Erythritol is a popular sugar substitute that contains almost no calories. It is a tooth-friendly additive that may prevent heart disease and cancer. But is it healthy or harmful to health? Keep reading to find out more about the benefits, dangers, and side effects of erythritol.
What Is Erythritol?
Erythritol is a low-calorie “natural” sweetener that tastes almost exactly like sugar. It belongs to the family of sugar alcohols (polyols) and is used in the food and pharmaceutical industries .
Scottish chemist John Stenhouse discovered it in 1848. It was approved by the Food and Drug Administration (FDA) as a food additive in 2001 .
It’s more difficult to produce erythritol than other sweeteners. Currently, researchers are trying to use other bacteria or fungi to optimize the fermentation process .
Mechanism of Action
Erythritol brings about the sensation of sweetness by activating sweet-taste receptors in the tongue, like other sweeteners. These receptors are activated in the brain, which stimulates reward, and in the gut, which may increase the breakdown of fats [5, 6, 7, 8, 9].
Due to its small size, erythritol is taken in by the small intestine faster than other common sweeteners (like xylitol and mannitol). It is then transported throughout the body .
Benefits of Erythritol
1) Erythritol May Prevent Tooth Decay
In another study (RCT), 136 teenagers received a daily dose of either xylitol, erythritol, or sorbitol over 6 months. Erythritol and xylitol greatly reduced dental plaque .
Erythritol effectively decreases dental plaque, tooth decay, and the presence of bacteria on teeth (systematic review). Erythritol improved oral health better than sorbitol or xylitol .
2) Erythritol Does Not Cause Diarrhea
Erythritol is rapidly taken in by the small intestine. Because it doesn’t stay in the gut for long, it can’t attract water to itself – the main cause of watery diarrhea from sweeteners .
This is why erythritol causes diarrhea less frequently than other sweeteners like xylitol .
In a study (RCT), 55 adults were given erythritol, xylitol, and lactitol in increasing doses and stopped at the dose that caused diarrhea. The dose at which erythritol causes diarrhea was higher than the other sweeteners .
In another study (DB-RCT), 185 children aged 4 to 6 years consumed different doses of erythritol. Even up to 15 g of erythritol did not cause diarrhea or other gut-related problems. Only doses of 20 and 25 g caused diarrhea .
3) Erythritol Does Not Raise Blood Sugar or Insulin
In a pilot study, 5 healthy males received either erythritol (0.3 g/kg body weight) or the same amount of glucose. Erythritol did not change blood levels of glucose or insulin. More than 90% of ingested erythritol was quickly taken up by the body and excreted unchanged through urine .
In another study (RCT), 10 lean and 10 obese subjects were given different doses of erythritol, glucose, and xylitol through a tube. Erythritol did not alter blood insulin and glucose levels, making it a suitable sweetener for obese people .
4) Erythritol Does Not Cause Digestive Upset
Unlike other sugar alcohols, erythritol doesn’t normally cause digestive problems or stomach discomfort .
In a study (DB-RCT) of 64 healthy young adults, erythritol caused a less digestive upset (bloating, flatulence, rumbling sounds) even at a high dose (50 g) compared to xylitol .
5) Erythritol Is Safe to Use for Diabetes
In another pilot study, 24 diabetic patients consumed 36 g of erythritol daily for 4 weeks (and 24 g on their first and final visits). Erythritol improved flow to blood vessels (by relaxing small arteries in the fingertips) and reduced stiffness of the largest artery (aorta) in diabetic patients. So, it may be a beneficial sugar substitute to use in diabetes .
6) Erythritol May Protect Against Heart Disease
Erythritol increased the blood flow to the fingertips, a measure that shows how well small blood vessels are functioning. It also reduced the stiffness of large arteries in a pilot study of 24 patients with type 2 diabetes .
Further studies are required to confirm these findings.
7) Erythritol Does Not Cause Cancer
In rats that consumed different doses of erythritol or mannitol daily for 2 years, erythritol did not cause or advance tumors .
In cells, erythritol did not damage DNA, so it is highly unlikely that it causes cancer .
Erythritol and Keto
The main goal of a keto diet is to reduce carbohydrate consumption as much as possible by excluding foods such as bread, pasta, and sugar .
