What is Erythritol?
Erythritol is a sugar alcohol (a type of carbohydrate called a polyol) that is widely used as a low-calorie sweetener and sugar replacement in many food and beverage products. It is found naturally in small quantities in some fruits, like grapes and melons, but is mass-produced commercially through the fermentation of cornstarch. As a sweetener, erythritol is about 70% as sweet as table sugar but contains almost no calories. Unlike other sugar alcohols, it is not fully metabolized by the body. The small intestine absorbs most of it, and it is then excreted, largely unchanged, in the urine within 24 hours. This unique metabolic process is why it has traditionally been associated with fewer gastrointestinal side effects compared to other polyols like xylitol and sorbitol.
The Cardiovascular Concern: Is There a Link to Heart Attack and Stroke?
The primary reason for the recent surge in concern around erythritol is a study published in Nature Medicine in February 2023. Conducted by researchers at the Cleveland Clinic, the study accidentally discovered a link between higher blood levels of erythritol and an elevated risk of heart attack and stroke. The researchers analyzed blood samples and found that individuals with existing cardiovascular risk factors who also had higher levels of erythritol were at a greater risk for adverse cardiovascular events within a three-year period.
Further in-lab and animal testing showed that erythritol was associated with enhanced thrombosis, or blood clotting. Platelets, which are blood cells responsible for clotting, appeared to become more reactive in the presence of erythritol. Researchers also noted that consuming just one processed food item containing a substantial amount of erythritol, like a pint of keto ice cream, could cause blood erythritol levels to spike and remain high for several days. This led the study's senior author, Dr. Stanley Hazen, to suggest that those at risk for cardiovascular issues may want to limit or avoid erythritol until more definitive long-term research is completed.
Common Side Effects: Digestive Discomfort
Beyond the cardiovascular risk, erythritol is also known to cause digestive issues, particularly in high doses. While it is generally better tolerated than other sugar alcohols, consuming large amounts can still lead to unpleasant symptoms. The gastrointestinal side effects occur because a small percentage of erythritol is not absorbed and travels to the large intestine, where it can be fermented by gut bacteria.
Symptoms may include:
- Bloating: A feeling of fullness or swelling in the abdomen.
- Cramping: Stomach pain or discomfort.
- Gas: Increased flatulence.
- Diarrhea: A laxative effect, particularly with very high intake.
Individual tolerance can vary widely, with some people experiencing symptoms from a relatively small amount, while others can handle larger doses without issues.
The FDA's 'GRAS' Classification and Labeling Issues
Despite the recent concerns, the U.S. Food and Drug Administration (FDA) currently classifies erythritol as "Generally Recognized as Safe" (GRAS). This classification is one reason why manufacturers are not always required to list erythritol specifically on a product's nutrition label. Instead, it might be included under a broader category like "sugar alcohol" or even be part of a "natural flavor" blend. This lack of clear labeling can make it difficult for consumers to track their intake and avoid the ingredient if they choose to.
Comparison Table: Erythritol vs. Table Sugar
| Feature | Erythritol | Table Sugar (Sucrose) |
|---|---|---|
| Calories | Virtually zero (0.2 kcal/g) | High (4 kcal/g) |
| Glycemic Index | Zero (does not raise blood sugar) | High (rapidly raises blood sugar) |
| Dental Health | Beneficial (inhibits bacteria) | Detrimental (contributes to cavities) |
| Cardiovascular Risk | Potential link suggested by recent study (blood clotting) | Well-established link to heart disease and metabolic syndrome with excess consumption |
| Digestive Effects | Can cause bloating and gas in high doses | Generally mild, though high-fructose corn syrup can cause issues |
| Flavor Profile | Clean, sweet taste with a cooling sensation | Familiar, purely sweet taste |
Natural and Artificial Alternatives
For those who decide to reduce or eliminate erythritol, several alternatives are available, though each has its own pros and cons.
- Stevia and Monk Fruit: These are natural, high-intensity sweeteners often found blended with erythritol to reduce the cooling aftertaste. They have been widely studied and are generally considered safe, though some people dislike their specific taste profile.
- Allulose: This is another low-calorie sweetener that occurs naturally in some fruits and is recognized as safe by the FDA. It does not significantly impact blood sugar and is well-tolerated, although research is still ongoing.
- Whole Fruits: A simple and natural way to sweeten foods is to use whole fruits and vegetables, which come with added fiber and nutrients. For instance, date paste or applesauce can be used in baking as a sugar replacement.
- Moderate Amounts of Sugar/Honey: Some experts suggest that consuming small, moderate amounts of regular sugar or honey might be a safer option than high doses of artificial sweeteners until further long-term studies are conducted. However, this should only be considered for those without underlying health conditions like diabetes.
Conclusion
The question of whether you should stay away from erythritol does not have a simple yes or no answer. For the average healthy individual consuming erythritol in moderation, the risk appears to be minimal, and the benefit of reducing caloric sugar intake for dental health and weight management may be a valid trade-off. However, for those with pre-existing cardiovascular conditions, diabetes, or other risk factors, the recent research warrants a more cautious approach. The Cleveland Clinic study, while not establishing a definitive causal link, raises significant red flags about the potential for high doses to increase the risk of blood clots. Given the FDA's current labeling rules, it can be challenging to know exactly how much erythritol you are consuming, particularly from processed "sugar-free" or "keto" products. The best approach is to limit processed foods and, when a sweetener is needed, consider natural alternatives like stevia, monk fruit, or whole fruits. Speaking with a healthcare provider or a registered dietitian is always recommended to receive personalized dietary guidance based on your individual health profile.
Explore healthier sugar substitutes and more from the Cleveland Clinic.
