Is Erythritol Bad For Type 2 Diabetes and Prediabetes?

As a person with type 2 or pre diabetes you may already be aware that consuming sugar will do no favours for your 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 – we covered all sweeteners over here and listed the variety of sweetener options.

Right now, we here to discuss whether erythritol is bad for you, because there have been some sensational headlines announcing that erythritol is going to lead to cardiac events like stroke or heart attack.

Right off the bat, let’s get it clear this is NOT going to happen. The headlines were just that, headlines; and they grossly misreported the facts of the study.

So, let’s clear some things up now shall we…

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 crystalised into a pure polyol (sugar alcohol) and used as a replacement to sugar.

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, Stroke and Heart Attack

As stated above, the news headlines 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:

1. 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.
2. 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.

Erythritol and Type 2 Diabetes Research

In one clinical trial, neither stevia nor erythritol affected glucose balance in people with diabetes. It has little, if any, influence on blood sugar levels, insulin or HbA1c.

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 utilisation. 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 has strong oral health benefits with no influence on glucose or insulin.

Erythritol may help with appetite-regulation.

So Is Erythritol Safe To Eat?

Yes! Overall, studies to date indicate that it is safe to consume erythritol.

As far as sugar alcohols go, erythritol is one of the best because it is handled by most people, as far as digestion goes.

As always we’ll keep an eye on the research, but at this stage there is no cause for concern in regards to erythritol.

In future, don’t trust everything you see in the news. Turn to a trusted source of information, such as we provide here at DMP! Subscribe to our bi-weekly news below.