Erythritol
A polyol with moderate sweetening power, almost calorie-free with no glycaemic impact and better tolerated by the gut than other sugar alcohols, but recently scrutinised for cardiovascular health.
Erythritol is a special polyol: unlike other sugar alcohols, it is absorbed in the small intestine and then excreted unchanged in the urine (it is barely metabolised or fermented). The result: zero effective calories, a glycaemic index of zero, and much better digestive tolerance than xylitol or sorbitol (less bloating and laxative effect, because it is little fermented).
These qualities have made it the darling of ketogenic and low-sugar diets, and a common ingredient in “natural” sweetener blends (often combined with stevia).
The original angle (the 2023 cardiovascular controversy): long considered the “cleanest” sweetener, erythritol was called into question by a notable study (Witkowski et al., Nature Medicine, 2023). It linked high blood levels of erythritol to an increased risk of cardiovascular events (clots), suggesting a possible effect on platelet aggregation.
The important nuance: this study is observational (correlation, not proven causation) and complex to interpret. The body also makes erythritol endogenously (from glucose), so a high blood level could reflect a pre-existing metabolic problem rather than being caused by dietary erythritol. The scientific debate is open and more studies are needed.
A pragmatic position: erythritol remains authorised and useful for cutting sugar, notably in people with diabetes. But the affair is a reminder of a general lesson: no sugar substitute is perfectly neutral, and the best strategy remains to reduce your overall sweet taste rather than multiply substitutes. Caution suggests not eating very large amounts while we wait for more data.
Sources/use: produced by fermenting glucose, found in sweetener blends, keto products and “sugar-free” products. Trace amounts occur naturally in some fruits and fermented foods.