Is Erythritol Safe?
Unpacking the Latest Research

Here’s What the Erythritol Paper Says

1. Circulating levels of Erythritol are associated with a 3 year risk for major cardiovascular events (cohort studies, thousands of people). Confirmed with other cohort studies.

2. In follow-up mechanistic studies (designed to understand the process), they found that Erythritol makes platelets stickier, more prone to clots.

3. Finally, in an interventional study involving healthy subjects, it was found that Erythritol ingestion significantly increased levels of Erythritol in the blood. Not only they stayed 1000 times higher for several hours, but for several days they also stayed above the levels seen in their coagulation studies. These levels have shown an increased platelet reactivity and thrombosis potential.

What Do the Critics Say?

Critics mentioned reverse causation by the omission of the effect of endogenous Erythritol produced in the body via the pentose phosphate pathway (PPP) which might be upregulated by oxidative stress. Increased levels of serum Erythritol may therefore be the reflection of their poor metabolic health.

Others mentioned confounding factor as subjects in the cohort studies were unhealthy as they already had increased CVD risk. (Maybe unhealthy people simply consume more erythritol so fair enough?)

Others have pointed to potential financial interests. While this is a valid consideration, it shouldn't be the only factor in our analysis, or any analysis for that matter. If we focus solely on potential financial interests, we risk falling into a rabbit hole of endless suspicion. For instance, with this mindset, we could even suspect that all health and food bloggers who use Erythritol in their recipes have financial motives to dismiss this study. This kind of thinking doesn't lead us forward. It's crucial to maintain a balanced perspective when evaluating research and opinions.

Some critics noted that the amount of Erythritol used in the study was significantly higher than what people would typically consume in a day. I strongly disagree with that. Subjects were fed 30 grams of Erythritol which may seem high but it is what you will find in just one (!) keto mug cake. As someone who spent almost 15 years creating recipes using Erythritol, and developing a tracking app, I can assure you that 30 grams per serving, several times per week, is nothing unusual.

Finally, there were only 8 subjects in the follow up intervention study but as you’ll read in this Twitter thread by a brilliant scientist Adrian Soto-Mota, MD, this is not necessarily an issue. This is also the best study breakdown I found, although it is a bit more technical.

Erythritol: Use or Ditch?

Could the data be misinterpreted? Possibly. But does that mean we should ignore this study? In my opinion, that wouldn't be wise. All I’m saying is let’s not automatically dismiss this study. I'm sure there will be follow-up studies in the coming months and years.

Who might need to be more cautious? Individuals with a history of diabetes, CVD, kidney disease, increased risk of blood clots, and generally poor metabolic health (many of whom adopt a keto diet) might be better off avoiding Erythritol.

The way I see it is that Erythritol is not an essential ingredient. It can be replaced by other options like pure stevia or monk fruit. Allulose is another excellent option and unlike Erythritol it has no cooling aftertaste. In fact, since Allulose became available, I don’t remember last time I used Erythritol!

How To Substitute Erythritol in Recipes

In the vast majority of recipes Erythritol can be substituted with other options like stevia, monk fruit, Xylitol, yacon syrup, and Allulose. Please refer to our Sweetener Conversion Chart to see how exactly you can swap the sweetener options below.

Stevia and Monk Fruit

Stevia or monk fruit sweeteners can be used in recipes where you only need a small amount of sweetener. These include beverages and other desserts which are already sweetened by fruit (ice lollies, smoothies, etc.) and require hardly any sweetener.

Remember that some stevia and monk fruit products are sweetener blends and may already be mixed with Erythritol. Opt for pure stevia or monk fruit, ideally in liquid form and only use a few drops per serving to avoid a bitter aftertaste.

Xylitol

Xylitol is a good option if used in moderation. However, note that it's known to cause GI issues if recommended amount is exceeded. The only way for you to know if xylitol affects you is to try it and see if you tolerate it.

Yacon Syrup

Yacon syrup is a good option for some low-carb desserts, however, it is not carb-free and it has to be used sparingly. Use no more than a few tablespoons per recipe, or no more than 1 teaspoon per serving (if you are strictly keto), or up to a tablespoon (for a low to moderate carb intake).

Allulose

Finally, Allulose is a great alternative to Erythritol. It's just as low in carbs and calories but with no aftertaste. That's why it's a popular option in our recipes. Since Erythritol is only 70% as sweet as Allulose, you'll need slightly less Allulose to get the same results.

There are a few drawbacks to using Allulose. Firstly, some recipes won't work as well without Erythritol. One example is a classic shortbread recipe, or any crunchy cookie recipe. Sadly, Erythritol is what provides that perfect crunch. If you use Allulose in these Classic Keto Shortbread Cookies, they won't be crunchy but instead will have a soft and chewy texture. Still delicious but not what you might be going for.

Another disadvantage of Allulose is its higher price tag. However, remember when Erythritol first became widely available over a decade ago? It was more than double the current price! It's all about demand and supply and the number of competitors. I'm sure the price of Allulose will eventually be close to other sweetener options.

Also, Allulose might not be available in your region. There are options for shipping from the US, but be prepared for additional fees. If you do, make sure to buy in bulk like I do.

Will I be Using Erythritol?

I've always believed in erring on the side of caution, especially as someone who will be adjusting hundreds of recipes to offer alternatives. As inconvenient as it may be, I'll have to reflect this on my blog and in our app. These changes will take time so you won't see them all just yet.

Please note that I'm not a health professional. I'm not trying to dictate your choices, but rather encourage open-mindedness. As someone with  Factor V Leiden I will be taking my own precautions. At least for now until there’s more clarity (We are expecting more studies).

What are your thoughts? Will you continue using Erythritol, reduce the amount you use, or ditch it altogether? I'd love to hear your perspective!