Artificial Sweeteners and Your Heart: What are the Dangers of Erythritol?

Michelle Routhenstein, MS, RD, CDE

By:

November 7, 2024

Artificial sweeteners, like erythritol, are often seen as fairly innocuous ways to reduce calorie intake from favorite foods and beverages. However, while they’re generally considered safe, we don’t have long-term data on potential health consequences. 

What are the dangers of erythritol, particularly when it comes to cardiovascular health? We’re exploring what the science says about erythritol and heart disease, including tips for reducing intake.

What is Erythritol?

Erythritol is a sugar alcohol used as a low-calorie sweetener in various foods and beverages. It naturally occurs in some fruits, like grapes and melons, but is commonly produced through the fermentation of glucose from cornstarch. It’s also made in our cells as part of normal metabolism. 

Erythritol provides about 70% of sugar’s sweetness but contains virtually no calories, making it a popular alternative to reduce sugar intake without sacrificing sweetness. When used as a sweetener, erythritol levels are more than 1,000-fold higher than what naturally occurs in food. 

Unlike other sugar alcohols, erythritol is mostly absorbed in the small intestine and excreted unchanged, reducing digestive discomfort. It doesn’t raise blood sugar levels or cause tooth decay, making it suitable for diabetics and those following a low-carb diet.

What are the Dangers of Erythritol? 

Erythritol (and other artificial sweeteners) has been generally considered safe for most people by regulatory bodies. However, not much is known about their long-term use yet. 

Plus, there is emerging evidence that erythritol consumption may have adverse heart health effects in some people. A 2023 study evaluating data from over 3,000 US and European adults found a link between higher blood levels of erythritol and an increased risk of cardiovascular events like heart attacks and strokes

Specifically, those who had the highest levels of erythritol in their blood (top 25%) were nearly twice as likely to have cardiovascular events over the following three years as those who had the lowest blood levels (bottom 25%).

To understand the “why” behind this association, they directly exposed human platelets to erythritol. This increased platelet sensitivity to blood clotting signals and, in animal studies, more erythritol in blood sped up clot formation. 

To further examine the link between diet and erythritol levels, the researchers measured blood levels of erythritol in 8 healthy adults after they drank an erythritol-sweetened beverage. Blood levels increased 1,000-fold, where they stayed for several days, influencing platelet behavior. 

The study suggested that erythritol could promote the formation of blood clots, which may increase the risk of heart disease, heart attacks, and strokes among people who are already susceptible. 

Erythritol and Heart Disease: Is There a Link?

Does consuming erythritol increase your risk of heart disease? Maybe, but there’s some nuance here. First, some medical professionals explain that our bodies make erythritol, and usually, if you’re not metabolically healthy, your body will make more of it

This increase is thought to be linked to the body’s response to oxidative stress and inflammation often associated with metabolic disorders, such as obesity and type 2 diabetes. There may be flaws in some study designs on the potential association. 

On the other hand, as we can see from that 2023 study and other recent research, erythritol can increase platelet reactivity among healthy people, so we may want to reduce intake.

Overall, given the prevalence of erythritol in artificially sweetened foods and drinks, it’s not a bad idea to 1) know what sources you might be consuming and 2) moderate your intake, especially until we have more safety data.

How to Reduce Your Erythritol Intake

Erythritol is often used to provide sweetness without the calories from added sugars in things like:

  • Sugar-free and keto-friendly products: Erythritol is commonly found in sugar-free snacks, desserts, and keto products like cookies, chocolates, and ice creams.
  • Beverages: Many diet or low-sugar drinks, including flavored waters and energy drinks, use erythritol.
  • Sugar substitutes: Erythritol is often a key ingredient in sugar substitute blends marketed as low-calorie or zero-calorie sweeteners.
  • Baked goods: Sugar-free or reduced-sugar baked goods like cakes, muffins, and pastries frequently contain erythritol.
  • Protein bars and shakes: Many “healthy” protein bars, shakes, and powders use erythritol for sweetness without added sugar.

If you’re looking to reduce your intake of this artificial sweetener, here are a few actionable tips.

Prioritize minimally processed foods

Minimally processed foods have not undergone significant processing (compared to ultra-processed foods). 

Prioritizing your intake of fruits, vegetables, nuts, seeds, whole grains, legumes, and other lean proteins — over items like freezer meals, baked goods, and packaged snack items — is the best way to avoid extra ingredients you may be looking to avoid, like erythritol. 

Read labels carefully

While the FDA does not require quantities of artificial sweeteners to be listed, the only way to know whether a product contains erythritol is to check the nutrition facts panel. Many times, it’s combined with other artificial sweeteners. 

Avoid sugar-free foods and drinks

Sugar-free, “light” and “diet” products often contain erythritol and other artificial sweetening agents to save on calories, so avoiding these is an easy way to reduce your intake. However, this doesn’t mean sugar-sweetened beverages are a healthier alternative. 

After all, regular consumption of added sugar is associated with insulin resistance, obesity, and related metabolic conditions. Ideally, you’ll want to prioritize water for hydration. 

Use other natural sweetening agents

You might want to use other natural sweetening agents like honey, maple syrup, or date syrup instead of erythritol to avoid potential cardiovascular risks. These alternatives offer natural sweetness and may even provide some antioxidants and minerals. Added sugar can have a place in the diet, but no sweetening agent offers health benefits in excess.  

