Erythritol's Hidden Dangers: New Study Links Popular Sweetener to Increased Risk of Blood Clots

A new pilot study has revealed that consuming a beverage sweetened with erythritol—a widely used artificial sweetener often added to stevia, monk fruit, and low-carb keto products—more than doubled the risk of blood clotting in 10 healthy participants. Erythritol, a sugar alcohol, has already been associated with an increased risk of stroke, heart attack, and even death in previous research.

Blood clots can have serious consequences, such as breaking off from the blood vessel and traveling to the heart, causing a heart attack, or to the brain, leading to a stroke. In this study, each participant showed a marked increase in platelet responsiveness, or clotting, after consuming erythritol, according to Dr. Stanley Hazen, the lead author of the study. Dr. Hazen is also the director of the Center for Cardiovascular Diagnostics and Prevention at the Cleveland Clinic Lerner Research Institute.

The study also compared the effects of consuming erythritol with those of glucose. In another group of 10 participants who consumed a drink with an equivalent amount of glucose, there was no impact on blood platelet activity. This finding highlights the difference in how these two substances affect the body. "Glucose doesn’t impact clotting, but erythritol does," Dr. Hazen emphasized.

Although this was a small study, it has raised significant questions within the medical community. Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver, called the findings "very intriguing and interesting." He noted that while the study does not suggest an immediate halt to the use of sugar alcohols like erythritol, it does question their safety.

The Calorie Control Council, an industry association, responded to the study by defending erythritol, pointing to 30 years of research that has demonstrated its safety as a sweetener. The council's president, Carla Saunders, cautioned against over-interpreting the study's results, noting that the participants were given nearly four times the maximum amount of erythritol approved in any single beverage in the United States. However, Dr. Hazen countered that the 30 grams of erythritol used in the study is comparable to the amount found in common sugar-free products like sodas, ice creams, or muffins—foods that people often consume in multiples.

This research suggests that even a standard serving of food or drink sweetened with erythritol could potentially trigger clot formation, according to Dr. Wai Hong Wilson Tang, a co-author of the study and research director for heart failure and cardiac transplantation at the Cleveland Clinic.

Erythritol belongs to a class of sugar alcohols that includes sorbitol and xylitol. These are naturally occurring carbohydrates found in many fruits and vegetables. The human body also produces small amounts of erythritol during glucose metabolism. Unlike some other sugar alcohols, erythritol is less likely to cause a laxative effect and does not spike blood sugar levels. It is approximately 70% as sweet as sugar and is considered zero-calorie by experts.

Erythritol is the main ingredient by weight in many "natural" stevia and monk fruit products. It resembles sugar in appearance and taste, making it popular for baking and as a key component in keto-friendly foods like ice cream. Dr. Hazen points out that a typical pint of keto ice cream can contain between 26 and 45 grams of erythritol.

The U.S. Food and Drug Administration (FDA) has classified erythritol and similar substances as "generally recognized as safe" (GRAS).

The study, published in the journal Arteriosclerosis, Thrombosis, and Vascular Biology, involved 20 participants who fasted overnight before consuming either 30 grams of erythritol or 30 grams of sugar in the morning. Blood tests taken 30 minutes after consumption revealed a thousandfold increase in erythritol levels in those who drank the erythritol beverage, while blood sugar levels rose only slightly in those who consumed glucose. The most striking finding was the increased platelet activity, which could lead to faster clot formation—a model similar to what happens during a heart attack or stroke.

This finding is consistent with a 2023 study by Dr. Hazen and his team, where eight healthy volunteers who consumed erythritol also experienced a thousandfold increase in the substance in their blood. The elevated levels remained above the threshold necessary to trigger clotting risk for two to three days.

In the 2023 study, the researchers also analyzed the blood of more than 4,000 individuals from the United States and Europe. Those with the highest levels of erythritol in their blood were found to be twice as likely to suffer a heart attack or stroke. "The platelets become super responsive with erythritol: A mere 10% stimulant produces 90% to 100% of a clot formation," Dr. Hazen explained.

While these studies were conducted on healthy individuals without chronic diseases, Dr. Hazen believes the findings are still relevant for the general population. He notes that many middle-aged Americans have two to three risk factors for heart disease, and with 70% of the population likely to develop heart disease at some point, the implications are significant.

Given the potential risks, Dr. Hazen suggests that occasional sugar-sweetened treats in moderation might be safer than consuming foods and drinks sweetened with sugar alcohols like erythritol. This is particularly important for individuals at high risk for cardiovascular issues, such as those with existing heart conditions or diabetes.

"Cardiovascular disease builds over time, and heart disease remains the leading cause of death worldwide," Dr. Hazen said. "It's crucial that the foods we eat don't become hidden contributors to this global health crisis."