Erythritol: Separating Facts from Fiction

Nutrition headlines love turning an incremental scientific discovery into a scary myth. These days, it’s erythritol’s turn in the hot seat. You may have read headlines that send shivers down your spine:

This type of reporting has spawned the internet myth that erythritol is some poisonous additive that instantly clogs your arteries and causes dangerous clots as soon as it touches your tongue.

But that’s just not how it works. Erythritol isn’t some foreign, man-made chemical someone created in a lab. It’s naturally found in grapes and pears. Your body even produces it.

It’s like water.

Too much can kill you by causing hyponatremia and brain swelling. However, water itself isn’t toxic; like erythritol, it all comes down to dosage. So how does your body defend against scary headlines? Let’s dig into why erythritol is found in our bloodstream to begin with.

It’s a blood sugar problem

Your body can make erythritol (a “sugar alcohol”) as a normal byproduct of glucose metabolism, mainly by routing some glucose through an alternate processing route called the pentose phosphate pathway (PPP). (1)

How your body makes erythritol

When glucose enters a cell, a portion of it can be diverted from the usual “burn it for energy” route into the PPP—a pathway cells use to rearrange sugar fragments for other purposes. (1)

As glucose moves through the PPP, it can be converted into a 4 carbon sugar fragment called erythrose 4 phosphate, which can then be chemically “reduced” (think: converted into a more alcohol like form) to become erythritol. (1)

What makes the body manufacture more

Having more glucose in the body is the main reason endogenous erythritol levels rise, as the body produces it from glucose via the pentose phosphate pathway. In humans, higher long-term blood sugar (higher HbA1c) is linked to much higher blood erythritol, supporting the idea that more glucose exposure boosts the body’s erythritol production. (1)

A marker of cardiovascular risk, not the cause

Conditions that reflect higher glucose exposure over time are linked with higher circulating erythritol, suggesting the body may “make more” when it’s dealing with more glucose.

• Large observational studies have found that people with higher fasting blood erythritol are more likely to develop central obesity, type 2 diabetes, and later cardiovascular disease. (1)
• Genetic studies do not show that erythritol itself directly causes coronary artery disease. Instead, higher erythritol levels are usually associated with other problems, such as obesity and insulin resistance. (3)
• Endogenous erythritol is produced via the pentose phosphate pathway, which becomes more active when cells encounter excess glucose and oxidative stress—common in obesity, diabetes, and atherosclerosis. (1)
• Because of this, chronically high erythritol often reflects a body under metabolic strain (high sugar load, insulin resistance, inflammation), all of which independently raise cardiovascular risk. (1)
• In lab and animal experiments using high erythritol concentrations, platelets become more “sticky” and form clots more readily, which could increase heart attack or stroke risk if this occurred in people at typical blood levels. (1.2)
• So far, human studies haven’t found that the erythritol our bodies naturally make directly causes heart disease. Instead, higher levels appear to be a warning sign that the body is under stress due to conditions such as high blood sugar or inflammation. (3,4)

The takeaway: no connection to intranasal use

Chronic hyperglycemia increases erythritol production. Our Immune Mist nasal spray contains only a microscopic amount of erythritol, administered intranasally (not consumed). It is used seasonally during cold and flu months. It is not the main driver of the cardiovascular erythritol connection.

For further reading, check out Dr. Peter McCullough’s Substack “Focal Points.”

References

1. Hootman, K. C., Trezzi, J. P., Kraemer, L., Burwell, L. S., Dong, X., Guertin, K. A., Jaeger, C., Stover, P. J., Hiller, K., & Cassano, P. A. (2017). Erythritol is a pentose-phosphate pathway metabolite and associated with adiposity gain in young adults. Proceedings of the National Academy of Sciences of the United States of America, 114(21), E4233–E4240. https://doi.org/10.1073/pnas.1620079114
2. Khafagy R, Paterson AD, Dash S. Erythritol as a Potential Causal Contributor to Cardiometabolic Disease: A Mendelian Randomization Study. Diabetes. 2024 Feb 1;73(2):325-331. doi: 10.2337/db23-0330. PMID: 37939167.
3. EFSA Panel on Food Additives and Nutrient Sources added to Food. Scientific Opinion on the safety of the proposed extension of use of erythritol (E 968) as a food additive. EFSA J. 2015 Mar 5;13(3):4033. doi: 10.2903/j.efsa.2015.4033. PMID: 40061618; PMCID: PMC11883093.
4. Trumble, B. C., et al. (2023). Plasma erythritol and incident cardiovascular risk: Controversies and context. Nature Medicine, 29(5), 1049–1058. https://doi.org/10.1038/s41591-023-02223-9

Written by Brooke Lounsbury