Erythritol

What it is

Erythritol is a polyol, the group also called sugar alcohols, alongside sorbitol, xylitol and maltitol.^[3] It occurs naturally in small amounts in fruits and vegetables, and the body makes a little of its own through the pentose phosphate pathway, a branch of glucose metabolism.^[4] The commercial ingredient is made by fermenting glucose with the yeasts Moniliella pollinis or Moniliella megachiliensis, then purifying and drying it into white, heat-stable crystals.^[1] A 2026 FDA notice also covers erythritol made by fermentation with Yarrowia lipolytica.^[5]

What sets erythritol apart from other polyols is where it goes. Between 78% and 92% of a dose is excreted unchanged in urine within 24 hours, less than 1% is metabolized, and gut bacteria break down very little of it.^[1] The EU's former Scientific Committee on Food found that it has a laxative effect, but at higher doses than other polyols.^[1]

On a US Nutrition Facts label, sugar alcohols are their own line, separate from sugars, and declaring them is voluntary unless the label makes a claim about sugar or sugar alcohols.^[6] In Replenish, erythritol gives bulk alongside the two high-intensity sweeteners, Reb M and monk fruit extract.

Official reference values

Erythritol is not a nutrient, so there is no RDA. The reference values that exist are safety limits set by food regulators.

Sources: EFSA Panel on Food Additives and Flavourings, Re-evaluation of erythritol (E 968) as a food additive, 2023, which also reports the JECFA evaluation and the EU labeling rule;^[1] FDA GRAS Notice Inventory.^[2][5] ADI = acceptable daily intake. GRAS = generally recognized as safe.

Replenish lists erythritol under Other Ingredients, which carry no declared amount.

For scale, the EFSA limit works out to 35 g a day for a 70 kg adult. EFSA judged its exposure estimates to be overestimates, but noted that high consumers, especially children and adolescents, could exceed the limit; 2 liters of a flavored drink at the maximum EU level of 1.6% erythritol would exceed it for anyone weighing 60 kg or less.^[1]

What the evidence says

Blood sugar. EFSA found that the human evidence, though limited, consistently showed no short-term effect of erythritol on blood glucose after a meal, and that no long-term studies of glucose control exist.^[1] FDA describes sugar alcohols in general as not causing a sudden increase in blood glucose.^[3]

Heart and clotting: the 2023 study. Researchers measured fasting blood erythritol in 2,149 US and 833 European patients undergoing cardiac evaluation and followed them for 3 years. People in the top quarter of erythritol levels had a higher risk of heart attack, stroke or death than those in the bottom quarter, with adjusted hazard ratios of 1.80 and 2.21 in the two cohorts.^[4] In lab and animal work, erythritol at levels found in blood made platelets more reactive and clots form more readily. In 8 healthy volunteers, a drink with 30 g of erythritol raised blood levels well above those thresholds for more than 2 days.^[4]

The authors listed the limits themselves. It was observational and can show association, not causation. Erythritol was measured once. The patients were referred for cardiac testing and had high rates of heart disease and risk factors, so the results may not apply to the general population. Diet and other factors may not have been fully accounted for.^[4] The body makes erythritol too, so a fasting level reflects both diet and metabolism; the US cohort was largely recruited before erythritol was common in processed foods.^[4]

The 2024 follow-up. The same group gave 10 healthy volunteers 30 g of erythritol and 10 others 30 g of glucose. Erythritol, but not glucose, increased platelet responsiveness on several lab measures, in every participant.^[7] The authors note the study was small, measured only acute effects of a single large dose, and needs replication.^[7] It measured platelet tests, not heart attacks or strokes.

What regulators said. FDA reviewed the 2023 paper and concluded that the observational studies did not establish a causal link between eating erythritol and the effects observed; it says it will keep monitoring.^[3] EFSA's 2023 re-evaluation considered this and other observational studies and found that they do not demonstrate a causal relationship with cardiovascular disease, while noting further studies could clarify the association.^[1] The 2024 platelet study was published after both assessments. The fair summary is an open question: a signal from observational and short-term lab studies, no trial showing harm to the heart, and no long-term trial showing safety either.

WHO guidance. WHO's 2023 guideline on non-sugar sweeteners does not apply to erythritol: sugar alcohols contain calories and are excluded from its definition.^[8]

Safety and interactions

The adverse effect regulators base their limit on is diarrhea. EFSA concluded erythritol very likely has the potential to cause it, treated it as adverse because of possible fluid and electrolyte loss, and also noted abdominal pain, bloating and flatulence in the studies.^[1] The risk depends on how much is taken at once and in a day, which is why EFSA's limit is by body weight. Fluid balance matters more than usual when eating and drinking less; see what to drink on a GLP-1 besides water.

If you have cardiovascular disease, have had a stroke or clot, or take medicine that affects clotting, the 2023 and 2024 findings are reasonable to raise with your clinician when deciding how much erythritol-sweetened food and drink to have. We found no labeled drug interactions for erythritol in the sources we used.

If you take prescription medicine, ask your pharmacist or prescriber before adding a supplement.

In Replenish

Replenish uses erythritol with Reb M and monk fruit extract to sweeten a drink mix that provides key vitamins and minerals.^† It appears under Other Ingredients, which carry no declared amount; the Supplement Facts panel lists the nutrients. See Replenish, and how sweeteners fit into choosing a mix in the best electrolytes for a GLP-1.