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Is Erythritol Safe to Use as a Sweetener?

Erythritol is becoming commonly used as a sweetener added to supplements, foods, and drinks. There has been some concern about the health effects of erythritol and in this article, Cliff looks at the evidence for the impact of erythritol on health.

Key points

  • Erythritol is a commonly used, natural polyol sweetener
  • It has little if any effect on markers of human health
  • High doses (greater than 20 g) can result in diarrhoea and gastrointestinal symptoms
  • Symptoms are not typically observed with doses lower than this
  • Overall, erythritol appears to be an innocuous, non-toxic sweetener with no negative effects on human health

Erythritol is a ‘sugar alcohol’ (polyol) used as a sugar substitute in foods and beverages. It is approximately 60-70% as sweet as table sugar, yet is functionally non-caloric and greater than 82% is excreted in the urine.1 Erythritol is classed as a natural sweetener as it naturally in some foods and beverages such as wine, beer, mushrooms, pears, grapes, and soy sauce,2, 3 and the majority of erythritol used in products comes from yeast fermentation of glucose.

Are there any health effects?

Erythritol and glucose control

While some animal models of diabetes have shown effects such as reduced post-meal blood glucose, increased muscle glucose uptake and reduced intestinal glucose absorption,4 in non-diabetic human subjects there has been demonstrated to be no significant effect on blood glucose, insulin, or blood lipids.4 It does not appreciably affect blood glucose, insulin, water consumption, diuresis or electrolyte balance, at 0.4 and 0.8 g per kilogram of body weight per day (the equivalent of 68 g for me!).5 Additionally, gut responses and tolerance were equivalent to sugar of the same dosage.5 A 20 g single dose of erythritol resulted in no change in glucose or insulin levels. When this dose was repeated daily for 14 days, there were reductions in fasting glucose and HbA1c, with no change in markers of kidney function.1

In non-diabetic human subjects there has been demonstrated to be no significant effect on blood glucose, insulin, or blood lipids

Erythritol and the gut microbiome

Erythritol does not appear to be fermentable by colonic bacteria and is unlikely to have any effect on the gut microbiome.6

Erythritol and cardiovascular health

There is some suggestion that chronic, high-dose intake of erythritol might be associated with higher uric acid levels and triglycerides but human studies have shown there to be no effect from acute, sub-chronic or chronic exposure to erythritol.4

In a study of (24) patients with type 2 diabetes, 36 g of erythritol per day (in an orange-flavoured beverage) for 4 weeks, and a single dose of 24 g at baseline and post-study actually resulted acutely in improved endothelial function (measured by fingertip peripheral arterial tonometry [0.52 ± 0.48 to 0.87 ± 0.29 au, p = 0.005]). Chronic erythritol decreased central pulse pressure (47 ± 13 to 41 ± 9 mmHg, p = 0.02) and tended to decrease carotid-femoral pulse wave velocity (p = 0.06). It was concluded that erythritol consumption acutely improved small vessel endothelial function, and chronic treatment reduced central aortic stiffness.7

Is it safe?

Animal studies in rats, mice, rabbits and dogs have shown no significant or meaningful adverse effects in doses up to 5g/kg per day or up to 10% of food volume in studies lasting over two years and up to two generations of animals.8-13 In mice, doses of 45 g/kg per day (for 90 days) did not result in any symptoms of toxicity.14

In humans, erythritol is considered to be non-toxic.15, 16  At high oral doses, approximately 90% is excreted in the urine.16 However, doses of 20 g or more result in significantly greater episodes of diarrhoea and gastrointestinal symptoms (pain, bloating etc.) than 5-15 g (which do not produce these effects).17 The estimated average daily intake of erythritol is 1.24 g.18

In humans, erythritol is considered to be non-toxic

Conclusion

Based on the evidence, erythritol appears to be a fairly innocuous sweetener with no negative effects on any parameter of human health. The only caution would be high doses in the range of greater than 4 tsp. of erythritol sweetener per day, due to an increased risk of GI distress and diarrhoea.

References

1.            Ishikawa M, Miyashita M, Kawashima Y, Nakamura T, Saitou N, Modderman J. Effects of oral administration of erythritol on patients with diabetes. Regulatory toxicology and pharmacology : RTP. 1996;24(2 Pt 2):S303-8.

