What is Erythritol?
Erythritol is a sugar alcohol, or polyol, that is used as a zero-calorie, low-carbohydrate sweetener. It is naturally found in small amounts in some fruits, such as grapes, pears, and watermelons, as well as fermented foods. However, most erythritol used in food products is manufactured by fermenting glucose from genetically modified cornstarch. It is about 70% as sweet as table sugar but contains a fraction of the calories. Its clean taste and stability make it a popular ingredient in many 'sugar-free,' 'keto-friendly,' and diet products, including beverages, ice cream, candies, and baked goods.
The Benefits and How the Body Processes Erythritol
Erythritol's popularity stems from several perceived benefits. It has a glycemic index of zero, meaning it does not raise blood sugar or insulin levels, making it suitable for people with diabetes or those following low-carb diets. It is also non-cariogenic, which means it doesn't feed the oral bacteria that cause tooth decay, potentially benefiting dental health.
One of the most notable features of erythritol's metabolism is its unique pathway in the body. Roughly 90% of ingested erythritol is rapidly absorbed in the small intestine and excreted unchanged in the urine within 24 hours. This high absorption rate means very little reaches the large intestine, where it could be fermented by gut bacteria. This is why erythritol typically causes fewer gastrointestinal side effects compared to other sugar alcohols like xylitol or sorbitol.
Potential Risks of Daily Erythritol Consumption
While the FDA considers erythritol "Generally Recognized as Safe" (GRAS), recent research has sparked new debates and concerns about its long-term health effects, particularly with daily, high-level intake.
Cardiovascular Risk
In early 2023, a study published in Nature Medicine linked high circulating blood levels of erythritol with an increased risk of major adverse cardiovascular events, such as heart attack and stroke. The study found that erythritol enhanced blood platelet reactivity, increasing the potential for blood clot formation. It is important to note the following:
- The study primarily involved participants with existing cardiovascular risk factors, which may not represent the general healthy population.
- An intervention with healthy volunteers showed that a single high dose (30g) of erythritol led to significantly elevated blood levels for days, well above the threshold shown to increase clotting potential.
- Experts caution that this study demonstrated a correlation, not necessarily a definitive cause-and-effect relationship, and call for more long-term research.
Digestive Discomfort
Although better tolerated than other sugar alcohols, consuming large amounts of erythritol can still lead to gastrointestinal distress, with symptoms that can include:
- Bloating
- Gas
- Cramping
- Diarrhea
Individual tolerance varies widely, so while one person might handle a specific amount with no issues, another might experience side effects. Moderation is key to avoid these unpleasant symptoms.
Cancer Risk
The association between sugar substitutes and cancer risk is a topic of ongoing debate. Some observational studies have shown associations, but definitive causal links are complex to establish due to confounding factors like diet and lifestyle. One Mendelian randomization study specifically found no causal link between erythritol and lung cancer. However, a more recent prospective study associated high serum erythritol levels with increased cancer mortality risk in men, warranting further investigation.
Erythritol vs. Table Sugar: A Comparison
| Feature | Erythritol | Table Sugar (Sucrose) |
|---|---|---|
| Calorie Content | Almost zero calories | 4 calories per gram |
| Blood Sugar Impact | Does not raise blood sugar or insulin levels | Causes rapid spike in blood sugar and insulin |
| Dental Health | Does not cause cavities and may inhibit plaque bacteria | Major cause of tooth decay |
| Sweetness Level | About 70% as sweet as sugar | Standard for sweetness (100%) |
| Gastrointestinal Effects | High doses can cause gas, bloating, and diarrhea | Excessive intake of sugar can lead to other health issues, but not typically these GI symptoms directly |
| Metabolism | Absorbed and excreted unchanged | Metabolized by the body for energy |
| Cardiovascular Risk | Linked to enhanced platelet activity and clotting potential at high levels in some studies | High intake linked to obesity, diabetes, and heart disease |
How Much is Too Much? Understanding Daily Intake
There is no universally accepted "acceptable daily intake" (ADI) for erythritol set by regulatory bodies like the FDA, though various studies suggest a tolerated upper limit before digestive effects occur. Dosages are typically expressed relative to body weight:
- For men: up to 0.66 grams per kilogram of body weight per day.
- For women: up to 0.80 grams per kilogram of body weight per day.
This translates to approximately 40-68 grams per day for average-sized adults, which is significantly more than found in a typical packet of tabletop sweetener. However, it is possible to consume a large dose through processed foods and drinks, like a pint of keto ice cream or a large artificially sweetened beverage, which can contain a substantial amount of erythritol.
Practical Recommendations for Consumers
Given the mixed information and need for further research on long-term effects, especially for at-risk individuals, consumers should be mindful of their erythritol intake.
- Read Labels: Carefully check ingredient lists, particularly for low-calorie and sugar-free products. Some products combine erythritol with other sweeteners to add bulk and texture.
- Mind the Dose: Be aware that the erythritol in a single processed item can be high, potentially exceeding amounts linked to adverse effects in some studies. Don't assume that because an item is sugar-free, it is automatically safer in large quantities.
- Listen to Your Body: If you experience digestive issues like bloating or diarrhea, consider reducing your intake. Individual tolerance is the most reliable guide for managing these side effects.
- Prioritize Whole Foods: As with any added ingredient, the healthiest approach is to prioritize whole, unprocessed foods. Fruits and vegetables offer natural sweetness and essential nutrients without relying on added sweeteners.
- Consult a Professional: If you have pre-existing health conditions, such as a history of heart disease, diabetes, or obesity, discuss your sweetener choices with a healthcare provider.
Conclusion: Is Daily Erythritol Consumption Safe?
While regulatory bodies classify erythritol as safe, and it offers clear benefits like zero calories and no blood sugar impact, recent scientific findings introduce important caveats regarding daily consumption. The link between high blood erythritol levels and increased cardiovascular risk, particularly in at-risk populations, warrants caution and further investigation. For the average healthy person, moderate, daily intake is likely not a concern, but consuming large quantities, especially from highly processed foods, may elevate health risks. Ultimately, the safest approach is to use erythritol and all sweeteners in moderation, prioritize a diet rich in whole foods, and consult a healthcare professional, especially if you have existing health conditions. For those concerned about heart health, limiting intake of products that contain erythritol may be a prudent measure until more long-term data is available.(https://www.cnn.com/2023/02/27/health/zero-calorie-sweetener-heart-attack-stroke-wellness)
