What erythritol is, the evidence behind the benefits of erythritol for blood sugar and teeth, its digestive side effects, the safe daily limit and the recent research on blood clotting.
Erythritol is a sugar alcohol (polyol) used as a low-calorie sweetener in reduced-sugar foods, candies and baked goods. It occurs naturally and is produced commercially by fermentation (1, 5). Most of what you eat is absorbed and passed out unchanged in urine, so it provides almost no calories and does not raise blood sugar (4).
The benefits of erythritol are real but come with caveats. Regulators in Europe set a daily intake limit in 2023 because of its laxative effect (1), and studies from the Cleveland Clinic have linked erythritol to increased blood clotting (2, 3). This guide covers both sides.
Key Takeaways
- Erythritol did not raise blood glucose or insulin in healthy adults, and about 90% was excreted unchanged in urine (4).
- It is better tolerated than xylitol, but large doses can cause diarrhea and nausea (7, 8).
- The European Food Safety Authority set an acceptable daily intake of 0.5 g per kg of body weight in 2023 (1).
- Higher blood erythritol levels were linked to heart attack and stroke, and 30 g increased platelet clotting in healthy volunteers (2, 3).
- Reviews report benefits for teeth, but several were written by authors linked to erythritol producers (9, 10).
What Is Erythritol?
Erythritol is a four-carbon polyol. It is naturally abundant but hard to make chemically, so it is produced by fermentation (1, 5). Unlike other sugar alcohols, it is absorbed in the small intestine rather than fermented in the colon, then excreted in urine (1, 10). In Europe, it is authorized as a food additive (E 968) in many food categories (1).
Erythritol Benefits and Risks at a Glance
| Topic | Evidence | Caveats |
|---|---|---|
| Blood sugar and insulin | No rise in glucose or insulin in healthy adults (4); glycemic index 0 (6) | Small study from a manufacturer |
| Calories | Less than 0.4 kcal per gram; about 90% excreted unchanged in urine (4) | — |
| Teeth | Reviews report less plaque and fewer cavities than with sorbitol or xylitol (9, 10) | Reviews by authors linked to an erythritol producer |
| Digestion | Better tolerated than xylitol (7) | Large amounts can still cause diarrhea (1, 8) |
| Heart and clotting | Higher blood levels linked to heart attack, stroke and death; 30 g increased platelet clotting in volunteers (2, 3) | Observational data and small studies; cause not proven |
| Antioxidant | Lab and diabetic rat studies (11) | Not shown in people |
Blood Sugar, Insulin and Calories
In a small study of five healthy men, 0.3 g per kg of body weight of erythritol did not raise blood glucose or insulin, while the same dose of glucose raised both within 30 minutes. Erythritol did not change cholesterol or triglycerides, and more than 90% was excreted in urine within 48 hours, giving it less than 0.4 kcal per gram (4). The study was conducted by a company that produces sweeteners. A review of polyols gave erythritol a glycemic index of 0, compared with 65 for sucrose (6).
Replacing sugar with a non-caloric sweetener can reduce calories, but no trials have shown that erythritol itself causes weight loss. It works best as part of an overall balanced diet and lower-sugar drinks; see our guide to drinks that support weight loss.
Erythritol and Teeth
SaveA 2016 review concluded that erythritol reduced dental plaque, lowered the adherence and growth of cavity-causing bacteria such as Streptococcus mutans, reduced the number of cavities, and worked better than sorbitol and xylitol. It is also used as a powder for subgingival air polishing in gum treatment (9). A 2018 review reported similar findings (10). Two authors of the 2016 review worked for Cargill, a sweetener producer, and the author of the 2018 review previously worked there (9). For whitening, see our article on hydrogen peroxide for teeth.
Digestive Side Effects
Because most erythritol is absorbed before it reaches the colon, it causes fewer gut symptoms than other sugar alcohols (10). In a randomized trial in 64 young adults, 20 g and 35 g of erythritol in water caused no significant symptoms, while 50 g increased nausea and stomach rumbling. Xylitol caused more watery stools at every dose (7).
Children are more vulnerable per serving. In a trial of 184 children aged 4 to 6, a drink containing 15 g of erythritol was well tolerated, but 20 g and 25 g caused significantly more diarrhea or severe gut symptoms (8). A co-author worked for Cargill.
How Much Erythritol Is Safe?
