A randomized, single-blind crossover trial in 14 healthy adults tested whether acute oral doses of erythritol (50 g) or xylitol (33.5 g) elevate platelet reactivity compared with water. Despite large rises in circulating sweetener concentrations, neither compound increased ex vivo platelet aggregation, nor did it shift markers of platelet activation (P-selectin), endothelial activation (sVCAM-1), or coagulation (D-dimer). Complementary in vitro experiments using platelet-rich plasma from 11 donors exposed to escalating erythritol and xylitol concentrations confirmed the null result.
This finding pushes back directly against two earlier interventional studies — publicized widely in 2023–2024 — that reported enhanced platelet aggregation following acute erythritol or xylitol ingestion and triggered significant public and regulatory concern about these popular low-calorie sweeteners. The current data, if confirmed, would meaningfully reassure the millions of adults substituting sugar alcohols for sucrose as part of weight or glycemic management strategies.
Several important caveats apply. The sample is small (14 participants), confined to healthy individuals, and examines only acute single-dose exposure — chronic or high-frequency consumption, or effects in people with metabolic syndrome or cardiovascular disease, remain untested. The crossover design and registered protocol (NCT04966299) are methodological strengths, but the study is underpowered to detect modest effect sizes. Critically, this is a preprint posted on medRxiv and has not yet been peer-reviewed; findings and conclusions may change substantially before publication. Treat this as preliminary evidence, not settled science.