Who Should Not Eat Erythritol?
For years, erythritol was considered one of the most benign sugar substitutes, lauded for its clean taste and minimal impact on blood sugar. However, groundbreaking research has shifted the conversation, revealing potential risks for specific populations. The most significant concern comes from a 2023 study published in Nature Medicine led by researchers at the Cleveland Clinic. This study found a strong association between high blood levels of erythritol and a greater risk of major cardiovascular events, such as heart attack and stroke, over a three-year period.
Individuals with Cardiovascular Risk Factors
Based on the Cleveland Clinic study, individuals with pre-existing risk factors for heart disease—such as obesity, diabetes, and high blood pressure—should exercise extreme caution with erythritol. The research, which included both human participants and animal models, found that high levels of erythritol in the blood enhanced the sensitivity of blood platelets, promoting the formation of blood clots. These clots can block arteries, potentially leading to a heart attack or stroke.
It is important to note the distinction between the naturally occurring, small amounts of erythritol our bodies produce and the massively higher concentrations found in many processed, "sugar-free" products. The study found that consuming just one erythritol-sweetened beverage could cause a thousandfold spike in blood erythritol levels, with levels remaining high for several days. This significant increase is what researchers believe could trigger or exacerbate clotting risks in vulnerable individuals.
People with Gastrointestinal Sensitivities
Erythritol is a type of sugar alcohol, also known as a polyol. While it is generally better tolerated than other sugar alcohols like sorbitol or xylitol, high consumption can still cause significant digestive upset, particularly for those with sensitive digestive systems.
For individuals with Irritable Bowel Syndrome (IBS), Chron's disease, or ulcerative colitis, erythritol is part of the high-FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) category of carbohydrates. For these people, polyols are poorly absorbed in the small intestine and fermented by gut bacteria in the colon, leading to symptoms such as:
- Bloating
- Gas
- Abdominal pain
- Diarrhea
Symptoms are often dose-dependent, and the risk increases with larger single servings. The standard advice for those with IBS is to avoid or strictly limit intake of polyols, including erythritol.
Pregnant and Lactating Women
While the FDA has categorized erythritol as “Generally Recognized as Safe” (GRAS), there is still a lack of sufficient long-term data on its effects, especially during sensitive periods like pregnancy and breastfeeding. Some regulatory bodies and health experts, including those from the World Health Organization, advise caution and moderation regarding non-sugar sweeteners, especially for sensitive populations. Though some sources suggest erythritol is likely safe in moderation during pregnancy, it is prudent for pregnant or breastfeeding women to consult a healthcare provider before regularly consuming products with non-nutritive sweeteners.
Other Individuals to Consider
- Individuals prone to allergies: Though rare, some people may experience an allergic skin reaction to erythritol, which can manifest as hives, swelling, and rash.
- People on bariatric surgery plans: Some evidence suggests non-nutritive sweeteners may affect satiety and dampen the sweet taste threshold, which is a consideration for individuals intending to undergo bariatric surgery.
Erythritol vs. Other Sweeteners
This table compares erythritol with other common sweeteners based on key health considerations.
| Feature | Erythritol | Sucralose (e.g., Splenda) | Stevia | Table Sugar (Sucrose) |
|---|---|---|---|---|
| Calories | Virtually zero (0.24 kcal/g) | Zero | Zero | 4 kcal/g |
| Glycemic Impact | Zero; does not raise blood sugar | Zero | Zero | High; spikes blood glucose |
| Aftertaste | Minimal; similar to sugar | Can have a bitter aftertaste | Often described as bitter or metallic | None |
| Digestive Impact | Can cause bloating, gas, and diarrhea at high doses | Generally low, but can affect gut health | Minimal impact | Minimal at moderate intake |
| Cardiovascular Concerns | Linked to enhanced platelet activity and clot risk, especially at high blood concentrations | Limited but long-term data needed; not linked to clotting risk | Not linked to clotting risk | High intake linked to metabolic and cardiovascular disease |
The Importance of Moderation and Informed Choices
For the general population consuming erythritol in moderation as part of a balanced diet, the risks are often considered minimal. However, a balanced diet is key. The issue arises with the large amounts found in highly processed, low-calorie foods and beverages. The World Health Organization (WHO) has recommended against the use of non-sugar sweeteners for weight control, citing potential long-term adverse effects like increased risk of type 2 diabetes and cardiovascular diseases. They emphasize that people should instead aim to reduce the overall sweetness of their diet.
Ultimately, making an informed choice about erythritol requires a personal health assessment. For those with heart health concerns, a predisposition to clotting, or a sensitive gut, reducing or eliminating consumption may be the safest route. Reading product labels is also crucial, as erythritol can be hidden in many "sugar-free" or "keto" products. Instead of relying on sweeteners, focusing on naturally occurring sugars from whole foods like fruits is a widely recommended alternative.
Conclusion
While erythritol has long been considered a safe sugar alternative, recent research suggests potential dangers, particularly for individuals with pre-existing health conditions. People with heart disease risk factors, including those with obesity and diabetes, should be cautious due to evidence linking high blood erythritol levels to increased blood clotting and a higher risk of heart attack and stroke. Furthermore, individuals with sensitive digestive systems, such as IBS sufferers, may experience unpleasant gastrointestinal symptoms from high intake. Until more long-term research is conducted, especially regarding the levels found in commercial products, the safest course of action for at-risk individuals is to limit or avoid erythritol consumption. Always consult a healthcare professional for personalized dietary advice.
For more information on the Cleveland Clinic study regarding erythritol and cardiovascular risk, see their publication in Nature Medicine(https://www.nature.com/articles/s41591-023-02223-9).
