Understanding the Study on Erythritol and Cardiovascular Event Risk
A recent Nature Medicine publication titled “The Artificial Sweetener Erythritol and Cardiovascular Event Risk” has sparked public interest and debate. In this study, researchers explored whether certain diet‑derived compounds circulating in the bloodstream—including erythritol—may be associated with heart health outcomes. The findings linked varying plasma levels of erythritol to potential increases in cardiovascular events in high‑risk individuals. As a result, “Erythritol and Cardiovascular Event Risk” has become a prominent topic of discussion. However, the authors themselves acknowledged the need for additional long‑term research, stating that more comprehensive studies are required to fully understand “Erythritol and Cardiovascular Event Risk,” particularly in people already predisposed to heart disease.
Robert Rankin, Executive Director of the Calorie Control Council, emphasized that these findings run counter to decades of scientific literature demonstrating the safety of reduced‑calorie sweeteners such as erythritol. He stressed that the results should not be generalized to the broader population, noting that the study participants were already at elevated cardiovascular risk.
Erythritol has been used safely for over 30 years in reduced‑sugar foods and beverages, providing sweetness while improving taste and texture. Rankin noted that low‑ and reduced‑calorie sweeteners remain important tools—alongside exercise and balanced nutrition—for helping consumers manage weight and reduce risk factors associated with non‑communicable diseases, including cardiovascular disease.
Key Limitations of the Study
The research was composed of several small studies using diverse and inconsistent methods, each with important limitations:
1. Observational—not causal
The study was observational and did not establish dietary erythritol as a cause of cardiovascular risk.
2. Participants were not representative
Subjects were already at high risk for cardiovascular events, limiting general applicability.
3. Non‑typical erythritol doses
Human feeding studies used erythritol doses three times higher than the maximum levels typically found in beverages.
4. Other critical factors were not controlled
The study did not control participants:
- diet
- physical activity
- or other known cardiovascular risk variables.
5. Single plasma measurement
Erythritol levels were taken only once, providing no insight into variability over time.
6. Selective reporting
Although multiple plasma components correlated with cardiovascular risk, the authors focused disproportionately on erythritol.
7. Limitations of in‑vitro methods
Lab‑based thrombosis tests cannot replicate human physiological complexity—such as absorption, metabolism, and excretion.
8. Rodent models were predisposed to disease
Rodents used in the study already had cardiovascular disease, limiting relevance to healthy populations.
9. Endogenous erythritol ignored
The study did not distinguish between dietary erythritol and endogenously produced erythritol, which the human body naturally synthesizes.
10. Unrealistic consumption levels
Study participants consumed 30 g of erythritol in 2 minutes, far exceeding a standard real‑world serving of about 8 g, based on FDA guidance.
11. Misclassification of erythritol
The authors incorrectly labeled erythritol as an artificial sweetener. While commercially produced from glucose, erythritol naturally exists in fruits and fermented foods.
Erythritol’s Safety Record
For over three decades, erythritol has been widely used to enhance the sweetness, flavor, and texture of foods and beverages—without contributing calories or affecting blood glucose or insulin levels. Research demonstrates that erythritol:
- is well‑tolerated
- does not cause tooth decay
- has been validated through short‑ and long‑term safety studies, including reproduction and teratology research
The FAO/WHO Joint Expert Committee on Food Additives (JECFA) reviewed erythritol and assigned an Acceptable Daily Intake (ADI) of “not specified,” the highest safety category. Erythritol is approved for use in more than 50 countries, including the U.S., Canada, Mexico, Brazil, Australia, New Zealand, and those in the European Union.
Related Resources:
Learn about erythritol.
Learn about sweeteners.
Statements from 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.“