Erythritol: Side Effects, the Heart Attack Study and Is It Safe?

Erythritol is a sugar alcohol about 70% as sweet as table sugar that adds almost no calories, because most of it is absorbed and then leaves the body unchanged in urine. That also makes it easier on the gut than most sugar alcohols, though large amounts can still cause diarrhea. In 2023, a Cleveland Clinic study linked higher blood erythritol with heart attack, stroke and death in people already being checked for heart disease, and erythritol made platelets more reactive in lab tests. That study shows an association, not proof of cause, and both the FDA and European regulators concluded it does not establish that eating erythritol causes heart problems. Here is what the research shows and where it falls short.

Peptide Labs sells supplements, but none of the products we carry list erythritol on the label, and this article does not recommend any product. It is general information, not medical advice.

What is erythritol?

Erythritol is a polyol, the chemical family usually called sugar alcohols, which also includes sorbitol, xylitol and maltitol. It occurs naturally in small amounts in grapes, pears, melon and watermelon and in fermented foods such as cheese and soy sauce. The erythritol in food products is made by fermenting sugars with yeasts and then purifying the result. Your body also makes a little from glucose, a point that turns out to matter for the heart research.

Because erythritol looks and bakes somewhat like sugar but is less sweet, it is often used in large amounts. The 2023 heart study noted that it can make up as much as 60% of the weight of some creams and pastries, and it is common in keto and zero-sugar foods and in tabletop blends with stevia or monk fruit. One widely sold stevia sweetener lists erythritol first, ahead of the stevia; see our stevia guide for that sweetener’s own safety record.

How the body handles erythritol

Erythritol is a small molecule, so most of it is absorbed in the small intestine. Studies summarized in a 2023 review recovered about 90% of an ingested amount in urine within a day, and a small fraction is converted to a related compound called erythronate. Because so little is used for energy, its nutritive value has been estimated at less than 0.4 calories per gram, compared with about 4 for sugar. The same review found that it does not raise blood glucose or insulin. Its authors had ties to a sweetener manufacturer, which is worth knowing when reading its more positive conclusions.

Erythritol side effects

The most clearly documented erythritol side effects are digestive. The NIDDK lists sugar alcohols, erythritol included, among foods that can cause gas. In its 2023 re-evaluation, the European Food Safety Authority (EFSA) identified diarrhea as the key adverse effect, because it can upset fluid and electrolyte balance. It set an acceptable daily intake of 0.5 grams per kilogram of body weight per day, the level below which diarrhea was not seen in human studies, and noted that some high consumers, especially children and teenagers, may exceed it. That figure is a regulatory benchmark, not a target. EFSA also refused a request to exempt erythritol from the European laxative warning that applies to foods with added polyols.

• Digestive symptoms: gas, bloating, rumbling and loose stools, more likely with large amounts or when erythritol is combined with other polyols or fiber. Our guide to fiber supplement side effects explains why fermentable ingredients cause these symptoms.
• Gentler than other polyols: because most erythritol is absorbed before it reaches the colon, less is left for gut bacteria to ferment than with sorbitol or maltitol.
• Blood sugar: erythritol does not raise blood glucose, but foods sweetened with it may still contain flour, fat and calories. Read the whole label.
• Heart and clotting questions: covered in the next section. Researchers have called for more study in people with heart disease or reduced kidney function.

Erythritol and heart attack risk: what the studies found

The erythritol heart attack headlines came from the 2023 Cleveland Clinic study. Researchers measured blood erythritol once, after an overnight fast, in thousands of people being evaluated for heart disease, then tracked who had a heart attack, stroke or died over three years. People in the top quarter of erythritol levels had roughly double the risk of those in the bottom quarter. In lab and animal experiments, erythritol made platelets clump more readily, and in eight volunteers a sweetened drink raised blood erythritol far above the levels linked to platelet effects for more than two days. A 2024 follow-up in 20 volunteers found that an erythritol drink, but not a glucose drink, made platelets more reactive.

Why this does not prove erythritol causes heart attacks

The authors themselves listed the limits. The participants were patients at specialist heart centers, many with existing disease, so results may not apply to the general population. Observational data can show only an association, and diet and other factors may not have been fully accounted for. Most important, the body makes erythritol from glucose, and a 2017 study found higher levels in young adults who were gaining belly fat. High blood erythritol may therefore partly be a marker of metabolic strain rather than a measure of how much sweetener someone ate. A 2023 review also noted that people with rare inherited conditions that keep erythritol permanently high do not show more clotting, though one of its authors had been paid by a sweetener company to write earlier reviews. The platelet studies are small and short, and no trial has tested whether eating erythritol over years changes heart outcomes.

What regulators concluded

The FDA says it reviewed the 2023 paper and determined that the observational studies did not establish a causal link between consuming erythritol and the observed effects. EFSA reached a similar conclusion in its 2023 re-evaluation, adding that further studies might help clarify the association. Erythritol has been regarded as GRAS in the US since 2001, the FAO/WHO expert committee assigned it an acceptable daily intake of not specified, and it is authorized in dozens of food categories in the European Union.

Is erythritol safe? A balanced reading

For most people, erythritol in normal food amounts is an approved ingredient whose main proven drawback is digestive upset. The heart findings are a genuine scientific question rather than settled fact, and both the researchers raising concerns and those skeptical of them agree that long-term trials are needed. Since no one needs erythritol, a cautious approach is reasonable if you have heart disease, have had a stroke or blood clot, or are at high cardiovascular risk: ask your cardiologist or primary care clinician whether to limit it. Get emergency care for chest pain, sudden weakness on one side, slurred speech or sudden shortness of breath, whatever you have eaten.

Swapping sugar for any sweetener also has limits. The WHO advises against relying on non-sugar sweeteners for weight control, though its guideline does not cover sugar alcohols such as erythritol. For ways to need less sweetness overall, see our guide on sugar cravings, and if you take a GLP-1 medicine, our GLP-1 eating guide covers food choices that matter more than the sweetener.

Frequently Asked Questions

Questions about a label? Contact us or read our Buyer’s Guide. Follow the label and ask a healthcare provider before starting any supplement, especially if you take medicines. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

Last reviewed October 2026.

Related guides: Stevia Side Effects: Is Stevia Safe, and How Does It Compare to Sugar?, Sugar Alcohols: Xylitol, Diarrhea, Blood Sugar and Labels, How to Stop Sugar Cravings: Why They Happen and What Research Supports.