The ‘Protected’ Sweetener That is Something However

On this episode we focus on:

• Why erythritol grew to become the go-to sweetener for “sugar-free” and keto merchandise
• New proof linking erythritol to elevated threat of coronary heart assault and stroke
• The FDA’s GRAS designation and the way it didn’t catch long-term dangers
• Intestine well being results of sugar alcohols, together with IBS-like signs
• Safer alternate options to erythritol, together with allulose, pure stevia, and monk fruit
• When small quantities of actual sugar could also be much less dangerous than power sweetener use
• Sensible label-reading tricks to keep away from hidden erythritol and steerage for sweetener use

Present notes:

Hey all people, Chris Kresser right here. Welcome to a different episode of Revolution Well being Radio. In the event you’re attempting to shed extra pounds, handle your blood sugar, or comply with a keto eating regimen, chances are high you’ve reached for merchandise labeled “sugar-free” or “zero calorie.” Perhaps it’s a protein bar, a eating regimen soda, or that pint of keto ice cream in your freezer. These merchandise promise all of the sweetness with out the metabolic penalties of sugar, and for individuals with diabetes, weight problems, or metabolic syndrome, they appear like the plain selection. However what if I advised you that one of the vital widespread sweeteners in these merchandise, an ingredient that’s been marketed as protected and even wholesome, could be doing the precise reverse of what you suppose? What if it’s rising your threat of coronary heart assault and stroke?

I’m speaking about erythritol, a sugar alcohol that’s present in a whole bunch of merchandise, from Truvia to Monster Vitality drinks to Halo Prime ice cream. It’s in your protein bars, your electrolyte drinks, even blended into “pure” stevia and monk fruit sweeteners as a bulking agent. And for years it’s been thought of Typically Acknowledged As Protected, or GRAS, by the FDA with just about no requirement for long-term security research.

Right here’s the issue. A sequence of rigorous research from Cleveland Clinic and the College of Colorado Boulder have discovered that erythritol doesn’t simply fail to guard your cardiovascular well being, it seems to actively hurt it. We’re speaking about elevated blood clotting, impaired blood vessel perform, and a roughly two-fold enhance within the threat of coronary heart assault and stroke in individuals with the best blood ranges of this sweetener. The irony is painful. Erythritol is being marketed to the precise inhabitants at highest threat, individuals with diabetes and coronary heart illness, and it might be making their situation worse.

I need to be clear up entrance, this doesn’t imply you might want to panic in the event you’ve had erythritol previously, and it doesn’t imply there aren’t any protected alternate options. By the top of this episode, you’ll perceive what the analysis reveals, how erythritol impacts your blood vessels at a mobile degree, why the regulatory system didn’t catch this, and most significantly, what safer choices exist for individuals who want or need to keep away from sugar. Let’s dive in.

Okay, let’s begin with the fundamentals. What’s erythritol, and the place is it hiding in your meals? Erythritol is a sugar alcohol, technically a four-carbon polyol, that’s produced by fermenting corn. It’s about 70 p.c as candy as desk sugar, nevertheless it has nearly zero energy, doesn’t increase blood sugar or insulin ranges, and in contrast to some synthetic sweeteners, it doesn’t have that lingering chemical aftertaste. It seems to be like sugar, tastes moderately near sugar, and you may bake with it. For the meals trade, it was good.

The human physique does produce small quantities of erythritol naturally as a byproduct of glucose metabolism. That’s partly why regulators assumed it was protected. However right here’s the essential distinction– when erythritol is used as a sweetener in processed meals, you’re consuming ranges which can be greater than a thousand instances larger than what happens naturally in vegatables and fruits or what your physique produces by itself. And since erythritol is poorly metabolized by your physique, it doesn’t get damaged down. It goes into your bloodstream and stays there for days earlier than ultimately being excreted in your urine. Any extra consumption stacks up.

