Erythritol: Healthy or Increased Risk of Heart Attacks?

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Nutrition World > Heart Health > Erythritol: Healthy or Increased Risk of Heart Attacks?

Does Erythritol increase heart attacks? If you read the headlines lately, you’re probably thinking – yes!

I’ve seen the natural sweetener erythritol recently linked to increased risk of heart attack, stroke, and cardiovascular death. I knew immediately, we’d have a flurry of comments and concerns around this popular, calorie-free sweetener.

Many health foods, protein drinks, and food bars contain erythritol.  I always read the headlines and know from 4 decades of experience how lacking and misleading health headlines can be. So, I decided to read the actual studies and other expert commentary on what was being reported.

What is Erythritol?

This “natural sweetener” comes from sugar, but it has a slightly different chemical structure. It occurs naturally in many fruits in small quantities. But it’s created by fermenting glucose with yeast. That makes it a sugar alcohol.

Commercial producers create erythritol through the hydrolysis of corn starch.

Watch our video on “The Best (and Worst) Sweeteners.

What are the Benefits of Erythritol?

One of the major benefits of erythritol includes moving people away from sugar and fructose! We know how the overuse of sugar wreaks havoc on the body.

Read about Optimal Blood Sugar Levels in this article here.

However, we believe in many other benefits of using this natural sweetener.

  1. Low calorie. Erythritol contains about 5% of the calories found in sugar. This makes it ideal for people trying to reduce calories and lose weight while still consuming occasional “sweets.”
  2. Low GI. Considered low on the glycemic index, erythritol has little affect on blood sugar. That makes it a great choice for diabetics or others trying to manage blood sugar levels.
  3. Non-cariogenic. That just means it doesn’t cause tooth decay. I’m not saying you don’t have to brush your teeth, but you won’t risk the same effects as sugar.
  4. No aftertaste. Ever had a sugar free food that tastes good at first? And then you’re left feeling like you swallowed a penny? No worries if you use erythritol. There’s no aftertaste.

How Does Erythritol Taste?

So, how does it taste? Well, like sugar, actually. The only weird thing that happens with high concentrations of erythritol involves a cooling sensation in the mouth. That’s because erythritol is endothermic. Meaning, heat is taken from the environment as it dissolves. And yes, that can happen right in your mouth.

In order to avoid these affects, most commercial producers of products with erythritol include a combination of monk fruit or other natural sweetener to eliminate the cooling feeling.

View all natural sweeteners in our online shop here.

Who Shouldn’t use it?

While Erythritol remains safe for most, we’ve listed those who should avoid it.

  • Dogs! It’s toxic for dogs, even in small amounts. Small amounts can induce low blood sugar. So, keep foods with erythritol away from pets.
  • Those allergic to corn. While this natural sweetener appears safe for most people with allergies to gluten, soy, or dairy, those allergic to corn should steer clear.
  • Gastrointestinal distress. If you already experience gastric distress, erythritol may not be the sweetener for you. Sugar alcohols digest differently than sugar, which can lead to digestive side effects.

How Erythritol Causes Gastric Distress for Some

Erythritol is osmotic. Meaning it pulls water into the intestinal tract. If it’s consumed in excessive amounts, that can cause loose stools or diarrhea.

However, erythritol seems to be tolerated better than other low calorie sweeteners like xylitol.

What’s Wrong With the Recent Natural Sweetener Studies?

Erythritol is considered a safe sweetener for those who understand the possible toxicity of other sweeteners such as aspartame but let me elaborate on this new study of risk.    

I have researched Erythritol for many years and came to the conclusion in my mind that it was a safe method of sweetening foods and drinks.  Erythritol is a natural sugar alcohol, just like xylitol. As of 1997 it earned the status by the FDA as “generally recognized as safe.”

Are There any Risks to Using Erythritol?

The downside to this ingredient is occasionally stomach distress, gas or nausea in higher than normal amounts.   I am a very sensitive individual as to sweeteners so I cautiously started using it and found it very friendly to my gut unless large amounts were consumed.   

However the study that came out in February 2023 stated that found a link between circulating erythritol and cardiovascular risk.  This risk included heart attack, stroke and cardiovascular death. Sounds pretty scary no doubt.  However after digesting the details of the study and consulting others who I respect regarding its safety, I have little worries.   

What Researchers Saw

The investigators Witkowski et al. first identified erythritol as a molecule of interest by conducting analyses on fasting plasma samples from 1507 participants. This study plus two other independent studies in fasting levels related to cardiovascular risk showed a link between circulating levels of erythritol and heart events. The mechanism of action seems to indicate it enhances blood clotting. Sounds like a case closed, however not so fast, cowboy!  

The conflicting issue is that our body also produces erythritol through a process known as pentose phosphate pathway which relates to glucose metabolism.   

Dr Peter Attia, who I highly respect, states that we cannot come to a conclusion based on this study because we have no way of knowing which participants were consuming erythritol containing foods. In fact most of the study participants were enrolled prior to erythritol becoming popular.   

Type of Research Conducted

This research is referred to as an “observational study” which limits its information significantly due to limitations of how those studies are conducted.   

Dr Attia states, another flawed study of alarming headlines but thankfully the wise scientific community will set the record straight before panic spreads.   

Conclusion on Erythritol Studies

I state often that publications create 90% of health headlines to attract attention, create fear, or market something. When a headline about a new study comes out, I like to understand if the bold words mask a hidden agenda. This study on erythritol falls directly under the click-bait label.

I believe the value of the study could come from further research. In fact, circulating blood levels of erythritol actually could indicate risk. And we need to start checking that correlation. However, it is obvious that high levels likely have little to do with consumption from foods. And we need to look at natural endogenous formation within the body.   

My advice:  Continue to use erythritol, stevia, monk fruit, and xylitol. Reducing your intake of fructose or sugar is a must to the path of optimal health. I believe these natural sweeteners are a godsend on this path!    

Here we’re answering FAQs related to using Erythritol as a natural sweetener:

  1. Will erythritol negatively affect my hormones?

    Rather than negatively affecting hormones, some studies have shown erythritol positively affects hormones like insulin and glucagon. Other than those hormones, we find no current research linking erythritol to negatively affecting hormones.

  2. Will erythritol cause migraines?

    We find no current evidence of links to erythritol and migraines. As a matter of fact, many studies show a correlation between migraines and sugar intake or other types of artificial sweeteners. At this time erythritol seems to be a good substitute to those migraine causing foods.

  3. Will erythritol interfere with my medications?

    While we haven’t found any studies indicating contraindications between erythritol and medications, it’s best to always consult with your medical practitioner to discuss your specific medications

  4. Could I have an allergic reaction to erythritol?

    There are rare instances of allergic reactions noted after ingestion of erythritol. As with all foods, some people are sensitive to different substances. If you’ve experienced allergic reactions before, consult your medical professional for advice.

  5. Does Erythritol change the gut microbiome?

    A 2020 study shows no impact to the gut microbiome when consuming erythritol. Since erythritol is a sugar alcohol, it’s difficult to ferment it in the stomach. That means, there’s not much energy to feed good or bad bacteria. No feeding? No change.

  6. Will erythritol knock me out of ketosis?

    When erythritol is absorbed into the body, it’s excreted in the urine unchanged. That just means, there’s not a lot happening between going into the body and coming out. For this reason, it’s considered a “carb-free” sweetener. However, as with everything, it’s best to use things in moderation. There could be unknown side effects when consuming very large quantities of any type of food.

    Find keto friendly recipes here with our ideal protein recipes.
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