Erythritol and Heart Risk: Blood Levels Fell and Risk Scores Improved

A new analysis of a two-year weight-loss trial found that when blood levels of erythritol fell, estimated heart risk scores improved. The body makes erythritol itself from glucose, so the amount in blood is partly a sign of metabolism, not only of sweetener eaten, and that changes how earlier erythritol studies should be read.

Key takeaways

• On September 18, 2026, researchers published an analysis in the American Journal of Clinical Nutrition showing that 6-month declines in plasma erythritol during dietary weight loss tracked lower estimated 10-year ASCVD risk and improved atherogenic lipid profiles at two years.

• The study analyzed blood plasma concentrations and estimated statistical risk scores; it did not feed participants erythritol sweetener or evaluate clinical endpoints like heart attacks or strokes.

• Shoppers evaluating zero-sugar, keto, and reduced-calorie items can monitor the Nutrition Facts panel for sugar alcohols and use ingredient transparency tools like Aurascan to identify erythritol and its alternatives.

What happened

On September 18, 2026, Heianza and colleagues published an observational analysis of the two-year POUNDS Lost trial in the American Journal of Clinical Nutrition (DOI: 10.1016/j.ajcnut.2026.101528).

The team evaluated baseline plasma concentrations of multiple polyols, including erythritol, arabitol/xylitol, and mannitol/sorbitol, across 802 adults with overweight or obesity. The researchers then tracked changes in 664 participants at six months and two years following dietary weight-loss interventions. At the start of the trial, higher baseline concentrations of all three polyol groups were associated with higher estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk scores.

Larger declines in plasma erythritol over the first six months were associated with lower estimated 10-year ASCVD risk at six months and with improvements at two years. Changes in arabitol/xylitol and mannitol/sorbitol were not associated with the risk-score improvements.

What changed in how scientists interpret erythritol?

An earlier study in Nature Medicine (Witkowski and colleagues, 2023) found that higher circulating erythritol was associated with a higher three-year risk of major adverse cardiovascular events in patients undergoing cardiac evaluation. The same paper reported that erythritol enhanced platelet reactivity in lab and animal experiments, and that eating erythritol raised blood levels in eight healthy volunteers for more than two days. Those findings led to wide public concern about the sweetener.

The September 2026 analysis adds a different angle. In the POUNDS Lost trial, adults with overweight or obesity were assigned to weight-loss diets; they were not given erythritol, and the analysis did not measure how much erythritol they ate. It measured blood levels, which reflect both the body's own production and any erythritol eaten.

Larger declines in plasma erythritol were also associated with lower cholesterol in VLDL and LDL particles that contain apolipoprotein C-III, a lipid pattern linked to atherosclerosis. That is an association within the trial, not proof of mechanism.

Who is affected by these findings?

People who buy zero-sugar, keto or reduced-sugar products, and people living with overweight, obesity or diabetes, are the most interested readers. The study suggests that a single high blood erythritol reading can partly reflect metabolic health. It does not answer whether the erythritol in food raises cardiovascular risk: the 2023 study and this one measured different things, and neither tested heart attacks or strokes as outcomes of eating erythritol over time.

What it means for shoppers reading food labels?

For everyday grocery shoppers, this study emphasizes the importance of looking at both overall metabolic health and individual package labels. Erythritol is a sugar alcohol used in zero-sugar and keto products. In the European Union it appears on ingredient lists as E968.

When reviewing a packaged food label, erythritol is often blended with high-intensity sweeteners such as stevia or monk fruit extract to balance flavor profiles. On US labels, sugar alcohols can be listed as a separate line under Total Carbohydrate; when they are not, their grams are still counted within Total Carbohydrate, and the ingredient list names erythritol.

Shoppers choosing between alternative sweetening agents can compare how different compounds behave. For instance, our guide on Allulose vs Erythritol: Which Sugar Substitute Is Better? examines how rare sugars differ from polyols in baking and digestive tolerance. Similarly, our breakdown of Xylitol vs Erythritol: Which Sugar Alcohol Is Better for You? details variations in caloric density and dental benefits.

To inspect packaged goods quickly, shoppers can check for key label indicators:

• Check the ingredient list for "erythritol" or "E968" in keto, low-carb, and "no sugar added" products.
• Review the Nutrition Facts panel to see whether sugar alcohols are broken out beneath Total Carbohydrate.
• Note secondary sweeteners: erythritol is frequently paired with monk fruit extract, steviol glycosides, or allulose to mask bitter off-notes.
• Check personal tolerance: large amounts of sugar alcohols can cause digestive upset in some people.

The background

To understand why this study matters, one must look at how the body produces its own polyols. According to metabolic research published in Frontiers in Nutrition, human cells synthesize erythritol internally from glucose via the pentose phosphate pathway. The same review notes that high plasma erythritol might be an indicator of dysregulation in that pathway, which is why blood erythritol can rise with poor metabolic health.

In the POUNDS Lost trial (NCT00072995), falling plasma erythritol during dieting tracked better risk estimates. This fits the idea that blood erythritol partly reflects metabolic health, but it does not show whether eating erythritol is harmful or harmless.

Nonetheless, critical scientific limitations remain. This analysis was an observational sub-study inside a lifestyle trial. It evaluated calculated ASCVD risk scores and lipoprotein fractions, not actual cardiovascular events such as heart attacks, revascularizations, or strokes. Furthermore, because researchers did not track dietary erythritol consumption, the study cannot definitively prove how consuming packaged foods sweetened with erythritol affects long-term heart disease risks in diverse populations.

What to watch next

Erythritol remains permitted as a food ingredient in the US and as E968 in the EU; our erythritol review covers its regulatory status.

Future research will focus on differentiating the physiological impacts of ingested dietary erythritol from internally synthesized erythritol. The open question is what controlled feeding studies with clinical outcomes would show.

In the meantime, shoppers do not need to assume erythritol is either definitively cleared or inherently toxic. Its presence on food labels should be considered within the context of an individual's total dietary pattern, carbohydrate goals, and digestive comfort.