Medical Community Response to the Erythritol Heart Attack and Stroke Study

The keto and low carb community has been shaken by a study associating the popular sweetener erythritol with a potentially higher risk of heart attack and stroke but some experts have cast doubt on its relevance.

WARNING: This is not medical advice

We are learning and processing the information from the recent erythritol study like the rest of you. Since some of our recipes include erythritol, we want to share the information we've collected to date regarding the study and will continue to update this post with additional information becomes available.

However, please note, we are not medical professionals and this site should not be taken as medical advice, including diet or nutritional advice. We encourage readers to seek out medical, diet, or nutritional advice from a qualified medical professional.

The Cleveland Clinic Erythritol Study

A recent study by researchers at Cleveland Clinic found a possible link between higher levels of erythritol in the blood and an elevated risk of stroke or heart attack, especially by those who are at a higher risk of a heart attack or stroke (the study followed people with preexisting cardiac risk factors). However, some experts noted that the increased risk of heart attack and stroke could be due to other factors not accounted for in the study. Regardless, the findings of this study suggest the need for more studies evaluating the long-term health effects of erythritol and other alternative sweeteners.

Medical community response

There have been (and continues to be) varied responses from the medical and scientific community regarding this study. We've collected a list of these responses, with an emphasis on prominent low carb and nutrition experts, and will continue to update this list as additional experts make statements regarding the study. 

Who?	Bio	Study changes erythritol safety?	Quote
Dr. Nicola Guess	PhD, Registered Dietitian, Nutrition scientist at the University of Oxford	No	"Subterranean level of evidence"
Dr. Karen Aspry	MD, Asst Professor at Brown University, Chair of American College of Cardiology Nutrition working group	No	"If you’re a diabetic and you have a choice between eating sugar and eating [erythritol], I would put my bets on [erythritol].”
Dr. Peter Attia	MD, Host of the The Drive, Focused on longevity and metabolism	No	"You’re more likely to get a heart attack from the fear-mongering surrounding this study than from erythritol itself."
Dr. Gil Carvalho	MD and PhD, Host of Nutrition Made Simple	No	"In my opinion the study that just came out doesn't change much."
Layne Norton	PhD Nutritional Sciences, Fitness & nutrition expert	No	"This study certainly warrants more research, but it hardly is evidence that erythritol causes heart attacks or is unhealthy...If you stop consuming things based on this kind of data you will have no foods left to consume."
Kevin C. Klatt	PhD, RD. On editorial board of American Journal of Clinical Nutrition	No	"If you see this and think, it’s time to scare everyone away from using any erythritol ever, you might be putting the cart before the horse and probably just selling clicks or bolstering a fearmongery wellness brand that has folks micro-optimizing every aspect of their lives."
Dr. Avi Bitterman	MD, Frequent communicator regarding nutrition studies	No	"I don't see why you would have a reason to be any more afraid of erythritol from this study compared to before the study was published...If you want to play it safe there's there's things higher on the list than erythritol."
Dr. Bret Scher	MD, Cardiologist. Former medical director for DietDoctor.com	Maybe	"If you were looking for a black and white answer of 'erythritol is good' or 'eythritol is bad', I don't know that we can conclude it from this study. I personally am going to reflect and probably get rid of it because I don't think I need it."
Dr. Adrian Soto Mota	MD, PhD. Focused on Human Metabolism and Evidence-Based Medicine.	Yes	"At least to me, these data look strong enough to recommend against [erythitol]."
Dr Tro Kalayjian	MD. Board certified in Obesity Medicine and Internal Medicine.	Yes	"I would encourage all of my patients to limit [erythitol] use until more information is available."

Substituting Erythritol in Recipes

We encourage you to consult your doctor or dietician before making changes to your diet and won't make a recommendation either way here. However, as low-carb cooks we can provide some tips and guidelines if you are looking to replace or reduce erythritol in your recipes.

First off, in many cases you can swap out erythritol with other alternative sweeteners in many of our recipes, but you can't usually make a 1:1 swap. You will need to likely adjust the amount of the alternative sweetener using a sweetener conversion chart.

Second, make sure to check the ingredients list as many sweeteners that are marketed as Monk Fruit or Stevia may be blended with erythritol. This is more common for powdered sweeteners (where erythritol is added to give the bulk and texture of sugar crystals) than for liquid ones.

Third, it's worth noting that each sweetener has a unique flavor, baking, and sweetness profile. For example, in our Ninja Creami Keto Coffee Ice Cream, we have tried replacing Swerve (which uses erythitol but swaps 1:1 for sugar in sweetness) with allulose, and found it resulted in a less dense, more airy texture and wasn't quite as sweet. Additionally, when we used allulose in our Keto Chocolate Chip Cookies, the allulose resulted in more "cakey" cookies, but there was no cooling effect from erythritol (which we enjoyed). These differing results aren't necessarily positive or negative, but should be noted.

Finally it's worth noting, some erythritol alternatives themselves are simply newer which means they are potentially more expensive, may not be as easily available (e.g. allulose for example is not available in Europe), and have a safety profile that is less researched.