What is Erythritol?
Erythritol is a type of carbohydrate known as a sugar alcohol, or polyol. It is found naturally in small quantities in some fruits and fermented foods, but the majority of erythritol used in processed foods today is commercially produced. It has about 70% of the sweetness of sugar but contains almost zero calories because the human body does not metabolize it for energy. Instead, it is quickly absorbed by the small intestine and excreted, mostly unchanged, in urine. This makes it a popular sugar substitute for those on low-carb diets, such as the ketogenic diet, and for individuals managing their blood sugar, like diabetics. It is often used as a bulking agent in 'natural' no-calorie sweeteners like stevia and monk fruit to add texture. The FDA currently categorizes erythritol as "Generally Recognized as Safe" (GRAS).
The Cardiovascular Risk Controversy
In early 2023, a significant study led by researchers at the Cleveland Clinic sparked widespread concern about erythritol's safety. The study, published in Nature Medicine, found a correlation between higher blood levels of erythritol and an increased risk of heart attack and stroke.
Researchers accidentally discovered the link while searching for unknown compounds in blood that could predict future heart disease risk.
- They analyzed over 4,000 blood samples from individuals in the US and Europe and found that those with the highest blood erythritol levels had an elevated risk for major cardiovascular events over three years.
- Further lab and animal studies revealed that erythritol enhanced blood clot formation by increasing the reactivity of platelets.
- When a small group of healthy volunteers consumed a drink containing 30 grams of erythritol (an amount similar to that found in a pint of keto ice cream), their blood levels of the sweetener increased dramatically for several days, exceeding the threshold linked to heightened clotting risks.
While the study showed an association, not a definitive cause-and-effect relationship, the authors and other experts urged caution, especially for individuals already at risk for cardiovascular disease, such as those with diabetes or existing heart problems.
Potential for Digestive Issues
Long before the cardiovascular concerns, erythritol was known to cause gastrointestinal distress in some people, particularly when consumed in large amounts. Unlike other sugar alcohols, most erythritol is absorbed before it reaches the large intestine, minimizing digestive side effects. However, sensitivity varies by person, and excessive intake can still lead to symptoms.
Common digestive issues include:
- Bloating and abdominal cramping
- Excessive gas or flatulence
- Diarrhea or increased stool frequency
- Worsened symptoms in individuals with irritable bowel syndrome (IBS)
The mechanism is linked to the sugar alcohol drawing water into the intestines, causing a laxative effect.
Comparison: Erythritol vs. Other Sweeteners
| Feature | Erythritol | Sucrose (Table Sugar) | Stevia (with bulking agent) | Monk Fruit (with bulking agent) |
|---|---|---|---|---|
| Calories | ~0.24 kcal/g | 4 kcal/g | 0 kcal/g | 0 kcal/g |
| Glycemic Index | 0 | 65 | 0 | 0 |
| Cardiovascular Risk | Concerns raised by recent studies linked to clotting. | High intake contributes to obesity, inflammation, and heart disease. | No direct links, but often blended with erythritol. | No direct links, but often blended with erythritol. |
| Taste Profile | Clean, sweet taste with a cooling sensation. | Classic sweetness standard. | Intense sweetness, sometimes with a bitter aftertaste. | Intense sweetness, less aftertaste than stevia. |
| Digestive Impact | Well-tolerated in moderate amounts, but high doses can cause GI upset. | Can cause blood sugar spikes and inflammation. | Minimal, but often mixed with erythritol which causes issues. | Minimal, but often mixed with erythritol which causes issues. |
| Dental Health | Non-cariogenic; inhibits oral bacteria growth. | Contributes to tooth decay. | Does not contribute to tooth decay. | Does not contribute to tooth decay. |
How to Avoid Erythritol and Find Alternatives
Given the cardiovascular concerns, a cautious approach is warranted, particularly for those with pre-existing heart conditions or diabetes. Avoiding erythritol requires diligence when reading food labels.
Steps to Reduce Erythritol Intake
- Read Labels Carefully: Look for "erythritol" or its European food additive code, "E968". Check the ingredients list, not just the nutrition facts, as it is often used to bulk up other zero-calorie sweeteners.
- Beware of "Natural" Blends: Many products marketed with stevia or monk fruit contain erythritol as the primary bulking agent to create a sugar-like texture. Always check the ingredients list for these products.
- Minimize Processed Foods: As with all sugar substitutes, the best approach is to reduce overall consumption of highly processed foods that use these ingredients.
Safer Alternative Sweeteners
- Whole Fruit: For natural sweetness, whole fruits like apples, pears, and dates are excellent choices, providing fiber and nutrients. Date paste, for instance, is a whole-food sweetener that is simple to make at home.
- Small Amounts of Added Sugars: The American Heart Association recommends limiting daily added sugar intake to 24 grams for women and 36 grams for men. Using small amounts of table sugar, honey, or maple syrup may be a safer choice than processed foods with erythritol.
- Sweet Proteins: An emerging class of natural sweeteners called sweet proteins, derived from certain tropical fruits, offers an intense, clean sweetness without the health risks associated with sugar alcohols or artificial sweeteners.
Conclusion: Navigating the Erythritol Debate
The question of whether you should avoid erythritol depends on your health profile and risk tolerance. While it has benefits like being low-calorie and safe for teeth, recent studies linking it to increased cardiovascular risk are concerning, especially for vulnerable populations. The industry's own council has pushed back, noting the high-risk nature of the study participants, but experts widely agree that more research is needed. The best course of action is to exercise caution, read labels meticulously, and consider whole-food sweeteners and other natural alternatives as part of a balanced diet. Consulting a healthcare provider or nutritionist for personalized dietary advice is always recommended. Ultimately, minimizing reliance on any added sweetener, whether artificial or natural, remains the healthiest path forward.
For more information on the Cleveland Clinic's findings, you can read the report: Cleveland Clinic Study on Erythritol and Heart Health.
