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Erythritol: Is it really that bad?

A recent study highlighted cardiac risks associated with the widely used sweetener, which received FDA (GRAS) generally recognized as safe status almost three decades ago.

A common sweetener recently became headline news when a study conducted by Cleveland Clinic researchers linked erythritol to adverse cardiac event risk (Nat Med. 2023).

The Calorie Council, speaking on behalf of sweetening suppliers, noted that erythritol has been commercially produced and added to foods and beverages for more than 30 years. “The safety of erythritol as a food ingredient under conditions of its intended use is substantiated by a number of human and animal safety studies, including short- and long-term feeding, multigeneration reproduction and teratology studies.”

While the current study utilized various methodologies, the findings do not establish causality and realistic erythritol consumption, the Council emphasized. “As most commercial products containing erythritol usually contain a small amount, usually blended with other sweeteners, the intervention where subjects were instructed to consume 30 g of erythritol dissolved in 300 ml water within two minutes does not reflect a typical real-world serving.”

Erythritol became a workhorse in formulations after it received FDA (GRAS) generally recognized as safe  status almost three decades ago. Erythritol, though incorrectly labeled an artificial sweetener in the study, exists naturally in a variety of fruits and can be produced by the human body from glucose. As noted in a 2023 review in Nutrients, although it’s a sweetener, erythritol has almost zero calories and has no impact on blood sugar levels (15[1]:204). It’s safe for people with diabetes, does not cause tooth decay, has a positive taste profile, offers superior stability and provides broad application opportunities. Of all the polyols, erythritol has the highest digestive tolerance and requires no warning labels.

“Erythritol can lower water activity in processed foods, thus extending shelf life,” said Thom King, president, Icon Foods. Other qualities include excellent pH and heat stability in food processing, a neutral sweet flavor with little or no aftertaste, and good synergy with high-intensity sweeteners like stevia and monk fruit. Plus, he added, “erythritol is the least expensive of the natural sweeteners, with a strong and redundant supply chain. Erythritol is the only polyol produced through fermentation, making it a clean option.”

When blended with other sweeteners, erythritol displays a synergistic effect, meaning lower usage levels can achieve a higher, more balanced sweetening effect. This attribute, combined with its desirable flavor, has allowed formulators to reduce sugar levels in a wide variety of products while maintaining a healthier, same-taste profile product.

Kerry Kenny, chief technology officer of Apura Ingredients, noted, “As the rate of obesity has increased around the world due to increased sugar consumption, it is critical that food and beverage manufacturers have formulation tools and ingredients in their portfolio to allow them to decrease the sugar levels in their products while providing the consumer a good-tasting product.”

A primary function of erythritol is to add bulk to formulas with high-intensity sweeteners such as stevia. King pointed out other bulking sweeteners don’t quite stack up. “Xylitol, maltitol, sorbitol and glycerol all have a more intense gastrointestinal (GI) impact and are really not great options,” he said. “Formulators can use fibers such as soluble tapioca fibers and inulin; however, bowel tolerance is easily exceeded. I am not sure removing erythritol is the answer as much as reducing the amount of erythritol.” He suggested keeping the dosage below 12 grams per serving and keeping the average daily intake below 50 grams.

The most obvious replacement for erythritol is allulose, though King cautioned it is not allowed as a sweetener in the EU or Canada. Allulose is a simple (monosaccharide) sugar found naturally in figs and raisins. It has 90% less calories than sugar and a similar sweetness level as erythritol.

The price of allulose is significantly higher than erythritol, although Kenny said that can change. “As demand and capacity increase, technologies are being developed to lower the manufacturing cost to what the market can bear. When the FDA announced that allulose did not have to listed as part of the total sugars on nutritional labels in 2019, the market saw a significant uptick in usage of allulose,” he stated. That said, “It will take some time for the price to decrease due to current capacities and technologies.”

Besides cost considerations, reformulating without erythritol has other challenges. “The most difficult would be baked goods, dairy products, hard candies and syrups,” Kenny continued. “These products need a bulk, low-calorie sweetener to replace the bulk that is lost when sugar is replaced. Beverages and tabletop products would most likely be the easiest product lines to reformulate. Historically, there are other options available to the ready-to-drink (RTD), powder soft drink and tabletop sweetener manufacturers.”

Perhaps it’s not time to throw out the baby with the bathwater, so to speak, in a rush to reformulate. Apura Ingredients strongly feels any further studies (or previously published studies) will continue to support the safety and efficacy of low- and no-calorie sweeteners including erythritol. The company not only encourages the research and science on reviewing the safety and efficacy of low- and no-calorie sweeteners, “but we also financially support third-party unbiased studies that are peer-to-peer reviewed,” Kenny said. “However, we also encourage that studies like the one published by the Cleveland Clinic need further research before any judgment is drawn. The authors themselves admitted “this study has severe limitations” and “another limitation of our clinical observational studies is that by design, these studies can only show association and not causation.”

King concurred. “If there are 200 studies that say something is great and one study that says that same something will kill you, we all know which study will find its way into the news. We have had a lot of folks in a panic; however, calm minds have prevailed. I think everybody is in agreement that it is too soon to tell.”

Note: Stanley Hazen, M.D., Ph.D., chairman for the Department of Cardiovascular & Metabolic Sciences at Cleveland Clinic and spokesperson for the study, is not related to Cindy Hazen.

Cindy Hazen has more than 25 years of experience developing seasonings, dry blends, beverages and more. Today, when not writing or consulting, she expands her knowledge of food safety as a food safety officer for a Memphis-based produce distributor.

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