Erythritol, In today’s health-conscious world, many people are seeking alternatives to sugar. Among these, erythritol has gained significant popularity as a supposedly “natural” zero-calorie sweetener. But recent research has raised questions about its safety profile, particularly related to cardiovascular health. Is erythritol truly the miracle sweetener it’s marketed to be, or should consumers approach it with caution?
What Exactly Is Erythritol?
Erythritol belongs to a class of compounds called sugar alcohols or polyols. While it occurs naturally in small amounts in fruits like pears and watermelons, commercial erythritol is typically produced through fermentation of glucose from corn or wheat starch. The final product appears as white crystalline powder that resembles table sugar but with approximately 70% of sugar’s sweetness at only 6% of the calories.
Unlike other sugar alcohols such as xylitol and sorbitol, erythritol contains remarkably fewer calories—only 0.24 calories per gram compared to sugar’s 4 calories per gram. It’s also worth noting that erythritol isn’t just something we consume in food products; our bodies naturally produce small amounts of it through the pentose phosphate pathway.
This sweetener has been generally recognized as safe (GRAS) by the U.S. Food and Drug Administration since 2001 and was approved by the World Health Organization in 1999. These designations have helped erythritol become a staple ingredient in many sugar-free and keto-friendly products on store shelves today.
How Is Erythritol Metabolized?
Erythritol’s metabolism differs significantly from other sugar alcohols. After consumption, it is rapidly absorbed in the small intestine and circulates in the bloodstream before being excreted largely unchanged in urine. This unique metabolic pathway explains why erythritol typically causes fewer digestive issues than other sugar alcohols, which ferment in the large intestine and can cause gastrointestinal discomfort.
The Potential Benefits of Erythritol
Proponents of erythritol highlight several potential benefits that have made it an attractive sugar alternative:
Blood Sugar and Insulin Benefits
One of erythritol’s most touted advantages is its minimal impact on blood glucose and insulin levels. Research shows that erythritol does not affect glucose or insulin responses, making it potentially beneficial for people with diabetes or those monitoring their carbohydrate intake. This quality has led many healthcare professionals to recommend erythritol-containing products for patients with diabetes or metabolic syndrome.
Weight Management
With virtually no calories, erythritol offers sweetness without contributing to caloric intake. Some evidence suggests it might even help with weight management. According to research, erythritol may induce gut hormone secretions that modulate satiety signals, potentially promoting weight loss. Long-term rodent studies have shown erythritol consumption was associated with lower body weight or reduced adiposity.
Tooth-Friendly Properties
Unlike sugar, erythritol does not contribute to tooth decay. Dental health is another area where this sweetener appears to offer advantages over traditional sugar.
Emerging Concerns: Cardiovascular Risks
Despite its apparent benefits, recent scientific research has raised serious questions about erythritol’s safety, particularly regarding cardiovascular health.
The Cleveland Clinic Studies
In February 2023, researchers at the Cleveland Clinic published findings in Nature Medicine that sent shockwaves through the nutrition community. Led by Dr. Stanley Hazen, the study found that people with higher blood erythritol levels had an elevated risk of experiencing major adverse cardiac events such as heart attack, stroke, or death.
“The degree of risk was not modest,” explained Dr. Hazen. “If your blood level of erythritol was in the top 25% compared to the bottom 25%, there was about a two-fold higher risk for heart attack and stroke. It’s on par with the strongest of cardiac risk factors, like diabetes.”
Further laboratory and animal research revealed that erythritol appeared to cause blood platelets to clot more readily. This finding is particularly concerning because blood clots can trigger heart attacks when they reach the heart or strokes when they travel to the brain.
Newer Evidence Strengthens Concerns
In August 2024, Cleveland Clinic researchers published additional research that reinforced these concerns. Their intervention study with healthy volunteers showed that consuming foods with erythritol increased the risk of cardiovascular events by making platelets more active, raising the risk of blood clots. Notably, sugar (glucose) did not have this effect in the same study.
“Many professional societies and clinicians routinely recommend that people at high cardiovascular risk—those with obesity, diabetes or metabolic syndrome—consume foods that contain sugar substitutes rather than sugar,” said Dr. Hazen. “These findings underscore the importance of further long-term clinical studies to assess the cardiovascular safety of erythritol and other sugar substitutes.”
The study found that ingesting erythritol at doses typically contained in a “sugarless” soda or muffin rapidly enhanced platelet reactivity in human blood, thereby increasing thrombosis potential. This is particularly alarming because the populations often advised to use sugar substitutes—those with obesity, diabetes, or metabolic syndrome—are already at elevated risk for cardiovascular events.
Industry Response to Cardiovascular Concerns
The sweetener industry has pushed back against these findings. The Calorie Control Council, an industry association, stated that “the results of this study are contrary to decades of scientific research showing reduced-calorie sweeteners like erythritol are safe, as evidenced by global regulatory permissions for their use in foods and beverages.”
