People with higher levels of erythritol and xylitol in their blood tend to have a greater risk of heart attacks and strokes, but this is likely because these substances are produced more when the body's metabolism is impaired—such as in obesity or diabetes—not because consuming them causes harm.
Evidence from Studies
No evidence studies found yet.
What Would Prove This
Per GRADE and EBM methodology, here is what ideal scientific evidence would look like to definitively prove or disprove this claim, ordered from strongest to weakest.
A systematic review and meta-analysis of prospective cohort studies with standardized metabolite measurements could quantify the strength and consistency of the association between plasma erythritol/xylitol and MACE across diverse populations.
A systematic review and meta-analysis of 15+ prospective cohort studies with at least 5,000 participants each, using standardized mass spectrometry to measure fasting plasma erythritol and xylitol, adjusting for BMI, HbA1c, lipids, smoking, and renal function, with MACE as the primary endpoint over 10+ years of follow-up.
A long-term RCT could determine whether chronically elevating plasma erythritol or xylitol through supplementation increases MACE incidence compared to placebo in high-risk individuals.
A double-blind, placebo-controlled RCT of 3,000 adults with prediabetes or metabolic syndrome, randomized to consume 30g/day of erythritol, 30g/day of xylitol, or placebo for 5 years, with primary endpoint being time to first MACE (non-fatal MI, stroke, CV death), and plasma metabolite levels monitored quarterly.
A prospective cohort study measuring baseline plasma erythritol/xylitol and tracking MACE over time could confirm whether these metabolites independently predict future cardiovascular events.
A prospective cohort study of 10,000 adults aged 45–75 with no prior CVD, measuring fasting plasma erythritol and xylitol via targeted metabolomics at baseline, then tracking MACE over 10 years while adjusting for diet, medication, renal function, and genetic variants near TKT and AKR1A1.
A case-control study could compare plasma erythritol/xylitol levels in individuals who recently experienced MACE versus matched controls to assess whether elevated levels precede the event.
A nested case-control study within a biobank of 5,000 individuals, comparing plasma erythritol and xylitol levels in 500 individuals who had a first MACE within 2 years of blood draw versus 1,500 matched controls without events, with samples collected before event onset.
A cross-sectional study could describe the prevalence of elevated erythritol/xylitol levels in populations with and without established CVD, but cannot determine directionality.
A cross-sectional analysis of 2,000 adults with and without documented coronary artery disease, measuring fasting plasma erythritol and xylitol alongside markers of insulin resistance, inflammation, and endothelial function.