What are the maximum acute and daily doses for adults and children to avoid gastrointestinal effects?
How Much Erythritol Sweetener Is Too Much?
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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
Erythritol is a sugar alcohol naturally found in small quantities in certain fruits and vegetables, now produced in mass quantities commercially for use as a sweetener at about 70 percent as sweet as table sugar. Previously I talked about its role in actively preventing tooth decay. It’s reported to be “totally safe,” with almost no calories, and, as a bonus, it’s less laxative. That’s always a good selling point.
Erythritol has the highest digestive tolerance of all the sugar alcohols. But how much is that really saying? I’ve talked about the case report of the air stewardess with puzzling diarrhea––found not so puzzling, given how much sorbitol-containing sugar-free gum she was chewing. Sorbitol has also been implicated in “Halloween diarrhea,” where people eat one too many sugar-free candies.
Erythritol, however, is said to be well-tolerated even up to 80 grams if it’s spread out throughout the day, which is like 19 teaspoons, or the sugar equivalent of what you’d find in a 20-ounce bottle of Mountain Dew. In terms of a single dose, though, the average-weight man in the U.S. could get away with 14 teaspoons of erythritol at a time, and the average-weight woman 15 teaspoons.
Children do not appear to be more sensitive on a per weight basis, but because they’re so much lighter, the maximum dose would be more like three or four teaspoons at a time, since above that, you start seeing diarrhea and/or severe gastrointestinal symptoms. And while adults may get away with downing about a quarter cup at a time, that’s based on when they started having the runs. If you don’t want to have any symptoms, you’d want to stick to under about three tablespoons at a time, since once you hit four, it can make you nauseated and give you borborygmi, a fancy medical term for rumbling in your tummy.
Erythritol is also purported to have anti-oxidant properties. I did a video about the paper that first discovered it. But that was just demonstrating it in a test tube. Does it actually make a difference? Erythritol appears to have endothelial protective effects, meaning protecting the cells that line our arteries. Under normal blood sugar conditions, little effect, but stress them out in a petri dish with high blood sugars, and erythritol protected human endothelial cells. Under normal blood sugars, a few endothelial cells were dying off, but under high blood sugars, cell death shoots up. But add some erythritol at that same high blood sugar level, and death comes back down. Erythritol attenuates cell death induced by diabetic stressors. The researchers conclude that erythritol may have a therapeutically important protective effect on endothelial cells. But you don’t know, until you put it to the test.
“Effects of erythritol on endothelial function in patients with type 2” and…erythritol consumption acutely improved small vessel endothelial function, and chronically reduced major artery stiffness. The researchers conclude that the beneficial effects of erythritol may be clinically relevant if confirmed in a controlled study. Wait, it wasn’t controlled? No, so you don’t know if it would have just happened anyway. So, validation of these findings will require a randomized, placebo-controlled study, which should be easy to do, since there are lots of things you could secretly swap in for the erythritol, and no one would know. It hasn’t been done yet, but things were looking pretty good for erythritol, and then…
Erythritol is associated with body fat gain in young adults? What? Erythritol is a predictive biomarker of metabolic dysfunction? Significantly associated with getting diabetes? Significantly associated with getting coronary heart disease? What is going on? We will find out next.
Please consider volunteering to help out on the site.
- Grembecka M. Sugar alcohols—their role in the modern world of sweeteners: a review. Eur Food Res Technol. 2015;241:1-14.
- Moriconi E, Feraco A, Marzolla V, et al. Neuroendocrine and Metabolic Effects of Low-Calorie and Non-Calorie Sweeteners. Front Endocrinol (Lausanne). 2020;11:444.
- Honkala S, Runnel R, Saag M, et al. Effect of erythritol and xylitol on dental caries prevention in children. Caries Res. 2014;48(5):482-90.
- de Cock P, BC. Erythritol. Functionality in noncaloric functional beverages. Pure Appl Chem. 2002;74(7):1281-9.
- Breitenbach RA. 'Halloween diarrhea'. An unexpected trick of sorbitol-containing candy. Postgrad Med. 1992;92(5):63-6.
