What is Erythritol?
Erythritol is a type of carbohydrate known as a sugar alcohol, or polyol, that is found naturally in small quantities in fruits like grapes and melons and in fermented foods. For mass production, erythritol is commercially produced through the fermentation of glucose from corn or wheat starch by specific yeasts. It provides about 70% of the sweetness of table sugar but with only a fraction of the calories, roughly 0.24 calories per gram compared to sugar's 4 calories per gram.
Unlike most other sugar alcohols, a significant portion of ingested erythritol (about 90%) is absorbed in the small intestine and then excreted unchanged in the urine, minimizing gastrointestinal distress. The remaining portion reaches the colon, where some fermentation by gut bacteria may occur, but at a much lower rate than other polyols.
How Erythritol Impacts Your Blood Sugar and Weight
For individuals with diabetes, or those on low-carb and keto diets, erythritol is often seen as an ideal sugar substitute. This is because it does not raise blood sugar or insulin levels. The body lacks the enzymes to break it down, so it is absorbed and eliminated without affecting glucose metabolism. This property can be beneficial for managing blood sugar levels and potentially supporting weight loss by reducing calorie intake without sacrificing sweetness. Some studies even suggest it may induce the release of gut hormones that promote satiety, potentially aiding in appetite control.
However, some observational studies have found an association between higher plasma erythritol levels and cardiometabolic diseases and obesity, though researchers believe this may be a reflection of underlying metabolic dysregulation rather than a direct cause from dietary erythritol. The evidence is complex and still requires more long-term clinical trials to fully understand the relationship.
The Alarming Research on Erythritol and Heart Health
Perhaps the most significant and concerning recent finding regarding erythritol involves its potential link to cardiovascular issues. A 2023 study published in Nature Medicine and conducted by the Cleveland Clinic found that higher blood levels of erythritol were associated with an increased risk of heart attack and stroke.
Researchers discovered that erythritol enhanced blood clot formation by increasing the reactivity of platelets. In a follow-up test with human volunteers, a single serving of a beverage with 30 grams of erythritol caused a significant spike in blood levels for several days, exceeding the threshold linked to enhanced clotting risks. This study has led many health experts to urge caution, especially for individuals already at risk for cardiovascular events.
Erythritol's Effect on Dental Health and Digestion
In contrast to the heart health concerns, the effects of erythritol on dental health are overwhelmingly positive. Unlike sugar, it does not feed the harmful oral bacteria that cause cavities and plaque. In fact, some studies show that erythritol can actively inhibit the growth of oral bacteria, making it effective in preventing tooth decay. This is why it is often found in “tooth-friendly” products like sugar-free gums and candies.
From a digestive standpoint, erythritol is generally better tolerated than other sugar alcohols like xylitol and sorbitol. Its high absorption rate in the small intestine means less reaches the colon, where fermentation can cause bloating, gas, and diarrhea. However, excessive consumption, particularly in a single dose, can still lead to digestive issues for some individuals. The European Food Safety Authority has set a lower recommended daily intake of 0.5 grams per kg of body weight to prevent potential laxative effects.
Comparison: Erythritol vs. Other Sweeteners
| Feature | Erythritol | Sucrose (Table Sugar) | Xylitol |
|---|---|---|---|
| Caloric Content | ~0.24 kcal/g (near-zero) | ~4 kcal/g (high) | ~2.4 kcal/g (reduced) |
| Glycemic Index | 0-1 (negligible impact) | 65 (high impact) | ~13 (low impact) |
| Taste Profile | Clean, mild sweetness; some cooling effect | Standard sweetness | Cool, clean sweetness; no aftertaste |
| Digestive Impact | Well-tolerated; low risk of GI issues in moderate amounts | Can cause weight gain and metabolic issues | Can cause diarrhea, gas, and bloating; higher risk than erythritol |
| Dental Health | Non-cariogenic; inhibits bacterial growth | Cariogenic; promotes tooth decay | Non-cariogenic; can inhibit bacterial growth |
| Cardiovascular Risk | Recent studies link high levels to increased risk of heart attack and stroke | High intake linked to increased risk of heart disease | Also linked to potential cardiovascular risk in recent studies |
Conclusion
What erythritol can do to your body is complex and nuanced. While it offers clear benefits for blood sugar management, dental health, and reduced caloric intake, particularly for those on specific diets, recent alarming findings about its impact on cardiovascular health cannot be ignored. The most concerning evidence links high levels of erythritol to enhanced platelet activity and an increased risk of heart attack and stroke, especially for those already at risk. While the food industry and regulatory bodies re-evaluate its safety, consumers should approach its consumption with caution and moderation. It is crucial to read labels, be aware of high concentrations in processed foods, and consult with a healthcare provider for personalized advice, especially for individuals with pre-existing cardiovascular conditions or diabetes.
For more information on the latest research concerning erythritol and heart health, see the study published in Nature Medicine [https://www.nature.com/articles/s41591-023-02223-9].
