Erythritol
A sugar alcohol used as a low-calorie sweetener. Large amounts cause loose stools, and high blood levels have been linked to increased risk of heart attack and stroke.
A 2023 study found people with high erythritol in their blood were around twice as likely to have a heart attack or stroke over three years. Erythritol also stiffens platelets, making blood more likely to clot. Amounts in keto or diabetic products can be large per serving.
What is it?
Erythritol is a sugar alcohol (polyol) that occurs naturally in small amounts in some fruits and fermented foods. Commercially it is produced by fermenting glucose with yeast. It has about 70 percent of the sweetness of sugar and contributes roughly 0.2 kcal per gram, far less than sugar.
What does it do?
It provides sweetness without raising blood glucose or insulin in the way sugar does, because the body absorbs most of it in the small intestine and excretes it unchanged in urine. This absorption pattern means it causes less fermentation and fewer digestive symptoms than most other polyols, though large doses still trigger a laxative effect.
Where you will see it
Most commonly found in sugar-free and reduced-sugar products aimed at diabetic or low-carb consumers: protein bars, keto confectionery, chewing gum, low-sugar chocolate, table-top sweetener blends (often combined with stevia), zero-sugar energy drinks, and some ice creams. On a UK label it appears as 'erythritol' or 'E968' in the ingredients list. Products providing more than 10 g per day must carry the warning 'excessive consumption may produce laxative effects'.
What the science says
Cardiovascular risk: the 2023 signal
A large 2023 study found that people with higher erythritol levels in their blood were about twice as likely to have a heart attack or stroke over the following three years. The researchers also showed in laboratory tests that erythritol makes platelets stickier, which could promote clot formation. This is an observational association, not proof of cause, and a key limitation is that people eating more processed sweet food likely have higher erythritol exposure, which itself tracks with poorer metabolic health.
In a prospective cohort of over 1,000 at-risk cardiac patients, those in the highest quartile of plasma erythritol had roughly twice the risk of major adverse cardiovascular events (heart attack, stroke, death) over three years compared with those in the lowest quartile.
Adding erythritol to blood in laboratory conditions at concentrations matching those seen after a typical consumer dose enhanced platelet aggregation and adhesion, a mechanism that could increase clotting risk.
The association was replicated in two independent cohorts: one in the United States and one in Europe, each exceeding 1,000 participants, with consistent direction and magnitude.
Laxative effect
Unlike many polyols, erythritol is almost completely absorbed before reaching the large intestine, so the fermentation and bloating common with sorbitol or maltitol are much reduced. However at higher intakes, exceeding roughly 50 g in a single sitting in adults, unabsorbed erythritol reaches the colon and causes loose stools and diarrhoea. EU and UK rules require a laxative warning label when a product delivers more than 10 g of polyols per day.
EFSA set an Acceptable Daily Intake for erythritol of 0.5 g per kg of body weight per day, primarily to manage the laxative threshold rather than any toxic endpoint.
Human intervention studies have found that single doses of around 50 g or more in adults produce loose stools; lower doses are generally tolerated without acute gastrointestinal symptoms.
Blood glucose and insulin response
Erythritol is not metabolised to glucose and has a glycaemic index of zero. Multiple clinical trials in people with and without type 2 diabetes confirm it does not raise blood glucose or insulin. This is why it became popular in diabetic-friendly and ketogenic products. However, the 2023 cardiovascular data suggest this metabolic neutrality for glucose does not necessarily mean the compound is without broader circulatory effects.
Erythritol has a glycaemic index of zero and does not provoke an insulin response in clinical studies, making it distinct from other polyols that undergo partial metabolism.
Tooth decay
Like other polyols, erythritol is not fermented by oral bacteria and does not contribute to tooth decay. Some studies suggest it may actively reduce levels of the bacteria Streptococcus mutans, although the clinical significance of this for dental health in normal use is still being researched.
Erythritol-containing confectionery reduced counts of Streptococcus mutans in plaque and saliva compared with xylitol and sorbitol in a randomised trial in children.
Where it stands with the regulators
Who should be careful
People with cardiovascular disease or who are at elevated risk of heart attack or stroke may want to take note of the 2023 observational data and discuss erythritol intake with their doctor. People with irritable bowel syndrome or other digestive sensitivities can be affected by large amounts. Look for 'erythritol' or 'E968' in the ingredients list, particularly in keto, diabetic, or sugar-free products where doses per serving can be substantial.
The honest read
Erythritol spent years being considered an unremarkable low-calorie sweetener. The 2023 Nature Medicine study changed that picture. The observational association with heart attack and stroke is real, replicated in multiple cohorts, and backed by a plausible platelet mechanism. What it cannot tell us is whether erythritol causes the risk or whether people who consume a lot of erythritol-sweetened products are already metabolically unwell in ways that drive both their sweetener choices and their cardiovascular outcomes. Regulatory bodies had not acted on the findings as of mid-2026. The science is live, not settled, and the cardiovascular signal is a genuine open question.
Related additives
Common questions
Is E968 banned in the UK?
No. Erythritol (E968) is an approved food additive in the UK under the assimilated EU Regulation 1333/2008, and it remains on the UK FSA approved-additives list. EFSA completed a re-evaluation in 2023 and maintained its approval, setting a formal ADI for the first time.
Does erythritol raise the risk of heart attacks?
A 2023 study published in Nature Medicine found that people with higher erythritol levels in their blood were about twice as likely to have a heart attack or stroke over three years, and that erythritol made platelets stickier in laboratory tests. This is an association from observational data, not proof of cause. No regulatory body has changed its guidance as a result, but the signal is considered significant enough to warrant further research.
What foods contain E968?
Erythritol is most common in sugar-free or keto products: protein bars, low-sugar chocolate, chewing gum, table-top sweetener blends (often with stevia), zero-sugar energy drinks, and some ice creams. It appears on the label as 'erythritol' or 'E968'.
Is E968 vegan?
Yes. Commercial erythritol is produced by fermenting plant-derived glucose with yeast. No animal products are used in its manufacture, and it is suitable for vegans.
Sources
- Witkowski et al., 'The artificial sweetener erythritol and cardiovascular event risk', Nature Medicine, 2023
- EFSA ANS Panel, 'Re-evaluation of erythritol (E 968) as a food additive', EFSA Journal, 2023
- UK Food Standards Agency, Approved additives and E numbers
- NIH Research Matters: Erythritol and cardiovascular events
- Noda et al., 'Glycemic indices of erythritol and xylitol', European Journal of Clinical Nutrition, 1994
- Arrigoni et al., 'Human gut microbiota does not ferment erythritol', British Journal of Nutrition, 2005
- Makinen et al., 'A descriptive report of the effects of a 16-month xylitol chewing-gum programme subsequent to a 40-month sucrose gum programme', Caries Research, 2005
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