Many people are concerned about erythritol right now. They’re concerned because this noncaloric, Keto-friendly sweetener was recently linked to higher risks of major heart events in thousands of humans.[*]
Should you be worried too? That depends on your definition of worried.
If you’re being cautious with erythritol for now, that’s sensible. But if you’re panicking because you ate a small cup of erythritol ice cream last Tuesday, you may be overreacting.
We’ll explore why caution (not panic) makes sense as we address the question: “what are the dangers of erythritol?” We’ll also explore the safety of other Keto sweeteners, our sweetener recommendations, and how to think about sweetening responsibly.
First, though, let’s cover the basics of erythritol.
What Is Erythritol?
Erythritol is a sweet, indigestible carbohydrate called a sugar alcohol. It’s about 70% as sweet as sugar and contains nearly zero calories.[*]
Most sugar alcohols (xylitol, sorbitol, etc.) are low in calories because they’re not digested like ordinary carbohydrates. Instead of being absorbed through the small intestine and raising blood sugar, they pass through to the large intestine to become food for gut bacteria.
Erythritol works differently, though. It does absorb through the small intestine, but it absorbs intact—so you excrete 90% of it through urine.[*]
That’s why erythritol is nonglycemic (doesn't raise blood sugar) and calorie-free. It’s also why, until recently, we recommended erythritol for low-carb and Keto diets.
The New Erythritol Study
The February 2023 erythritol paper in Nature Medicine is making waves in the news media.[*] Let’s start with the most reported section: the observational findings.
The authors looked at several thousand people and found that higher circulating erythritol levels correlated with higher risks of heart attack, stroke, and cardiac death over three years.
In these situations, it’s helpful to remember that correlation is not causation. Could something else (besides consuming erythritol) explain the link between elevated erythritol levels and heart problems?
Possibly. As it happens, we produce erythritol (in our body) in the presence of inflammation, oxidative stress, diabetes, and other cardiovascular risk factors.
Were the high erythritol folks eating too many frozen desserts or just sick to begin with? Is consuming erythritol bad for you? The observational data can’t answer these questions.
Yes, the authors statistically controlled for well-known heart disease risk factors, but they didn’t test how much erythritol each person produced naturally. It’s a big fat question mark.
But wait, there’s more. The researchers also found erythritol increases platelet aggregation in test tubes and mice. (More platelet aggregation means a higher risk of blood clots that precipitate a heart attack or stroke.)
And here’s the kicker. Feeding eight humans a reasonable 30 grams of erythritol raised blood levels 1000x over baseline (for days) and increased platelet aggregation following ingestion.
To summarize, we have:
- Correlational data linking circulating erythritol to heart events
- A mechanism (blood clotting) that might explain the correlation
- Human evidence that consuming regular doses of erythritol raises blood clotting risk
It’s not an iron-clad case against this sugar alcohol. But it’s concerning enough to take erythritol off the recommended list.
Is Erythritol Safe? And Erythritol Side Effects
The FDA designates erythritol as GRAS (generally recognized as safe.) This designation, however, does not incorporate the recent findings.
And so, it’s probably wise to avoid erythritol until further notice. The data is strong enough to warrant caution.
Other sugar alcohols—xylitol, mannitol, maltitol, etc.—have similar safety profiles to erythritol.[*] But again, we don’t know enough about these molecules.
We do know that xylitol is lethal to dogs.[*] That’s a disturbing factoid, even to self-proclaimed cat people.
The side effects of erythritol (and sugar alcohols generally) tend to be gastrointestinal. We’re talking about bloating, gas, diarrhea, and the fun social consequences that come along with them.
Erythritol is usually better tolerated than xylitol, sorbitol, and the rest of the gang. But some folks have bad reactions to any sugar alcohol.
Fortunately, there are other sugar substitutes available.
What About Other Keto Sweeteners?
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.[*]
Many of us turn to noncaloric options to reduce sugar consumption. These Keto sweeteners include:
- Sugar alcohols—especially the nonglycemic erythritol
- Monk fruit
We covered sugar alcohols already. Proceed with caution.
Stevia and monk fruit are plant-based, zero-calorie sweeteners with a long history of traditional use.[*] They’re considered safe by the FDA, but (as with erythritol) our knowledge has limits.
For instance, some worry that stevia is an endocrine disruptor that interferes with sex hormones. This fear, however, is based on test tube data.[*] (Bathing sperm cells in stevia says little about ingesting stevia.)
Finally, allulose is another GRAS sweetener found in raisins and jackfruit (pass the jackfruit, Agatha!) with little long-term supporting data. It’s become popular because it feels and bakes like sugar, plus it may enhance fat burning after a meal.[*]
The Sweeteners We Recommend
Before the Nature Medicine study, the data on erythritol was mainly positive.[*] That’s why we—your friendly neighborhood Carb Manager—recommended it.
Things change. New data arrives. We must update our views. It’s part of staying informed and intellectually honest.
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.)
