Does Erythritol Actually Put Your Health at Risk? What the Research Says

A recent study found that people with more erythritol in their bloodstream had an increased 3-year cardiovascular risk, including heart attack and stroke. Headlines made waves, discouraging people from consuming products made with erythritol. 

A few years prior, a different study found a link between erythritol in the bloodstream and weight gain. 

But, does erythritol actually make you overweight and sick? 

Here’s what the research says. 

Erythritol studies point to risk, but do we have the full picture?

Erythritol is naturally occurring in fruits and vegetables but most commercially available erythritol sweetener is produced by fermentation. 

Recently, researchers found a link between higher levels of erythritol in the bloodstream and an increased 3-year cardiovascular risk, including heart attack and stroke. 

Naturally, the safety of erythritol comes into question. But, should we worry about erythritol? More research is needed, but like your old statistics teacher used to say, correlation does not equal causation. Here’s why we think the risk might be attributed the wrong way. 

Researchers measured circulating erythritol, not erythritol consumption

The main measure used in this study was circulating erythritol, not dietary erythritol. You might assume that erythritol in the bloodstream points to how much erythritol the study participants consumed in their diets, but this isn’t necessarily the case. 

When you eat sugar, your body metabolizes a portion of the sugar you eat into erythritol. In this study, the researchers found a similar link between erythritol in the bloodstream and obesity, but they also explain the pathway by which some of your blood glucose breaks down into erythritol. 

In one study, sugar water consumption in mice raised erythritol in the bloodstream and also increased the presence of erythritol in urine, without feeding the mice erythritol. https://pubmed.ncbi.nlm.nih.gov/37245661/ This further supports the notion that dietary sugar may be what’s raising erythritol in the bloodstream, not eating foods containing erythritol. 

If that’s the case, sugar consumption could be at the root of the issues that erythritol is being blamed for, although more research is needed. 

Neither of these studies measures dietary consumption of erythritol. Instead of assuming that eating erythritol causes weight gain and cardiovascular problems, could circulating erythritol be an estimate of how much sugar the person consumes? 

It’s well established that consuming excess sugar may contribute to weight gain and cardiovascular issues. So, are we pointing fingers in the right direction? 

Research also shows the benefits of erythritol

There is research that shows that erythritol has antioxidant properties and that it may improve vascular function in people with type 2 diabetes. This article compiled research that shows erythritol’s benefits to oral and overall health, and how it works. 

For example, the oral health studies listed in the review showed that erythritol may reduce dental plaque, could potentially reduce dental plaque acids, may decrease certain bacteria that causes tooth decay, and could reduce the risk for cavities better than sorbitol and xylitol, both common toothpaste ingredients. 

Another study showed that erythritol improved vascular function in diabetes patients. 

Is erythritol safe? 

The FDA designated erythritol as GRAS, which stands for Generally Recognized as Safe as a food additive. 

There is research showing non-toxicity of erythritol. This study showed that humans excreted the erythritol they consumed largely unchanged, even at high doses. When it’s excreted unchanged, the assumption is that it didn’t have much if any effect on the body—but we cannot be certain without thorough testing. 

Takeaway

When research finds a correlation between two events, it’s important to understand that there may be other factors involved. Even though a study found a link between erythritol in the bloodstream and health risks, understand that the researchers did not make a distinction between dietary erythritol and the erythritol that is made when your body breaks down sugar as a normal byproduct of metabolism. Sugar is known to cause a whole host of health issues, so sugar consumed may be another consideration to take into account. When in doubt, talk to your doctor to determine what is safe for you. 

References

1. C Munro, Bernt WO, Borzelleca JF, Flamm G, Lynch BS, Kennepohl E, Bär EA, Modderman J. Erythritol: an interpretive summary of biochemical, metabolic, toxicological and clinical data. Food and Chemical Toxicology: Vol 36, Iss 12, Dec 1998, pp 1139-1174.
2. Flint, N., Hamburg, N.M., Holbrook, M. et al. Effects of erythritol on endothelial function in patients with type 2 diabetes mellitus: a pilot study. Acta Diabetol 51, 513–516 (2014). https://doi.org/10.1007/s00592-013-0534-2
3. GRAS Notification—Erythritol. FDA Briefing Document. Accessed May 26, 2023 from https://www.fda.gov/media/132946/download. 
4. Hootman KC, Trezzi JP, Kraemer L, et al. Erythritol is a pentose-phosphate pathway metabolite and associated with adiposity gain in young adults. Proc Natl Acad Sci U S A. 2017;114(21):E4233-E4240. doi:10.1073/pnas.1620079114
5. Obesity, Sugar and Heart Health. Johns Hopkins Medicine. Accessed May 28, 2023 from https://www.hopkinsmedicine.org/health/wellness-and-prevention/obesity-sugar-and-heart-health
6. Ortiz SR, Field MS. Sucrose intake elevates erythritol in plasma and urine in male mice [published online ahead of print, 2023 May 26]. J Nutr. 2023;S0022-3166(23)72115-9. doi:10.1016/j.tjnut.2023.05.022
7. Sreenath K, Venkatesh Y. Analysis of erythritol in foods by polyclonal antibody-based indirect competitive ELISA. Analytical and Bioanalytical Chemistry 391(2):609-15. April 2008.
8. Witkowski, M., Nemet, I., Alamri, H. et al. The artificial sweetener erythritol and cardiovascular event risk. Nat Med 29, 710–718 (2023). https://doi.org/10.1038/s41591-023-02223-9