Erythritol has become a favored sugar substitute in the realm of low-calorie, ketogenic, and high-protein products. Marketed as a natural, zero-calorie sweetener that doesn’t spike blood sugar, it's found in various items, from sugar-free protein bars to low-carb desserts and energy drinks. However, recent research suggests that this sugar alcohol may not be as harmless as previously thought.
What is Erythritol?
Erythritol is a sugar alcohol that occurs naturally in some fruits but is often produced industrially through the fermentation of corn. It possesses about 70% of the sweetness of sugar and is known for its minimal impact on blood glucose and insulin levels. Because of this, it's a common ingredient in "healthy" alternatives for people with diabetes or those following ketogenic or low-carb diets.
Why the Popularity?
Erythritol is popular because it has:
- Zero calories
- Low glycemic index
- Tooth-friendly qualities
- Suitability for keto and diabetic diets
- Natural derivation
These benefits have made erythritol a go-to sweetener for health-conscious consumers, but emerging research suggests its effects on the body may be more complex than previously understood.
Recent Research and Concerns
Two major studies have recently raised concerns about erythritol's impact on cardiovascular and metabolic health:
Read also: Easy Low-Carb Cheese Crackers
Erythritol and Brain Vascular Cell Damage (Berry et al., 2025)
A study published in the Journal of Applied Physiology examined how erythritol affects human brain microvascular endothelial cells (the cells lining small blood vessels in the brain). Researchers found that erythritol:
- Increased oxidative stress
- Reduced nitric oxide (NO), which helps blood vessels relax
- Increased endothelin-1, a vasoconstrictor
- Suppressed tPA, a key enzyme that breaks down blood clots
These findings suggest that erythritol may contribute to vascular dysfunction and increase the risk of blood clots and stroke, especially concerning for people with existing cardiovascular risk factors.
Erythritol Linked to Increased Risk of Heart Attack and Stroke (Witkowski et al. 2023)
A large-scale study published in Nature Medicine investigated erythritol levels in the blood and their association with major adverse cardiovascular events (MACE) such as heart attack and stroke. The study, which included individuals in the U.S. and Europe, found that individuals with higher erythritol levels had a significantly increased risk of experiencing these cardiovascular events.
Beyond observational data, laboratory experiments showed that erythritol enhanced platelet reactivity and clot formation, providing a plausible biological explanation for the clinical findings. The researchers noted that erythritol remained elevated in the blood for many hours after ingestion, particularly concerning for people who frequently consume erythritol-rich products.
These results underscore the need for further clinical studies, but they also suggest that regular use of erythritol may not be advisable for those with existing cardiovascular risk factors.
Read also: Keto Calorie Counting: A Detailed Guide
Interpreting the Research: Should You Be Concerned?
These studies don't mean you should immediately stop consuming anything with erythritol. However, they do raise red flags, especially for people with heart disease, diabetes, or those who frequently consume large amounts of sugar alcohols. As with many things in nutrition, "natural" doesn’t always mean safe. The dose matters, and long-term human studies are still needed to fully understand erythritol's health impact.
Expert Opinion
Stanley Hazen, MD, PhD, a specialist in preventive cardiovascular medicine, led a study highlighting the risks of erythritol. He explains that while our bodies naturally create erythritol, the high doses from packaged foods are causing adverse effects. His study showed that erythritol is closely associated with risk for major adverse cardiovascular events. People with more erythritol in their blood were at elevated risk for major heart problems. He also notes that serving of erythritol in common ‘keto-friendly’ processed food products made blood levels of erythritol go up 1,000-fold, well above the levels linked to enhanced clotting risks. He emphasizes that this research shows that we should be really cautious about eating processed foods containing erythritol.
Erythritol Uses
Erythritol is often used as a replacement for table sugar in low-calorie and low-sugar products. It’s also included as an ingredient to “bulk up” some other artificial sweeteners. It’s a favorite of food manufacturers for two big reasons. First, it’s very low in calories, which makes it ideal for “diet” foods. Second, its taste and texture are closer to table sugar than some other non-nutritive sweeteners. Erythritol is added to many sugar substitutes that are sold as “natural” alternatives to sugar, including some (but not all) formulations of stevia and monk fruit sweeteners. Sugar-free products containing erythritol are often recommended for people who have obesity, diabetes or metabolic syndrome and are looking for options to help manage their sugar or calorie intake. And those products may not say on their nutrition labels whether they include erythritol or other sugar alcohols.
How to Avoid Erythritol
It's important to note that the FDA considers erythritol safe because it’s a naturally occurring compound. But the problem is that the quantities it’s used for in foods are much, much higher than what is natural and known to be safe for your body. While your foods may not state specifically that they contain erythritol, Dr. Hazen adds that it’s commonly found in items like sugar-free varieties of:
- Ice cream
- Candy
- Gum
- Cookies
- Cakes
- Protein bars
- Fruit spreads
- Energy drinks
There are some red flags that can be a hint that your food may contain erythritol (or another sugar alcohol), even if it’s not listed on the nutrition label. If the package includes these words or similar claims, it may indicate your food contains erythritol:
Read also: Magnesium Supplements for Keto
- Contains sugar alcohol
- Keto-safe
- Diabetes-safe
- No sugar
- Low-sugar
- Artificially sweetened
- Naturally sweetened
- Sweetened with natural compounds
- Low-calorie
- No calories
One sure way to avoid erythritol is to focus your diet on whole foods. That means natural, non-packaged foods, like fresh fruits and vegetables. And if you need something a little sweet, Dr. Hazen advises using stevia - in a dropper, not a packet. Granulated artificial sugars often include sugar alcohols like erythritol as a “carrier.”
