What’s Erythritol? And Is It Bad for You?

Erythritol is one of the most common artificial sweeteners around. It’s a popular ingredient in a lot of food marketed for weight loss, keto-friendly diets and diabetes management.

It’s normal to think that foods labeled as “no sugar” or “less sugar” must be better for us. And artificial sweeteners can sound like a better choice than sugar.

But in truth, that might not be the case. A growing body of evidence suggests artificial sweeteners can be worse for you than table sugar. And research is connecting erythritol in particular with some very serious health risks. Namely, increased risk for heart attack and stroke.

We talked about the concerns with Stanley Hazen, MD, PhD, a specialist in preventive cardiovascular medicine. He is the senior author of a study highlighting the risks of erythritol.

What is erythritol?

Erythritol is a kind of artificial sweetener known as a sugar alcohol. (Though, it’s not actually sugar or alcohol in the way we typically think of those words.)

In addition to erythritol, common sugar alcohols include:

• Xylitol
• Sorbitol
• Maltitol
• Mannitol
• Isomalt
• Lactitol
• Hydrogenated starch hydrolysates

Sugar alcohols aren’t as sweet as sugar. Artificial sugars like aspartame (Equal®) and saccharine (Sweet’N Low®), on the other hand, can be up to 700 times sweeter than sugar.

Our bodies naturally create sugar alcohols, including erythritol. Erythritol is also commercially manufactured by fermenting corn. That commercially made erythritol is added to foods — and that’s where things get messy.

“Erythritol is made by our own bodies as part of our metabolism, but at very low levels,” Dr. Hazen explains. “Naturally occurring erythritol isn’t the problem. It’s the high doses of erythritol from packaged foods that we’re seeing have very adverse effects.”

Is erythritol safe?

Sugar alcohols like erythritol have long been known to cause digestive issues for some people. But Dr. Hazen’s research has linked erythritol to much more serious troubles.

His study shows that erythritol is closely associated with risk for “major adverse cardiovascular events.” In other words, people who have high blood levels of erythritol are more prone to heart attacks, stroke and even death.

Dr. Hazen and his team studied the blood of more than 4,000 people in the U.S. and Europe. They were looking for common threads that could indicate an increased risk for heart conditions. What they found was that people who had more erythritol in their blood were at elevated risk for major heart problems.

“We were looking for compounds in blood that predict risk for experiencing a future heart attack or stroke. The top candidate that kept showing up was erythritol,” he shares.

Taking it a step further, the researchers gave erythritol to non-human models. They saw enhanced clot formation in models of arterial disease. They added erythritol to blood outside of the body. And they found that adding erythritol to blood made it “clump up,” or form a blood clot by lowering the threshold to activate platelets.

Platelets are the tiny components in our blood that rush to the site of an injury to stop us from bleeding. That keeps us from bleeding out. But when platelets are activated within our bodies, they cause blood clots, which can lead to heart attacks and strokes.

“A serving of erythritol in common ‘keto-friendly’ processed food products made blood levels of erythritol go up 1,000-fold, well above the levels linked to enhanced clotting risks,” Dr. Hazen states. “We found that the risk for clotting can be increased for several days after consumption of just one serving of artificially sweetened food containing erythritol.”

Dr. Hazen and his team have found similar concerns with another sugar alcohol, xylitol.

Dr. Hazen makes it clear that more studies will be needed to confirm these findings and to learn more. But the results should be taken as a very serious warning sign.

“It wasn’t a modest effect. It was a very large effect that we were seeing reproduced across multiple groups and across geographies,” he emphasizes. “This research shows that we should be really cautious about eating processed foods containing erythritol.”

Erythritol uses

Erythritol is often used as a replacement for table sugar in low-calorie and low-sugar products. It’s also included as an ingredient to “bulk up” some other artificial sweeteners.

It’s a favorite of food manufacturers for two big reasons. First, it’s very low in calories, which makes it ideal for “diet” foods. Second, its taste and texture are closer to table sugar than some other non-nutritive sweeteners.

Erythritol is added to many sugar substitutes that are sold as “natural” alternatives to sugar, including some (but not all) formulations of stevia and monk fruit sweeteners.

Sugar-free products containing erythritol are often recommended for people who have obesity, diabetes or metabolic syndrome and are looking for options to help manage their sugar or calorie intake. And those products may not say on their nutrition labels whether they include erythritol or other sugar alcohols.

How to avoid the dangers of erythritol

Here’s where it can get tricky. You could be eating foods that contain erythritol and not even know it.

Erythritol falls into the category of Generally Recognized as Safe (GRAS) by the U.S. Food and Drug Administration (FDA). That means long-term safety studies of erythritol aren’t required currently. It also means food companies don’t have to list erythritol on their nutrition labels.

The FDA considers erythritol safe because it’s a naturally occurring compound, Dr. Hazen explains. But the problem is that the quantities it’s used for in foods are much, much higher than what is natural and known to be safe for your body.

While your foods may not state specifically that they contain erythritol, Dr. Hazen adds that it’s commonly found in items like sugar-free varieties of:

• Ice cream
• Candy
• Gum
• Cookies
• Cakes
• Protein bars
• Fruit spreads
• Energy drinks

And there are some red flags that can be a hint that your food may contain erythritol (or another sugar alcohol), even if it’s not listed on the nutrition label. If the package includes these words or similar claims, it may indicate your food contains erythritol:

• Contains sugar alcohol
• Keto-safe
• Diabetes-safe
• No sugar
• Low-sugar
• Artificially sweetened
• Naturally sweetened
• Sweetened with natural compounds
• Low-calorie
• No calories

“It’s very troubling,” Dr. Hazen says. “We know that people buying these products are trying to do something good for their health by eating foods that are promoted as better for them. But in reality, they may be inadvertently increasing their risk for harm.”

Reading food labels can give you a clue whether a product contains sugar substitutes or sugar alcohols. But they can still be tough to recognize.

One sure way to avoid erythritol is to focus your diet on whole foods. That means natural, non-packaged foods, like fresh fruits and vegetables. And if you need something a little sweet, Dr. Hazen advises using stevia — in a dropper, not a packet. Granulated artificial sugars often include sugar alcohols like erythritol as a “carrier.”

And if you can tolerate some amounts of table sugar, maple syrup or honey, they may prove to be healthier choices over the artificial stuff.

“With the knowledge we have now, it’s probably better to have moderate amounts of sugar itself, or honey, as opposed to artificial sweeteners,” he emphasizes. “Until we have further studies and long-term studies on the safety of these kinds of compounds, it’s hard to say that they’re safe.”

If you have questions about how to avoid sugars and artificial sweeteners, talking with a certified dietitian and other healthcare providers can help you learn more about food choices that are appropriate for your health.

“Virtually all insurance companies cover meeting with a dietitian,” Dr. Hazen encourages. “And studies show that people with diabetes who see a dietitian more frequently live longer. It can be an enormous benefit for your health.”