Health risk of using erythritol (a sugar substitute additive)

Study finds risk in using erythritol for people who are at risk of heart disease, including those with diabetes. Erythritol is used to “add bulk or sweeten stevia, monkfruit and keto reduced-sugar products.”

“The degree of risk was not modest,” said lead study author Dr. Stanley Hazen, director of the Center for Cardiovascular Diagnostics and Prevention at the Cleveland Clinic Lerner Research Institute

More here:

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Saw this yesterday and did a lot of googling but I’m a little confused. Do all artificial sweeteners have this? I drink a pre-workout that has sucralose in it but the ingredients don’t list erythritol. Powdered stevia lists it but liquid stevia doesn’t. Would it be listed as an ingredient if it was in there or is it just part of the listed sweetener. I know no one my know the answers to this, it’s just what I was confused about.

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Pretty sure the study was done on only 8 people. Not a lot to go off there. Erythritol has been around for quite some time. But who really knows?? Think they would need to do I bit more digging. More people and in a controlled study to really draw a conclusion.

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The article I first read on this showed a much larger sample size:

“To confirm the findings, Hazen’s team tested another batch of blood samples from over 2,100 people in the United States and an additional 833 samples gathered by colleagues in Europe through 2018. About three-quarters of the participants in all three populations had coronary disease or high blood pressure, and about a fifth had diabetes, Hazen said. Over half were male and in their 60s and 70s.”

My personal concern is over the Stevia connection. The article implied that Stevia products may have Erythritol included. I try to avoid Stevia but I use chocolate Ascent Protein which includes Stevia. I’ve sent Ascent an mail to ask to clarify if their Stevia includes Erythritol.

Time to find an unsweetened, unflavored whey isolate with no additives. I’m not usually reactionary on this kind of stuff, but it does create doubt and trust issues.

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The eight people were only part of the final study. They used eight healthy people to examine elevated blood levels over a period of days after ingesting 30g of erythritol.

A lot of their initial results came from examining 1157 blood samples from people at risk for heart disease. They were examining risk factors in blood for heart disease and weren’t even initially looking at erythritol. Once they identified a correlation between high levels of erythritol and clotting they examined another 2100 blood samples.

Then in the final part of the study they look at the eight healthy individuals.

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Yes, the connection to “healthy” products was why I shared this. I’ve seen several protein powders with Stevia in them. Do they contain this additive? I don’t know, but thought it was worth sharing.

This is my gripe. I guess cyclists are unique in that we often want the carbs.

From my web browsing, Stevia seemed to be most often used in the flavored protein powders. I’m partial to chocolate so that was my search. My sense was a number of these products were eager to say No Added Sugar, so they chose products like Stevia.

Once I started searching for unflavored weigh isolate, I was able to find products with fewer ingredients. I’ll just do my own flavoring.

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From what I could find (for example, here,) no. I put stevia in my coffee and normally just get whatever is in the supermarket, so I never thought to check the ingredients. Looking in my cabinet, Truvia and Wholesome brand stevia do contain erythritol, Stevia in the Raw doesn’t.

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You’re going to find lots of products that have erythritol if you’re into non-nutritive sweeteners. Plenty of Stevia products have fillers to make it easier to use similar amounts to what you would use with real sugar. Steve by itself is way too potent to substitute in equal quantities of sugar.

If we get back to the study mentioned above, the scariest part of that study was that the increase in clot risk is immediate. It’s not a risk that develops over your lifetime similar to heart disease. This is an immediate, increased risk for clotting while blood erythritol levels remain above the threshold. Granted, it is riskiest for those who already have existing risk factors.


I looked at the ingredients of powdered stevia, like in the packets, it listed it. My wife puts “organic” liquid stevia in her coffee and it doesn’t list it. Flip a coin maybe?

I’m too lazy to read the study right now (sorry!) - does the risk go back down when the blood level decreases? What is the half-life of erythritol in the blood?

I have to imagine there are plenty of nutrition companies in a panic right now. Those that explicitly call out use their use of Erythritol are the obvious and ones, but anyone that uses a non-sugar sweetener is now scrambling, even if they don’t use Erythritol. As this thread has already pointed out, we as consumers don’t have enough info from labels to know if the products we use are free of that sweetener.


I think you can conclude from this study that the risk would go back down once blood levels return to baseline. The bolus dose study seems to indicate that erythritol can stay elevated for days after ingestion though so reaching this baseline will just take a bit of time.

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You should be able to get an idea if you check the label and it calls out sugar alcohol. If it does, it contains erthritol or another sugar alcohol compound



Thank you for that pointer. The product I use doesn’t list any sugar alcohol. It does say Stevia Leaf Extract; I hope the company responds to my request for clarification.

Ascent Protein got back to me:

“Thank you for bringing this to our attention,

While the article references that “Erythritol is also the largest ingredient by weight in many “natural” stevia and monkfruit products, …”, that is in reference to retail Stevia and Monkfruit branded products like Truvia® & Lankanto® which blend Stevia with Erythritol. I can confirm that our Stevia Leaf Extract is comprised only of compounds from stevia leaves and does not contain Erythritol .

I’m glad they were prompt and direct in their response.


My understanding is that it is used with some of the granular sugar substitutes as a filler since the sweetener are so much sweeter than ordinary sugar. It shouldn’t be used in the liquid sweeteners.


That’s a really important clarification.

The way the articles read was that it equated the use of Stevia and Monk Fruit with Erythritol being present, but based on what Ascent Protein wrote this is not the case.

I suspect in the months to come we are going to see labels that say “Does not contain Erythritol” in products where it is not present but use Stevia or Monk Fruit as sweeteners.


I emailed ON nutrition about some of thier products that I use and no response yet…

I agree. I reread the article a couple of times to try to understand the scope. Based on some other web info I found, consumers will need the producers to explicitly state whether or not their products contain Erythritol. For example, I don’t think it’s possible to say “all stevia leaf extract products are free of Erythritol” — that’s too broad of a generalization.

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