As a diabetic you may already be aware that consuming sugar will do no favors for your A1C or blood sugar levels.
But when it comes to the world of sweeteners, there seems to be so many choices, so which one is safe to eat?
That is a very good question. Because although majority of ‘sugar free’ or ‘diet’ food products contain a sugar substitute, it is more common to see artificial sweeteners.
Rather than help (which is what you’ll hope they do), these have been shown to worsen obesity, diabetes and other health conditions.
On the other hand, sugar alcohols such as erythritol appear to provide a safe alternative that you can use to sweeten your recipes – without any negative side effects.
So let’s explore a bit more about this sugar substitute now.
What Is Erythritol?
Erythiritol is a hydronated form of carbohydrate used as a replacement for sugar. It’s 60-80% times the sweetness of sugar.
Erythritol is one of the ‘sugar alcohols.’ You might have heard of xylitol, sorbitol and mannitol – these are sugar alcohols, too. These aren’t really alcohol at all, they are just termed a sugar alcohol because of their chemical structure.
Erythritol is claimed to be a “natural” sweetener because it can be found in nature in food sources such as seaweeds, fungi/mushrooms, and fruits like melons, grapes and pears. The erythritol metabolite can also be found in fermented foods like soy sauce and miso, wine, beer, and cheese.
Since erythritol is now used as a sweetener on mass scale, it gets produced in large amounts using a chemical and fermentation process.
The fermented solution is then purified and crystalized into a pure polyol (sugar alcohol) and used as a replacement to sugar.
Erythritol is often found in combo with other sweeteners such as stevia.
Erythritol Metabolism and Nutrition Facts
Around 90% of erythritol is resistant to metabolism in the body. It does get absorbed in the small intestine but does not ‘uptake’ into the bloodstream. Most of it simply gets excreted in urine.
Erythritol contains just 0.24 calories per gram. It contains zero carbohydrates and zero nutrients.
Erythritol and Type 2 Diabetes Research
In one clinical trial, neither stevia nor erythritol affected glucose balance in diabetics. It has little, if any, influence on blood sugar levels, insulin or A1c.
In both lean and obese subjects, the consumption of erythritol released gut hormones that help slow down gastric emptying. What this means is that foods you eat take longer to digest, which helps improve nutrient absorption and utilization. There was also no effect on insulin shown.
In diabetic patients, consuming erythritol was found to improve endothelial function, meaning it improved artery function and may provide heart-healthy benefits.
Another study has shown that erythritol may have a protective effect on diabetic stress to the endothelium. The endothelium is the thin layer of cells that lines all the blood vessels and lymph vessels in the body. These linings get affected in a negative way by diabetes and can contribute to diabetic complications.
According to the study, erythritol doesn’t influence a person with normal blood sugar in the same way but only has this influence on diabetics.
The progression of diabetes and development of diabetic complications is linked to high blood glucose and oxidative stress. Erythritol is an antioxidant and has been shown to scavenge those free radicals (produced from oxidative stress) that may cause havoc in the body.
Erythritol, Stroke and Heart Attack
Recent news headlines have proclaimed that erythritol will lead to stroke, heart attack or cardiac events. These were just news headlines and both the researchers and the journalists grossly misreported the facts, which is really poor conduct.
The facts of the study are:
- The study examined blood levels of erythritol NOT consumption of erythritol – the body naturally makes erythritol internally and that’s what the study was examining overall.
- The study was based on review of population data, which only indicates associations and cannot prove causations, so they cannot claim consumption of erythritol leads to cardiac events.
- There were 4,139 people in the study. 2,149 US people studied by the researchers were enrolled before erythritol was widely used in food, which means any data related to these people would have been only blood levels of erythritol produced internally, NOT from consumption.
- Diet was not factored into the researchers model, so they were never really looking at consumption.
- The people involved in the study were all undergoing cardiac assessments, which means they were already at greater risk of cardiac events, and that any findings would be inapplicable to normal health people. That said, people with diabetes are at greater risk of cardiac events and were among the studied population.
Although the news headlines did cause this misinformation damage, the researchers/authors are responsible for the misinformation. The reporters were taking their information from two places:
- The title of the manuscript: ‘The artificial sweetener erythritol and cardiovascular event risk’ – this should have been flagged in peer-review and the authors should have changed it to reflect what the study was really about.
