For many years, consumers viewed zero-calorie sweeteners as a simple trade-off between health and taste. While both stevia and erythritol have been popular sugar alternatives for those managing weight or diabetes, recent scientific evidence has drawn a sharp contrast between their long-term safety profiles. Understanding the fundamental differences in their origins, metabolic effects, and health implications is crucial for making an informed choice for your well-being.
Understanding the Sweeteners: Origins and Composition
Stevia
Stevia is a natural, zero-calorie sweetener derived from the leaves of the Stevia rebaudiana plant, native to South America. The sweet compounds, known as steviol glycosides, are extracted and purified for commercial use. It is significantly sweeter than table sugar, with high-purity extracts often being 200–400 times sweeter.
Erythritol
Erythritol is a sugar alcohol (polyol) that occurs naturally in some fruits and fermented foods. Industrially, it is produced by fermenting glucose from corn or wheat starch with yeast. It provides about 70% of the sweetness of sugar, with very few calories (0.2 per gram).
The Cardiovascular Safety Concerns with Erythritol
In early 2023, groundbreaking research from the Cleveland Clinic linked high blood levels of erythritol to an increased risk of major cardiovascular events, including heart attack and stroke. The study found that erythritol consumption enhanced platelet activity, which increases the potential for blood clotting. Further cellular research presented in 2025 at the American Physiology Summit added supporting evidence, showing that erythritol could harm brain blood vessel cells, potentially contributing to stroke risk by increasing oxidative stress and reducing nitric oxide, a molecule crucial for blood vessel dilation. These findings, while needing more long-term human studies, have fundamentally shifted the safety conversation around erythritol, particularly for individuals with existing cardiovascular risk factors.
Stevia's Well-Established Safety Profile
In stark contrast to erythritol's emerging concerns, purified stevia extract maintains a long and robust safety record. Regulatory bodies globally, including the U.S. Food and Drug Administration (FDA), have deemed high-purity steviol glycoside extracts "generally recognized as safe" (GRAS) for consumption. Decades of research and traditional use have found no evidence of carcinogenic, mutagenic, or reproductive toxicity. For most people, stevia is well-tolerated at normal consumption levels, without significant adverse effects. Any potential mild digestive issues are typically temporary and associated with very high intake or fillers in blended products.
Stevia vs. Erythritol: A Comparative Table
| Feature | Stevia (Purified Extract) | Erythritol |
|---|---|---|
| Origin | Natural, from Stevia plant leaves | Natural, found in fruits; commercially fermented |
| Calories | Zero | Near-zero (0.2 kcal/gram) |
| Sweetness | 200–400x sweeter than sugar | ~70% as sweet as sugar |
| Blood Sugar Impact | Glycemic Index (GI) of 0; no effect | GI of 0; no effect (minimal rise with carbs) |
| Cardiovascular Risk | No evidence of increased risk based on current research | Recent studies link higher levels to increased heart attack and stroke risk |
| Digestive Impact | Well-tolerated at normal levels; high intake may cause mild issues | High doses can cause gas, bloating, and diarrhea |
| Flavor Profile | Intense sweetness with potential for a bitter aftertaste | Clean, sugar-like taste with a cooling effect |
| Cooking/Baking Use | Requires recipe modification due to volume | Functions more like sugar for bulk and browning |
How Stevia and Erythritol Affect Digestion
One of the main differences between stevia and erythritol is how they are processed by the body. Erythritol, as a sugar alcohol, is poorly absorbed in the small intestine. About 90% is excreted unchanged in urine, but the remaining portion can cause digestive upset like gas and bloating, especially with excessive intake. Stevia, on the other hand, is a non-nutritive sweetener. Purified steviol glycosides are broken down by gut bacteria and eliminated, with minimal digestive side effects for most people at normal usage levels. Products blended with other sugar alcohols, however, may still trigger gastrointestinal issues.
Impact on Blood Sugar Levels
Both stevia and erythritol are excellent choices for individuals managing blood sugar, such as those with diabetes or on ketogenic diets. Neither has a significant impact on blood glucose or insulin levels. Human studies confirm their minimal glycemic effects. For diabetics, this means they can enjoy sweetness without the spikes associated with table sugar. However, some blends containing fillers like maltodextrin may still affect blood sugar, so it is crucial to read labels carefully.
Which is Safer? The Verdict
Based on current research, purified stevia extract appears to be the safer choice, especially for regular, long-term consumption and for individuals with cardiovascular risk factors. The decades of research and lack of concerning long-term side effects support its use. Conversely, erythritol's recent association with increased risk of heart attack and stroke presents significant safety questions.
Making the Best Choice for You
Your final decision should weigh safety against personal preference and intended use. If you are concerned about cardiovascular health or prefer a sweetener with a well-established long-term safety record, purified stevia extract is the better option. For occasional baking where a sugar-like bulk and taste are needed, erythritol might be acceptable, but it is prudent to monitor intake and avoid regular, high-dose consumption. Always read ingredient labels, as many 'stevia' products are actually blended with erythritol or other fillers.
For additional health information, consult your healthcare provider or a registered dietitian. Authoritative sources like the Cleveland Clinic offer valuable insights into emerging research on sugar substitutes.(https://newsroom.clevelandclinic.org/2024/08/08/cleveland-clinic-study-adds-to-increasing-evidence-that-sugar-substitute-erythritol-raises-cardiovascular-risk)