- Jacqz-Aigrain E, Kassai B, Cornu C, et al. Gastrointestinal tolerance of erythritol-containing beverage in young children: a double-blind, randomised controlled trial. Eur J Clin Nutr. 2015;69(6):746-51.
- Storey D, Lee A, Bornet F, Brouns F. Gastrointestinal tolerance of erythritol and xylitol ingested in a liquid. Eur J Clin Nutr. 2007;61(3):349-54.
- den Hartog GJ, Boots AW, Adam-Perrot A, et al. Erythritol is a sweet antioxidant. Nutrition. 2010;26(4):449-58.
- Boesten DM, Berger A, de Cock P, et al. Multi-targeted mechanisms underlying the endothelial protective effects of the diabetic-safe sweetener erythritol. PLoS One. 2013;8(6):e65741.
- Flint N, Hamburg NM, Holbrook M, et al. Effects of erythritol on endothelial function in patients with type 2 diabetes mellitus: a pilot study. Acta Diabetol. 2014;51(3):513-6.
- Hootman KC, Trezzi JP, Kraemer L, et al. Erythritol is a pentose-phosphate pathway metabolite and associated with adiposity gain in young adults. Proc Natl Acad Sci U S A. 2017;114(21):E4233-40.
- Ortiz SR, Field MS. Mammalian metabolism of erythritol: a predictive biomarker of metabolic dysfunction. Curr Opin Clin Nutr Metab Care. 2020;23(5):296-301.
- Rebholz CM, Yu B, Zheng Z, et al. Serum metabolomic profile of incident diabetes. Diabetologia. 2018;61(5):1046-54.
- Wang Z, Zhu C, Nambi V, et al. Metabolomic pattern predicts incident coronary heart disease. Arterioscler Thromb Vasc Biol. 2019;39(7):1475-82.
Motion graphics by Avo Media
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
Erythritol is a sugar alcohol naturally found in small quantities in certain fruits and vegetables, now produced in mass quantities commercially for use as a sweetener at about 70 percent as sweet as table sugar. Previously I talked about its role in actively preventing tooth decay. It’s reported to be “totally safe,” with almost no calories, and, as a bonus, it’s less laxative. That’s always a good selling point.
Erythritol has the highest digestive tolerance of all the sugar alcohols. But how much is that really saying? I’ve talked about the case report of the air stewardess with puzzling diarrhea––found not so puzzling, given how much sorbitol-containing sugar-free gum she was chewing. Sorbitol has also been implicated in “Halloween diarrhea,” where people eat one too many sugar-free candies.
Erythritol, however, is said to be well-tolerated even up to 80 grams if it’s spread out throughout the day, which is like 19 teaspoons, or the sugar equivalent of what you’d find in a 20-ounce bottle of Mountain Dew. In terms of a single dose, though, the average-weight man in the U.S. could get away with 14 teaspoons of erythritol at a time, and the average-weight woman 15 teaspoons.
Children do not appear to be more sensitive on a per weight basis, but because they’re so much lighter, the maximum dose would be more like three or four teaspoons at a time, since above that, you start seeing diarrhea and/or severe gastrointestinal symptoms. And while adults may get away with downing about a quarter cup at a time, that’s based on when they started having the runs. If you don’t want to have any symptoms, you’d want to stick to under about three tablespoons at a time, since once you hit four, it can make you nauseated and give you borborygmi, a fancy medical term for rumbling in your tummy.
Erythritol is also purported to have anti-oxidant properties. I did a video about the paper that first discovered it. But that was just demonstrating it in a test tube. Does it actually make a difference? Erythritol appears to have endothelial protective effects, meaning protecting the cells that line our arteries. Under normal blood sugar conditions, little effect, but stress them out in a petri dish with high blood sugars, and erythritol protected human endothelial cells. Under normal blood sugars, a few endothelial cells were dying off, but under high blood sugars, cell death shoots up. But add some erythritol at that same high blood sugar level, and death comes back down. Erythritol attenuates cell death induced by diabetic stressors. The researchers conclude that erythritol may have a therapeutically important protective effect on endothelial cells. But you don’t know, until you put it to the test.
