If you follow a keto diet, you may want to check the labels of some of your foods. Erythritol is a zero-calorie sugar alcohol made from corn that often replaces sugar in many diets or low-carb products. It’s also found in sugar substitutes such as Splenda and Truvia. According to a 2023 study in Nature Medicine, these artificial sweeteners, particularly erythritol, might increase your risk of blood clots.
The study had four parts. At first, the researchers looked at more than 1,000 people to analyze their risk of having a cardiovascular event such as a heart attack or stroke in the following three years. The people most at risk were those who had higher amounts of erythritol in their blood.
But the researchers weren’t completely sure about the link between erythritol and cardiovascular risk, so they followed up with more people. They found more than 2,000 people in the United States and more than 800 people in Europe to participate in the study.
The people in the United States with the highest amounts of erythritol in their system were 80% more likely to have a cardiovascular event. The people in Europe had twice the risk.
Effects of erythritol
The researchers wanted to see how erythritol impacts the blood, so they conducted more tests in the lab. The erythritol makes platelets more reactive and might cause clotting of the blood.
The fourth part of the study recruited eight healthy people. When they drank 30 grams of erythritol dissolved in water, their blood registered significant levels of erythritol for up to three days after.
These levels were high enough to affect the blood platelets, according to levels measured in the lab test. If 30 grams of erythritol sounds like a lot, the researchers noted in the study that a pint of keto ice cream has about this amount. Some doctors tell U.S. News and World Report that if you’re at risk for cardiovascular disease, it’s best to steer clear of erythritol.
Other experts note that the study may not be representative because it largely focused on populations that were already at risk of cardiovascular disease. Some experts raised the possibility of “reverse causation”, in which people might turn to erythritol to lose weight if they already have heart problems. Another limitation is that the study didn’t consider the people’s overall diet to see what other foods could put them at risk for heart attack or stroke.
For these reasons, some experts say that using erythritol in small amounts might not be a cause for concern, but that more research is needed before we can draw definitive conclusions. Either way, it’s best to limit highly processed foods, some of which do contain erythritol.
