Is the Sugar Substitute Erythritol Still Safe to Use?

In today's increasingly health-conscious world, there are plenty of sugar alternatives that are marketed to offer the same sweetness without the added carbs and calories. But one of the most popular "natural" zero-calorie sweeteners, erythritol, has come under fire after a recent study found it may raise the risk of blood clots, stroke, and heart attack.

The study followed over 4,000 people in the United States and Europe over three years and found that those with higher blood erythritol levels were at an elevated risk of these dangerous health conditions. That being said, the population used in the study was more at risk than the general public because the participants already had cardiovascular diseases and other medical conditions that put them at an increased risk of heart attack and stroke to begin with, says Roger Seheult, MD, an internal medicine physician and a medical advisor for Intrivo, the developer of On/Go rapid COVID-19 tests.

In other words, the study did not directly find that erythritol causes heart attack or stroke, adds Sean Heffron, MD, a preventative cardiologist at NYU Langone Health. So before you go scouring your kitchen cabinets to rid your house of this sweet ingredient, learn whether erythritol is still safe to use and if you should be swapping it for different sweeteners instead.

Erythritol belongs to a group of substitute sweeteners known as sugar-alcohols that are carbohydrates chemically resembling both sugars and alcohols but are not as sweet as regular sugar, Dr. Heffron explains. "Erythritol is a naturally occurring sugar calorie that has little to no impact on blood sugar level, and for that reason, it's a fan favorite among health-conscious and blood-sugar-cautious consumers," adds Lisa Moskovitz, RD, the CEO of NY Nutrition Group and the author of "The Core 3 Healthy Eating Plan."

"Up until now, erythritol had the GRAS designation by the FDA, which means it's 'generally recognized as safe,'" Moskovitz says. "Most of the research [on erythritol] has had positive outcomes, and the only commonly reported side effect is that larger amounts of erythritol can cause stomach discomfort and diarrhea," she explains.

From a heart-disease standpoint, there is nothing to suggest that erythritol directly causes heart attacks and/or strokes, Dr. Heffron adds. "There are some studies that have associated levels of erythritol in the blood with heart attacks and strokes, but that doesn't mean that it's causing them," he explains. "It just means that higher levels tend to be present in people who have heart attacks and strokes which could be a chicken-or-the-egg type of situation."

All of this to say, it's a big jump to assume that erythritol is unsafe, and there is not enough evidence to prove it has negative health consequences in the general population. "My view on erythritol has not changed by the recent study," Dr. Heffron says. "Erythritol is not something I tell my patients to avoid completely because I am not convinced by the data that it is a direct cause of heart attacks and strokes."

While erythritol is not a direct cause of heart attacks and strokes, too much of the sweetener can cause stomach discomfort, digestion issues, bloating, and diarrhea due to the sugar alcohol content, Moskovitz says. In fact, an older 2006 study published in the European Journal of Clinical Nutrition found that 50 grams of erythritol in a single serving increased nausea and stomach rumbling. But unless you're eating huge amounts of the sweetener per serving, it's unlikely to have these negative consequences.

Overall, erythritol appears to be safe, Dr. Seheult says. "There are no studies suggesting that small amounts of erythritol are dangerous, but it's important to do everything in moderation."

Many nonnutritive sweeteners, such as Splenda, may contain small amounts of erythritol, but every brand is different, Moskovitz says. If you are concerned about erythritol consumption, always read the nutritional labels of your products.

Since erythritol contains almost no calories and has 70 percent of the sweetness of sugar, it's found in many low-calorie snacks and sugar-free or keto foods. "Aside from some sweeteners like Splenda and stevia, erythritol is commonly used in low-sugar food products such as ice cream, some beverages, certain candies, and protein bars," says Moskovitz.

However, erythritol is also naturally found in some foods such as watermelon, peaches, pears, and grapes, Dr. Seheult explains. Some fermented foods like cheese, wine, and beer may also contain small amounts of erythritol.

While it's not confirmed that erythritol is unhealthy or dangerous, if you are at risk for heart attacks, Moskovitz recommends reducing regular consumption and monitoring your intake. Try swapping erythritol with erythritol-free stevia brands or replace it with natural sweeteners like honey or maple syrup.

Additionally, if you're concerned about blood sugar levels, using these higher-sugar sweeteners sparingly is best, Moskovitz says. "Fresh, frozen, and preserved fruit can also go a long way for sweetening up cereals, yogurt, and baked goods."

If you're wary about erythritol but you can't imagine your morning coffee or tea without it, gradually weaning down can also reduce the need to sweeten your foods, Moskovitz explains. "The less sweeteners you consume, the less you may need to enjoy and feel satisfied with what you're eating."