Erythritol and Other Sugar Alcohols

When you pick up something labelled “sugar-free” or “no added sugar,” chances are you’re about to eat or drink something sweetened with sugar alcohols, also called polyols. These compounds look like sugars chemically, but they’ve been slightly altered. A normal sugar has a carbonyl group which is a carbon double-bonded to oxygen. In sugar alcohols, that part of the molecule is reduced to a hydroxyl group (–OH). That small change makes a big difference. They taste sweet, they behave like sugar in terms of bulk and texture, but they are absorbed differently by the body, and this changes their calorie value, their impact on blood sugar, and even the way they affect your gut.

The most common polyols you’ll find on ingredient lists include erythritol, xylitol, sorbitol, mannitol, maltitol, isomalt, and lactitol. Each of them is used for slightly different reasons. Xylitol, for example, is popular in chewing gum because it fights cavity-causing bacteria. Sorbitol is often found in diet candies and mints. Erythritol is everywhere these days, especially in keto-friendly products, because it is so well absorbed and contributes almost no calories.

Absorption, Metabolism, and Excretion

One of the best studied polyols is erythritol, and its story is quite different from the rest. Human studies have shown that erythritol is absorbed efficiently in the small intestine, much more so than xylitol, sorbitol, or maltitol. Once it enters the bloodstream, the body doesn’t do much with it. Unlike glucose, which gets metabolized to provide energy, erythritol is largely excreted unchanged in the urine. Because of that, its caloric contribution is extremely small, around 0.2 kilocalories per gram compared with sugar’s 4 kilocalories per gram.

That efficient absorption also means erythritol usually doesn’t cause the stomach upsets that people experience with other polyols. A large human study tested repeated daily doses up to 1 gram per kilogram of body weights, about 70 grams for a 70-kilogram person and reported that the participants tolerated it without serious gastrointestinal issues. Compare that with sorbitol or maltitol, where far smaller amounts can cause bloating, flatulence, and diarrhea.

Other sugar alcohols follow a different path. Xylitol is absorbed only partially, the rest is left for bacteria in the colon to ferment. Sorbitol, maltitol, isomalt, and lactitol are even less completely absorbed, which means more of them reach the colon. There, bacteria ferment them into gases like hydrogen, carbon dioxide, and methane, and into short-chain fatty acids that can be absorbed. While short-chain fatty acids may have benefits, the gas and the osmotic pull of unabsorbed molecules often lead to uncomfortable symptoms gas, bloating, and loose stools.

Physiological Effects

One of the biggest reasons sugar alcohols have become so common is their effect on blood sugar and insulin. Because they are absorbed either slowly or incompletely, they don’t produce the same rapid rise in glucose and insulin that table sugar does. Reviews of both erythritol and other polyols consistently show that these compounds have minimal to low postprandial glycemic effects, making them especially appealing for people with diabetes or those managing blood sugar for metabolic health.

The gut effects are another story. What happens in the colon depends on how much of the sweetener escapes absorption. For erythritol, very little does, which is why it is tolerated better than others. But sorbitol and maltitol often make it through in larger amounts, and that is why the labels on candies and gums warn about “excess consumption causing a laxative effect.” The fermentation process isn’t all bad, though. Short-chain fatty acids produced in the colon can benefit the intestinal lining and have systemic metabolic effects. The problem is that they come along with gas and discomfort.

Dental health is one of the bright spots for polyols. Oral bacteria like Streptococcus mutans thrive on sugars, producing acids that erode tooth enamel. Polyols, on the other hand, are poorly fermented by these microbes. That means they don’t contribute to cavities. Xylitol has even been shown to inhibit bacterial growth, and erythritol appears to reduce plaque formation, which makes both favorites for toothpaste and chewing gum.

Tolerance, Safety, and Emerging Concerns

For decades, erythritol has been considered one of the safest sugar alcohols, in part because of its absorption profile. The European Food Safety Authority has not set a strict Acceptable Daily Intake but does suggest that about 0.5 grams per kilogram of body weight per day is a reasonable upper limit to avoid gastrointestinal side effects. For sorbitol, maltitol, and isomalt, this is the most immediate downside. Because they aren’t absorbed well, they reach the colon and pull water with them, while bacteria ferment them into gases. That’s why people who eat sugar-free candies sometimes end up with cramps, bloating, or diarrhea. Labels warn about this for good reason. Even erythritol, though usually well tolerated, can trigger problems if consumed in very large doses, especially for sensitive individuals.

