blood levels; it does not establish what happens to cardiovascular risk with everyday use. The study measured short-term biological responses, not clinical events, and its small, single-dose design cannot settle long-term safety.
What Regulators Say—and What That Means For You
EFSA’s 2024 review concluded that a causal relationship between eating erythritol and cardiovascular disease risk had not been demonstrated. It also said further research could help clarify the association. In the United States, the FDA has not questioned companies’ GRAS conclusions for erythritol under their specified conditions of use; its 2023 review of the cardiovascular paper said the observational findings did not establish that consuming erythritol caused the reported effects.
These decisions do not mean that every possible long-term effect has been ruled out. They also do not mean regulators have found that ordinary dietary use causes cardiovascular disease. Regulatory systems differ: in the US, erythritol has been considered through GRAS notices, while in the EU it is authorized as food additive E 968. JECFA, the joint FAO/WHO expert committee, assigned it an “ADI not specified,” a category based on the committee’s assessment of use at levels needed for its intended purpose—not a personal target for daily consumption.
For now, the strongest conclusion is a limited one: elevated blood erythritol is associated with cardiovascular events in certain higher-risk groups, and laboratory findings suggest a possible clotting mechanism. Neither line of evidence proves that eating erythritol causes heart attacks or strokes. There is no established cardiovascular-risk threshold or intake limit to calculate from these studies.
If you want to reduce erythritol in your diet, check ingredient lists on products marketed as sugar-free or low-carbohydrate; blends may contain erythritol alongside another sweetener. If you have cardiovascular disease or are making a significant diet change because of health concerns, ask a clinician who knows your circumstances. The research does not support diagnosing your personal risk from a blood erythritol result or from occasional use of a product.