Erythritol: How It’s Made, Safety Concerns, Substitutes

Erythritol is touted as a zero-calorie sweetener. It is a sugar alcohol that occurs naturally in fruits such as watermelon, grapes, and pears, as well as in fermented foods such as soy sauce and cheese.

For those monitoring calories, it adds sweetness without cost to the diet. While erythritol is popping up in more and more foods, the public has not yet entirely made up its mind about it.

In this article, you'll find out what erythritol is, whether it is considered good or bad for you, how much you can safely have, and what you need to know to be a savvy consumer of this sweetener.

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Erythritol is a carbohydrate classified as a sugar alcohol that occurs in tiny amounts in fruits, vegetables, and even human cells (produced by our metabolism). So, it is natural. It is not digested to be used for energy by the body. Rather, it is absorbed into the blood and excreted in the urine.

Erythritol is 70% as sweet as sucrose (table sugar). Since the amount of this sugar alcohol in sweeteners is 1,000 times greater than amounts found in nature, erythritol falls under the artificial sweetener umbrella. It is made commercially by a natural process of microbes such as yeast-fermenting corn.

Erythritol has some definite benefits to its use but also some drawbacks. If you're looking for a sugar substitute, you may wish to weigh the facts.

Research finds that erythritol may cause side effects, such as:

The link to cardiovascular events came to light in a study published in 2023. Study findings show that those with levels of erythritol in the top 25% range had twice the risk of cardiovascular issues as those in the lowest 25% range. Researchers think erythritol may increase the chances of blood clot formation. But further research is needed on this.

On the positive side, this sweetener can offer real benefits for dental health. It has proven effective at minimizing the development of cavities and keeping bacterial growth in the mouth low.

Erythritol also has the potential to benefit those with diabetes since some research shows it doesn't affect blood insulin or glucose levels the way sugar does. This makes it safer than table sugar (sucrose) for people with diabetes.

Research shows erythritol can reduce inflammation in the small intestine caused by eating a high-fat diet. Investigators found erythritol decreased the expression of genes causing inflammation in the small intestine. Erythritol reduced disorders such as glucose intolerance, obesity, abnormal blood fat levels, and fat accumulation in the liver.

It's easy to see why some people may be wild about erythritol while others are wary.

Since erythritol can cause digestive side effects if you eat too much of it, it's important to know the accepted limits and then find out what yours are.

In general, it's OK to take in about 0.66 grams per kilogram (g/kg) of body weight a day for men and 0.80 g/kg of body weight a day for women. (Note that when research or health authorities are cited, the terms for sex or gender from the source are used). This would be 60 grams (2.1 ounces) for a 200-pound man and 54 grams (1.9 ounces) for a 150-pound woman.

But in some, doses as high as 1 g/kg of body weight per day can be consumed without digestive side effects. That would be 90 grams (3.2 ounces) for a 200-pound person, 68 grams (2.4 ounces) for a 150-pound person, and 54 grams (1.9 ounces) for a 120-pound person. All in all, it's a question of finding your limits.

If erythritol does not agree with you, there are other sugar substitutes you can try, such as the following:

Keep in mind that the artificial sweetener Truvia contains both erythritol and stevia. Avoid Truvia if you have issues with erythritol. Consider taking a sweetener that contains just stevia since there are differences between these two.

Stevia is made from the leaves of the stevia plant. Although erythritol can be found naturally, the levels are too low in fruits, and it is instead produced commercially by yeasts through fermentation. Stevia is about 200 to 400 times sweeter than sugar. But erythritol is a much milder sweetener that provides only about 60% to 80% of the sweetness you get with sugar.

Finding sweeteners like erythritol on labels may require a little detective work. Rather than listing erythritol by name on the label, manufacturers usually use the broad term "sugar alcohol." Sugar alcohols are used in reduced-calorie foods like gum, cookies, cakes, candies, sweetened jellies and jams, pudding, and candies.

Remember, though, that erythritol is not the only sugar alcohol. Others include sorbitol, mannitol, lactitol, isomalt, xylitol, and hydrogenated starch hydrolysates (HSH).

Don't assume that because something is listed as "sugar-free" and contains sugar alcohol that it also is low in calories. It's possible for products containing sugar-alcohol substitutes to still have a large number of calories, fat, and carbohydrates.

To find out exactly what foods containing erythritol may be adding to your diet, check the nutritional facts label. It will break down the different components in the food, such as carbohydrates, cholesterol, and sodium.

Also, when looking for sugar amounts, remember to note the total carbohydrates, which will include sugar, sugar alcohols, and fiber. But do keep in mind that your body will only absorb about half of the sugar from most types of sugar alcohol. In figuring out the total amount of carbohydrates, such as when counting carbohydrates for diabetes management, you need to factor this in.

For those for whom sugar is currently not an option, the sweetener erythritol may be a viable alternative. It does occur naturally in some foods, but in such low amounts it must be artificially produced.

While it can offer benefits such as minimizing tooth decay and not affecting glucose or insulin levels, there's a potential downside as well. Erythritol has been linked to some heart issues. If too much is consumed, it can lead to digestive problems.

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Mazi TA, Stanhope KL. Erythritol: an in-depth discussion of its potential to be a beneficial dietary component. Nutrients. 2023;15(1):204. doi:10.3390/nu15010204

National Institute of Health. Erythritol and cardiovascular events.

Witkowski M, Nemet I, Alamri H, et al. The artificial sweetener erythritol and cardiovascular event risk. Nat Med. 2023;29(3):710-718. doi: 10.1038/s41591-023-02223-9

Kawano R, Okamura T, Hashimoto Y, et al. Erythritol ameliorates small intestinal inflammation induced by high-fat diets and improves glucose tolerance. Int J Mol Sci. 2021;22(11):5558. doi:10.3390/ijms22115558

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Center for Science in the Public Interest. Thaumatin.

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American Diabetes Association. Nutrition for life: sugar substitutes.

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Food & Drug Administration. Interactive nutritional facts label - sugar alcohol.

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By Maxine LipnerMaxine Lipner is a long-time health and medical writer with over 30 years of experience covering ophthalmology, oncology, and general health and wellness.