Welcome to Straight Talk on Health. I’m your host Dr. Chet Zelasko. Straight Talk on Health is a joint production with WGVU in Grand Rapids MI. I examine the practical application of health information. Nutrition. Exercise. Diet. Supplementation. I look at the science behind them, and let you know whether it’s something to consider or not. You can check out other things that I do on my website Drchet.com and sign up for my free emails.
If you pay attention to the health news, you’ve probably seen headlines that relate the sugar alcohol erythritol to major adverse cardiovascular events (MACE) such as heart attacks and strokes. I’ve been following this since 2023. I began to write an outline of a podcast or email on erythritol (Ery) back then. This past summer in 2025, a different research group published another article raising concerns about Ery. I thought it time to talk about what I found in the research.
Ery is a sugar alcohol that is naturally made in the body albeit in small quantities. As of this date, there is no known metabolic use for Ery in the body but that doesn’t mean there is none. Due to the chemical structure, Ery and other sugar alcohols are difficult to break down and thus are generally eliminated via the kidneys.
In the first paper published in 2023, researchers undertook a monumental series of studies. In the first study, they assessed the relationship between people undergoing an evaluation for cardiac risk and a number of dietary ingredients. Serum Ery levels wereassociated with an increased 3 year risk for major adverse cardiovascular events or MACE. As mentioned earlier, that includes death or non-fatal myocardial infarction or stroke. They then replicated that approach in CAD patients with separate US and European subject pools, focusing on just Ery and found the same relationship, when comparing the 4th quartile intake with the 1st quartile intake.
They then focused on the clotting effect of Ery on human blood cells as well as other factors found in blood associated with clotting. Dosing the blood cells with dietary amounts of Ery demonstrated the same propensity for clotting and other stimulating chemicals promoting and preventing clotting. Those factors were impacted by Ery. Finally, they fed 8 young human subjects a 30 g dose of Ery in a drink and found the Ery levels elevated as long as 2 days later. Their conclusion was that, while nothing they examined demonstrated cause and effect, there should be more studies before Ery becomes more commonly used, especially in products making claims for low carbohydrate content.
The second study was published in June of 2025. It was much more focused in scope. Researchers examined the impact of physiological amounts of Ery on brain micro- vascular endothelial cells. They grew the cells in laboratory and exposed them to Ery. The factors associated with oxidative stress and clotting factors increased while nitric oxide levels decreased. That means that blood vessels would not dilate as might be expected while blood clots could potentially form. If that actually happened in a human being.
Researchers from both research groups talked about the potential negative impact on the health of people who use Ery on a regular basis. They suggested that the use of this and perhaps other sugar alcohols could be hazardous and contribute to MACE and CAD. Of course, they realize that randomized controlled trials need to be done to confirm their theory based on observational and laboratory based tests.
I think there is a lot more than RCT before Ery or any sugar alcohol is abandoned. Let me give you a few observations and questions I have after reading the studies that I admit contained some complex biochemical techniques beyond my expertise.
Did Ery cause the increased in MACE or did the present CAD respond to the Ery by increasing clotting? The first observational study was assessing people who presented for a cardiac risk assessment. The second was for people with known disease who presented for further evaluation. We don’t know how the Ery levels increased. The assumption is that it was dietary yet no dietary information was collected. Further, there could be a genetic component involved. Some people may make more Ery than others do on a regular basis or it may be exacerbated when they gain weight, age, or are sedentary. The mean age of the subjects were in their 60s in the observational trials. If this is a concern for that age group, why did they use young healthy people to test Ery levels?
The real problem with both studies, which the researchers cite, is that there are hundreds of factors that could impact or interact Ery from other foods, medications, and other hormones naturally made by the body. For example, protein intake has a tendency to decrease as people age. Could that be a factor in the processing of Ery?
Platelets, AKA as thrombocytes, are the primary clotting organ in the body. They live for 8-10 days. In fact, all platelets are replaced every 72 hours. What impact would that have in adhesion and aggregation due to Ery?
Where do medications come into play? Aspirin? Warfarin? Eliquis? Statins? BP medications? All are known to reduce adhesion and clotting.
The paper suggested up to 60% of a cream filling could be erythritol. That’s an exaggeration at best. Does such a product exist? I couldn’t find one, checking keto friendly products, frostings, and homemade recipes.
What about foods that have a natural anti-clotting tendency, those with high levels of vitamin K? What about a high fiber diet? And on and on.
The one thing they never addressed in the latest research was gas. Flatulence. Many people reject the use of sugar alcohols because they can cause an increase in fermentation by gut bacteria. That results in the potential over production of flatulence. That’s why I don’t use products with sugar alcohols very much. I think the use of Ery will be found to be self-limiting.
I understand the concern by the scientists and physicians who conducted the research. They only have their patients and the health of people in mind. But they are also calling Ery an artificial sweetener.It is not artificial as it’s made in the body and by plants and really isn’t all that sweet. There is a lot of work before we prohibit its use in food products because it may contribute to MACE and CAD. Anything with fat or sugar, when eaten to excess, are more of a contributor to MACE and CAD, than sugar alcohols probably ever will be.
One final thing in this episode. I talked about the fluid physics of pasta for making Cacio e Pepe, a three ingredient pasta dish last season. Researchers analyzed the best way to get the pasta to the right temp and starch level of the water. Then they used sodium citrate to compensate for the experience of an Italian grandmother who know exactly when to add the pasta water. I finally tried it. I used fresh chopped basil instead of pepper and I added a teaspoon of sodium citrate as I added the cheese. No lumps in the sauce for the first time! Smooth and silky. Delicious. You can use the sodium citrate to make any cheese sauce smooth and not grainy or lumpy. Leave it to physicists who love pasta to come up with the solution to clumpy cheese.
That’s all the time I have for this episode. If you like this podcast, please hit the share button and tell your friends and colleagues about it. Until next time, this is Dr. Chet Zelasko saying health is a choice. Choose wisely today and every day.
Nat Med. 2023 March ; 29(3): 710–718.
J Appl Physiol 138: 1571–1577, 2025.