Stable blood sugar levels are important for the keto diet to work properly. To achieve this, erythritol works as a sugar alternative as it’s low-calorie and doesn’t change blood sugar levels in the body [30, 19].
Erythritol Glycemic Index
Erythritol has a glycemic index of 0 and glucose of 100, meaning that its consumption doesn’t have any effect on a person’s blood sugar level. Its glycemic index is also the lowest among other sweeteners .
Usually, erythritol doesn’t have any side effects and is well tolerated by the body; however, if consumed in large amounts, it may cause the following side effects:
Erythritol May Cause Nausea and Upset Stomach
Consumption of 50 g of erythritol caused nausea and stomach rumble in 64 healthy adults in one study (DB-RCT) .
Erythritol May Cause Diarrhea
In a pilot study of 55 subjects, erythritol caused diarrhea after the consumption of 0.45 g/kg body weight in males and 0.68 g/kg in females (that’s about 50 g for a female of 154 pounds) .
Erythritol May Cause Hives
Some people may be allergic to erythritol. One woman had an allergic reaction (red, raised, itchy bumps on her skin) after she drank a glass of canned milk-tea, which contained erythritol (case study) .
Erythritol May Be Associated with Obesity
In a study (RCT), blood samples of 264 university freshmen were evaluated to identify markers of weight gain. Freshmen who gained weight and fat around the waist over 9 months had high blood levels of erythritol at the start of the year, suggesting an association between erythritol and weight gain. This was the first study to show that erythritol is made from glucose in the body and may contribute to weight gain risk .
Limitations and Caveats
- Lack of blinded randomized controlled human trials – Although there are human studies about how effective erythritol is as a sugar substitute, very few of them are blinded, randomized, and controlled trials. More studies are needed to confirm the beneficial effects of erythritol [24, 23, 17].
- A small number of people per study- Several studies enrolled very few people, meaning that erythritol’s beneficial effects may not hold true if the studies are repeated with a large number of people [19, 20, 23].
Erythritol vs. Other Sweeteners
Erythritol vs. Stevia
Stevia is generally safe, and the acceptable daily intake of stevia is 4 mg/kg body weight. There isn’t a standardized dose for erythritol consumption; however, a daily consumption of 35 g has proven to be safe and free of side effects [37, 32].
Erythritol vs. Xylitol
Unlike erythritol, xylitol has a glycemic index of 13, meaning that it can raise blood sugar levels. It also has a caloric value of 2.4 kcal/g, which is 12 times more than erythritol .
Xylitol has a sweetness level of 1, meaning that it provides the same sweetness as table sugar. This is an important advantage of xylitol, as the sweetness level of erythritol is between 0.6 to 0.8 .
Digestive symptoms like flatulence, diarrhea, and stomach discomfort occur more often from xylitol .
Erythritol in Combination with Fructose
In a study (DB-RCT), 37 healthy adults consumed beverages containing fructose and glucose, fructose and erythritol, or only fructose. Combining erythritol and fructose worsened digestive symptoms such as diarrhea and stomach discomfort .
When fructose is not well absorbed in the small intestine, digestive problems occur. Erythritol blocks fructose absorption, leading to problems like diarrhea and stomach rumble .
Natural Sources (or Forms of Supplementation)
- Soy sauce
Erythritol is most commonly available as tablets and granulated powders. It is also found as a sweetener in chewing gums, syrups, and oral health products .
There is no standardized dose for erythritol use. Still, digestive symptoms like diarrhea and stomach upset are possible after taking 50 g of erythritol in a single dose. Daily consumption of 35 grams of erythritol is considered safe with no risk of side effects .
Consult your doctor before using erythritol routinely, as the safety of long-term use has not been established and allergic reactions may occur .
Many users stated that erythritol is a good sugar alternative when preparing drinks and desserts because of its low calories. They also liked that it was the closest sweetener to table sugar with no aftertaste.
Users also praised its tooth-protecting properties.
Diabetic users stated that thanks to erythritol, they can enjoy the privilege of sweet products without the concern of increasing their blood sugar levels.
Some users reported no stomach or digestive problems with erythritol use.
Even though there aren’t many negative reviews regarding the side effects of erythritol, a lot of people complain that it lacks sweetness compared to other sugar substitutes such as stevia.