In our blog posts, we have examined the potential health risks of artificial sweeteners in detail. Emerging research now indicates that certain artificial sweeteners may, in some cases, pose greater risks than table sugar. Of particular concern is erythritol, a sugar alcohol, which has been associated with an increased risk of serious cardiovascular events, including blood clots, heart attack, and stroke.
Erythritol is a commonly used artificial sweetener. Although it occurs in small amounts in some fruits and vegetables and is produced naturally in the body as part of normal metabolism, the quantities used in processed foods and beverages are far higher—often more than 1,000 times the levels found in nature.
Erythritol belongs to a group of ingredients known as “sugar alcohols,” which are not required to be listed individually on Nutrition Facts labels, making it more difficult for you to identify and monitor your intake.
In this article, you will learn what current research is revealing about erythritol, how it may be showing up in your diet, and what this could mean for your long‑term health. You will also learn how to spot it before buying, as well as safe alternatives.
Study Links Erythritol to Heart Attack and Stroke Risk
A National Institutes of Health-funded team led by Dr. Stanley Hazen at the Cleveland Clinic studied the link between erythritol and the risk of heart attack and stroke. In a study of over 1,000 people, they tracked blood markers related to future heart problems and followed participants for three years, monitoring for serious events like heart attack, stroke, or death. Their results, published in Nature Medicine in February 2023,[1. Witkowski, M., Nemet, I., Alamri, H. et al. The artificial sweetener erythritol and cardiovascular event risk. Nat Med 29, 710–718 (2023). https://doi.org/10.1038/s41591-023-02223-9] showed that people with higher blood levels of erythritol were much more likely to experience major cardiovascular problems.
The researchers discovered that erythritol can make blood more likely to clot by lowering the threshold for platelet activation. Those in the top 25% for erythritol levels had about twice the risk of heart attack, stroke, or death compared to those in the lowest 25%. Dr. Hazen’s team also found similar risks with another sugar alcohol, xylitol.
Platelets are small blood cells that help stop bleeding when you’re injured, but if they’re activated inside the body, they can form clots that may cause heart attacks or strokes. Although the FDA considers erythritol safe because it’s naturally found in small amounts in foods, the levels added to processed foods are much higher than what is naturally present or considered safe for your body.
What is Another Side-Effect?
Sugar alcohols are not fully absorbed by the body and are fermented by bacteria in the large intestine, which can lead to gas, bloating, and diarrhea in some individuals. Because of this, foods containing sorbitol or mannitol must display a warning that “excess consumption may have a laxative effect.”
What is Erythritol?
Erythritol belongs to a category of artificial sweeteners called sugar alcohols. Despite the name, sugar alcohols are neither traditional sugars nor the type of alcohol found in drinks. Chemically, these compounds are carbohydrates that share some properties with both sugars and alcohols.
Sugar alcohols offer sweetness with fewer calories than sugar. They are often used alongside other artificial sweeteners. In foods, they add bulk, improve texture, help retain moisture, and prevent browning during cooking. At higher amounts, they create a cooling effect, such as in sugar-free gum or candies. Unlike sugar, they don’t interact with mouth bacteria, so they don’t cause cavities.
Sugar alcohols such as erythritol are absorbed from the small intestine into the bloodstream slowly and incompletely. This results in fewer calories per gram compared to sugar and causes a smaller increase in blood glucose (blood sugar) than other carbohydrates.
Where Do We Find Erythritol in Our Food?
Tiny amounts of erythritol are natural in vegetables and fruit. Our bodies produce microscopic amounts of erythritol in our cells as part of the metabolic process. However, when used as an artificial sweetener, erythritol is present at much higher levels than it occurs naturally.
Erythritol is found in packaged foods, including but not limited to ice cream, keto and low-carb baked goods, toothpaste, protein bars, cookies, gum, candy, fruit spreads, and energy drinks. Sugar substitute baking blends, such as granulated artificial sugars, often include sugar alcohols as a “carrier.”
It can be hard to spot on food labels because the FDA only requires manufacturers to list specific sugar alcohols if a claim is made about the product’s sugar content. For example, if the package says it contains sugar alcohol, no sugar, naturally sweetened, artificially sweetened, or no calories, then you should see “erythritol” on the ingredient label. If no such claim is made, like with toothpaste, the label may simply say “sugar alcohol.” If you see this general term, “sugar alcohol,” without specifics, the product could contain erythritol or any other sugar alcohol or combination.
Read labels. Common sugar alcohols found in foods include: erythritol, sorbitol, maltitol, isomalt, mannitol, lactitol, xylitol, and hydrogenated starch hydrolysates.