2.            Shindou T, Sasaki Y, Miki H, Eguchi T, Hagiwara K, Ichikawa T. Determination of Erythritol in Fermented Foods by High Performance Liquid Chromatography. Food Hygiene and Safety Science (Shokuhin Eiseigaku Zasshi). 1988;29(6):419-22_1.

3.            Bernt WO, Borzelleca JF, Flamm G, Munro IC. Erythritol: a review of biological and toxicological studies. Regulatory toxicology and pharmacology : RTP. 1996;24(2 Pt 2):S191-7.

4.            Wölnerhanssen BK, Meyer-Gerspach AC, Beglinger C, Islam MS. Metabolic effects of the natural sweeteners xylitol and erythritol: A comprehensive review. Critical Reviews in Food Science and Nutrition. 2019:1-13.

5.            Bornet FR, Blayo A, Dauchy F, Slama G. Gastrointestinal response and plasma and urine determinations in human subjects given erythritol. Regulatory toxicology and pharmacology : RTP. 1996;24(2 Pt 2):S296-302.

6.            Arrigoni E, Brouns F, Amado R. Human gut microbiota does not ferment erythritol. Br J Nutr. 2005;94(5):643-6.

7.            Flint N, Hamburg NM, Holbrook M, G. Dorsey P, LeLeiko RM, Berger A, et al. Effects of erythritol on endothelial function in patients with type 2 diabetes mellitus: a pilot study. Acta Diabetologica. 2014;51(3):513-6.

8.            Shimizu M, Katoh M, Imamura M, Modderman J. Teratology Study of Erythritol in Rabbits. Regulatory Toxicology and Pharmacology. 1996;24(2):S247-S53.

9.            Dean I, Jackson F, Greenough RJ. Chronic (1-Year) Oral Toxicity Study of Erythritol in Dogs. Regulatory Toxicology and Pharmacology. 1996;24(2):S254-S60.

10.         Waalkens-Berendsen DH, Prooije AES-v, Wijnands MVM, Bär A. Two-Generation Reproduction Study of Erythritol in Rats. Regulatory Toxicology and Pharmacology. 1996;24(2):S237-S46.

11.         Prooije AES-v, Waalkens-Berendsen DH, Bär A. Embryotoxicity and Teratogenicity Study with Erythritol in Rats. Regulatory Toxicology and Pharmacology. 1996;24(2):S232-S6.

12.         Lina BAR, Bos-Kuijpers MHM, Til HP, Bär A. Chronic Toxicity and Carcinogenicity Study of Erythritol in Rats. Regulatory Toxicology and Pharmacology. 1996;24(2):S264-S79.

13.         Til HP, Modderman J. Four-Week Oral Toxicity Study with Erythritol in Rats. Regulatory Toxicology and Pharmacology. 1996;24(2):S214-S20.

14.         Til HP, Kuper CF, Falke HE, Bär A. Subchronic Oral Toxicity Studies with Erythritol in Mice and Rats. Regulatory Toxicology and Pharmacology. 1996;24(2):S221-S31.

15.         Carocho M, Morales P, Ferreira I. Sweeteners as food additives in the XXI century: A review of what is known, and what is to come. Food Chem Toxicol. 2017;107(Pt A):302-17.

16.         Munro IC, Bernt WO, Borzelleca JF, Flamm G, Lynch BS, Kennepohl E, et al. Erythritol: an interpretive summary of biochemical, metabolic, toxicological and clinical data. Food and Chemical Toxicology. 1998;36(12):1139-74.

17.         Jacqz-Aigrain E, Kassai B, Cornu C, Cazaubiel JM, Housez B, Cazaubiel M, et al. Gastrointestinal tolerance of erythritol-containing beverage in young children: a double-blind, randomised controlled trial. European Journal of Clinical Nutrition. 2015;69(6):746-51.

18.         Ruiz-Ojeda FJ, Plaza-Díaz J, Sáez-Lara MJ, Gil A. Effects of Sweeteners on the Gut Microbiota: A Review of Experimental Studies and Clinical Trials. Advances in Nutrition. 2019;10(suppl_1):S31-S48.

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