Erythritol Is it Really Bad for Me?

April 02, 2023

Erythritol: Is it Really Bad for Me?

Headlines, headlines......"Common Sweetener Tied To Higher Risk of Stroke and Heart Attacks". Goodness, is that true? Well, maybe. It certainly is something we need to think about and watch. We are all exposed to a lot of it.

What is erythritol? It is a 4-carbon sugar you naturally make on your own, in tiny amounts. You can find it in human blood and even in amniotic fluid at very low levels. When you use it as a sweetener, it shows up in your blood in minutes, and takes as much as 3-4 days to fully excrete. 78% is gone in one day. Once erythritol is in you, the vast majority of it is excreted through your urine. None of it gets turned into energy. The Japanese were the first to find out how to make it in bulk by fermenting a portfolio of yeasts. It was brought to market in the US in 2001 and generally recognized as safe (GRAS) in the US and in some 50 other countries. Its use currently is to supplement stevia and monk fruit sweeteners with which it is frequently the number 1 ingredient, albeit it with Stevia or Monkfruit taking the lead advertising. But we have only been exposed to it for 22 years now. This study is the first to find harm.

What did the researchers do? They first analyzed blood samples from 1,157 participants for multiple compounds linked to cardiovascular risk. In that analysis, erythritol showed up as one of the strongest links to the risk of cardiovascular type disease. That includes stroke.

A second group of subjects (2149 from the United States and 833 from Europe) undergoing cardiac evaluations were then analyzed for plasma levels of erythritol and for the presence of cardiovascular disease. That's where the association popped up. They found that participants in that second group with the highest 25th percentile erythritol blood levels were 2.5 (US) and 4.5(Europe) times more likely to have a cardiovascular event than those in the lowest 25 percentile. On face value, that makes erythritol one of our highest risks for cardiovascular disease. Is this credible?

Not everyone agrees that it is credible. It was not a randomized group of people. And it was blood levels that were measured, not what was consumed. The assumption that your blood level comes only from what you eat may be false, as humans make a tiny bit on their own. But it may be a marker of diseased arteries, or some other internal biological pathway yet unexplained.

www.What will Work for me. What is one to make of all this? The level of disease associated with this observation is startling. Observational studies are just that. They call to your attention a possible finding. What is a prudent person to do? I'm on the search for an alternative sweetener. I've been using "Stevia" from Cargill, only to note that its first ingredient is erythritol. Hmm. I order some Monk Fruit sweetener to try out, only to discover the big E as ingredient # 1 again. (Splenda Monk Fruit). Nature's Best1 Sugar Replacement has allulose. Hmm? Any better? I bought a bag of Trehalose as a sweetener. It works. And appears to be less bioactive at stimulating insulin. Heart disease? Unstudied. I'm now on a liquid Monk Fruit sweetener. We'll see how it goes.

References: Nature, Montreal Gazette, MedicalNewsToday, Yeast, Inter Jr Mol Sci, Nutrients, Crit Rev Food Sci,

Pop Quiz

1. What does erythritol do to folks with heart disease? Answer: Trick question. We don't know for sure. There is an association with higher use of erythritol and cardiovascular events.

2. What could be causing those "events" with erythritol? Answer: It could be the erythritol or it could be the heart condition making the erythritol.

3. How do we sort that out? Answer: Long-term, randomized, placebo-controlled trial measuring the amount consumed. (This will never be done as there is no money in it.)

4. How do I make my own decisions in a messy world when I hear information like this? Answer: Prudent folks can find alternatives until they see better science. Or not.

5. Is trehalose any better? Answer: We don't know. We do know that table sugar (glucose and fructose bonded together) and HFCS is 10-15% of our calories and added to 80% of prepared foods in one hidden fashion or another. And it's harmful. In one month on a fast food diet, you can prove someone is near death from fatty liver. (Small study: the movie "SuperSize Me.")