What is Erythritol?
Erythritol is a sugar alcohol, or polyol, that has gained immense popularity as a low-calorie, low-carb sugar substitute. It is naturally found in small amounts in some fruits, like grapes and melons, but is commercially produced by fermenting cornstarch. It provides about 70% of the sweetness of table sugar but contains virtually zero calories and does not spike blood sugar or insulin levels.
Unlike many other sweeteners, the human body absorbs erythritol into the bloodstream but does not metabolize it for energy. The majority of it is excreted unchanged in the urine, which is why it has minimal impact on blood sugar and is often recommended for those with diabetes or on ketogenic diets. This unique metabolic pathway also means it causes less gastrointestinal distress than other sugar alcohols.
Erythritol and Heart Health: The 2023 Study
In early 2023, a study conducted by the Cleveland Clinic and the National Institutes of Health (NIH) received widespread media attention for connecting erythritol to an increased risk of cardiovascular events. Researchers analyzed blood samples from over 4,000 individuals in the US and Europe and found that higher blood erythritol levels were associated with a greater risk of heart attack, stroke, and death over a three-year period.
The Link to Blood Clotting
To investigate the mechanism behind this association, researchers conducted further lab and animal studies. They discovered that erythritol was provoking enhanced thrombosis, or blood clotting. Specifically, it made blood platelets more sensitive and more prone to forming clots. This is a significant concern, especially for people who are already at high risk for cardiovascular issues, including those with pre-existing heart disease, diabetes, or obesity, who are also the target demographic for many erythritol-sweetened products.
The study also featured an intervention where eight healthy volunteers drank a beverage containing 30 grams of erythritol, an amount comparable to that found in a pint of keto ice cream. The volunteers' blood erythritol levels spiked a thousandfold and remained elevated for days, exceeding the threshold needed to trigger enhanced clotting. For more details, see the Cleveland Clinic's newsroom announcement on the study's findings Cleveland Clinic Study: Substitute Erythritol Raises Cardiovascular Risk.
Interpreting the Cardiovascular Risk
It's important to note that the 2023 study showed a correlation, not definitive causation, and more long-term research is needed. However, experts believe the findings warrant caution. The risks appear most significant for individuals with pre-existing cardiovascular conditions, and the high doses used in many processed foods are a key factor. For healthy individuals, the risk from moderate consumption is likely minimal, but the long-term effects remain largely unknown.
Digestive Side Effects
While erythritol is often marketed for causing less digestive discomfort than other sugar alcohols, it is not completely free of side effects, especially at higher doses.
- Bloating and Gas: Some individuals experience bloating, gas, and cramping due to the fermentation of unabsorbed erythritol by gut bacteria.
- Diarrhea: Like other sugar alcohols, large amounts can draw water into the intestines, leading to a laxative effect.
- Nausea: High consumption can trigger nausea, with some individuals being more sensitive than others.
Comparing Erythritol to Other Sweeteners
Understanding how erythritol stacks up against other popular sweeteners is crucial for making informed choices. The following table provides a quick comparison:
| Feature | Erythritol | Xylitol | Stevia | Table Sugar |
|---|---|---|---|---|
| Sweetness | 70% of sugar | 100% of sugar | 200-400x sweeter | 100% |
| Calories | Virtually zero | 2.4 kcal/g | Virtually zero | 4 kcal/g |
| Glycemic Index | 0 | 7-13 | 0 | 65 |
| Digestive Effects | Low risk, but possible at high doses | Moderate risk, can cause diarrhea | Minimal to none in pure form | Low risk in normal consumption |
| Taste/Aftertaste | Cooling, no bitter aftertaste | No aftertaste | Licorice-like aftertaste possible | Standard sweet |
| Notes | Potential cardiovascular risk at high levels | Toxic to dogs; moderate GI risk | Often blended with erythritol | High calories, spikes blood sugar |
Who Should Be Cautious About Erythritol?
Based on current research, specific populations should exercise extra caution regarding erythritol consumption. These include:
- Individuals with pre-existing cardiovascular risk factors: This includes people with heart disease, diabetes, obesity, and high blood pressure, who were the primary focus of the 2023 study.
- People who consume large quantities: Because higher doses lead to significantly elevated blood erythritol levels, those who regularly consume many 'keto' or sugar-free products are at higher potential risk.
- Those with digestive sensitivities: While generally well-tolerated, anyone with a sensitive digestive system or conditions like IBS may experience adverse effects.
How to Limit Your Erythritol Intake
If you are concerned about your erythritol intake, here are some strategies for reducing it:
- Read Labels Carefully: Check ingredient lists for erythritol, especially in 'sugar-free', 'keto', and 'diet' products. Be aware that many popular stevia and monk fruit sweeteners are bulked up with erythritol.
- Opt for Pure Stevia or Monk Fruit: Seek out products that contain only pure stevia or monk fruit extract, not blends with added sugar alcohols.
- Choose Whole Foods: Focus on naturally sweet foods like fresh or frozen fruit. This is the healthiest way to get sweetness into your diet.
- Experiment with Other Sweeteners: Consider using smaller amounts of natural alternatives like honey, maple syrup, or fruit purees, factoring in their caloric and sugar content.
The Verdict: How Unhealthy is Erythritol?
The classification of erythritol as 'unhealthy' depends heavily on individual health status and quantity consumed. For the average, healthy person consuming it in moderation, the health risks are likely minimal. However, for high-risk individuals or those with high intake, the 2023 study introduced significant and concerning new evidence linking it to cardiovascular events. Until more long-term research is conducted, an abundance of caution is warranted, especially for at-risk populations. The best approach is to prioritize a balanced diet of whole foods and view erythritol as a sweet treat to be used sparingly, not a staple.
Ultimately, the science is still evolving, and the trade-offs of using any sugar substitute must be weighed. The most prudent advice for managing added sugars, regardless of the type, is moderation.
