Erythritol: Benefits and Risks

Dr. Christopher McGowan
August 4, 2020

You can’t pay much attention to your health in the United States and escape the consistent calls to cut sugar from your diet. It seems sugar is taking a beating these days as new studies link sugar intake to a host of medical issues. 

Avoiding sugar is not as easy as you might think. Sugar is hiding in nearly all the foods we eat. From baked goods to canned tomato sauces and even diet-centric granola bars, sugar seems to be lurking everywhere. Eliminating sugar entirely from your diet might be possible, but it would often leave you eating a bland, cardboard-flavored diet sure to drive nearly anyone to a sudden craving for donuts or ice cream. So, what do you do if you want to avoid sugar but still want that sweet taste?

Thankfully sugar substitutes like erythritol are the answer. Alternatives to regular sugar are abundant, and even if you aren’t seeking out “sugar free” labels at the grocery store, you are probably already consuming more of these alternative sweeteners than you think.

What Is Erythritol?

Erythritol is a naturally occurring sugar alcohol found in fruits such as grapes, watermelon, and pears. It is a member of the polyol family, and is related to other sugar alcohol sweeteners such as mannitol, sorbitol, and xylitol. Erythritol is not easily metabolized by your body, and is therefore considered a zero-calorie sweetener that can be used in place of transitional sugar. Erythritol has few of the side effects common to other forms of artificial sweetener, such as diarrhea and bloating. 

During the last century, the average American diet changed to include more and more sugar. As our diet transitioned, waistlines expanded and we began looking for new ways to pack in the sweet taste without packing on the pounds. The question arises, though, if food is sugar-free and still tastes sweet, where is that taste coming from? It may surprise you to know that even though sugar has a powerful hold on the Western diet, there are far more powerful sweeteners in nature and a few more we have come up with on our own. 

These days, there are sugar-free options available for products in nearly every aisle of the grocery store. The hunt for the perfect zero-calorie sweetener has yielded additives like Splenda, NutraSweet, and others that have become household names. Sugar-free products can also be made from natural sweeteners. This can include extracts from plants like stevia, as well as a family of naturally occurring chemicals known as sugar alcohols. One of these sugar alcohols is a promising and relatively new product known as erythritol. Erythritol may not be a name you have heard, but you have almost certainly eaten this polyol food additive.

How Does Erythritol Work?

To understand how sugar alternatives work, you have to break the link between what sugar is and how it tastes. The sucrose that makes up sugar is chemically very different from polyols, but the sweet taste we associate with sugar can be found in many different substances. 

Polyols have long been used to create natural alternatives to artificial sweeteners such as saccharin and aspartame. Unlike common table sugar, or sucrose, which is extracted from sugarcane, polyols like erythritol are fermented from simple sugars such as dextrose. In commercial production, this dextrose is found in plants such as corn.

Erythritol can be used to add a sweet flavor and still claim that “zero calorie” label on beverages because of how sugars and sugar alcohols are digested by your body. Erythritol is processed out of your body quickly by the small intestine, and is moved through your bloodstream and out of your body before you have a chance to metabolize it. Unlike regular sugar, erythritol is not readily converted into glucose. 

Since erythritol is not metabolized in the same manner as glucose, there are various positive health effects you can gain from switching to sugar alternatives. If you have been directed to cut calories as part of a weight loss program, erythritol is an attractive sugar replacement. Since your body does not convert it into glucose in the same way as sugar, the metabolic energy in erythritol simply passes unused through your body. 

Management of blood sugar levels can also be a reason to switch from sugar to a substitute like erythritol. Individuals diagnosed with diabetes need to be careful about monitoring blood sugar levels, and taking in large amounts of traditional sugar can wreak havoc on the careful management of glucose levels in your blood. Studies show that erythritol can help manage post-meal blood sugar levels and even blood pressure. There have even been studies that suggest there may be benefits to the health of vascular tissue for diabetic individuals who regularly consume erythritol. 

From a weight loss perspective, the bottom line is that consuming foods made with erythritol results in fewer calories being absorbed into your body than eating similar foods containing sugar.

Is Erythritol Safe?

We have covered the potential health benefits of erythritol like lower caloric intake and better oral health. There are even surprising benefits such as improvements in vascular health for individuals with type 2 diabetes who switch from sugar to erythritol. Before you start thinking sugar substitutes have nothing but upsides, it is important to know there are some potential drawbacks. 

Understanding whether a sugar substitute is safe for you can be complicated. Just because the FDA gave a stamp of approval to an additive does not mean your body will react well to it, or that it is ideal in all situations. There is understandable confusion about artificial sweeteners, as that catch-all term is commonly used to refer to a range of compounds, some of which are actually naturally occurring sugar alcohols.

Taken out of proportion nearly any substance can harm you, so your focus in food safety should be on whether a reasonable amount of any given food or additive is generally recognized as safe. The Food and Drug Administration (FDA) finally gave approval in 2001 to use erythritol in food. As naturally occurring sugar alcohols, polyols are not as prone to causing problems in people when consumed in reasonable amounts. In fact, it has been estimated that on average, a 150 lb. individual can tolerate a whopping 13 teaspoons of erythritol a day—an amount almost four times larger than you are likely to consume normally. 

No matter what you use to sweeten your food, there can be negative consequences for your health. Studies have generally been positive in their evaluation of erythritol for the wider population, but some research has linked erythritol to severe morbidity in young adults. While this sugar alcohol has been approved by the FDA, it is important to remember that we still have less than two decades of serious research behind understanding the long-term effects of consuming erythritol. More research needs to be completed before we know the full picture of the positive and negative effects of consuming large amounts of this sugar alcohol. 

