Erythritol: The Popular Keto Sweetener Now Under Scientific Scrutiny

Erythritol is a popular sugar substitute found in many low-calorie, keto, and high-protein products. From sugar-free protein bars to low-carb desserts and energy drinks, erythritol is marketed as a natural, zero-calorie sweetener that doesn’t spike blood sugar. But recent peer-reviewed research suggests this sugar alcohol may not be as harmless as it seems.

What Is Erythritol?

Erythritol is a type of sugar alcohol that naturally occurs in some fruits but is often industrially produced from fermented corn. It’s about 70% as sweet as sugar and is known for its minimal impact on blood glucose and insulin levels. Because of this, it's a common ingredient in "healthy" alternatives for people with diabetes or those following ketogenic or low-carb diets.

Why Is Erythritol So Popular?

• Zero calories
• Low glycemic index
• Tooth-friendly
• Keto & diabetic-friendly
• Naturally derived

These benefits make erythritol a go-to sweetener for health-conscious consumers. However, new research reveals that its effects on the body might go beyond what’s on the label.

New Research: What the Studies Show

Two major studies have recently raised concerns about erythritol's impact on cardiovascular and metabolic health:

Erythritol and Brain Vascular Cell Damage (Berry et al., 2025)

Published in the Journal of Applied Physiology, this study examined how erythritol affects human brain microvascular endothelial cells (the cells that line small blood vessels in the brain). Researchers found that erythritol:

• Increased oxidative stress
• Reduced nitric oxide (NO), which helps blood vessels relax
• Increased endothelin-1, a vasoconstrictor
• Suppressed tPA, a key enzyme that breaks down blood clots

These findings suggest that erythritol may contribute to vascular dysfunction and increase the risk of blood clots and stroke—especially concerning for people with existing cardiovascular risk factors.

Erythritol Linked to Increased Risk of Heart Attack and Stroke (Witkowski et al.2023)

Published in Nature Medicine, this large-scale study investigated erythritol levels in the blood and their association with major adverse cardiovascular events (MACE) such as heart attack and stroke. Researchers analyzed data from three distinct cohorts in the U.S. and Europe and found that individuals with higher erythritol levels had a significantly increased risk of experiencing these cardiovascular events.

Beyond observational data, the study also explored mechanisms. Laboratory experiments showed that erythritol enhanced platelet reactivity and clot formation, providing a plausible biological explanation for the clinical findings. Importantly, the researchers noted that erythritol remained elevated in the blood for many hours after ingestion—particularly concerning for people who frequently consume erythritol-rich products.

These results underscore the need for further clinical studies, but they also suggest that regular use of erythritol may not be advisable for those with existing cardiovascular risk factors.

Should You Be Concerned?

These studies don't mean you should immediately stop consuming anything with erythritol. However, they do raise red flags, especially for people with heart disease, diabetes, or those who frequently consume large amounts of sugar alcohols.

As with many things in nutrition, "natural" doesn’t always mean safe. The dose matters, and long-term human studies are still needed to fully understand erythritol's health impact.

Bottom Line

Erythritol might not be the guilt-free sweetener it appears to be. If you're using it regularly in your diet as part of keto, diabetic-friendly, or "clean" eating plans, it might be time to reconsider your options. Speak with a healthcare provider if you have questions about what sweeteners are best for your health goals.

Moderation is key—even for zero-calorie sweeteners.