You’ll discover erythritol in an infinite vary of merchandise. Food plan sodas like Bai, Monster Vitality, Gatorade G2, and Vitamin Water Zero. Frozen desserts like Halo Prime, Nick’s, and Sambazon. Tabletop sweeteners together with Truvia and Splenda Naturals. Protein bars from manufacturers like SlimFast, suppose!, and sure flavors of Quest and Excellent Keto. And right here’s the kicker– erythritol is the most important ingredient by weight in lots of merchandise labeled as “stevia” or “monk fruit” sweeteners. As a result of stevia and monk fruit are 200 to 400 instances sweeter than sugar, producers solely want a tiny quantity for sweetness. The remainder of the product, typically 95 p.c or extra by weight, is erythritol serving as a bulking agent to present it that sugar-like texture and look.

The regulatory panorama makes this much more problematic. Erythritol is classed as GRAS by the FDA. This classification, which was granted in 2001, means there’s no requirement for long-term security research. Meals producers can use it with out restriction. And right here’s one other situation– merchandise aren’t required to checklist particular person sugar alcohols on vitamin labels. They will simply say “sugar alcohols” within the components. So until you’re studying fastidiously, you won’t even know you’re consuming erythritol.

Erythritol’s Hyperlink to Elevated Cardiovascular Dangers

The invention of erythritol’s cardiovascular threat was utterly unintentional. Dr. Stan Hazen, a heart specialist at Cleveland Clinic, wasn’t in search of issues with sweeteners. His analysis crew was attempting to establish unknown chemical compounds in individuals’s blood which may predict future threat of coronary heart assault, stroke, or dying. They have been analyzing blood samples from over a thousand sufferers in danger for coronary heart illness, collected between 2004 and 2011, utilizing a method known as untargeted metabolomics. Once they ranked all of the compounds by their affiliation with cardiovascular occasions over the subsequent three years, erythritol rose to the highest. Hazen has publicly stated that they’d no thought what this compound was initially. They weren’t even in search of it. As soon as they recognized it as erythritol, they validated the discovering in two extra impartial cohorts, one with over 2000 sufferers in the USA and one other with 833 sufferers in Europe. The outcomes, printed in Nature Medication in February 2023, have been placing. Sufferers within the highest quartile of blood erythritol ranges, in comparison with these within the lowest quartile, had roughly double the chance of main hostile cardiovascular occasions over the subsequent three years. Within the US cohort, the hazard ratio was 1.8. Within the European cohort, it was 2.21. These should not modest will increase. To place this in perspective, Hazen famous that erythritol gave the impression to be on par with the strongest cardiac threat elements, akin to having sort II diabetes.

The crew didn’t cease there. They wished to grasp the mechanism, so that they carried out laboratory research including erythritol to blood and platelet samples at concentrations sometimes seen in sufferers. What they discovered was that erythritol made platelets, the cell fragments that type clots, considerably extra reactive. It enhanced platelet aggregation, elevated clot formation, and did so quickly inside minutes of publicity. Then in August 2024, the identical analysis group printed a human intervention examine in wholesome volunteers. Twenty individuals with no heart problems consumed a single beverage sweetened with erythritol, the type of quantity you’d discover in a sugar-free soda or muffin. Their blood erythritol ranges elevated greater than a thousand-fold in comparison with baseline, and people elevated ranges continued for days. Each measure of platelet clotting potential elevated instantly after consumption. The researchers then gave the identical volunteers a glucose-sweetened beverage for comparability. Glucose didn’t have these results. This was particular to erythritol. What makes this notably regarding is that these results have been seen in wholesome individuals. If erythritol can improve clotting threat in people with no underlying heart problems, the implications for individuals who have already got diabetes, weight problems, or coronary heart illness, the very populations these merchandise are marketed to, are troubling.

Now let’s speak about what’s occurring on the mobile degree, as a result of that is the place the story will get much more attention-grabbing. A analysis crew on the College of Colorado Boulder, led by Dr. Christopher DeSouza, wished to grasp precisely how erythritol could be rising stroke threat. Their examine, printed within the Journal of Utilized Physiology in June 2025, examined human mind microvascular endothelial cells, the cells that line the small blood vessels in your mind. They handled these cells with six millimolar erythritol, which is equal to the quantity you eat in a typical artificially sweetened beverage, about 30 grams. After simply three hours of publicity, they discovered 4 distinct pathological adjustments.