- The research press release: again misinformation and titled ‘Cleveland Clinic study finds common artificial sweetener linked to higher rates of heart attack and stroke’ – this is highly irresponsible of the researchers /authors/ institutions!
Misreporting like this only perpetuates the confusion that people go through in making food choices.
What the researchers SHOULD have done
Since the study showed higher erythritol blood levels in a particular group, the researchers should have asked the question: WHY?? They didn’t.
As stated by another study looking at similar studies to that noted above: “Obviously, dietary erythritol intake does not explain the associations between circulating erythritol and cardiometabolic disease.”
In fact, other authors suggest it’s the other way around, that circulating blood levels of erythritol are an indicator of cardiometabolic disease.
So the question should have been WHY do some people have higher blood levels of erythritol; what are the characteristics of these people; and what is it actually an indicator of?
If they asked those questions, they may have concluded that it is somehow related to impaired glucose or high glucose, as suggested by other authors. This would seem logical and impaired glucose or high glucose are related to higher risk of cardiovascular disease, so we obviously need more research in this area, but the reported study wasn’t helpful in illuminating any helpful outcomes.
So Is Erythritol Safe To Eat?
YES, the overall evidence shows erythritol is safe to eat.
As far as sugar alcohols go, erythritol is one of the best because it is produced by “natural” means and this makes it one of the better ones to handle for most people, as far as digestion goes.
Some of the other sugar alcohols cause stomach upsets such as diarrhea, gas, bloating, and cramps. Erythritol causes less of these side effects because it has a very small molecule size compared to the other ‘tols.’
There seems to be no reported side affects or studies to prove any adverse affects, unlike artificial sweeteners like aspartame. And it even seems there may be some additional health benefits for people with diabetes specifically.
We mainly use stevia to sweeten our desserts and saucy meals. But if you prefer the taste of erythritol over stevia or you like the taste of the combo, then it could be a great sweetener option for you.
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Like one of the reviews, I don’t know what or who believe. The above article stated that “consumption” was NOT part of the study. Yet, the NIH, who performed the study, stated the following:
“ he scientists next asked how diet affects erythritol levels in people. To find out, they measured blood erythritol levels in eight healthy volunteers after drinking a beverage sweetened with erythritol. Blood erythritol levels increased 1,000-fold and remained substantially elevated for several days. For at least two days, the erythritol levels grew more than high enough to trigger changes in platelet function.”
Clearly, the people consumed the beverage containing erythritol. However, the NIH is part of the federal government (remember Anthony Fauchi?). Should we believe them?
Hi Scott – I can’t tell which study you are looking at, so if you link it we can try to explain a bit better.
A few other thoughts, your body does produce a small amount of erythritol naturally during sugar metabolism so that could be where some of the confusion is coming from. Any research should alway be heavily scrutinized — how was the study conducted? were there any bias? funding source? population size? However, I will say that when numerous studies all point to the same thing, in this case that erythritol is safe, it’s something we can generally accept as true. Everything we cover and promote is always based on current research and data. But, the point of research is to spurt new research so we can continue learning and asking questions to better our understanding of a certain topic.
So well written and easy to understand! I’m new to this diagnosis and learning/reading everything I can find. Thank you SO much for this!!
Thank you – our blog articles are a wealth of free information for a wide variety of topics!
we do not know who or what to believe any more,why are they not retracting there findings and should be sued for misinformation,I and many people disposed of products.They should be held responsible if what you claim is true.
Hi Richard, The study findings are clearly reported in the journal article and what we state here certainly is true. Unfortunately, the title of the research, the press release and the reporting across the news was inaccurate – this actually happens quite a lot, it shouldn’t but does sadly. We agree, this is highly irresponsible and it’s unfortunate that in most cases where this happens, no one is held responsible.
I use Lakanto Monkfruit Sweetner which is mostly erythritol. My husband’s nutritionist told him it’s bad for him to not use it. I just started using it to help my husband’s diabetes and to help his and my diet. I read to him your article on it. Who is right?
Hi Iris,
I guess my question would be why did they say it was bad for him? I am unaware of any contraindications of erythritol and overall is tolerated well. Of course we don’t want to rely on using these types of sweeteners in everything and anything we consume. So as long as he isn’t replacing nutrient dense foods for sugar-free “junk” food I don’t see a problem with it.
thanks a lot
So good to find someone knowledgeable of diabetics and their struggle with food and complications inherent to the condition. Thanks for your research, and your platform on which to share!
This was very useful information. Thank you for the article.