The Study
The artificial sweetener erythritol and cardiovascular event risk
This study found that people with more erythritol in their blood were more likely to have heart problems later, but it didn’t prove that erythritol caused those problems. It’s like noticing that people who eat more ice cream also get more sunburns — maybe it’s the summer heat, not the ice cream, causing the sunburn.
Analysis score
Maximum 72 for a cohort study.
Where the score came from
Scientists found that a sugar substitute called erythritol, often used in sugar-free foods, might make your blood more likely to form dangerous clots.
Where does this study sit?
Reviews of RCTs (Meta-analyses)
Max 100Randomized Trials
Max 90Reviews of Cohort Studies
Max 85Cohort Studies
Max 72Reviews of Case-Control Studies
Max 63Case-Control Studies
Max 58Cross-Sectional & Case Series
Max 50Expert Opinion
Max 559 / 100
Quality score
Groups of people are followed over time to see who develops an outcome. Strong for identifying risk factors and associations, but cannot prove causation as firmly as RCTs.
Key takeaways
Summary
Based on the study abstract and findings.
- 1Yes — even healthy people who eat common keto or sugar-free products may have blood levels that could increase clotting risk for days, which is dangerous for people with heart disease.
- 2Eating 30g of erythritol (like one can of diet soda) makes its level in your blood spike over 1,000 times higher than normal and stay high for more than 2 days.
- 3People with naturally high erythritol levels had up to 121% higher risk of heart attack or stroke.
Score breakdown, methodology, conflicts of interest, evidence analysis & raw study data
Publication
Journal
Nature medicine
Year
2023
Authors
Marco Witkowski, Ina Nemet, H. Alamri, Jennifer D Wilcox, N. Gupta, Nisreen Nimer, A. Haghikia, Xinmin S. Li, Yuping Wu, P. P. Saha, I. Demuth, Maximilian König, E. Steinhagen-Thiessen, T. Cajka, O. Fiehn, Ulf Landmesser, W. Tang, Stanley L. Hazen
Related Content
Claims (6)
Adults with higher levels of erythritol in their blood have a significantly higher rate of heart attacks, strokes, or death compared to those with lower levels, even when accounting for other known risk factors like age, diabetes, and cholesterol.
At normal levels found in the human body, erythritol increases platelet activity when exposed to adenosine diphosphate and thrombin receptor agonists, while glucose and 1,5-anhydroglucitol do not produce this effect.
Eating 30 grams of erythritol, found in one can of diet soda or a pint of keto ice cream, causes a more than 1,000-fold increase in blood erythritol levels that stay above levels linked to increased platelet activity for more than two days in healthy people.
Erythritol levels in the blood of people being evaluated for heart conditions are affected by both natural body production and consumption of processed foods, and rising processed food intake has led to higher levels in modern populations, making it harder to determine whether erythritol is a marker of disease or a cause of it.
In mice with injured arteries, erythritol causes blood clots to form faster and blocks blood vessels more quickly than saline or 1,5-anhydroglucitol.
Eating 30 grams of erythritol increases erythritol levels in the blood more than 1,000 times and increases the tendency of blood platelets to clump together and form clots.
Not medical advice. For informational purposes only. Always consult a qualified healthcare professional before making health decisions.