First, erythritol brought on a dramatic enhance in oxidative stress. The cells produced roughly double the quantity of reactive oxygen species, or free radicals, in comparison with untreated cells. These are the metabolic byproducts that injury cells, speed up growing older, and set off irritation. The cells responded by ramping up their antioxidant defenses, producing extra superoxide dismutase and catalase, which tells you the cells have been below important stress.

Second, erythritol disrupted nitric oxide manufacturing. Nitric oxide is one in all your physique’s most necessary signaling molecules for vascular well being. It relaxes and widens blood vessels, or vasodilates them, maintains wholesome blood movement, and helps stop clots. The overall quantity of the enzyme that produces nitric oxide, known as endothelial nitric oxide synthase, or eNOS, didn’t change. However erythritol altered how that enzyme was regulated. It lowered the activating phosphorylation by about 33 p.c and elevated the inhibitory phosphorylation by 39 p.c. The web consequence was a 20 p.c drop in nitric oxide manufacturing. Much less nitric oxide means your blood vessels are extra constricted, blood movement is impaired, and you’ve got the next baseline threat for stroke.

Third, erythritol elevated manufacturing of endothelin-1, a peptide that constricts blood vessels. Ranges of its precursor protein, Massive ET-1, have been considerably elevated, and the quantity of endothelin-1 launched from the cells elevated by roughly 30 p.c. That is the other of what you need. You’re getting much less of the molecule that opens blood vessels and extra of the molecule that narrows them.

Fourth, and maybe most regarding, erythritol, impaired the cells’ potential to interrupt down blood clots. Below regular circumstances, when cells are uncovered to thrombin, a compound that indicators clot formation, they reply by releasing tissue-type plasminogen activator, or t-PA, which helps dissolve clots. That’s one in all your physique’s pure defenses in opposition to stroke. Within the untreated cells, t-PA launch elevated by about 25 p.c in response to thrombin. Within the erythritol-treated cells, there was no enhance in any respect. The response was utterly blunted. This implies when your physique wants to interrupt down a clot, erythritol-exposed cells can’t do it successfully.

Put these 4 mechanisms collectively, extra constricted blood vessels, elevated oxidative injury, elevated clotting threat, and lowered clot-busting potential, and you’ve got an ideal storm for stroke. This wasn’t some large dose, this was the quantity of erythritol in a single serving of a product most individuals would think about wholesome.

Erythritol is in every single place—from keto snacks to “stevia” sweeteners—however new analysis suggests it might double the chance of coronary heart assault and stroke. On this episode, Chris Kresser breaks down the science, explains who’s most in danger, and shares safer alternate options to sugar-free sweeteners. #ChrisKresser #erythritol

The FDA’s GRAS Designation

Right here’s the place I get annoyed with our regulatory system. Erythritol has been labeled as GRAS since 2001. Below the GRAS designation, there’s no requirement for the type of long-term cardiovascular security research that may have caught these dangers many years in the past. The idea was easy: erythritol happens naturally in small quantities in some fruits, and the physique produces tiny quantities as a part of regular metabolism, so including it to meals have to be effective. However that logic breaks down if you’re consuming a thousand instances the quantity that happens naturally when the substance accumulates in your bloodstream as a result of it’s not metabolized, and when it’s being consumed each day by thousands and thousands of individuals, lots of whom have already got cardiovascular threat elements. Bear in mind the dose at all times makes the poison. The regulatory framework wasn’t designed to guage these sorts of long-term, population-level results.

And it’s not simply erythritol. The identical Cleveland Clinic analysis crew discovered almost an identical cardiovascular threat with xylitol, one other sugar alcohol, in a examine printed within the European Coronary heart Journal in June 2024. Xylitol is much less widespread in US keto merchandise, nevertheless it’s extensively utilized in sugar-free gum, sweet, and oral care merchandise like toothpaste. The examine confirmed that folks with the best xylitol ranges had a 57 p.c elevated threat of cardiovascular occasions, and identical to with erythritol, consuming a xylitol-sweetened drink brought on instant enhancement of platelet clotting in wholesome volunteers.