Keto-Friendly Sweeteners: A Broader Perspective
Following a ketogenic diet involves cutting back on high carb foods like starches, desserts, and processed snacks. This is essential to reaching a metabolic state called ketosis, which causes your body to begin breaking down fat stores instead of carbs to produce energy. Ketosis also requires reducing sugar consumption, which can make it challenging to sweeten beverages, baked goods, sauces, and dressings.
Other Keto-Friendly Sweeteners
Fortunately, there are various low carb sweeteners that you can enjoy. These include:
- Stevia: A natural sweetener derived from the Stevia rebaudiana plant. Unlike regular sugar, animal and human studies have shown that stevia may help lower blood sugar levels.
- Sucralose: An artificial sweetener that is not metabolized, meaning it passes through your body undigested and thus doesn’t provide calories or carbs.
- Xylitol: Another type of sugar alcohol commonly found in products like sugar-free gum, candies, and mints. Because the carbs in xylitol don’t raise blood sugar or insulin levels the same way as sugar, they don’t count towards the total amount of net carbs.
- Monk Fruit: A natural sweetener extracted from the monk fruit, a plant native to southern China. Monk fruit extract contains no calories and no carbs, making it a great option for a ketogenic diet.
- Yacon Syrup: Comes from the roots of the yacon plant, a tuber widely grown in South America. Human and animal studies suggest that yacon syrup may help lower blood sugar and insulin levels.
Sweeteners to Avoid on Keto
Watch out for sweeteners that are high in sugar and carbs when following a ketogenic diet. A key part of following a ketogenic, or keto, diet is reducing your sugar intake. This is necessary for your body to enter ketosis, a state in which your body burns fat rather than sugar for energy.
Sweeteners to avoid include:
- Maltodextrin
- Honey
- Coconut Sugar
- Maple Syrup
- Agave Nectar
- Dates
Sugar Alcohols: A Detailed Look
Sugar alcohols are sweeteners that have tastes and textures similar to those of sugar, but fewer calories and a less significant effect on blood sugar levels. As a result, they can be a satisfying option for individuals looking to reduce their sugar intake, such as those following a keto diet.
Common Sugar Alcohols
Common sugar alcohols you may see on food labels include:
- Erythritol
- Isomalt
- Maltitol
- Sorbitol
- Xylitol
Due to their low calorie contents, sugar alcohols are frequently used to sweeten sugar-free or diet products like gum, yogurts, ice cream, coffee creamers, salad dressings, and protein bars and shakes.
Glycemic Index of Sugar Alcohols
When you eat sugar, your body breaks it down into smaller molecules. These molecules are then absorbed into your bloodstream, which causes your blood sugar levels to rise. In contrast, your body cannot fully break down and absorb carbs from sugar alcohols. As a result, they cause a much smaller rise in blood sugar levels.
Here are the GI values of common sugar alcohols:
- Erythritol: 0
- Isomalt: 2
- Maltitol: 35-52
- Sorbitol: 9
- Xylitol: 7-13
Overall, most sugar alcohols have negligible effects on your blood sugar levels. To compare, white table sugar (sucrose) has a glycemic index of 65.
Sugar Alcohols and the Keto Diet
Given that they negligibly affect blood sugar levels, most sugar alcohols are considered to be keto-friendly. Maltitol has a more pronounced effect on blood sugar and should be limited on a keto diet.
Potential Side Effects
When consumed in normal amounts through food, sugar alcohols are considered safe for most individuals. However, they do have the potential to cause digestive issues, especially in larger amounts. Side effects like bloating, nausea, and diarrhea have been observed when intake of sugar alcohols exceeds 35-40 grams per day. Additionally, individuals with irritable bowel syndrome (IBS) may experience negative side effects with any amount of sugar alcohols. As a result, if you have IBS, you may want to avoid sugar alcohol completely.
The ChocZero Perspective
ChocZero is a company that uses monk fruit to sweeten all of its products. They avoid sugar alcohols like erythritol because, as a company, they do not think sugar alcohols are a good enough quality for their customers. They believe food should taste good and be filled with quality ingredients. ChocZero also does not use artificial sweeteners like aspartame. Instead, they derive their sweetness naturally from monk fruit then add a healthy prebiotic fiber called soluble corn fiber (resistant dextrin) to all of their products.
Responsible Sweetening: A Balanced Approach
Whether you’re Keto or simply eating healthy, minimizing sugar makes tons of sense. The less sugar you eat, the lower your risk for obesity and a broad spectrum of chronic diseases. While we no longer recommend erythritol, we still think consuming limited amounts of stevia, monk fruit, and allulose is okay. But to be on the safe side, use them sparingly.
Consider sweetening your coffee with stevia 1-2 times weekly. (Not daily.) Make allulose cookies on the holidays. (Not every Friday.) Have monk fruit pudding as a special treat. (Not a post-dinner ritual.) The more rarely you consume sweet foods, the more you’ll enjoy them. It’s the psychology of pleasure. If you eat sweets constantly, your tastes adapt. But if you make them a treat, that’s exactly what they’ll be. Scarcity makes everything better.
tags: #is #erythritol #keto #friendly?