Erythritol is one of the world's most popular sugar substitutes. But is it safe?

Erythritol is an artificial sweetener that was commercialized in Japan during the 1990s before gaining popularity in other parts of the world. It's now approved for human consumption in more than 50 countries, including in the United States, Mexico, France, Ireland, Italy, Spain, Sweden, Canada, Brazil and Australia. It has many benefits including being low in calories and carbohydrates, tooth-friendly, stable in cooking, and suitable for diabetics because it has no effect on one's glucose or insulin levels. The sugar substitute is sold as white crystal granules or powder under brand names like Whole Earth Sweetener Co, Durelife, and Anthony's, and is an ingredient in many popular sugar-free foods such as chocolate, chewing gum, yogurt, protein bars, hard candy and ice cream.

Despite its popularity, experts say erythritol isn't for everyone and may come with some risks and side effects. 

Is erythritol safe?

"Various studies and regulatory agencies have assessed the safety of erythritol and determined that it is generally safe to consume provided it is used within the recommended levels," says Jen Messer, a nutrition consultant and registered dietitian at Jen Messer Nutrition. Such agencies include the World Health Organization (WHO) which approved it for use in 1999, and the Food & Drug Administration (FDA) which classified it as “generally recognized as safe” in 2001. 

Notwithstanding its decades-long established safety profile, recent research suggests that erythritol could come with some health risks. In early 2023, for instance, The National Institutes of Health published research showing that high consumption of erythritol could cause blood clot formation and increased risk of heart attack and stroke - though it did not conclusively prove that consuming erythritol directly leads to these outcomes since our bodies also produce erythritol naturally. Instead, "the results highlight the need for further study of erythritol’s long-term risks for cardiovascular health," the agency notes. 

Dosage amount also matters when considering the safety of any artificial sweetener. "When issues arise, it may be that the amount of erythritol used in foods or drink exceeded what is safe for the body," explains Lisa Young, PhD, RDN, an adjunct professor of nutrition at New York University and author of "Finally Full, Finally Slim." Research shows that tolerated upper limits for erythritol are .66 grams per kilogram of a man's weight each day and .80 grams a day for women, however, larger doses have also been shown to be well tolerated. For example, "a 150 lb. person could safely tolerate up to 68 grams of erythritol per day without experiencing negative side effects," explains Messer. (For reference, a teaspoon of granulated erythritol typically contains about 4 grams.) "Thus, consuming about 17 teaspoons per day would still fall within the tolerable limit," she says.

Is erythritol the same as stevia?

In addition to questions about the safety profile of erythritol, some believe that stevia and erythritol are the same since both artificial sweeteners are derived from plants. But stevia and erythritol are totally different as stevia is a high-intensity sweetener in the same category as aspartame, saccharin and sucralose; while erythritol is a type of sugar alcohol along with other sugar substitutes like maltitol, sorbitol and xylitol.

There are some commonalities in how both artificial sweeteners are manufactured, however, and neither is known to affect a person's blood sugar levels. 

What are the side effects of erythritol?

Both stevia and erythritol also have potential side effects associated with consumption. In the case of erythritol, "it has long been known to cause digestive issues in some people," says John DiBaise, MD, a physician in the Division of Gastroenterology and Hepatology at Mayo Clinic in Arizona. Such issues include the possibility of bloating, cramping, nausea or diarrhea. 

Such issues can arise because erythritol is not fully absorbed by the body and can cause water to be drawn into the intestines. "In addition, unabsorbed sugar alcohols can undergo fermentation by intestinal microbiota, resulting in uncomfortable gas formation," explains Messer. "As with any food ingredient, moderation is key," she adds. "If you are concerned about the potential side effects of erythritol, it's always the best practice to speak with your healthcare provider." 

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