As more people look to reduce their sugar intake, the debate over sugar substitutes like erythritol and stevia has intensified. While both offer a sweet taste with minimal to no calories, their safety records, side effect profiles, and long-term health implications differ significantly based on recent scientific findings. This comprehensive guide breaks down the science behind each sweetener to help you make an informed decision for your health.
Understanding Erythritol's Safety Profile
Erythritol is a sugar alcohol, or polyol, that occurs naturally in some fruits and fermented foods. Commercially, it is produced by fermenting glucose derived from corn starch. It is approximately 70% as sweet as sugar and offers a clean, sugar-like taste. From a metabolic standpoint, about 90% of ingested erythritol is absorbed in the small intestine and excreted unchanged in the urine, without impacting blood sugar or insulin levels.
However, erythritol's safety profile has come under scrutiny due to recent research:
- Cardiovascular Concerns: A 2023 study published in Nature Medicine, led by researchers at the Cleveland Clinic, found an association between higher blood erythritol levels and an increased risk of major adverse cardiovascular events, such as heart attack, stroke, or death, particularly in individuals with existing risk factors. Further research suggested that high erythritol levels can enhance blood clot formation, although experts emphasize that correlation is not causation and more long-term research is needed.
- Gastrointestinal Distress: While generally better tolerated than other sugar alcohols, excessive consumption of erythritol (especially over 50g in a single dose) can cause digestive issues like bloating, gas, cramping, and diarrhea in sensitive individuals. This is because unabsorbed erythritol can draw water into the intestines.
- Regulatory Status: Erythritol has a Generally Recognized as Safe (GRAS) status from the FDA, but the agency has been prompted by the recent findings to reconsider its safety.
Understanding Stevia's Safety Profile
Stevia is a natural sweetener derived from the leaves of the Stevia rebaudiana plant. The FDA and global regulatory bodies only approve high-purity stevia leaf extracts, or steviol glycosides, for use in food. Crude stevia extracts or whole leaves are not approved due to a lack of safety data. Stevia is intensely sweet (200-400 times sweeter than sugar) and has a clean, decades-long safety record.
Here's what the evidence says about stevia's safety:
- Metabolic Impact: Purified steviol glycosides are not metabolized for energy and do not affect blood glucose or insulin levels, making them safe for people with diabetes.
- Digestive Effects: Most people tolerate high-purity stevia extract very well. The minimal amount of stevia required for sweetening significantly reduces the likelihood of digestive issues compared to sugar alcohols. However, some commercial blends include sugar alcohols like erythritol, which can cause bloating or gas. Always check the ingredient list.
- Regulatory Status: The FDA has given high-purity steviol glycosides GRAS status, and regulatory agencies worldwide have established Acceptable Daily Intakes (ADIs), a level that is extremely difficult for a person to exceed.
Which sweetener is for you? Weighing the evidence
The choice between erythritol and stevia depends on individual health status and concerns. For most healthy people consuming moderate amounts, both sweeteners are likely fine. However, the emerging concerns around erythritol present a compelling reason to favor stevia, especially for at-risk populations. Stevia offers a more established and reassuring long-term safety record.
Here is a comparison of key aspects:
| Feature | Erythritol | Stevia (High-Purity Extract) |
|---|---|---|
| Origin | Sugar alcohol, naturally in some fruits, commercially from corn fermentation. | Plant-derived, from leaves of the Stevia rebaudiana plant. |
| Sweetness | Approximately 70% as sweet as sugar. | 200-400 times sweeter than sugar. |
| Taste | Clean, sugar-like taste, no aftertaste. | Some perceive a bitter or licorice-like aftertaste, though modern formulations minimize this. |
| Cardiovascular Risk | Linked to an increased risk of heart attack and stroke in at-risk individuals in a 2023 study; further research is ongoing. | Decades of research have shown no link to cardiovascular risk factors. |
| Digestive Effects | Can cause bloating, gas, or diarrhea in large amounts, though generally better tolerated than other sugar alcohols. | Minimal side effects at normal usage levels due to small required amounts. |
| Regulatory Status | GRAS status, but recent cardiovascular research is prompting re-evaluation by experts and regulators. | GRAS status and established ADI for high-purity extracts, backed by extensive safety data. |
| Consideration for Blends | Often used as a bulking agent with other sweeteners, including stevia. | Many consumer stevia products are blended with erythritol or other fillers. |
Conclusion: Making the Safest Choice
When evaluating which is safer, erythritol or stevia, the evidence increasingly points toward high-purity stevia extract as the more prudent choice for most consumers, particularly for long-term daily use. The emerging cardiovascular concerns linked to erythritol introduce a significant health question that has not been associated with stevia. While both are superior to table sugar in terms of glycemic impact, stevia’s decades of established safety and low potential for side effects make it the more reassuring option.
Regardless of which sweetener you choose, adopting a healthier diet that relies less on intense sweetness is beneficial. Always check product labels, as many “stevia” or “natural” sweetener blends actually contain erythritol as a bulking agent. For individuals with pre-existing cardiovascular conditions or other health concerns, consulting a healthcare provider or dietitian is highly recommended.
For more information on the erythritol cardiovascular study, refer to the article by the Cleveland Clinic.
Other Safety Considerations
- Look Beyond the Name: The key takeaway from the comparison is not simply that "stevia is better," but that high-purity steviol glycosides are the approved and extensively studied form. Many consumer products labeled simply as "stevia" contain other ingredients, including erythritol, to improve taste and texture. Read the ingredient list carefully to ensure you are getting a high-purity product.
- Individual Sensitivity: While generally well-tolerated, some individuals may have specific sensitivities. Erythritol's potential for digestive upset varies significantly between people. Some individuals also dislike stevia's taste, making a blend or another sweetener a better fit for their palate, as long as they are aware of the risks involved with other sweeteners.
- The Bottom Line: The healthiest approach is to reduce overall intake of intensely sweet products, whether they contain sugar or alternatives. Over-relying on any single sweetener can perpetuate a reliance on sweet flavors and distract from a diet based on whole, unprocessed foods.
Choosing the right sweetener requires careful consideration of personal health risks and ingredient sourcing. Based on the current scientific consensus, high-purity stevia leaf extract remains the safest, most vetted option for long-term use.
