Erythritol: Safe Sweetener or Heart Risk?

The Truth About Erythritol Header

Hey all!  So many thousands of you have now read my Guide to “Healthy” Sugars & Sweeteners (it’s here if you missed it), I have been emailed about 550 times (no joke) with questions about the safety of erythritol as a sweetener.  I know how many of you are using it, or using products that have erythritol as an ingredient, so we must get to the truth of it.  In the next iteration of that guide, I will include it.

The question marks over erythritol are now especially heightened, thanks to a study published in Nature last month called “The Artificial Sweetener Erythritol and Cardiovascular Event Risk” (doi: 10.1038/s41591-023-02223-9)

As always, I want to bring the truth.  Many…MANY insta-nutritionists have posted their usual scare stories to get clicks and traffic since the study came out (fear sells, right?), and based on the nonsense I’ve seen, I’d bet absolutely none of them have read the study or understand it.

So let’s get to the truth of the matter and give you the clarity you need to make the best decisions for you and your family.

First Up, What Is Erythritol?

Erythritol is a sugar alcohol (much like xylitol, sorbitol, and maltitol), a type of carbohydrate that occurs naturally in some fruits, such as grapes, peaches, pears, watermelon, and fermented foods in small amounts.  It is often used as a low-calorie sweetener in various food products, as it provides sweetness similar to sugar (it’s about 70% as sweet as regular table sugar), but with fewer calories, and has almost no taste, smell or after-taste some sweeteners (such as stevia) can have if accidentally overused.

Erythritol can be industrially produced through the fermentation of glucose derived from corn or another starch source, and this is what we are seeing grow hugely in popularity as a more ‘healthy’ sweetener in sugar-free foods and drinks.

Endogenous vs Exogenous Erythritol

This is essential to understand before we get into the study.  

Erythritol is either exogenous, meaning it comes from outside sources through your diet, or endogenous, meaning it is produced naturally inside your body. This is similar to exogenous dietary cholesterol versus the endogenous cholesterol our liver naturally produces.  

Even if you have never eaten a speck of dietary erythritol, your body naturally produces erythritol every single day. It’s a metabolic byproduct of a biochemical pathway called the pentose phosphate pathway.

P3 is an essential anabolic pathway, which means it is used to build important things like fatty acids, DNA, RNA, and an important antioxidant molecule called glutathione.  We’ll come back to this in another guide later because it is really important, but for now, please remember that there is the erythritol we EAT, and the erythritol that your body naturally produces, whether you eat it or not.

What Determines HOW MUCH Erythritol Your Body Produces?

When you live an acidic life (overeating, lots of processed foods, and inflammatory, acidic foods) your P3 pathway gets over-stimulated and worked up – it overproduces. And erythritol is one of the metabolic byproducts that increase in your bloodstream when P3 is revved up and overstimulated. Your body is desperately trying to produce masses of glutathione, to combat all of the free radicals that result from acidic lifestyle habits. 

Important: an acidic lifestyle, as we know, is proven to lead to a greatly increased risk of disease, including cardiometabolic disease.

So as we move into the study it is important to know:

  1. Erythritol occurs naturally in some fruits and fermented foods – this is exogenous erythritol, meaning it’s outside the body and we consume it.
  2. Erythritol is also produced in the body – this is endogenous erythritol and is a byproduct of the P3 pathway that is used in the body to build DNA, fatty acids, glutathione, and other essential things.
  3. When we stress the body with an acidic diet, the P3 pathway gets overstimulated, resulting in an excess of endogenous erythritol swirling around inside our body.

The Study Findings, and the ACTUAL Truth

The study, “The Artificial Sweetener Erythritol and Cardiovascular Event Risk” has been hyped by a lot of pop nutritionists, insta-coaches, and the mainstream media to scare folks into believing that if you EAT erythritol, you will raise your risk of cardiovascular disease.  