Sugar alcohols are less sweet than regular sugar. In contrast, artificial sweeteners such as aspartame (Equal®) and saccharin (Sweet’N Low®) can be up to 700 times sweeter than sugar.
Past articles have discussed the dangers of Aspartame and other artificial sweeteners.
Alternative Sweeteners
One alternative is stevia, a plant-based sweetener that doesn’t raise blood sugar levels, making it a good option for people with diabetes. It’s best to choose stevia in liquid dropper form rather than packets. Be cautious, though—some stevia products are mixed with erythritol to increase sweetness.
Also consider raw honey and blackstrap molasses, which are packed with nutrients.
Diabetes and Artificial Sweeteners
Research indicates that swapping sugar-sweetened drinks for those with artificial sweeteners does not reduce overall calorie intake and may even lead to increased consumption over time.[2. Lavin J.H., French S.J., Read N.W. The effect of sucrose- and aspartame-sweetened drinks on energy intake, hunger and food choice of female, moderately restrained eaters. Int. J. Obes. 1997;21 doi: 10.1038/sj.ijo.0800360.] Artificial sweeteners can heighten cravings for both sugary and artificially sweetened beverages by increasing feelings of hunger, which may contribute to higher energy intake and weight gain.[3. Almiron-Roig E., Drewnowski A. Hunger, thirst, and energy intakes following consumption of caloric beverages. Physiol. Behav. 2003;79 doi: 10.1016/S0031-9384(03)00212-9.] Additionally, aspartame use has been linked to a greater risk of type 2 diabetes, cardiovascular disease, nonalcoholic fatty liver disease, and hormone-related cancers.[4. Charalampopoulos D., McLoughlin A., Elks C.E., Ong K.K. Age at menarche and risks of all-cause and cardiovascular death: A systematic review and meta-analysis. Am. J. Epidemiol. 2014;180 doi: 10.1093/aje/kwu113.] [5. Gong T.T., Wu Q.J., Vogtmann E., Lin B., Wang Y.L. Age at menarche and risk of ovarian cancer: A meta-analysis of epidemiological studies. Int. J. Cancer. 2013;132 doi: 10.1002/ijc.27952.] [6. Janghorbani M., Mansourian M., Hosseini E. Systematic review and meta-analysis of age at menarche and risk of type 2 diabetes. Acta Diabetol. 2014;51 doi: 10.1007/s00592-014-0579-x.] [7. Mueller N.T., Pereira M.A., Demerath E.W., Dreyfus J.G., MacLehose R.F., Carr J.J., Terry J.G., Jacobs D.R. Earlier menarche is associated with fatty liver and abdominal ectopic fat in midlife, independent of young adult BMI: The CARDIA study. Obesity. 2015;23 doi: 10.1002/oby.20950.] [8. Mueller N.T., Duncan B.B., Barreto S.M., Chor D., Bessel M., Aquino E.M.L., Pereira M.A., Schmidt M.I. Earlier age at menarche is associated with higher diabetes risk and cardiometabolic disease risk factors in Brazilian adults: Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) Cardiovasc. Diabetol. 2014;13 doi: 10.1186/1475-2840-13-22.]
Gut Cells Can Crave Sugar
Studies reveal that our craving for sweetness goes beyond the taste buds—the duodenum, which is the upper section of the small intestine, also plays a key role in detecting and desiring sugar. Scientists have identified rapid communication pathways between the gut and the brain, involving the vagus nerve and specialized gut cells known as enteroendocrine or neuropod cells. These connections allow the gut to send signals to the brain almost instantly.
This research, partially funded by the NIH’s NIDDK, NCCIH, and NIMH, was published in Nature Neuroscience on January 13, 2022.[9. Buchanan, K.L., Rupprecht, L.E., Kaelberer, M.M. et al. The preference for sugar over sweetener depends on a gut sensor cell. Nat Neurosci 25, 191–200 (2022). https://doi.org/10.1038/s41593-021-00982-7] In experiments with mice, both sugar and artificial sweeteners introduced directly into the small intestine triggered the vagus nerve. However, the brain responded differently to sugar compared to artificial sweeteners. When researchers blocked the gut cells from sending signals through the vagus nerve, mice no longer preferred sugar over artificial sweeteners and chose both equally.
Editor’s Note: These results suggest that artificial sweeteners can continue to induce sugar cravings, much like eating foods with sugar.
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Recommended Books
Natural Eye Care: Your Guide to Healthy Vision and Healing
Natural Parkinson’s Support: Your Guide to Preventing and Managing Parkinson’s