Bottom Line: Erythritol and Heart Disease 

While the occasional use of artificial sweeteners like erythritol can be okay, there’s not enough evidence on their long-term health consequences to recommend them regularly (or not). Plus, the recent research suggesting that erythritol can increase the risk of cardiovascular disease warrants more caution. 

If you’re interested in exploring your overall cardiovascular wellness and identifying areas for improvement, I can help. I offer group coaching and 1:1 counseling where we will focus on reducing your risk of heart disease through personalized, science-based nutrition and lifestyle practices. Sign up for a complimentary 15-minute discovery call with me here

FAQs

What’s the difference between erythritol vs stevia?

Erythritol is a sugar alcohol that provides sweetness with virtually no calories, while stevia is extracted from the leaves of the Stevia plant, offering a zero-calorie option. Stevia is 200-300 times sweeter than sugar while erythritol provides about 70% of sugar’s sweetness.

Are allulose vs erythritol the same thing?

No, allulose is a rare sugar found in small amounts in fruits like figs, while erythritol is a sugar alcohol typically made through fermentation. Both are low-calorie sweeteners, but allulose has a taste and texture more similar to sugar, whereas erythritol can have a slightly cooling effect in your mouth.

Is there a difference between erythritol vs monk fruit?

Yes, erythritol is a sugar alcohol while monk fruit comes from the monk fruit plant, offering intense sweetness without calories. Monk fruit can be up to 300 times sweetener than sugar so it’s often mixed with erythritol.

What’s the difference between erythritol vs xylitol?

Erythritol and xylitol are both sugar alcohols, but erythritol contains almost no calories and is primarily absorbed in the small intestine. Xylitol has a similar sweetness to sugar but around 40% fewer calories. Both can trigger digestive discomfort if consumed in large amounts. 

Sources

  1. Ortiz SR, Field MS. Mammalian metabolism of erythritol: a predictive biomarker of metabolic dysfunction. Curr Opin Clin Nutr Metab Care. 2020 Sep;23(5):296-301. doi: 10.1097/MCO.0000000000000665. PMID: 32412980.
  2. Mazi TA, Stanhope KL. Erythritol: An In-Depth Discussion of Its Potential to Be a Beneficial Dietary Component. Nutrients. 2023 Jan 1;15(1):204. doi: 10.3390/nu15010204. PMID: 36615861; PMCID: PMC9824470.
  3. NIH.gov. (2023). Erythritol and cardiovascular events. Retrieved from:  https://www.nih.gov/news-events/nih-research-matters/erythritol-cardiovascular-events
  4. Mazi TA, Stanhope KL. Erythritol: An In-Depth Discussion of Its Potential to Be a Beneficial Dietary Component. Nutrients. 2023 Jan 1;15(1):204. doi: 10.3390/nu15010204. PMID: 36615861; PMCID: PMC9824470.
  5. Mazi TA, Stanhope KL. Elevated Erythritol: A Marker of Metabolic Dysregulation or Contributor to the Pathogenesis of Cardiometabolic Disease? Nutrients. 2023 Sep 16;15(18):4011. doi: 10.3390/nu15184011. PMID: 37764794; PMCID: PMC10534702.
  6. Witkowski M, Nemet I, Alamri H, Wilcox J, Gupta N, Nimer N, Haghikia A, Li XS, Wu Y, Saha PP, Demuth I, König M, Steinhagen-Thiessen E, Cajka T, Fiehn O, Landmesser U, Tang WHW, Hazen SL. The artificial sweetener erythritol and cardiovascular event risk. Nat Med. 2023 Mar;29(3):710-718. doi: 10.1038/s41591-023-02223-9. Epub 2023 Feb 27. PMID: 36849732; PMCID: PMC10334259.
  7. FDA.gov. (2024). Changes to the Nutrition Facts Label. Retrieved from: https://www.fda.gov/food/nutrition-food-labeling-and-critical-foods/changes-nutrition-facts-label 
  8. Cramer T, Gonder U, Kofler B. Plasma erythritol and cardiovascular risk: is there evidence for an association with dietary intake? Front Nutr. 2023 May 23;10:1195521. doi: 10.3389/fnut.2023.1195521. PMID: 37287998; PMCID: PMC10242034.
  9. Peteliuk V, Rybchuk L, Bayliak M, Storey KB, Lushchak O. Natural sweetener Stevia rebaudiana: Functionalities, health benefits and potential risks. EXCLI J. 2021 Sep 22;20:1412-1430. doi: 10.17179/excli2021-4211. PMID: 34803554; PMCID: PMC8600158.
  10. Shivani, Thakur BK, Mallikarjun CP, Mahajan M, Kapoor P, Malhotra J, Dhiman R, Kumar D, Pal PK, Kumar S. Introduction, adaptation and characterization of monk fruit (Siraitia grosvenorii): a non-caloric new natural sweetener. Sci Rep. 2021 Mar 18;11(1):6205. doi: 10.1038/s41598-021-85689-2. PMID: 33737610; PMCID: PMC7973523

© Copyright 2024 Entirely Nourished, LLC. All Rights Reserved. Terms. Privacy Policy. Disclaimer.

Brand and web design by