“Effects of erythritol on endothelial function in patients with type 2” and…erythritol consumption acutely improved small vessel endothelial function, and chronically reduced major artery stiffness. The researchers conclude that the beneficial effects of erythritol may be clinically relevant if confirmed in a controlled study. Wait, it wasn’t controlled? No, so you don’t know if it would have just happened anyway. So, validation of these findings will require a randomized, placebo-controlled study, which should be easy to do, since there are lots of things you could secretly swap in for the erythritol, and no one would know. It hasn’t been done yet, but things were looking pretty good for erythritol, and then…
Erythritol is associated with body fat gain in young adults? What? Erythritol is a predictive biomarker of metabolic dysfunction? Significantly associated with getting diabetes? Significantly associated with getting coronary heart disease? What is going on? We will find out next.
Please consider volunteering to help out on the site.
- Grembecka M. Sugar alcohols—their role in the modern world of sweeteners: a review. Eur Food Res Technol. 2015;241:1-14.
- Moriconi E, Feraco A, Marzolla V, et al. Neuroendocrine and Metabolic Effects of Low-Calorie and Non-Calorie Sweeteners. Front Endocrinol (Lausanne). 2020;11:444.
- Honkala S, Runnel R, Saag M, et al. Effect of erythritol and xylitol on dental caries prevention in children. Caries Res. 2014;48(5):482-90.
- de Cock P, BC. Erythritol. Functionality in noncaloric functional beverages. Pure Appl Chem. 2002;74(7):1281-9.
- Breitenbach RA. 'Halloween diarrhea'. An unexpected trick of sorbitol-containing candy. Postgrad Med. 1992;92(5):63-6.
- Jacqz-Aigrain E, Kassai B, Cornu C, et al. Gastrointestinal tolerance of erythritol-containing beverage in young children: a double-blind, randomised controlled trial. Eur J Clin Nutr. 2015;69(6):746-51.
- Storey D, Lee A, Bornet F, Brouns F. Gastrointestinal tolerance of erythritol and xylitol ingested in a liquid. Eur J Clin Nutr. 2007;61(3):349-54.
- den Hartog GJ, Boots AW, Adam-Perrot A, et al. Erythritol is a sweet antioxidant. Nutrition. 2010;26(4):449-58.
- Boesten DM, Berger A, de Cock P, et al. Multi-targeted mechanisms underlying the endothelial protective effects of the diabetic-safe sweetener erythritol. PLoS One. 2013;8(6):e65741.
- Flint N, Hamburg NM, Holbrook M, et al. Effects of erythritol on endothelial function in patients with type 2 diabetes mellitus: a pilot study. Acta Diabetol. 2014;51(3):513-6.
- Hootman KC, Trezzi JP, Kraemer L, et al. Erythritol is a pentose-phosphate pathway metabolite and associated with adiposity gain in young adults. Proc Natl Acad Sci U S A. 2017;114(21):E4233-40.
- Ortiz SR, Field MS. Mammalian metabolism of erythritol: a predictive biomarker of metabolic dysfunction. Curr Opin Clin Nutr Metab Care. 2020;23(5):296-301.
- Rebholz CM, Yu B, Zheng Z, et al. Serum metabolomic profile of incident diabetes. Diabetologia. 2018;61(5):1046-54.
- Wang Z, Zhu C, Nambi V, et al. Metabolomic pattern predicts incident coronary heart disease. Arterioscler Thromb Vasc Biol. 2019;39(7):1475-82.
Motion graphics by Avo Media
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Title
How Much Erythritol Sweetener Is Too Much?
LicenseCreative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Content URLDoctor's Note
Stay tuned for Update on Erythritol Sweetener Safety: Are There Side Effects?, my next video, where I detail a recent study that raised safety concerns. *SPOILER ALERT: DON’T EAT ERYTHRITOL*
The previous erythritol videos I mentioned are Erythritol vs. Xylitol for Preventing Cavities (Tooth Decay) and Erythritol May Be a Sweet Antioxidant.
The case report about the flight attendant’s sorbitol side effect is in Does Chewing Gum Help with Weight Loss?.
This is part of my new research on sweeteners. A couple of months ago, I released some videos on allulose: Does the Sweetener Allulose Have Side Effects? and Is Allulose a Healthy Sweetener?.
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