• Erythritol affects your brain blood vessels right away — After just a few hours of exposure, erythritol significantly weakened the cells' protective functions and increased markers of oxidative stress, meaning the cells started becoming damaged.

• There was a substantial rise in reactive oxygen species (ROS) — These refer to unstable molecules that aggressively interact with and damage healthy cells and tissues. Normally, your body carefully manages ROS to prevent harm, but erythritol exposure has significantly disrupted this balance. Higher ROS levels directly translated to increased cell injury and inflammation, ultimately affecting your blood-brain barrier:²

"Uncontrolled increase in oxidative stress in cerebral endothelial cells can lead to disruption in the blood-brain barrier integrity, resulting in increased vascular permeability promoting tissue damage and death."

• Erythritol affects endothelial cells' nitric oxide (NO) balance — NO helps maintain vascular health by relaxing blood vessels and supporting proper blood flow. Yet, after erythritol treatment, the endothelial cells showed reduced production, coupled with increased markers indicating endothelial dysfunction — a condition that often precedes serious cardiovascular issues like strokes.

• Vascular blood flow is affected — According to the researchers, your endothelial cells release tissue-type plasminogen activator (t-PA) to maintain vascular flow, and erythritol affects this important function:³

"In the present study, erythritol impaired t-PA release in response to thrombin, indicative of reduced endothelial fibrinolytic capacity. Moreover, impaired capacity of brain microvascular endothelial cells to release t-PA is also associated with weakened blood-brain barrier integrity. Thus, erythritol-induced impairment in t-PA release may extend beyond compromised thrombolytic potential and contribute to greater cerebrovascular dysfunction."

• Platelet reactivity surged significantly within minutes — Erythritol made the platelets rapidly prone to clumping together. This accelerates clotting, setting the stage for serious health events such as strokes or heart attacks, especially in individuals already facing cardiovascular risks. In fact, the researchers noted that erythritol caused a ">1000-fold increase in erythritol plasma concentration."⁵

In laboratory tests designed to mimic clot formation in your blood vessels, clots not only formed faster but were also structurally more robust, increasing the likelihood of dangerous blockages occurring in crucial arteries supplying your heart or brain.

• Erythritol vs. glucose — Glucose did not trigger similar platelet activation or clotting changes. The stark contrast highlights that erythritol uniquely and acutely endangers your vascular health, whereas glucose remains safer to use in this context.

• Thrombin generation was accelerated — This enzyme essentially acts as a catalyst, rapidly converting fibrinogen — a soluble protein circulating in your blood — into fibrin, the insoluble threads that physically form the clot.

Increased thrombin generation means more rapid and intense clot formation, creating the dangerous possibility of vessel blockage and impaired blood flow to critical organs.

• Erythritol amplified the release of dense granules — These are tiny packets of substances that help platelets stick together and form stable clots. When erythritol exposure triggers platelets, these granules quickly discharge their contents, dramatically boosting platelet aggregation and clot robustness. This intensifies the clot formation process even further, magnifying the threat to your cardiovascular system and raising your risk of stroke or heart attack.

• There was a measurable rise in cardiovascular incidents — This includes heart attacks and strokes, among individuals with high xylitol consumption. According to the data, these health events correlated strongly with elevated levels of xylitol detected in participants' blood. In other words, the more xylitol present in your bloodstream, the higher your chances of experiencing an adverse cardiovascular event.

• Even moderate, frequent consumption of xylitol significantly heightened platelet activity — Tests conducted on blood samples demonstrated that xylitol directly triggered an increase in platelet aggregation, ultimately forming clots. Moreover, the researchers emphasized that it happened to all participants:⁸

"[C]onsumption of a xylitol-sweetened drink markedly raised plasma levels and enhanced multiple functional measures of platelet responsiveness in all subjects."

• The effects of xylitol linger — The study highlighted a troubling time-related finding — platelet activation occurred quickly after xylitol consumption and persisted for several hours. Participants who consumed even modest amounts of xylitol-containing foods experienced a rapid increase in platelet aggregation within minutes.

• Groups who are vulnerable to xylitol’s harmful effects — The researchers observed that individuals already predisposed to cardiovascular disease — such as those with insulin resistance, diabetes, obesity, or hypertension — experienced the most pronounced increase in clotting risk after consuming xylitol. Simply put, if you're already managing a heart-related condition, consuming xylitol will significantly raise your risk of a heart attack or stroke.

• Platelet activity also surges — When comparing xylitol’s effects on platelets with other sugar alcohols, the researchers found similar but distinct patterns. Like erythritol, xylitol increased clotting risks and even increased platelet activity to concerning levels:⁹

"[W]e found xylitol, like erythritol, is readily absorbed following oral ingestion by humans, with plasma levels increasing over 1000-fold in the post-prandial setting."

• Xylitol causes changes in platelet calcium signaling pathways — Under normal conditions, calcium within platelets is tightly controlled. However, exposure to xylitol disrupted these delicate calcium balances, causing platelets to release chemicals rapidly that stimulate clumping and clot formation. This mechanism closely mirrors what researchers observed with erythritol, underscoring a shared risk profile among sugar alcohols.

1. Cut artificial sweeteners completely — Stop consuming erythritol, xylitol, and other products that contain sugar alcohols right away. Even if they're labeled "natural," these sweeteners increase clotting risks and cause harmful inflammation in your blood vessels. Check labels carefully, especially in products marketed as "sugar-free," and avoid items that contain these ingredients. In the same way, avoid products that use artificial sweeteners, such as aspartame and sucralose.

2. Consider these other sugar substitutes — If you get cravings for sweet food, consider making them at home using healthy alternatives. I recommend natural stevia (the plant itself), as well as Luo Han Guo. Pure dextrose, if it’s derived from clean cane sugar, is a third alternative I recommend.

3. Choose natural carbohydrates instead — Your body thrives on real carbohydrates for energy. Fruit juices with pulp or whole fruits like oranges, apples, and berries are great choices. Root vegetables such as sweet potatoes also offer safe sources of carbohydrates that support your metabolic health without harmful additives.

Aim for 200 to 250 grams of healthy carbohydrates daily to maintain stable insulin levels and improve overall metabolic health. White rice and ripe bananas are also good dietary sources of carbohydrates.

4. Focus on healing your gut microbiome — Gut health is deeply connected to your overall health, including your cardiovascular system. And, as noted in previous articles, artificial sweeteners greatly affect your gut microbiome diversity.

A healthy gut helps maintain balanced inflammation and reduces your overall risk of clotting and cardiovascular problems. That said, I recommend you eat fermented foods regularly such as homemade yogurt, sauerkraut, and kimchi to reseed your gut with healthy bacteria.

5. Lower your exposure to omega-6 fatty acids — If you’ve been eating foods high in alcohol sugars, you’re likely eating other foods that contain linoleic acid (LA), which I believe is one of the most pernicious toxins in the Western food supply.

High intake of LA from vegetable oils (like sunflower, soybean, and canola oils) severely damages your blood vessels and increases inflammation and clotting risk. Choose traditional, safer fats like raw butter from grass fed cows, tallow, or ghee to cook your food at home.

In addition, LA exists in the many foods you eat — even meat. I recommend you maintain your LA intake below 5 grams per day to protect your health. If you can keep it below 2 grams per day, that’s even better. To help you track how much LA you’re eating, I recommend signing up for the Pax health platform. It will feature the Seed Oil Sleuth tool, which calculates your LA intake down to a tenth of a gram.