Erythritol is an artificial sweetener used to replace sugar (and the calories from sugar) to create sugar-free foods. It is found naturally in some foods, like pears and watermelon, but most of the erythritol used as a sugar substitute is derived from corn. Erythritol was first discovered in 1848 but only became commercialized as a sugar replacement in the 1990s.

Since then, it has been accepted as safe and is approved for use in more than 60 countries worldwide, but recent research has many rethinking these assumptions.

Use as a Sweetener

While low amounts of erythritol occur naturally in many fruits and vegetables and inside our cells as a part of metabolism, in foods where it's used as a sweetener, erythritol levels are much higher. Foods that use erythritol typically have more than 1,000 times the amount existing naturally in foods.

Erythritol is included on food labels as "sugar alcohols" and does not have to be listed separately, making it hard to tell how much a product contains.

erythritol is an alternative to sugar, almost noncaloric and does not affect blood sugar seramo/ Getty Images


Why Erythritol?

Erythritol and other alcohol sugars have between a half and a third of the calories of sugar, but products that use them taste and look like they were made with real sugar.

Although classified as a carbohydrate, erythritol and other sugar alcohols do not affect blood glucose as much as regular sugar, making them preferable for people with diabetes.

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Recent Research

Recent research has concluded that erythritol may have long-term effects on cardiovascular health. Researchers found that people in the study who consumed higher levels of erythritol and related artificial sweeteners were twice as likely to have cardiovascular events as those with lower levels over three years of follow-up.

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Blood Clots

After these findings, researchers set out to discover why erythritol may have these effects. They found that exposing human platelets to erythritol in a lab increased sensitivity to clotting signals. When studied in mice, increased levels of erythritol led to faster clot formation and arterial blockage.

Although this has not yet been studied in humans, these results suggest that consuming erythritol can affect platelets and increase blood clot formation.

a phlebologist examines a patient with varicose veins on his leg. phlebology Kalinovskiy/ Getty Images


What the New Research Means

Although previous studies have shown that erythritol is a safe alternative to sugar, most of these studies were done on animals. It is also challenging to determine the exact effects of erythritol or any artificial sweeteners when consumed as part of a larger diet.

There is also the possibility of correlation rather than causation. People who eat a lot of artificial sweeteners may already have risk factors for cardiovascular issues, like diabetes or obesity, and would be at higher risk anyway. At the very least, this research shows that artificial sweeteners like erythritol require more in-depth studies.

A pharmacist checking a customers blood sugar levels with an insulin pen. Tom Werner/ Getty Images


Other Side Effects

Side effects of erythritol are generally milder than those of other artificial sweeteners. One study found that the two most commonly reported side effects of excess erythritol were nausea and borborygmi, the loud rumbling noise caused by gas moving through the intestines.

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Is Erythritol Safe?

According to the lead researcher of the erythritol study, "the degree of risk was not modest". More studies are needed, but if these results are replicated, the cardiovascular risks may be significant.

People already at risk for blood clots should talk to their doctor about whether it is safe to consume erythritol.

Erythritol is alternative natural low calorie sweetener. Tatsiana Niamera/ Getty Images


Alternatives to Sugar Alcohols

Alternatives to sugar alcohols like erythritol include artificial sweeteners and sweeteners derived from natural sources. Most artificial sweeteners are created in a lab and do not contain sugar or calories. Research is ongoing about whether artificial sweeteners pose health risks, like cancer or weight gain.

Natural sweeteners, like monk fruit or stevia, are derived from plants. They are less processed, similar to natural sugars, and do not lead to blood sugar spikes or weight gain. According to the FDA, they are generally regarded as safe.

Luo Han Guo aka Monk fruit natural herbal remedy on. Powerful healthy sweetener. eskymaks/ Getty Images


Health Benefits of Sugar Substitutes

Sugar substitutes generally do have some health benefits. They do not raise blood sugar levels, which makes them a possible alternative to sugar for people with diabetes. People with obesity may gain short-term benefits from using sugar substitutes as they are generally low in calories, but it is unclear whether they offer any long-term weight-loss benefits.

woman measuring waist with tape, showing results of slimming diet, standing in front of mirror, gesturing thumb up at home Prostock-Studio/ Getty Images


The Bottom Line

Erythritol may have some benefits for people who are trying to lessen the amount of sugar they use, but people need to be aware of the risks. Research is still evolving, but people who already have risk factors for heart attacks or strokes or who have already been diagnosed with heart disease should exercise caution and talk to their doctor about erythritol consumption.

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