Photo: DUSAN ZIDAR (Shutterstock)
A recent study suggests that the sweetener erythritol, found in many foods, may put us more at risk for blood clots, and thus for heart attack and stroke. So what is erythritol, and what are the chances you ate something containing it today? I’ll explain.
Erythritol is a polyol sweetener
When you think of artificial sweeteners, what probably come to mind are things like aspartame and sucralose (aka Splenda). These are sweeteners where a little bit goes a long way. Instead of adding sugar by the teaspoon, manufacturers need only the tiniest sprinkling of one of these “sweeter than sugar” sweeteners to give a serving of their product the same effect. This is why they are considered low calorie, or even zero-calorie: There’s just not much of them in the product. Stevia and monkfruit extract have similar properties, although you’ll sometimes hear them called “non-nutritive” sweeteners rather than “artificial” sweeteners since they come from plant extracts.
And then there is another family of sweeteners: the polyols. These are also known as sugar alcohols, since chemists can point out ways in which they are similar to sugars and similar to alcohols. (To be clear, they are not a type of sugar and not a type of alcohol, at least not in the way we use those terms in everyday life.)
Polyols used as sweeteners include erythritol, xylitol, sorbitol, and mannitol. These are different from the sweeteners described above. Instead of being so sweet that they can be added in small quantities, polyols are less sweet than sugar, about 60% to 80% as sweet. That means you can add more of them to a product than you would sugar, and they’re often used to add “bulk” to artificially sweetened products. They are still considered “non-nutritive” and low calorie because our bodies don’t digest polyols like we do sugars.
Polyols can have a laxative effect, by the way, which is why you don’t want to eat too much of foods that are sweetened with them. Erythritol has less of a laxative effect than other polyols—which is part of why it’s so popular.
Erythritol is in low-carb foods and foods marketed to people with diabetes
Where do you find erythritol? A lot of places. For one thing, because it’s less sweet than sugar, it’s often mixed with other artificial sweeteners just so there can be more material in the product. A packet of Splenda stevia sweetener, for example, contains stevia extract for sweetness, and erythritol to fill out the package. Otherwise you’d have to find a way to get just a few tiny specks of the stuff into your coffee.
Erythritol (and other polyols) are also found in foods that are sweetened but where the manufacturers want to keep the calorie count or the sugar content low. In a quick survey of my kitchen, I found maltitol in a Barebells protein bar, xylitol in a jar of Nuts-N-More high-protein peanut butter, and erythritol in a Quest protein cookie.
Erythritol is also found in Halo Top low-calorie ice creams, Bai antioxidant drinks, and HighKey’s “keto-friendly, gluten-free” cookies. Start checking labels anytime something tastes sweet but isn’t high in carbs or calories, and you’ll often see erythritol.
Small amounts of erythritol are also found naturally in fruits, and are even made by our own bodies. But the concern isn’t about those; it’s about the larger amounts that are used in sweeteners. The researchers found that eating 30 grams of erythritol—roughly the amount in a pint of low-calorie ice cream—raises blood levels of erythritol by a factor of 1,000. Those levels begin to drop within a few hours, but they’re still well above normal levels for at least two days after you eat the ice cream.
How much should I worry about the health effects of erythritol?
The recent study doesn’t mean you need to immediately chuck all your low-sugar snacks, but it may be worth keeping an eye on future research—and maybe eating less of those erythritol-containing items in the meantime, if you want to be cautious.
One concerning fact is that the foods that contain erythritol and other polyols are often marketed to people who are already at risk of thrombosis. If you have diabetes, or if you are trying to lose some extra body fat, you’re probably more likely to buy low-sugar, low-calorie foods.
The researchers found that people with higher levels of erythritol in their blood were more likely to have heart attacks or strokes. And blood samples with higher levels of erythritol clotted more easily than those with lower levels. Because our bodies don’t break erythritol apart the way we do sugar, it floats around in our bloodstream until eventually we pee it out. While clotting is a normal function of our blood, the researchers say that erythritol seems to make our blood unusually sensitive to the signals that tell it to clot.
So could this affect our risk for heart attacks and stroke? The researchers point out that their work suggests the answer is yes, but doesn’t prove it. “Following exposure to dietary erythritol, a prolonged period of potentially heightened thrombotic risk may occur,” they write, and they call out a need for trials that can properly answer the question of whether eating erythritol, or eating other artificially sweetened foods, directly causes the heightened risk.