The council further argued that the results “should not be extrapolated to the general population, as the participants in the intervention were already at increased risk for cardiovascular events.” They also claimed that in-vitro studies cannot mimic the complex physiological environment of the human body, which includes absorption, metabolism, and excretion.
Other Potential Side Effects of Erythritol
Beyond cardiovascular concerns, erythritol may cause other side effects in some individuals:
Digestive Issues
While erythritol is generally better tolerated than other sugar alcohols, consuming large amounts may still cause digestive disturbances in some people. These can include nausea, stomach rumbling, and diarrhea. Sensitivity varies significantly between individuals.
Emerging Questions About Metabolic Impact
Some research has raised questions about erythritol’s relationship with obesity. A 2017 study identified erythritol as a biomarker for increasing fat mass, finding that students who gained weight and abdominal fat over the course of a year had fifteenfold higher blood erythritol at the start of the year compared with those who maintained or lost weight.
This finding challenges earlier assumptions about how erythritol functions in the human body, suggesting it may be metabolized differently than previously thought.
Making Informed Decisions About Erythritol
With conflicting information about erythritol’s safety profile, consumers face difficult choices. Here are some considerations:
Who Should Exercise Caution?
Based on current research, people with existing cardiovascular risk factors, including those with heart disease, previous stroke, diabetes, or metabolic syndrome, may want to be particularly cautious about erythritol consumption. These populations appear to be at highest risk for potential negative effects.
Moderation Matters
As with many food ingredients, moderation may be key. The recent studies showing cardiovascular risks involved relatively high blood levels of erythritol. Occasional consumption in small amounts may present different risk profiles than regular, high-dose intake.
Consider Alternative Sweeteners
For those concerned about erythritol but still seeking sugar alternatives, other options exist. However, it’s worth noting that research into the long-term health effects of most sweeteners remains limited.
The Erythritol Debate Continues
The case of erythritol illustrates the evolving nature of nutritional science. What was once considered unequivocally safe based on short-term studies now faces serious questions as longer-term and more sophisticated research emerges.
Dr. Hazen and his team at Cleveland Clinic have urged regulatory agencies to reevaluate erythritol’s safety designation in light of the mounting evidence of potential cardiovascular risks. Meanwhile, the National Institutes of Health has noted that while recent research hasn’t conclusively proven that consuming erythritol directly leads to adverse cardiovascular outcomes, “the results highlight the need for further study of erythritol’s long-term risks for cardiovascular health.”
For consumers, the erythritol debate underscores the importance of staying informed about emerging nutrition research and making personalized decisions based on individual health profiles and risk factors. While erythritol may still be a better option than sugar for some individuals, the “miracle sweetener” narrative deserves a more nuanced interpretation in light of recent scientific findings.
What are the long-term effects of consuming erythritol regularly?
The long-term effects of regular erythritol consumption remain under intense scientific scrutiny, with emerging research revealing potential cardiovascular risks and metabolic impacts that challenge its status as a “healthy” sugar alternative. Here’s what current evidence suggests:
Cardiovascular Risks: Blood Clotting and Cardiac Events
Recent studies show erythritol may increase cardiovascular risks through platelet activation. Consuming a single erythritol-sweetened beverage elevates blood levels 1,000-fold for days—well above thresholds linked to clotting. This heightened platelet reactivity raises the likelihood of blood clots, doubling the risk of heart attack and stroke over three years in individuals with elevated erythritol levels. Notably, these effects persist even after short-term exposure, suggesting regular intake could compound risks.
Metabolic and Gut Health Concerns
– Insulin resistance: Long-term erythritol use is associated with bacterial dysbiosis, which may impair insulin sensitivity and promote metabolic disorders like diabetes. A 2017 study found erythritol acted as a biomarker for fat mass gain, hinting at unexpected metabolic interactions.
– Digestive issues: While better tolerated than other sugar alcohols, chronic high intake can cause bloating, diarrhea, and worsened symptoms in those with IBS or inflammatory bowel diseases.
Conflicting Regulatory Stances
Despite being FDA-approved as “Generally Recognized as Safe,” concerns arise because:
– Safety assessments relied on short-term studies.
– Modern diets often include erythritol at quantities far exceeding natural exposure.
– Industry-funded research dominates existing safety data, while independent studies flag risks.
Populations at Higher Risk
Those with preexisting conditions face amplified dangers:
– Cardiovascular disease patients: Enhanced clotting mechanisms could trigger events.
– Diabetic individuals: Though erythritol doesn’t spike blood sugar, its metabolic impacts might counteract benefits.
– Bariatric surgery candidates: May disrupt post-surgery satiety signals.
Recommendations for Consumers
1. Moderate intake: Limit erythritol-heavy processed foods (e.g., keto products, sugar-free snacks).
2. Prioritize whole foods: Opt for naturally sweet options like fruits when possible.
3. Consult healthcare providers: Especially if managing heart disease, diabetes, or gastrointestinal disorders.
While erythritol offers short-term benefits like dental protection and zero glycemic impact, its long-term safety profile remains uncertain. Ongoing research underscores the need for updated dietary guidelines reflecting these cardiovascular risks.