What is Erythritol?
Erythritol is a type of sugar alcohol, or polyol, that is naturally found in some fruits and fermented foods. However, the erythritol used commercially is mass-produced by fermenting glucose from corn or wheat starch. It has become a popular alternative to sugar, particularly in keto and diet-friendly products, for several reasons:
- Low-calorie: Erythritol contains virtually no calories (about 0.2 kcal/g) because the body absorbs it but does not metabolize it for energy.
- Minimal impact on blood sugar: It has a glycemic index of zero, making it a suitable sweetener for individuals with diabetes.
- Pleasant taste: It provides a clean, sweet taste with no lingering aftertaste, unlike many other artificial sweeteners.
- Bulking agent: In many packaged products, especially those also containing high-intensity sweeteners like stevia, erythritol is used to add bulk and texture.
The Heart Health Controversy
For years, erythritol was considered a safe, non-toxic sugar substitute, but a 2023 study published in Nature Medicine brought its safety into question. Here’s what the research found:
- Researchers analyzing blood samples of individuals at high risk for heart disease discovered that higher levels of erythritol were associated with an increased risk of major adverse cardiovascular events.
- Further testing in healthy volunteers showed that a single high-dose serving of erythritol (30 grams, comparable to a keto-friendly dessert) caused blood levels to spike a thousandfold and remain elevated for days, surpassing the threshold linked to enhanced clotting risk.
- Lab tests revealed that erythritol can make blood platelets more sensitive and prone to clotting, which can lead to a heart attack or stroke.
It is critical to note that the study found an association, not a definitive cause-and-effect relationship. Additionally, participants in the initial studies already had pre-existing risk factors for heart disease, such as diabetes and high blood pressure, which may skew the results. The study's lead author, Dr. Stanley Hazen, emphasized caution for at-risk individuals until more research is available.
Why Do High Erythritol Levels Exist?
One key detail from the research is that the human body produces erythritol naturally, but only in very low amounts. The extremely high levels observed in the study's intervention group were a result of consuming processed foods containing commercially manufactured erythritol. Some experts suggest high endogenous erythritol levels could be a biomarker for underlying metabolic dysfunction rather than the cause of heart disease itself.
Potential Side Effects and Benefits
Beyond the cardiovascular debate, erythritol has other known effects on the body. It is generally considered to be well-tolerated compared to other sugar alcohols, but side effects can occur, particularly with high intake.
Digestive Tolerance
Because erythritol is mostly absorbed in the small intestine and excreted unchanged in the urine, it is less likely to cause digestive issues like gas and bloating than other polyols. However, consuming large quantities can still lead to nausea, bloating, cramping, and diarrhea in sensitive individuals. A dose of over 50 grams in a single serving has been shown to cause stomach rumbling and nausea in some.
Dental Health Benefits
One of the most well-documented benefits of erythritol is its positive impact on oral health. Harmful bacteria in the mouth cannot metabolize erythritol for energy, which prevents them from producing the acids that cause tooth decay. Some studies even suggest it may be more effective at reducing plaque and inhibiting harmful oral bacteria than other sugar alcohols like xylitol.
Erythritol vs. Xylitol: A Comparison
| Feature | Erythritol | Xylitol |
|---|---|---|
| Calorie Content | Almost zero (0.2 kcal/g) | Reduced (2.4 kcal/g) |
| Sweetness Level | ~70% of table sugar | Similar to table sugar |
| Taste Profile | Clean, mild, slightly cooling | Very similar to sugar, no cooling effect |
| Digestive Impact | High tolerance; less likely to cause issues due to absorption | Can cause digestive issues like diarrhea in higher doses due to fermentation in the gut |
| Dental Health | Strong evidence for fighting plaque and cavities | Beneficial for oral health, reduces harmful bacteria |
| Cardiovascular Risk | Concerns raised by recent studies, especially at high intake | Concerns raised, similar to erythritol |
| Pet Safety | Safe for pets | Highly toxic to dogs; causes a rapid drop in blood sugar and liver damage |
Navigating Erythritol Safely
For those concerned about erythritol's potential risks, especially the new heart health findings, here are some actionable steps to take:
- Limit Highly Processed Foods: As commercially produced erythritol is used in high quantities in processed foods, reducing intake of these products is the most effective strategy. Be wary of items marketed as "keto-friendly," "sugar-free," or "naturally sweetened" that might use large amounts of erythritol as a bulking agent.
- Read Labels Carefully: Since regulatory agencies don't always require erythritol to be listed specifically, look for the broader term “sugar alcohol” on nutrition labels.
- Focus on Whole Foods: The safest way to avoid all controversial sweeteners is to opt for whole foods like fresh fruits and vegetables.
- Choose Alternatives Wisely: For low-calorie sweeteners, options like stevia (liquid form to avoid erythritol fillers) or moderate amounts of table sugar, honey, or maple syrup may be healthier for some individuals. Always consult a healthcare provider for personalized advice.
Conclusion: The Balanced Perspective
Determining if erythritol is safe is a complex issue, balancing decades of positive safety profiles with new, concerning research regarding cardiovascular risk. The prevailing consensus suggests that while erythritol has clear benefits—such as not raising blood sugar and protecting dental health—moderation is key, especially given the recent findings.
For most healthy individuals, occasional consumption of low-dose erythritol is unlikely to pose a significant risk. However, for those with pre-existing conditions like diabetes or heart disease, prudence is advised, as these populations were overrepresented in the studies raising concerns. Ultimately, the long-term health effects of high-dose, chronic erythritol consumption are still not fully understood, highlighting the need for continued research. As always, consulting a healthcare professional or registered dietitian for dietary guidance is the best approach for making informed choices about sweeteners.
Learn more about the 2023 study linking erythritol to cardiovascular events here.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Please consult with a healthcare professional before making any dietary changes.
