Understanding Erythritol: The Basics
Erythritol, also known as INS 968 in Europe, is a sugar alcohol (polyol) commonly used as a low-calorie sweetener and bulking agent. It is naturally found in small amounts in some fruits, but commercial versions are typically produced by fermenting glucose with yeast. Unlike other sugar alcohols, most of the erythritol consumed (about 90%) is rapidly absorbed in the small intestine and excreted unchanged in the urine. This unique metabolic pathway means less of it reaches the large intestine, resulting in fewer gastrointestinal issues compared to some other polyols. However, this doesn't mean it's without its drawbacks, especially when consumed in the high quantities now common in processed foods.
The Common Digestive Side Effects
Despite its better tolerance profile compared to other sugar alcohols, excessive intake of erythritol can lead to a range of gastrointestinal disturbances. This is often due to an osmotic effect, where the unabsorbed portion of the sweetener draws water into the intestines. The severity of these symptoms is typically dose-dependent, meaning the more you consume, the more likely you are to experience discomfort.
Common digestive symptoms include:
- Bloating and Gas: For sensitive individuals, the small amount of erythritol that reaches the large intestine can be fermented by gut bacteria, causing gas and abdominal bloating.
- Diarrhea: Consuming large quantities of erythritol can have a laxative effect, leading to diarrhea or increased stool frequency. Studies have identified dose-dependent thresholds, with one noting that doses over 50 grams can cause diarrhea in some adults.
- Stomach Upset: Nausea and stomach rumbling (borborygmi) have been reported, particularly with large single doses.
The Cardiovascular Risk: Recent Findings
A significant area of concern arose from a 2023 study by the Cleveland Clinic, which suggested a link between high blood levels of erythritol and an increased risk of cardiovascular events. The study revealed that:
- High erythritol levels were associated with a greater risk of heart attack, stroke, or cardiovascular-related death in a cohort of nearly 4,000 individuals.
- Laboratory and animal studies further demonstrated that erythritol can enhance platelet reactivity, making blood platelets more prone to forming clots.
- A subsequent human intervention study showed that after consuming a beverage with erythritol, blood levels of the sweetener increased a thousandfold and remained elevated for several days, exceeding thresholds associated with enhanced clotting potential.
This research, published in Nature Medicine, highlights a potential risk factor that warrants further investigation, especially for individuals already at a high risk for heart disease.
Potential Neurological and Allergic Reactions
Beyond digestive and cardiovascular issues, other side effects associated with erythritol have been documented, though they are less common.
- Neurological Concerns: A 2025 study on human brain blood vessel cells suggested that erythritol may increase oxidative stress and impair blood vessel function, potentially contributing to a higher risk of ischemic stroke.
- Allergic Hives (Urticaria): In rare cases, some individuals may experience hypersensitivity or allergic reactions to erythritol. Documented cases include symptoms like hives, swelling, and itching. One case study detailed a boy experiencing severe anaphylactic shock after consuming a drink with erythritol.
- Impact on Gut Flora: Emerging research suggests that erythritol may negatively impact the gut microbiome and potentially disrupt the balance of gut bacteria, though the long-term effects on humans require more study.
Comparing Erythritol with Other Sweeteners
To better understand erythritol's role and potential side effects, comparing it to other common sweeteners is helpful.
| Feature | Erythritol (INS 968) | Xylitol | Sorbitol | Table Sugar (Sucrose) |
|---|---|---|---|---|
| Calorie Content | Almost zero (0.24 kcal/g) | Reduced (2.4 kcal/g) | Reduced (2.6 kcal/g) | High (4 kcal/g) |
| Digestive Tolerance | Best tolerated among polyols; mostly absorbed in small intestine | Lower tolerance; can cause diarrhea and bloating at lower doses | Low tolerance; known for laxative effects | Generally no osmotic effect |
| Glycemic Index | Zero | Low | Low | High |
| Cardiovascular Risk | Recent studies suggest increased risk with high intake | No strong evidence of similar risks | No strong evidence of similar risks | Well-documented risk with excess consumption |
| Dental Health | Non-cariogenic; inhibits bacterial growth | Non-cariogenic; inhibits bacterial growth | Non-cariogenic | Promotes tooth decay |
Identifying and Moderating Erythritol Intake
Erythritol is widely used in many low-sugar and sugar-free products, sometimes listed as 'sugar alcohol' on nutrition labels. Common sources include diet sodas, flavored waters, keto snacks, protein bars, chewing gum, candies, and some ice creams. Since it is classified as 'Generally Recognized as Safe' (GRAS) by the FDA, long-term safety studies were not initially required, and its use in products has become pervasive. However, in light of the new research, moderation is strongly recommended.
To manage intake, carefully read ingredient lists for 'erythritol' or 'E968'. If consuming products containing erythritol, consider the total amount and your personal tolerance. Given the concerns, especially regarding heart health, high-risk individuals should consult a healthcare provider or a registered dietitian. Choosing natural, whole foods that are naturally sweet, like fruits, can be a safer alternative for satisfying sweet cravings.
Conclusion
While erythritol (INS 968) has long been praised for its low-calorie, zero-glycemic profile, recent evidence has cast a shadow on its long-term safety, especially with high consumption. The most concerning findings point toward a potential increase in cardiovascular risk by promoting blood clot formation. For most people, moderate intake poses minor digestive side effects, but for at-risk individuals, the elevated risk merits careful consideration and discussion with a medical professional. The key takeaway is that, like any dietary additive, moderation and awareness of individual health status are crucial when consuming products containing erythritol.
For additional context on the scientific findings, refer to the National Institutes of Health article on erythritol and cardiovascular events.
