Erythritol: The Sugar Alcohol with a Cardiovascular Question Mark
Erythritol is a sugar alcohol found naturally in some fruits and fermented foods, though it is commercially produced from cornstarch via fermentation. With a sweetness level about 60–70% of sugar, it is often favored for its bulk and texture, making it a popular choice for baking and blending with other high-intensity sweeteners like stevia. Erythritol is particularly attractive for low-carb and ketogenic diets because it contains almost no calories and is mostly absorbed in the small intestine before being excreted unchanged in urine, meaning it does not spike blood sugar or insulin levels.
The Cardiovascular Controversy
Despite its long-held reputation as a safe alternative, erythritol faced a significant safety challenge in 2023 with a study published in Nature Medicine. This research found that people with higher blood erythritol levels were at an elevated risk of major adverse cardiovascular events, such as heart attack and stroke. The study indicated that erythritol enhanced platelet reactivity and thrombosis formation in both laboratory and animal studies. Furthermore, a small pilot study showed a significant and sustained spike in blood erythritol levels for days after healthy volunteers consumed a single 30-gram dose.
Critics of the study point out that most participants already had pre-existing cardiovascular risk factors, suggesting that high erythritol levels might be a biomarker for metabolic dysfunction rather than the direct cause of cardiac events. The body can also produce erythritol endogenously, further complicating the findings. Nonetheless, the research has spurred calls for more long-term safety studies, especially concerning high-risk populations.
Digestive and Oral Health Considerations
Unlike other sugar alcohols that are fermented in the colon and can cause significant bloating and gas, erythritol is better tolerated because most of it is absorbed before reaching the large intestine. However, large doses can still cause digestive upset. A key benefit of erythritol is its contribution to dental health. It is not fermented by oral bacteria, which helps protect against cavities and dental plaque.
Sucralose: The Artificial Option with Emerging Concerns
Sucralose, famously known by the brand name Splenda, is an artificial sweetener made by replacing three hydroxyl groups of a sucrose molecule with chlorine atoms. This chemical modification makes it about 600 times sweeter than sugar and renders it non-caloric, as the body does not recognize it as a carbohydrate. For years, regulatory bodies like the FDA deemed sucralose safe based on studies suggesting it passed through the body largely unabsorbed and unmetabolized.
Gut Microbiome and Metabolic Disturbances
Recent research has cast doubt on the claim that sucralose is inert within the body. Animal and human studies have indicated that sucralose can alter the gut microbiome by reducing beneficial bacteria. This dysbiosis of gut flora has been linked to increased inflammation and potential metabolic issues, including reduced insulin sensitivity in some individuals. The impact of these microbiome changes on long-term human health is still under investigation.
Potential Toxicity When Heated
Another significant concern involves the heat stability of sucralose. While Splenda is often marketed as a baking sugar, studies have found that heating sucralose, particularly above 180°C (350°F), can cause it to break down and form potentially toxic compounds called chloropropanols. Some research even points to the potential formation of dioxin-like polychlorinated biphenyls and other harmful chlorinated substances. Additionally, a metabolite called sucralose-6-acetate, which can be formed during metabolism, has recently been identified as genotoxic and potentially inflammatory.
Comparison Table: Erythritol vs. Sucralose Safety and Functionality
| Feature | Erythritol | Sucralose |
|---|---|---|
| Origin | Naturally occurring sugar alcohol, commercially produced via fermentation. | Artificial, chlorinated derivative of sucrose. |
| Sweetness | 60-70% as sweet as sugar. | ~600 times sweeter than sugar. |
| Taste Profile | Clean, sugar-like taste with a slight cooling sensation. | Intense, purely sweet taste; no aftertaste in most applications. |
| Calorie Content | Almost zero (<0.2 calories per gram). | Zero calories. |
| Heat Stability | Stable for baking; provides bulk similar to sugar. | Potentially unstable at high temperatures (>180°C), may form harmful compounds. |
| Cardiovascular Concerns | Linked to increased thrombosis risk in at-risk individuals at high blood levels. | Not directly linked to cardiovascular events, but metabolic issues like inflammation may contribute. |
| Gut Health | High digestive tolerance; largely absorbed before reaching the colon. | May alter gut microbiome balance, potentially impacting insulin sensitivity. |
| Toxicity/Metabolites | Minimal, rapidly excreted unchanged. | Produces potentially toxic chlorinated compounds when heated and a genotoxic metabolite (sucralose-6-acetate). |
| Glycemic Impact | Zero glycemic index; safe for diabetics. | Zero glycemic index, but can affect insulin sensitivity in some cases. |
Choosing the Right Sweetener for Your Needs
When deciding which is safer, there is no single answer that fits everyone. The choice depends largely on your individual health profile and how you plan to use the sweetener.
For those focused on baking:
- Erythritol is a more reliable option due to its superior heat stability and bulking properties that closely mimic sugar.
- Sucralose should be used cautiously, especially in high-temperature applications, due to the risk of degradation and potential toxic byproducts.
For those managing diabetes or weight:
- Both sweeteners have a zero glycemic index, making them better choices than table sugar for controlling blood sugar levels.
- However, individuals with pre-existing heart conditions should approach high consumption of erythritol with caution, given the recent cardiovascular risk findings.
- Those with known gut sensitivities may also prefer erythritol, which is generally better tolerated than sucralose.
The Final Word: Moderation and Awareness
Ultimately, the safety of both erythritol and sucralose is under review. While regulatory bodies like the FDA still classify them as safe under current standards, emerging research indicates potential long-term risks, particularly with high consumption. For most people, moderate use is unlikely to pose a significant threat. However, being aware of the specific health concerns—the cardiovascular risk associated with erythritol and the gut/toxicity issues with sucralose—is vital.
Experts often recommend that the healthiest option is to reduce overall intake of all sweeteners and focus on whole, unprocessed foods. If you choose to use low-calorie sweeteners, consider diversifying your choices and using them in moderation. For in-depth information on the cardiovascular link and the need for more research, see the study in Nature Medicine on The artificial sweetener erythritol and cardiovascular event risk.
Best Practices for Sweetener Use
- Read ingredient lists: Check for sweeteners in processed foods, as they often contain higher concentrations than DIY use.
- Diversify your sweeteners: Instead of relying on a single one, rotate between different options like stevia, monk fruit, or allulose.
- Focus on whole foods: The most nutritious path is to retrain your palate to enjoy the natural sweetness of fruits and vegetables.
- Prioritize tolerance: Pay attention to how your body reacts to each sweetener, especially regarding digestive comfort.
- Consult a professional: If you have underlying health conditions like diabetes or heart disease, discuss sweetener choices with your doctor or a registered dietitian.
