Sweeteners · Metabolic & Cardiometabolic
erythritol increases cardiovascular disease
In plain terms: Does erythritol raise your risk of heart attack and stroke?
Part of: • erythritol
There's a real, repeated signal worth taking seriously: people with higher erythritol in their blood have more cardiovascular events, and lab work shows it makes platelets clot more readily. The catch is that blood erythritol partly reflects what your body makes on its own, not just what you ate — and no trial has tested whether consuming it actually causes events. A genuine flag, not a settled finding.
📅 Last reviewed: 2026-07-15 ⓘ
Evidence ladder
How far up the ladder this claim has climbed. A high consensus on a low rung means "consistent so far," not "proven in people."
Top evidence so far: Population patterns (Observational)
How the studies fall
What the evidence shows
A single high-profile research program (Hazen lab, Nature Medicine 2023) reported that higher circulating erythritol predicts 3-year major adverse cardiovascular events across three cohorts, and that erythritol enhances platelet reactivity and thrombosis in mechanistic models.
The evidence (13)
| Source | Grade | Stance | Quality | Finding |
|---|---|---|---|---|
| Abushamat LA, Yu B, Hoogeveen RC, Sun C, Cheng C, Hartig SM, Herman MA, Balasubramanyam A, Reusch JE, Selvin E, Ndumele CE, Nambi V, Ballantyne CM 2025 · JACC Adv | observational | supports | moderate | ARIC cohort (n=4,006, independent of the original lab): higher circulating erythritol and its metabolite erythronate associated with incident cardiovascular events in older adults. |
| Lim J, Hong HG, Huang J, Stolzenberg-Solomon R, Mondul AM, Weinstein SJ, Albanes D 2024 · Nutrients | observational | supports | moderate | Prospective cohort (ATBC Study, 4468 Finnish male smokers, 19.1y follow-up) found serum erythritol associated with increased overall mortality (HR 1.50) and CVD mortality (HR 1.86), plus cancer mortality (HR 1.54). Independent of Hazen lab |
| Berry AR, Ruzzene ST, Ostrander EI, Wegerson KN, Orozco-Fersiva NC, Stone MF, Valenti WB, Izaias JE, Holzer JP, Greiner JJ, Garcia VP, DeSouza CA 2025 · J Appl Physiol | in-vitro | supports | moderate | Independent in-vitro work: erythritol impaired brain microvascular endothelial cell function (oxidative stress, reduced nitric oxide) — mechanistic support. |
| Huang L, Huhulea E, Aifuwa E, Frishman WH, Aronow WS 2025 · Cardiol Rev | observational | mixed | moderate | Review of artificial sweeteners and CVD: erythritol among emerging concerns, evidence not yet conclusive. |
| Heianza Y, Sun Q, Wang X, Tiwari S, Watrous JD, Rexrode KM, Alotaibi M, Jain M, Mora S, Willett WC, Qi L, Manson JE 2025 · European journal of preventive cardiology | observational | mixed | moderate | Nested case-control in Nurses' Health Study (762 CHD cases/controls) measuring baseline plasma erythritol/mannitol/sorbitol; higher plasma erythritol associated with incident CHD (RR 1.15/SD; Q4 vs Q1 RR 1.55), attenuated (RR 1.21, ns) afte |
| Fletcher AA, Durieux JC, Bederman I, Feczko J, Atieh O, Baissary J, Labbato D, Ailstock K, Funderburg NT, McComsey GA 2024 · Nutrients | observational | mixed | low | Cross-sectional study (162 participants, PWH vs PWoH) found plasma erythritol positively associated with VLDL, visceral adipose tissue, TNFr1, HbA1c -- cardiometabolic risk markers, not incident CVD events. Explicitly frames elevated erythr |
| Fan J, Hu Y, Zhang J, Chen J, Yuan Y, Yu B 2025 · Am J Prev Cardiol | observational | supports | moderate | Two-sample Mendelian-randomization study of erythritol and CVD/stroke/diabetes: causal genetic evidence debated across sensitivity analyses (does not cleanly confirm causation). |
| Witkowski M, Wilcox J, Province V, Wang Z, Nemet I, Tang WHW, Hazen SL 2024 · Arterioscler Thromb Vasc Biol | observational | mixed | moderate | Brief report (same group): erythritol ingestion, but not glucose, enhanced platelet reactivity and thrombosis potential in healthy volunteers. |
| Sun Y, Sun D, Wu J, Peng Z, Jin J 2025 · Medicine | observational | supports | moderate | 2-sample Mendelian randomization using 60 SNPs for genetically-predicted erythritol levels vs FinnGen outcomes; found higher genetically-predicted erythritol associated with increased CHD (OR 1.077) and ischemic stroke (OR 1.157), suggestiv |
| Choi SS, Kim EJ, Shin SK, Lee JY, Han JW, Kwon EY, Bae HR 2024 · Nutrients | animal | supports | low | Mouse study comparing erythritol vs allulose on HFD-induced platelet aggregation; erythritol exacerbated platelet aggregation while allulose reduced it, with pathway analysis extended to sickle cell disease patient platelet transcriptomics. |
| Bao Y, Li B, Zhao C, Man X, Zhang S, Zhang J, Du Y, Gu K, Feng X 2025 · NPJ science of food | animal | supports | low | Zebrafish embryos exposed to erythritol (3-7 mg/mL) showed developmental/circadian disruption and thrombus formation via rev-erba dysregulation, oxidative stress and inflammation. Non-mammalian model, high supraphysiologic dietary-style exp |
| Wölnerhanssen BK, Meyer-Gerspach AC, Arduini A, D'Alessandro A, Gronda E, Carugo S, Bonomini M, Gallieni M, Masola V, Angelillo-Scherrer A, Prosdocimi T, Lopaschuk GD 2025 · Cardiovasc Res | observational | mixed | low | Review ('friend or foe?'): erythritol/xylitol cardiovascular signals real but confounded by endogenous production; net uncertain. |
| Witkowski M, Nemet I, Alamri H, Wilcox J, Gupta N, Nimer N, Haghikia A, Li XS, Wu Y, Saha PP, Demuth I, König M, Steinhagen-Thiessen E, Cajka T, Fiehn O, Landmesser U, Tang WHW, Hazen SL 2023 · Nat Med | observational | mixed | high | Nature Med: circulating erythritol associated with 3-yr MACE across 3 cohorts (adjusted HR ~1.8-2.2, top vs bottom quartile); erythritol enhanced platelet reactivity in vitro and thrombosis in vivo; ingestion in 8 volunteers raised plasma levels above prothrombotic thresholds for >2 days. |
Disagree, or know a study we missed?
We grade by evidence, not opinions. The way to weigh in is to point us to a study we haven't cited (check the evidence table above first), or to flag a problem with one we have. Every submission is reviewed; if it holds up, the grade updates and shows in Science Changes Its Mind.
Opens a short form. You'll sign in with Google so submissions are tied to a real account — we don't display your identity, and we only accept a link we can verify (PubMed, DOI, ClinicalTrials.gov).
Educational only, not medical advice. Grades and scores reflect published evidence weighted by study design and quality; see the methodology.