Natural sugar substitutes can be a great alternative to plain white sugar. They give you a sweet taste without spiking your blood glucose or insulin levels. Sustained high levels of blood glucose and insulin overtime can lead to insulin resistance and eventual diabetes. Erythritol was touted as a great natural sugar substitute when it first came out but now new research is pointing to potential health risks of using it.
In a new study published in the journal Nature Medicine researchers found that people who had high levels of erythritol in their blood had increased risk of developing cardiovascular events such as heart attacks and strokes (1). Researchers looked at the levels of erythritol in the blood of around 4,000 people from the United States and Europe and found that those with the highest blood concentration of erythritol were more likely to have a stroke or heart attack. The participants were mostly over the age of 60 and already had pre-existing conditions such as hypertension and diabetes. The researchers also directly gave erythritol to mice in the lab and found that it promoted blood clot formation. Erythritol has a long half life, meaning it lingers in the body for a long period of time before it’s total volume is reduced by half, up to 2 days.
It is important to note that while the study found an association between erythritol and elevated cardiovascular risk, it did not prove that erythritol itself caused strokes and heart attacks. Because the study was observational the researchers found a correlation but did not prove causation. Nevertheless the fact that it caused increased clot formation in mice is concerning and makes sense that the observational data would show that correlation.
Erythritol is in a lot of “keto foods” so has become pretty ubiquitous in the health and wellness food space in the last 5-10 years. You can find it in everything from Keto protein bars to Keto ice cream. The other issue is that it is added to many other natural sugar substitutes like monk fruit to add texture and make it feel more like crystalline sugar.
So what's the best option for someone interested in keeping sugar out of their diet? You can also always just opt for a small amount of natural, organic honey. That stuff has been around for millions of years, is safe, natural and as long as you use just a small amount shouldn’t be of too much concern in terms of modulating blood glucose or insulin levels. For now Stevia, Monk-fruit, Allulose and Xylitol are considered safe but if you use these natural sugar substitues I would use only small amounts in moderation.
(1)Witkowski, M., Nemet, I., Alamri, H. et al. The artificial sweetener erythritol and cardiovascular event risk. Nat Med (2023). https://doi.org/10.1038/s41591-023-02223-9