What is Erythritol?
Erythritol is a sugar alcohol, or polyol, that has gained immense popularity as a low-calorie sugar replacement. It is found naturally in small amounts in some fruits, like grapes and peaches, and fermented foods such as wine and soy sauce. For commercial production, erythritol is typically made by fermenting glucose from cornstarch. It has a sweetness level that is about 60-70% of table sugar but contains almost no calories, as the human body does not have the enzymes to metabolize it for energy. The vast majority of ingested erythritol (90% or more) is absorbed in the small intestine, circulates in the blood, and is excreted unchanged in urine within 24 hours. This unique metabolic pathway is why it has historically been praised for its limited impact on the body.
The Arguments for Erythritol's Health Benefits
For years, erythritol has been heralded as a healthier alternative to sugar due to several key characteristics. These benefits primarily revolve around its negligible glycemic impact and positive effect on dental health.
No Impact on Blood Sugar or Insulin
One of the primary advantages of erythritol is its glycemic index of zero. Because it is excreted without being metabolized, it does not cause spikes in blood sugar or insulin levels. This makes it an attractive sweetener for individuals with diabetes, insulin resistance, or those following ketogenic and low-carb diets who need to manage their blood glucose strictly.
Benefits for Dental Health
Unlike sugar, which oral bacteria ferment into acid that erodes tooth enamel, erythritol is non-cariogenic. Harmful bacteria in the mouth, such as Streptococcus mutans, cannot use erythritol for energy. Research suggests that erythritol may even help inhibit the growth of these bacteria and reduce dental plaque. This has led to its inclusion in many sugar-free gums, candies, and oral care products.
High Digestive Tolerance
Compared to other sugar alcohols like xylitol or sorbitol, erythritol is far less likely to cause digestive upset. Since most of it is absorbed in the small intestine before reaching the large intestine, where fermentation by gut bacteria can cause gas and bloating, erythritol is generally well-tolerated. Only very high doses (over 50 grams, or roughly 0.66 g/kg of body weight) may cause issues like stomach rumbling or diarrhea.
The Growing Concerns: What Makes Erythritol 'Unhealthy'?
Despite its benefits, recent research has brought erythritol's safety into question, particularly regarding cardiovascular health.
Cardiovascular Risks
The most significant and alarming finding came from a February 2023 study published in Nature Medicine, which linked higher blood erythritol levels with an increased risk of heart attack, stroke, and death. The research found that erythritol can enhance platelet reactivity, potentially promoting blood clot formation. An intervention study also revealed that consuming a drink sweetened with 30 grams of erythritol caused a massive spike in blood levels that remained elevated for several days. However, the study has been met with scrutiny, as it was observational, and causality was not proven. Some experts suggest that high erythritol levels could be a biomarker of underlying metabolic dysfunction rather than the cause of cardiovascular problems. Nonetheless, the results have prompted calls for further long-term safety studies.
Concerns for Brain Health
While less publicized, a July 2025 study highlighted concerns regarding erythritol and the blood-brain barrier. The research suggests that frequent consumption could compromise the protective functions of the blood-brain barrier over time, a finding that adds another layer of complexity to the sweetener's safety profile. This area requires more investigation to fully understand the implications.
How Does Erythritol Compare to Other Sweeteners?
Understanding how erythritol stacks up against other sweeteners helps put its pros and cons into context. Here is a comparison of erythritol, table sugar, and other popular sugar substitutes based on recent scientific understanding.
| Feature | Erythritol | Table Sugar (Sucrose) | Xylitol | Stevia (Reb A) |
|---|---|---|---|---|
| Source | Natural (fermented) | Natural (sugarcane/beets) | Natural (birch/corn) | Natural (Stevia plant) |
| Calories/g | ~0.24 (often labeled 0) | ~4 | ~2.4 | 0 |
| Glycemic Index | 0 | ~65 | ~12 | 0 |
| Sweetness | 60-70% of sugar | 100% (baseline) | 100% of sugar | 200-400x sugar |
| Dental Health | Prevents cavities | Causes cavities | Prevents cavities | Neutral |
| Aftertaste | Mildly cooling | None | Cool, minty | Bitter, licorice |
| Digestive Issues | Very low risk | None | Moderate risk | None |
Potential Pros and Cons of Erythritol
Here is a brief summary of the key takeaways for considering erythritol in your diet:
- Pros:
- Virtually calorie-free.
- Zero glycemic impact, making it suitable for managing blood sugar.
- Proven benefits for dental health by inhibiting bacteria.
- Higher digestive tolerance compared to many other sugar alcohols.
- Cons:
- New studies suggest a potential link to increased cardiovascular risk, specifically blood clots, although the evidence is still being debated.
- High doses can cause mild to moderate gastrointestinal discomfort.
- Potential concerns about its effect on the blood-brain barrier, though research is preliminary.
The Final Verdict: Is Erythritol Right for You?
The debate surrounding erythritol is a classic case of balancing known benefits with newly emerging risks. For many years, it was considered one of the most promising sugar substitutes, especially for those managing conditions like diabetes or obesity. Its minimal impact on blood sugar and its protective effect on dental health remain undisputed advantages.
However, the recent cardiovascular research is a significant warning. While it does not prove direct causation, the association between high blood erythritol levels and heart attacks and strokes cannot be ignored. The scientific community has called for more in-depth research to fully understand the long-term effects of consumption.
The most prudent approach for health-conscious consumers is to practice moderation. As recommended by some health organizations, limiting intake to a few grams per day to be safe is a reasonable strategy. A balanced diet that minimizes all processed foods—whether sweetened with sugar or substitutes—is arguably the healthiest approach. For people with pre-existing heart conditions, a heightened level of caution is warranted until more definitive long-term safety data is available. For more details on the 2023 cardiac study, see the National Institutes of Health news release.
Ultimately, erythritol is not a magic bullet. It is a tool that can aid in reducing sugar intake, but it is not without its potential downsides. Staying informed and consulting with a healthcare provider is the best path forward for making personal dietary choices.