Understand: higher usage might be healthy—even beneficial. But the erythritol findings highlight the need for prudence in these matters.
We Don’t Need Sweeteners
For most of human history, people survived without sweeteners. Early hominids weren’t drinking stevia soda.
We evolved to enjoy sweet things because sweet things (like fruit) were a dense source of calories. And because finding these treats happened infrequently.
This brings us to an important principle. 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.
You can also use whole food flavors to add a hint of sweetness to your bakes and hot beverages.
Anyways, it’s up to you how to proceed. Although the recent study doesn’t prove erythritol is harmful, it’s a reasonable step to avoid this sugar alcohol going forward. We’ll keep you updated on erythritol (and other Keto sweeteners) so you can continue making informed decisions about your health.
brendadouglas0eb43 4 days ago
Really great information. I'll stick with the natural sweetness at a minimum.
FortuitousCauliflower923288 4 days ago
I find that unrefined coconut oil in my coffee adds a nice flavor and aroma without adding sugar.
Cielamadrone 21 days ago
I remember my dentist giving me sugar-free lollipops in the 1980s that were sugar alcohol sweetened. I think we need more info before deciding if erythritol is a danger but I agree that we should be avoiding all sweeteners as this article suggests. Look at what happened with saccharine- which was considered a perfectly safe sugar substitute for years.
angeliKITTYx 23 days ago
dang I just bought a bag of monk fruit + erythritol from Costco. I will be more conscious about using it sparingly!
MomLife87 22 days ago
I think monk fruit is a lot safer less reactive from people I’ve talked to that had a sensitivity to erythritol
MirthfulKale686197 a month ago
I think we should look into maple syrup for coffee! Something more natural and unprocessed.
FortuitousAvocado460670 a month ago
I hope that further updates come out for this. I suffer migraines from Splenda and aspartame and major digestive issues from monk fruit. This has been the one sugar I mostly tolerate and enjoy daily in my coffee. I am not ready to drink sugarless coffee. When will regular sugar in moderation be ok? It also comes from a plant!
FortuitousCauliflower923288 4 days ago
That makes sense to me, as long as you have it during your eating window with your meal and count the carbs…
NanaGibbs 19 days ago
I love sweet coffee but have switched to heavy creamer in my coffee and I am able to tolerate not putting sugar in my coffee. I think I’ll get used to it!
JustMe!! a month ago
Yeah, I believe it's best in general, to consume natural foods that weren't concocted in a lab lol. Ingesting sweets as nature intended will always be the healthiest route. The natural juices extracted from fruit, honey, molasses, maple syrup and such... these natural sweetners will be the most healthy go-tos if used respectfully in moderation. Fooling around with nature will always have its consequences. Just my thoughts 😝😜
CoffeeBaconCheeseOHMY 21 days ago
👏🏽👏🏽👏🏽 EVERYTHING you just stated!!!! For me, COFFEE makes the world go round! I stopped using artificial sweetener (Splenda) appx 10 years ago, which literally & immediately ended my overactive bladder issue! I indulge in 1 mug of flavored coffee every morning. The thought of drinking unsweetened coffee or not having my version of liquid crack is just...OMG devastating LOL but I'm serious...developed a headache typing this lol
Chesapeake71 a month ago
Thanks for the update and a well-balanced report. As a side note, my most successful stretches of weight loss and ketosis maintenance were when I had weaned myself from feeding the sweet tooth. Even with sugar completely gone from my diet, the substitutes were still triggers for more sweet stuff and more calories. After a while the urge for sweets was almost gone.
UnbelievableKetone693518 a month ago
As a certifiable Sugarholic, I need to change my ways or The Grim Reaper will have his way with me in short order. This article was very helpful though and I feel comfortable having a small amount of erythritol with my protein pancakes once a month. It’s the best replacement I have found for maple syrup.
AmazingApple 🍎 a month ago
Cool. I hardly use sugar. not a baker nor a cook. I sweetened my coffee with splash of coconut and almond milk. That’s it!
FabulousKale881783 a month ago
Thx for the update.
UpbeatKale953677 a month ago
I just started and I always had to have 2 sweet lows in my coffee.addicted to the stuff! I bought some liquid stevia then today I saw it has erythritol in it and panicked but after reading this it made me feel ok so I will use a lil squirt in my butter coffe👍😃
FabulousAvocado434254 a month ago
Certainly most studies need to be done. We’ve seen this kind of medical news many times in the past, solid evidence is based on solid data, yet to be seen
FortuitousKetone761606 a month ago
I will continue to use erythritol, unless a more credible study is done- with healthy adults- that reliably measures the data pertaining to consuming it.
SuperCauliflower710796 2 days ago
Thomas Deleur did a good YouTube video on this study.
JustMe!! a month ago
I find it interesting that you would rather choose to continue using until... Rather than discontinue using until... Very interesting lol. Just my thoughts.
StephLovesAvocado+MTG a month ago
Yes! It’s like the study wasn’t even read for this article, just someone’s interpretation of it.