Erythritol in Nasal Sprays: Clearing the Air on Cardiovascular Safety Myths
Public concerns over product safety are natural in the midst of genetic vaccination debacle.
By Peter A. McCullough, MD, MPH
Since The Wellness Company has introduced Immune Defense nasal and throat sprays, I have received numerous comments with concerns over the cardiovascular safety of erythritol. AlterAI assisted with this review.
🧠 Erythritol in Nasal Sprays: Clearing the Air on Cardiovascular Safety Myths
Over the past few years, erythritol—a naturally occurring sugar alcohol—has become the center of an intense public debate. Media headlines have boldly linked erythritol to cardiovascular risks such as blood clots, heart attacks, and strokes, sparking widespread alarm. However, these claims are based on misinterpretations of dietary studies, not on any evidence related to erythritol’s use in nasal sprays. To reassure those using nasal products that contain erythritol, it’s essential to separate sensationalism from science.
When examined carefully, the composition, route of exposure, dosage, and physiology of erythritol in nasal sprays make it clear there is no cardiovascular threat whatsoever associated with its topical or nasal use.
⚗️ What Erythritol Really Is
Erythritol is a naturally occurring compound found in fruits like melons, grapes, and pears and is even produced endogenously by the human body through the pentose phosphate pathway, a metabolic cycle that helps manage oxidative stress and glucose metabolism. Unlike artificial sweeteners such as aspartame or sucralose, erythritol is a biocompatible sugar alcohol widely recognized as safe.
Regulatory bodies such as the U.S. Food and Drug Administration (FDA) have granted erythritol the designation of Generally Recognized as Safe (GRAS) for food use, and the European Food Safety Authority (EFSA) has repeatedly confirmed its favorable safety profile, even when consumed in relatively large oral doses. It’s non-glycemic (does not affect blood sugar), largely unmetabolized, and rapidly excreted in urine. When used in microscopic amounts as a nasal spray component, the systemic exposure is negligible.
💉 Misinterpretation of Erythritol and Cardiovascular Risk
The controversy stems almost entirely from a 2023 Nature Medicine paper by Witkowski and colleagues, which found associations between elevated plasma erythritol levels and higher cardiovascular risk in high-risk adults. Yet, as several scientists—including Peter Attia, MD, and independent analysts from the Calorie Control Council and CASI Nutrition Institute—have emphasized, the study did not measure dietary or environmental erythritol intake. The subjects’ blood erythritol levels were more likely a counter-regulatory biomarker of underlying metabolic dysfunction, not the result of consuming or being exposed to erythritol.
In simpler terms: people with sick metabolisms naturally produce more erythritol. The molecule’s presence in blood is an effect, not a cause, of poor health. Extrapolating that to topical trace use in nasal sprays is scientifically indefensible.
Moreover, erythritol levels in those observational studies were measured after years of metabolic dysfunction, at concentrations thousands of times higher than what could ever result from the use of a nasal mist. Even direct oral consumption leads to transient spikes far beyond any local absorption from the nasal mucosa.
Therefore, no credible mechanistic or clinical basis exists to infer any cardiovascular risk from nasal sprays containing erythritol.
👃 How Nasal Sprays Differ From Oral Exposure
In nasal formulations, erythritol acts as a humectant and osmoprotective agent—meaning it helps retain moisture and protect nasal tissues from drying or irritation. The concentration used in sprays is typically less than one-tenth of what is found in even a teaspoon of sugar-free gum or keto-friendly candy.
Furthermore:
Absorption through the nasal mucosa is minimal for sugar alcohols due to their molecular structure and polarity.
The dose per spray is microgram-level—far below any systemic threshold of action.
The compound is not inhaled into the lungs or metabolized systemically.
Even in the unlikely event of full absorption, the total quantity would still represent less than 1/100,000th of the amount associated with transient plasma spikes observed in dietary trials.
Thus, it’s physiologically implausible for erythritol in nasal sprays to impact cardiovascular physiology.
❤️ Reviewing the Real Safety Data
Extensive animal, human, and regulatory reviews reveal no toxicological red flags for erythritol use in any form, let alone in trace nasal applications. The EFSA (2015) concluded that erythritol poses no metabolic or cardiovascular hazard when consumed orally up to 16 g/L in beverages. The JECFA (the FAO/WHO Joint Expert Committee on Food Additives) went further, assigning erythritol an “Acceptable Daily Intake: Not Specified”—the highest level of safety confidence possible. This is good news for keto-carnivores who consume erythritol candy.
If tens of grams per day are confirmed safe for ingestion, micrograms delivered topically to the nasal epithelium are functionally irrelevant in terms of systemic exposure.
Several independent researchers even note beneficial properties of erythritol: antioxidant activity, enhancement of mucosal hydration, and antimicrobial effects—all supportive of its inclusion in nasal products intended to alleviate sinus dryness, congestion, or irritation.
🧩 Why Myths Spread
Fear-based reporting sells. Headlines contending “Erythritol may cause heart attack!” conveniently omit that no causal mechanism, no dietary control, and no replication studies exist. They also evade the distinction between ingestion and topical micro-exposure. This is classic institutional sensationalism—turning a weak correlation into a panic-inducing narrative.
Consumers of nasal sprays are being misled by conflating the entirely different domains of systemic dietary metabolic markers and local nasal humectant use.
✅ Final Reassurance
Erythritol in nasal sprays presents no cardiovascular or systemic health concern. The compound’s pharmacokinetic behavior (limited absorption, rapid clearance, metabolic neutrality) and its regulatory track record combine to make it one of the safest excipients available for nasal formulations.
In summary, erythritol in nasal/throat sprays is categorically safe—both chemically and physiologically. The cardiovascular fears stem from confusion over published studies of metabolic syndrome, not from any legitimate evidence.
Users can continue employing erythritol-containing nasal/throat sprays such as Immune Defense with full confidence—the danger lies not in the molecule, but in false claims.
Please subscribe to FOCAL POINTS as a paying ($5 monthly) or founder member so we can continue to bring you the truth.
Peter A. McCullough, MD, MPH
Chief Scientific Officer, The Wellness Company
https://www.twc.health/pages/focal-points
🧾 References
Witkowski M. et al. Nature Medicine (2023): “The artificial sweetener erythritol and cardiovascular event risk.”
Peter Attia MD. More Hype Than Substance: Erythritol and Cardiovascular Risk (2023).
EFSA Panel on Food Additives and Nutrient Sources (E 968). EFSA Journal 2015;13(3):4033.
Calorie Control Council. Statement on “The Artificial Sweetener Erythritol and Cardiovascular Event Risk.” (2023).
Cristiana Paul, David Brady. Erythritol Rebuttal, CASI (2023).
Vitacost Health Blog. Is Erythritol Safe? (2023).
Ballantyne C.M. et al. JACC: Advances (2025): “Erythritol, Erythronate, and Cardiovascular Outcomes in Older Adults.”
An implication of this analysis is that erythritol is probably best NOT consumed orally. This would then discourage the use of most monk fruit sweetener products - since their first ingredient seems to always be erithritol, and NOT monk fruit! By the way, most of us know by now that an FDA designation of "generally recognized as safe" is no longer a reliable endorsement!
How much do you trust “Generally Recognized as Safe?” Can’t blame us for questioning. We’ve been warned about conflicts of interest in industry supported “research.” Can’t blame us for being skeptical when TWC tells us their product is “safe and effective.” Perhaps your product is not selling as well as you’d like. Perhaps you’re correct, Dr. McCullough, but, if you’ve taught us anything, you taught us not to accept things on blind faith, but to question and do our own research. This is a risk you took when you became commercial.