There is a delicate art to finding chemicals that are not readily digested by the body but do not cause you harm or discomfort. Everything you eat will be handled by your intestines in some way, and too much of certain chemical compounds can cause problems. Many different sugar substitutes have been found that do not result in caloric gain by the body, but that does not mean they pass through your body without effect.  

Erythritol Side Effects

One of the most recognized side effects caused by many sugar substitutes is diarrhea. This unpleasant effect may seem like an odd outcome from a sugary drink or “sugar free” snack, but it turns out there is a very solid reason for this. Some artificial sweeteners can draw water into your intestines as you try to digest them. This can leave you with a condition known as osmotic diarrhea and, somewhat paradoxically, you may become dehydrated because of something you drank. Some sugar alcohols are known to have this effect, but erythritol is not on that list. This is good news, as the diarrhea and consequent dehydration associated with other sugar substitutes can be a serious concern to children and the elderly. 

Osmotic diarrhea and dehydration is not only a concern for the elderly. If you have undergone a surgery or procedure that alters the size of your stomach, it may be hard for you to consume enough liquid to maintain proper hydration. For this reason, people who have undergone weight loss procedures should take extra care to avoid drinks with mannitol and certain other sugar alcohols.

Bloating is another effect associated with sugar substitutes. Many sugar alcohols can be fermented in the gut. This process gives off gas that can lead to bloating and embarrassing flatulence. Here again, erythritol emerges as a winner. Your gut bacteria do not ferment erythritol, which largely eliminates another worrisome side effect of consuming erythritol. 

Many studies have determined erythritol is generally considered safe for consumption by adults, and may even have benefits for people with diabetes or other health conditions. For children, however, there is some debate about how healthy erythritol actually is. 

Some studies have suggested a link may exist between consuming large amounts of erythritol and juvenile adiposity, known more alarmingly as morbid obesity. This is a potentially serious finding, and underscores the general advice that lowering the amount of sweeteners of all kinds is important in kids’ diets. More research is needed to fully verify any link between obesity, body composition, and levels of erythritol that are safe for various age groups.  

Erythritol Side Effects and Weight Loss Benefits

A lot of attention has been given to the potential downsides of artificial sweeteners and sugar substitutes, but sugar itself is far from clear of any bad press. Everything you eat will have some kind of effect on you, and sugar has quite the list of negative side effects. Sugar combines with bacteria in your mouth to create acids that lead to tooth decay. Eating large amounts of sugar has also been linked to diabetes, inflammation, and heart disease. 

If you are looking to avoid these well-documented, detrimental effects of sugar, erythritol provides a compelling alternative. Erythritol does not increase your chances of tooth decay and other dental issues when compared to a high-sugar diet. You should still do what you can to reduce the amount of sweeteners you eat, but along the way you can take some comfort in knowing swapping some sugar for erythritol provides some benefits. 

If you are working toward a new weight loss goal, whether for aesthetic or health reasons, the empty calories found in sugar will only get in the way of your attempt to lose weight. This can be an inconvenience if you are trying to drop a few pounds, but things get more serious if you have undergone weight loss surgery, bariatric revision, or another weight loss procedure. Once your body, and the food you eat to power it has changed forever, you need to be very careful about counting every calorie carefully. 

Here additives like erythritol can be very beneficial. Since erythritol isn’t metabolized into your body and doesn’t draw water into your intestines, you get the added benefits of avoiding empty calories and staving off the dehydration caused by other alternative sweeteners.

The Effects of Erythritol on Blood Sugar and Insulin

If you have type 2 diabetes, managing your blood sugar levels has to become a way of life. Knowing the effect the food you eat will have on the amount of glucose in your blood is essential to staying healthy and living well. When sugary foods or drinks are added into the mix, you may experience major changes in your insulin levels in the hours immediately following a meal. Here additives like erythritol come to the rescue. Research has demonstrated erythritol has no significant impact on blood sugar levels in the crucial first hours following a meal. If you have diabetes, knowing this can help you plan better for how your body will respond than would be the case if you consumed foods made with regular table sugar.

The Bottom Line on Sugar Alcohols

Science continues to show us that sugar is not a very friendly thing to have in your diet. If you have a bit of a sweet tooth, and you are trying to lose weight, you might be afraid some tasty treats you have come to know and love are going to be off limits.

Losing weight is probably going to demand changes in your diet. Switching to erythritol, other sugar alcohols, or artificial sweeteners might let you eat some of the sweets you are used to, but eventually changing your diet is going to be necessary if you are serious about weight loss. Think instead of using sugar alcohols to supercharge your diet and exercise program. With every calorie from sugar you replace with erythritol, you are a tiny step closer to getting to a weight or figure that is sustainable for you. 

If you are looking to make major changes in your diet, or if you are contemplating a weight loss procedure that will dramatically change how you eat, it is important to know the benefits and potential downsides of the numerous sugar alternatives on the market. It can be overwhelming at first as you dig through the various options to replace the sugar in your diet. This is research worth doing, though. The benefits of erythritol may be exactly what you need to help keep you on your path to meeting your goals. 

If you need help as you start planning or living with a new diet, request a consultation at True You Weight Loss today. We can help you understand your options in everything from what you eat to what exercise programs, or even weight loss procedures, might be right for you. 

Dr. Christopher McGowan
Dr. Christopher McGowan

Dr. Christopher McGowan, MD, a leader in endobariatrics, specializes in non-surgical obesity treatments and is triple-board-certified in Internal Medicine, Gastroenterology, and Obesity Medicine. Renowned for pioneering endoscopic sleeve gastroplasty (ESG) with over 2,000 procedures, his global influence and research contributions define him as a top expert.

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