CCC Statement on “The Artificial Sweetener Erythritol and Cardiovascular Event Risk” 

A study was published in Nature Medicine entitled, “The Artificial Sweetener Erythritol and Cardiovascular Event ‎Risk,” in which the authors sought to examine potential links between circulating levels of plasma components ‎from the diet and atherothrombotic disease risk in at risk individuals. The findings suggest that varying levels of ‎erythritol as well as other components found in the plasma were associated with increased risk of cardiovascular ‎events and that erythritol could contribute to blood clots in rodent and in vitro (test-tube) studies. That said, ‎authors note the need for “further safety studies examining the long-term effects of artificial sweeteners in ‎general, and erythritol specifically, on risks for heart attack and stroke, particularly in patients at higher risk for ‎‎[cardiovascular disease].” ‎

“The results of this study are contrary to decades of scientific research showing reduced-calorie sweeteners like erythritol are safe, as evidenced by global regulatory permissions for their use in foods and beverages, and should not be extrapolated to the general population, as the participants in the intervention were already at increased risk for cardiovascular events,” said Robert Rankin, Executive Director, Calorie Control Council. “Erythritol is a proven safe and effective choice for sugar and calorie reduction and, for more than 30 years, has been used in reduced-sugar foods and beverages to provide sweetness, as well as enhance their taste and texture. Along with exercise and a healthy diet, reduced-calorie sweeteners are a critical tool that can help consumers manage body weight and reduce the risk of non-communicable diseases, such as cardiovascular disease.” 

This study is a collection of several small studies using varying methodologies with their own inherent flaws:

  • This study is observational in nature and does not establish dietary erythritol as a causal agent for cardiovascular disease risks.
  • The populations used in the study were at risk individuals and not representative of a normal population and in vitro and rodent studies were used to suggest effects of erythritol on disease risks.
  • The erythritol dose used in the human feeding studies is atypical and is approximately three times the maximum amount found in beverages.

Some additional key factors to consider include: 

  • The authors only included individuals who were already at increased risk for adverse cardiovascular events.
  • The authors did not control for overall diet, physical activity and other important factors that are known to be associated with cardiovascular disease risk. 
  • Plasma levels of erythritol were only measured once (i.e. at one time period).
  • The study found several other plasma components that are correlated to cardiovascular disease risks, yet only chose to focus and report on erythritol.
  • The authors conducted in-vitro studies to measure thrombosis, which cannot mimic the complex physiological environment of the human body which includes absorption, metabolism, and excretion.  
  • The rodent model used to address the effects of erythritol on cardiovascular disease risk was a cardiovascular disease model and not healthy rodents.
  • The study does not address differences in plasma erythritol between dietary erythritol and erythritol that can be produced in the body.
  • As most commercial products containing erythritol usually contain a very small amount, which are usually blended with other sweeteners, the subjects of the study consumed excessive amounts (30 g of erythritol dissolved in 300 ml water within 2 minutes) which does not reflect a typical real-world serving (which is closer to 8 g per serving based on the U.S. Food and Drug Administration approval for erythritol).  
  • The authors incorrectly referred to erythritol as an artificial sweetener. While erythritol may be commercially produced from glucose, it exists naturally in a variety of fruits and fermented foods. 

For more than three decades, erythritol has been commercially produced and added to foods and beverages to provide sweetness, as well as enhance their taste and texture. In addition to providing zero calories, erythritol is well-tolerated, does not affect blood serum glucose or insulin levels and does not cause tooth decay. The safety of erythritol as a food ingredient under conditions of its intended use is substantiated by human and animal safety studies, including short- and long-term feeding, multi-generation reproduction and teratology studies. The FAO/WHO Joint Expert Committee on Food Additives (JECFA) has reviewed the safety of erythritol and established an acceptable daily intake level of “not specified,” the highest safety category possible. It is approved for use in foods in more than 50 countries, including the United States, Canada, Brazil, Mexico, Australia, New Zealand, and the European Union. 

Read more about erythritols and polyols.

Statements for our Experts

Dr. Keri Peterson

Medical Advisor

The Calorie Control Council

This study had several limitations that challenge its credibility. The stated findings were only an association and do not imply causation. Additionally, the study did not control for risk factors that contribute to heart attack and stroke.  Their study population was made up predominantly of subjects who already had underlying risk factors including atherosclerosis, hypertension, diabetes and being male over the age of 60. This is an inherent bias towards developing cardiovascular events and cannot be applied to the general population.”

Dr. Keith Ayoob

Scientific Advisor

The Calorie Control Council

“The authors admit that these results are merely an association, thus not capable of showing any cause-and-effect.  In the pilot intervention study, on only 8 people, the amount of erythritol given was at least several times what anyone would consume at one time, and these people had to consume it within 2 minutes. I’m reluctant to change my position when research results fly in the face of many years of strong evidence indicating safety of erythritol.

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