Now, I need to emphasize that xylitol in toothpaste or mouthwash is unlikely to be a priority since you’re not swallowing significant quantities. The danger is particular to consumption in meals merchandise the place you’re ingesting important portions. However the sample is evident. Sugar alcohols as a category seem to have prothrombotic results, which means they promote blood clot formation. This wouldn’t be the primary time we’ve seen well-intentioned dietary suggestions backfire for weak populations. For many years, the American Diabetes Affiliation has beneficial low-fat, high-carbohydrate diets for individuals with Kind II diabetes. Each analysis and my medical expertise have proven {that a} low-carbohydrate strategy is much simpler for the overwhelming majority of individuals with metabolic and blood sugar dysfunction. But the low-fat dogma continued for years, probably making the diabetes epidemic worse. We’re seeing an identical sample with sugar alcohols. They’re being beneficial to individuals with weight problems, diabetes, and coronary heart illness, populations already at elevated threat. And the proof suggests we could also be making issues worse.

Intestine Well being Results of Sugar Alcohols

The cardiovascular dangers are probably the most alarming findings, however they’re not the one considerations with sugar alcohols like erythritol. There’s additionally the problem of intestine well being, which comes up often in my observe. Sugar alcohols are solely partially absorbed within the small gut. The portion that’s not absorbed attracts water into your colon by osmotic strain and will get fermented by intestine micro organism. For many individuals, this results in diarrhea, gasoline, bloating, stomach ache, and signs that may mimic or set off irritable bowel syndrome, or IBS. Individuals with current IBS or delicate guts are notably inclined to those results. In actual fact, polyols, the class that features erythritol, sorbitol, and xylitol, are one of many most important teams of fermentable carbohydrates that folks get rid of on a low-FODMAP eating regimen (the P in FODMAP standing for polyols) particularly as a result of they trigger dysmotility and digestive signs.

Now, erythritol is taken into account higher tolerated than another sugar alcohols as a result of extra of it will get absorbed earlier than reaching the colon. However tolerance varies extensively, and I’ve had loads of sufferers report digestive points when consuming merchandise with erythritol usually. The edge is particular person, in fact. Some individuals can deal with reasonable quantities with out issues, others react to even small doses. The broader level is, we’re studying that these compounds, which have been assumed to be inert as a result of they move by the physique largely unmetabolized, should not inert in any respect. They work together with our physiology in methods we didn’t anticipate. The cardiovascular results are once more probably the most regarding, as a result of they’re probably life-threatening. However the intestine results matter too, particularly for people who find themselves already coping with digestive points.

Safer Alternate options to Erythritol

Now, earlier than everybody listening throws out each sugar-free product of their pantry, let’s speak about context and alternate options. The important thing query is, in comparison with what? For somebody with extreme Kind II diabetes or important metabolic dysfunction, sugar ought to in all probability be prevented completely. The blood sugar spikes, the insulin surges, the glycation, these are actual issues that contribute to illness development. In that context, you want alternate options, and happily, not all sugar substitutes carry the identical dangers as erythritol. The most secure choice based mostly on present proof is allulose. Allulose is a uncommon sugar that’s naturally present in small quantities in figs, raisins, and maple syrup. Structurally, it’s just like fructose, however your physique metabolizes it in a different way. It will get absorbed within the small gut however then quickly excreted with out being transformed to glucose. The result’s just about no energy, no impression on blood sugar or insulin, and it’s about 70 p.c as candy as sugar, just like erythritol. What’s notably attention-grabbing about allulose is that in contrast to erythritol, which seems to trigger hurt, allulose might have useful results. Research recommend it might probably enhance insulin sensitivity, improve fats oxidation, which helps ketosis in the event you’re on a keto eating regimen, enhance ranges of GLP-1, the satiety hormone, and will even assist cut back irritation and forestall fats accumulation within the liver. The primary draw back is that in doses over about 10 grams, some individuals expertise GI misery, just like different sugar alcohols, although typically milder. It’s additionally dearer than erythritol, which is why meals producers haven’t embraced it as extensively.