It is essential to note that this study was NOT looking at the impacts of erythritol intake in the subjects, but rather it was looking at erythritol as a metabolite.   Meaning they took blood samples from these participants and looked at how much erythritol was in their blood.

At no point did the study look at the intake of erythritol.  

Nowhere in the paper is this mentioned.

It looked at blood levels of erythritol and then over 3 years looked at how many people had cardiovascular disease events, how many people died of cardiovascular disease, and then looked at the increased risk, about their blood levels of erythritol. 

The headline takeaway was that erythritol increases cardiovascular disease risk.  And this is what the media have run with.

However, the study was ONLY looking at endogenous erythritol, which as we know is higher in unhealthy people, and the subjects in the study were people who were already very, very sick. 

Look at this table from the paper:

table from study showing health events of participants

  • Over 15% of the subjects had heart failure
  • Over 40% had already had a heart attack
  • Over 70% had coronary artery disease
  • Over 25% were type 2 diabetics
  • Over 70% were hypertensive

These were very high-risk individuals.  The suggestion here is that people who are overweight, have type 2 diabetes, have cardiovascular disease risk, as we learned earlier, have an overactive P3 pathway, and have LOTS more circulating erythritol.

This is reverse causality.  People who are this sick are producing far more erythritol, and therefore you are observing that people are not getting sick because of high levels of blood erythritol, but have high levels of blood erythritol because they are sick.

The conclusion simply cannot be drawn that erythritol consumption causes an increase in cardiovascular disease risk.  

I hope this helps, and as ever, we’re here for the TRUTH, not the sensationalism.


PS. Do you want to learn how to quit sugar, without the hard work, the cravings, or the stress?  I will teach you every step in my free 60-minute training happening on 30th April 2023.  There are two sessions, so you can pick the one that best suits you.

Click here for more information. 

I can’t wait to see you on the call!

Quit Sugar Webinar Banner

order the alkaline life

Ask Me a Question or Leave a Comment Here - I'd Love to Hear from You


  1. Mia Reply

    Is erythritol acid or alkaline? If acid, would other ingredients, say almond flour as an example, neutralise it?

  2. Eleanor Reply

    What do you think of monk fruit as a sugar substitute?

  3. BarbE Reply

    Thanks for addressing that erythritol question Ross.
    So what # would you give it, if compared to stevia’s 8/10 rating from your healthy sugar article?

  4. Sue Brettell Reply

    Very reassuring Ross! I researched sweeteners when I started my cancer-busting vegan diet (I have breast cancer metastasised in my lungs). As we all know, cancer loves sugar.

    I chose stevia as being the safest natural alternative sweetener and found a product bulked out with inulin, rather than erythritol. In case readers don’t know, stevia is so intense, it has to be bulked out for normal use. Inulin is a prebiotic (encourages growth of healthy stomach flora, improving the biome, which is essential for good health). Its inclusion in the diet is actually a positive bonus.

    Ironically the UK high street health shop where I bought my preferred stevia product has stopped stocking it (no reason provided) and they now mainly offer erythritol as an alternative. This recent adverse publicity will confuse their customers for sure. Big chain supermarkets stock various brands of stevia sweeteners, but they seem to contain very little stevia, so you use more to get the sweetness and they work out as very expensive.

    The alternative sweetener business is growing, and is yet another area of food manufacture that needs clarifying for consumers. The best totally natural sweeteners are manuka honey, coconut sugar, coconut blossom syrup and date syrup. Xylitol is supposedly great for protecting the teeth but I’m not sure whether it has any adverse effects (other than having a laxative effect if over-consumed).

    Useful tip: look online for a pure powdered extract from the Stevia rebaudiana plant. Avoid unprocessed green or raw stevia powder, which may be harmful and is not approved as safe to use. Also purchase inulin powder, widely available. Mix together stevia 1part to inulin 9parts as a starting point. It is equal in sweetness to about half a teaspoon sugar. You can then adjust according to taste. This lasts a long time and is much more cost-effective.