The second concern is cardiovascular risk, which has only recently been spotlighted. Large cohort studies have found that people with higher blood erythritol levels were more likely to suffer heart attacks or strokes. The tricky part is that the body makes erythritol on its own, so high levels may signal metabolic dysfunction rather than be caused directly by diet. But controlled experiments add weight to the concern. In one human trial, a drink with 30 grams of erythritol increased platelet activity, essentially making the blood more likely to clot. Lab studies with blood vessel cells suggest erythritol can increase oxidative stress, reduce nitric oxide (which helps vessels relax), and upregulate endothelin-1, a vasoconstrictor. Together, these effects could, at least in theory, push the body toward a pro-thrombotic, a condition where your blood is more prone to forming clots (thrombi).

There’s also the problem of dosage mismatch. The average person might not consume 30 grams of erythritol in a single drink, but “keto” products or sugar-free baked goods can contain surprisingly high amounts. A single dessert could easily cross into the range where blood levels spike and lab effects become relevant. What we don’t yet know is whether long-term, moderate use leads to harm the way high acute doses might.

Finally, individual variability matters. People with existing cardiovascular disease, clotting disorders, kidney impairment, or sensitive digestive systems may be more vulnerable. What’s safe for one person might be risky for another, especially if combined with other dietary or lifestyle factors.

Erythritol and other sugar alcohols occupy an interesting middle ground in nutrition science. On one hand, they provide sweetness and bulk with fewer calories, less impact on blood sugar, and real benefits for dental health. On the other, they can cause digestive distress if consumed in excess, and erythritol is now being investigated for potential effects on blood clotting and cardiovascular risk.

The safest practical takeaway is moderation. Consuming small to moderate amounts of erythritol is unlikely to cause gastrointestinal problems, and it is probably less risky than frequent high sugar intake. But large bolus doses, like downing a drink with 30 grams or more, may not be advisable, especially for people with cardiovascular risk factors. Other polyols like xylitol and sorbitol should also be approached carefully, as their tolerance thresholds are lower.

What we don’t yet have are long-term randomized controlled trials that can tell us definitively whether chronic erythritol intake affects cardiovascular outcomes. Until those studies are done, the best advice is to enjoy polyols as occasional tools for reducing sugar intake, but not to treat them as entirely “free” foods without possible downsides.

After diving into erythritol and other sugar alcohols, one thing becomes clear: not all “sugar-free” or “low-carb” treats are created equal. Many rely heavily on polyols that can upset your gut or may carry emerging health concerns when eaten in large amounts. That’s why we set out to build something better.

No Spike cookies by B’spoke are crafted with a different philosophy. Instead of leaning on heavy doses of sugar alcohols, we use blanched almond flour, high-quality protein, 21 grams of prebiotic fiber, and 128 mg of magnesium, a nutrient blend designed to satisfy cravings while supporting metabolic health. The result is a cookie that tastes indulgent but works like a functional food. No sugar crashes, no empty calories, no artificial sugars, just smarter snacking that respects both your metabolism and your sweet tooth.

Because in the end, your cookie shouldn’t just fill you up it should fuel you well. That’s why No Spike cookies by B’spoke.

References:

Hazen, S. L., et al. (2023). The artificial sweetener erythritol and cardiovascular event risk. Nature Medicine, 29(3), 710–718. https://doi.org/10.1038/s41591-023-02223-9

Witkowski, M., Nemet, I., et al. (2024). Ingestion of the non-nutritive sweetener erythritol, but not glucose, enhances platelet reactivity in healthy volunteers. Arteriosclerosis, Thrombosis, and Vascular Biology, 44(3), 292–302. https://doi.org/10.1161/ATVBAHA.124.321019

Zheng, Y., Hu, F. B., & Rimm, E. B. (2023). The sugar-free paradox: Cardiometabolic consequences of erythritol. Signal Transduction and Targeted Therapy, 8(1), 313. https://doi.org/10.1038/s41392-023-01504-6

Lajous, M., et al. (2024). Sweeteners: Erythritol, xylitol and cardiovascular risk—friend or foe? Cardiovascular Research, cvaf091. https://doi.org/10.1093/cvr/cvaf091

U.S. Food and Drug Administration. (2023). FDA review of Hazen et al. (2023) on erythritol and cardiovascular risk. https://www.fda.gov/media/182122/download

Ouyang, P., et al. (2025). Erythritol, erythronate, and cardiovascular outcomes in older adults. JACC: Advances, 4(2), 101605. https://doi.org/10.1016/j.jacadv.2025.101605

ClinicalTrials.gov. (2023). Dietary erythritol on platelet reactivity and vascular inflammation (NCT05967741). Retrieved from https://clinicaltrials.ucbraid.org/trial/NCT05967741