Erythritol and Diabetes: Safe Sugar Substitute or Cause for Concern?
Explore whether erythritol is a safe sugar alternative for people with diabetes, its effects on blood sugar, benefits, and potential risks.
Erythritol and Diabetes: Is It Safe?
If you have diabetes, choosing the right sweetener is crucial for blood sugar control and long-term health. Erythritol is a popular sugar substitute promoted for its low calorie content and minimal impact on blood glucose. This article dives deeply into erythritol’s safety, benefits, and risks for people with diabetes, drawing on available scientific research and expert recommendations.
Table of Contents
- What Is Erythritol?
- Benefits of Erythritol
- Erythritol and Blood Sugar in Diabetes
- Scientific Research: What Does the Evidence Say?
- Potential Risks and Warnings
- Practical Tips for Using Erythritol with Diabetes
- Frequently Asked Questions (FAQs)
What Is Erythritol?
Erythritol is a sugar alcohol—a type of carbohydrate often used as a sugar substitute. Despite the name, sugar alcohols do not actually contain ethanol (the type of alcohol found in alcoholic drinks). Erythritol is nearly as sweet as table sugar but contains almost no calories.
Main properties:
- Looks and tastes like sugar
- About 70% as sweet as table sugar
- Virtually zero calories per serving
- Commonly found in low calorie and sugar-free foods and beverages
- Occurs naturally in small amounts in fruits (melons, grapes, pears) and some fermented foods
- Produced commercially by fermenting corn or wheat starch
Erythritol is available alone or as part of blends (such as Truvia), and comes in various forms including granulated and powdered varieties.
Benefits of Erythritol
Erythritol is embraced for a number of reasons, especially among people seeking to better manage their blood sugar or calorie intake. Key advantages include:
- Low in calories: Contains about 0.24 calories per gram, far lower than table sugar (about 4 calories per gram).
- Does not contribute to tooth decay: Unlike regular sugar, erythritol does not feed harmful mouth bacteria that cause dental caries and cavities.
- No carbohydrates: 100% of erythritol consumed is absorbed into the bloodstream in the small intestine and then excreted unchanged in urine—bypassing the digestive processes that would otherwise raise blood sugar.
- Does not raise blood sugar or insulin: Erythritol’s unique absorption and metabolism mean it has a glycemic index of 0, meaning it does not spike blood glucose or insulin levels.
- Generally well-tolerated: Compared to other sugar alcohols (like xylitol or sorbitol), erythritol is far less likely to cause digestive upset when consumed in moderation.
For individuals with diabetes, the combination of no sugar, zero impact on blood glucose, and reduced calorie content are significant potential benefits.
Erythritol and Blood Sugar in Diabetes
In diabetes, managing blood glucose is crucial to prevent spikes, avoid complications, and support long-term health. In contrast to table sugar and many artificial sweeteners, erythritol:
- Does not require insulin for metabolism, making it suitable for people with insulin resistance or impaired insulin production.
- Has a glycemic index of zero, as clinical studies have shown it does not cause measurable increases in blood glucose or insulin after consumption—even at relatively high doses.
What others are reading
How the body processes erythritol:
- Absorption: After ingestion, about 90% of erythritol is absorbed directly from the small intestine and circulates in the blood.
- Excretion: Unlike glucose, erythritol is not metabolized for energy and is excreted unchanged in the urine within 24 hours.
- Minimal fermentation: Only a small amount (if any) reaches the colon, minimizing the chance of gas or bloating common with other sugar alcohols.
By comparison, other sugar alcohols may cause digestive discomfort and can be partially absorbed or fermented, potentially affecting blood sugar in susceptible individuals.
How Diabetes Affects Blood Sugar Management
When you have diabetes (either type 1 or type 2), the body struggles to properly regulate blood sugar because of problems with the production or action of insulin—a hormone that enables cells to take up glucose from the blood. Diets high in sugar or rapidly digestible carbohydrates can contribute to unhealthy spikes in blood sugar, emphasizing the need for safe sugar alternatives.
Scientific Research: What Does the Evidence Say?
Multiple studies over the past two decades have weighed erythritol’s impacts on blood sugar, insulin, and overall metabolic health.
Erythritol and Blood Sugar in People With Diabetes
- In various human trials, acute ingestion of erythritol (20–75 grams) did not increase blood glucose or insulin levels in both healthy individuals and people with diabetes.
- One small, 2-week trial in people with type 2 diabetes (20 grams erythritol/day) significantly reduced HbA1c (a long-term blood sugar control marker).
- Systematic reviews have confirmed negligible impact on post-meal blood sugar—even with repeated exposure.
Glycemic and Insulinemic Index Table
| Sweetener | Glycemic Index | Insulinemic Index |
|---|---|---|
| Glucose | 100 | 100 |
| Table Sugar (Sucrose) | 65 | 70 |
| Erythritol | 0 | 2 |
| Xylitol | 13 | 15 |
Note: Glycemic and insulinemic indices are measures of how quickly a food raises blood sugar and insulin. Lower numbers indicate less effect.