In its 2023 re-evaluation, the European Food Safety Authority set an acceptable daily intake (ADI) of 0.5 g per kg of body weight per day. This was based on the lowest dose that avoided diarrhea, which EFSA considered an adverse effect because of possible fluid and electrolyte loss. EFSA estimated that some children and adolescents with high intakes could exceed this limit (1).
| Body weight | EFSA acceptable daily intake (0.5 g/kg) |
|---|---|
| 20 kg (44 lb) | 10 g per day |
| 40 kg (88 lb) | 20 g per day |
| 60 kg (132 lb) | 30 g per day |
| 80 kg (176 lb) | 40 g per day |
| 100 kg (220 lb) | 50 g per day |
Calculated from the EFSA acceptable daily intake of 0.5 g/kg body weight (1).
Heart Health and Blood Clotting Concerns
In 2023, researchers at the Cleveland Clinic reported that among nearly 3,000 patients undergoing cardiac evaluation in the US and Europe, those with the highest blood erythritol levels had about 1.8 to 2.2 times the risk of heart attack, stroke or death over three years compared with those with the lowest levels. In lab and animal tests, erythritol made platelets more reactive and increased clot formation, and in 8 healthy volunteers, consuming erythritol raised blood levels above those thresholds for more than two days (2).
In a follow-up study, 10 healthy volunteers who drank 30 g of erythritol had stronger platelet clotting responses, while 10 who drank 30 g of glucose did not. One figure from that paper is worth seeing on its own: the 30 g dose raised erythritol in the blood more than a thousandfold, from about 3.75 to 6,480 micromoles per litre. That is not a nudge, and it is the scale of change that made the authors call for the sweetener’s safety status to be reconsidered (3).
These studies have limits: the patient data are observational, and the volunteer studies were small and short. They do not prove that erythritol causes heart attacks or strokes. Until more research is available, people with heart disease, a history of blood clots or high cardiovascular risk may want to limit erythritol and discuss it with their doctor.
Other Safety Research
- Genotoxicity: erythritol did not damage genes or chromosomes in standard tests, and EFSA found no genotoxicity concern (1, 14).
- Long-term animal study: rats fed erythritol for about two years showed no tumor-causing effects; higher doses increased urine volume and mineral deposits in the kidneys of female rats (13).
- Antioxidant effects: erythritol scavenged hydroxyl radicals in the lab and protected blood vessel lining in diabetic rats (11), but this has not been shown in people.
Erythritol During Pregnancy
SaveA clinical review found that available data do not suggest adverse effects of sugar substitutes in pregnancy, but recommended using them in moderation within acceptable daily intake limits, and noted that more research is needed (12). There are no specific pregnancy studies of erythritol, so ask your doctor or midwife if you use it often.
Frequently Asked Questions
What are the benefits of erythritol?
Erythritol is a nearly calorie-free sweetener that does not raise blood sugar or insulin, and reviews report it is better for teeth than other sugar alcohols. However, some of that research came from sweetener manufacturers, and recent studies have raised questions about blood clotting.
How much erythritol is safe per day?
In 2023, the European Food Safety Authority set an acceptable daily intake of 0.5 g per kg of body weight, based on the dose that can cause diarrhea. That is about 30 g a day for a 60 kg (132 lb) adult and 10 g for a 20 kg child.
Is erythritol bad for your heart?
It is not proven, but there are concerns. In a 2023 study, people with the highest blood erythritol levels had about twice the risk of heart attack, stroke or death over three years, and a 2024 study found that 30 g of erythritol increased platelet clotting in healthy volunteers. These studies cannot show that erythritol causes heart disease, but people with heart disease or clotting risk may want to limit it and ask their doctor.
Does erythritol cause diarrhea?
It can in large amounts. Adults tolerated 20 to 35 g in a drink without symptoms, and 50 g caused nausea and stomach rumbling. In young children, 20 to 25 g caused diarrhea, while 15 g was tolerated.
Can people with diabetes use erythritol?
Erythritol does not raise blood glucose or insulin, so it does not directly affect blood sugar. Because people with diabetes often have higher cardiovascular risk, it is reasonable to discuss erythritol use with a doctor given the recent clotting research.
The Bottom Line
Erythritol is a nearly calorie-free sweetener that does not raise blood sugar or insulin and is gentler on digestion than xylitol, with reported benefits for teeth. However, the European limit is 0.5 g per kg of body weight a day, children can get diarrhea from a single sweetened drink, and recent studies linking erythritol to blood clotting and cardiovascular events call for caution. Use it in moderate amounts, keep an eye on how much is hidden in “sugar-free” and keto products, and talk to your doctor if you have heart disease or clotting risk. If you use it to sweeten cocoa, see our article on cacao benefits.
This article is for informational purposes only and is not a substitute for professional medical advice. If you have diabetes, heart disease, a history of blood clots, or are pregnant, talk to your doctor before using erythritol regularly.
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