One other protected choice is pure stevia extract, or pure monk fruit extract. I emphasize “pure” as a result of, as I discussed earlier, many industrial stevia and monk fruit merchandise use erythritol as a bulking agent. You’ll see a product labeled stevia sweetener, however in the event you verify the components, erythritol is commonly the second ingredient and makes up the overwhelming majority of the product by weight. You want to search for merchandise which can be one hundred pc pure stevia extract or monk fruit extract, normally in liquid or concentrated powder type. These are a lot sweeter than sugar, 200 to 400 instances sweeter, so you employ teeny quantities. They’re keto-friendly, they don’t have an effect on blood sugar, and there’s no proof linking them to cardiovascular hurt. Some individuals discover stevia has a bitter aftertaste, and there’s rising analysis that prime doses may have an effect on intestine micro organism, however on the ranges you’d use as a sweetener, they seem like comparatively protected.

Now right here’s the place I’m going to say one thing which may shock you. For individuals with delicate blood sugar dysregulation, not extreme diabetes, however possibly some insulin resistance or prediabetes, it might be that consuming a really small quantity of precise sugar sometimes is a better option than power consumption of erythritol. I’m not suggesting you return to ingesting common soda or consuming dessert daily, however in the event you’re having a cup of espresso and also you add a teeny little bit of actual sugar, that’s in all probability much less dangerous than ingesting a eating regimen soda with erythritol a number of instances a day, particularly if you have already got cardiovascular threat elements. The dose, once more, makes the poison. And we’re studying that the power each day consumption of those sugar alcohols at ranges far exceeding what the human physique developed to deal with might carry dangers that outweigh the advantages of voiding sugar in small quantities. It’s all about context.

Sensible Steerage for Sweetener Use

So what do you do in the event you’re presently consuming erythritol usually? Right here’s my sensible steerage. First, learn labels obsessively. Don’t assume a product is protected simply because it says “stevia,” “monk fruit,” “keto-friendly,” or “sugar-free.” Flip the bundle over and have a look at the components. In the event you see erythritol or the phrase “sugar alcohols,” that’s your purple flag. The identical goes for xylitol. You need merchandise sweetened with allulose, pure stevia extract, or pure monk fruit extract. These are more durable to search out, and sometimes dearer, however they don’t carry the cardiovascular considerations.

Second, in the event you’re utilizing erythritol-based merchandise each day, a number of servings a day, protein bars, eating regimen sodas, keto desserts, think about scaling again considerably or switching to alternate options. The Cleveland Clinic research confirmed that blood erythritol ranges keep elevated for days after consumption. In the event you’re consuming these merchandise daily, you’re sustaining chronically excessive ranges. That’s the state of affairs the place the cardiovascular dangers seem most pronounced.

Third, and that is particularly necessary when you’ve got Kind II diabetes, weight problems, metabolic syndrome, or current coronary heart illness, speak to your physician about these findings. You’re within the actual inhabitants that these merchandise are marketed to, and sadly you’re additionally within the inhabitants at highest threat from erythritol’s results. Your physician might need to aid you transition to safer alternate options or modify your total dietary strategy.

Fourth, think about whether or not you really want a sugar substitute in any respect. I do know that feels like a cop-out, however hear me out. In the event you’re utilizing these merchandise since you’re attempting to take care of a really low-carbohydrate or ketogenic eating regimen for therapeutic causes, managing epilepsy or extreme insulin resistance, then, sure, you want good alternate options, and allulose might be your greatest guess. However in the event you’re utilizing them primarily for weight reduction or common well being, it might be value reassessing whether or not the occasional small quantity of actual sugar within the context of an in any other case nutrient-dense, complete meals eating regimen is definitely an issue. Lots of people get caught within the mindset that any sugar, even the teeniest quantity, is poisonous, however that’s probably not supported by the proof for individuals with out important metabolic dysfunction.

Lastly, keep in mind that the objective isn’t perfection. It’s making knowledgeable decisions with the most effective accessible proof. In the event you’ve consumed erythritol previously, don’t panic. These research present elevated threat with power consumption and elevated blood ranges, not from occasional publicity. What issues is what you do going ahead. You now have info that wasn’t extensively recognized even a 12 months in the past, and you should use it to make higher choices.

Okay, everybody. Thanks for listening. You could find present notes and hyperlinks to all of the research I discussed at ChrisKresser.com. You probably have questions on something we mentioned as we speak, head over to ChrisKresser.com/podcastquestion, and we’ll attempt to reply them on a future episode. And in the event you’d wish to share this episode, please do. That is info lots of people want to listen to. I’ll speak to you subsequent time.