Effects on Glucose Absorption and Insulin Sensitivity
Animal studies have suggested erythritol may even reduce blood glucose levels by inhibiting enzymes involved in carbohydrate digestion (such as alpha-glucosidase), slowing glucose absorption when consumed alongside carbohydrates. However, evidence in humans is less clear, and the effect appears limited to cases where erythritol and carbohydrates are consumed together.
Dental Health Benefits
- Reduces mouth bacteria: Unlike regular sugar, erythritol does not feed oral bacteria. Studies show it inhibits plaque formation and may offer a degree of cavity protection comparable or superior to xylitol.
- Does not cause tooth decay: Its non-fermentable nature makes it “tooth-friendly.”
Long-term studies (including a 3-year trial with over 400 children) found a reduction in cavities and plaque with regular erythritol use, although results were mixed between studies in the degree of dental benefits achieved.
Potential Risks and Warnings
While erythritol is generally considered safe for most people—including those with diabetes—there are still factors to keep in mind:
- Gastrointestinal symptoms: Consuming erythritol in large amounts (above 50 grams per day) may cause nausea, bloating, or mild laxative effects, though this is less common than with other sugar alcohols.
- Individual sensitivity: Some people experience digestive discomfort at lower doses. Those with irritable bowel syndrome (IBS) or sensitive digestive systems should introduce erythritol slowly and monitor their reaction.
- Allergic reactions: While rare, allergic responses (such as hives, itching, or swelling) are possible. Discontinue use and seek medical help if symptoms occur.
- Not a license for unlimited consumption: Excessive use of sweeteners—erythritol included—may encourage a preference for sweet flavors, potentially making it harder to reduce sugar intake overall.
- Other ingredients: Sugar-free processed foods may contain carbohydrates from other sources, which can still impact blood sugar.
Precautions for Special Populations
- Pregnant or breastfeeding individuals should consult with a healthcare provider before regularly consuming erythritol.
- People with hereditary fructose intolerance or rare enzyme deficiencies should use caution, although erythritol is generally safer than other polyols.
Practical Tips for Using Erythritol with Diabetes
- Introduce erythritol gradually to assess your tolerance.
- Check product nutrition labels for any additional sources of sugar or carbohydrates.
- Use erythritol for sweetening coffee, tea, homemade desserts, or as a partial sugar replacement in baking—bearing in mind it is less sweet than sugar and may not caramelize.
- Pair with other low glycemic sweeteners, such as stevia, for a balanced flavor.
- Focus on whole foods and limit processed sugar-free foods as part of an overall healthy, diabetes-friendly diet.
Frequently Asked Questions (FAQs)
Q: Does erythritol increase blood sugar or insulin?
A: No. Erythritol has no measurable effect on blood sugar or insulin levels, making it an excellent choice for people with diabetes who want to avoid glucose spikes.
Q: Is erythritol safe for everyday use?
A: Yes, research and regulatory bodies such as the FDA have classified erythritol as Generally Recognized As Safe (GRAS) for consumption. For most people, moderate daily consumption is well tolerated, though very high doses may cause mild digestive upset.
Q: Can people with type 1 or type 2 diabetes use erythritol?
A: Yes, both people with type 1 and type 2 diabetes can safely use erythritol as a sugar alternative, provided they do not have rare sensitivities to it or other sugar alcohols.
Q: What are possible side effects of erythritol?
A: Possible side effects—mainly digestive, such as mild bloating or a laxative effect—are uncommon at moderate intake levels but may occur with excessive use. People who are especially sensitive to sugar alcohols should use caution.
Q: How does erythritol compare to other sugar substitutes?
| Sweetener | Calories per gram | Blood Sugar Impact | Digestive Tolerance | Dental Health |
|---|---|---|---|---|
| Table Sugar (Sucrose) | 4 | High | Good | Promotes cavities |
| Erythritol | 0.24 | None | Excellent | Protective |
| Xylitol | 2.4 | Low | Moderate | Protective |
| Aspartame | 0 | None | Excellent | Neutral |
| Stevia | 0 | None | Excellent | Neutral |
Q: Can erythritol be used in cooking and baking?
A: Yes. Erythritol is heat-stable and works well in many recipes but is less sweet than sugar and does not brown or caramelize as sucrose does. Some people notice a ‘cooling’ aftertaste.
Takeaway
For people with diabetes, erythritol offers a safe and effective way to enjoy sweetness without raising blood sugar or risking tooth decay. Used in moderation, it can help reduce calorie and sugar intake. Always pay attention to your body’s response, read labels carefully, and discuss any dietary changes with a healthcare provider—especially if you have additional health conditions or concerns.
References
- https://pmc.ncbi.nlm.nih.gov/articles/PMC9824470/
- https://www.healthline.com/nutrition/erythritol
- https://www.healthline.com/health/diabetes/erythritol-diabetes
- https://www.webmd.com/diet/what-is-erythritol
- https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-is-erythritol-a-safe-and-healthy-sugar-substitute/
- https://www.ahajournals.org/doi/10.1161/ATVBAHA.124.321019
- https://pmc.ncbi.nlm.nih.gov/articles/PMC10334259/
- https://academic.oup.com/cardiovascres/article/121/9/1319/8153562
- https://www.health.harvard.edu/blog/how-healthy-is-sugar-alcohol-202312183002
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