Sugar Alcohols Erythritol and Xylitol May Temporarily Affect Blood Clotting

This extensive review addresses growing concerns about the cardiovascular safety of erythritol and xylitol, two widely-used sugar alcohols that have recently been linked to increased blood clotting risk. The authors systematically examined the physiology, metabolism, and safety data for these popular zero-calorie sweeteners.

The review reveals that both compounds are naturally occurring substances found in berries and vegetables, and are also produced endogenously by the human body. Erythritol is rapidly absorbed and mostly excreted unchanged in urine, while xylitol is only 50% absorbed and metabolized in the liver. When consumed, erythritol reaches peak plasma concentrations of 1,810-7,680 μM depending on dose (10-50g), while xylitol peaks at around 630 μM after 30g doses.

Crucially, the authors examined patients with rare genetic disorders affecting sugar alcohol metabolism who have chronically elevated erythritol levels. Despite these elevated concentrations, none of these genetic conditions increase blood clot formation risk, challenging the proposed link between sugar alcohols and cardiovascular events. Additionally, both compounds trigger beneficial gastrointestinal hormone release, including GLP-1, and have satiating effects that could aid weight management.

The review notes that recent metabolomic studies linking higher erythritol levels to cardiovascular risk failed to distinguish between endogenous production and dietary intake. Importantly, studies on critically ill patients receiving large intravenous doses and Mendelian randomization trials have not established significant cardiovascular risks. The authors conclude that while temporary effects on platelet aggregation have been observed in pilot studies, the overall evidence does not support a causal relationship between sugar alcohol consumption and cardiovascular events, particularly given their 50+ year safety record in food and pharmaceutical applications.