Updated: Oct 7
If you have diabetes and purchase sugar-free foods and drinks, you may have seen the names erythritol or xylitol listed as ingredients on the nutrition labels. Erythritol and xylitol are commonly used in sugar-free candies, cookies and more. These and other sugar alcohols, generally have less of an impact on blood glucose than real sugar. So, they may seem like an obvious choice if you’re trying to manage your diabetes. Right? Not so fast…
It’s important to consider: Are sugar alcohols, and especially erythritol and xylitol, completely safe? The answer is more complicated than a simple yes or no.
Heart Attack and Stroke Risk
Recent research has raised concerns about an association between higher circulating blood levels of erythritol and xylitol and experiencing a major adverse cardiovascular event (known by the acronym MACE for short), including heart attack and stroke. These findings do not confirm that consuming foods and drinks containing these sweeteners directly causes a cardiovascular event. However, researchers have concerns that these and other sugar alcohols may pose a potential risk. More studies are needed to confirm the risks.
Sugar alcohols including erythritol and xylitol can offer two advantages, as generally they produce a smaller rise in blood glucose and are lower in calories than real sugar. However, several studies in the past few years on both erythritol and xylitol have raised questions about their safety, as both substances may increase the risk for blood clots to form (prothrombotic activity).
Current evidence does not prove that eating erythritol or xylitol causes a cardiovascular event. However, these new findings are worth understanding, especially for people with diabetes, who already have an increased risk of cardiovascular disease.
What Are Xylitol and Erythritol?
Erythritol and Xylitol are sugar alcohols, also known as polyols. They’re used as sugar substitutes because they generally produce a smaller rise in blood glucose than table sugar. This is one reason they can be appealing to people with any type of diabetes and prediabetes.
I discourage people living with any type of diabetes or prediabetes from using sugar alcohols. Why?
• Potential cardiovascular risks
• Gastrointestinal discomfort: They can cause diarrhea, bloating, gas, and digestive upset in some individuals.
• Better whole-food alternatives: It is far healthier to satisfy a craving for sweets with a piece of fresh fruit, berries, or grapes. Fruits are packed with essential nutrients and fiber that provide numerous health benefits. Just remember to pair your fruit with a protein source to help lessen the blood glucose spike.
Also, the words “sugar-free” or “keto” on a food label do not automatically mean the food or beverage is healthy. Many times, foods and drinks containing sugar alcohols and other sweeteners can still have substantial amounts of carbohydrates, calories, saturated fat, sodium, and food additives like artificial colors, flavors, and preservatives, which are unhealthy when consumed in large amounts.
The Gastrointestinal Side Effects of Xylitol and Erythritol
One of the best-known concerns about consuming sugar alcohols is the digestive discomfort they can cause in some people. Because sugar alcohols are not entirely absorbed in the intestine, they attract water into the gastrointestinal tract and have the potential to be fermented by the bacteria in the intestines. Depending on the amount of sugar alcohol consumed and a person’s other medical conditions, such as, but not limited to, irritable bowel syndrome (IBS), it can result in gas, bloating, abdominal discomfort, or diarrhea.
For someone with diabetes, diarrhea can create added challenges due to the potential for dehydration. Dehydration can make blood glucose more difficult to manage, especially when a person is taking diabetes medications that increase their urine output, or if their blood glucose is already running high (above range). In the latter case, they may already be somewhat dehydrated from frequent urination caused by high blood sugar. Ultimately, dehydration can lead to higher blood glucose readings and other medical complications.
Why This Matters for People with Diabetes
People living with diabetes should pay attention to research on the potential cardiovascular risks of erythritol and xylitol, because diabetes itself increases cardiovascular risk.
Also, it’s important to recognize that a sugar-free treat, drink, keto snack, or food is NOT automatically a healthier choice. The words ‘sugar-free’ simply tell you what a product does not contain. It does not tell you if a food is nutritious or healthy, as I mentioned above.
The big nutritional picture matters when planning your meals and snacks. Factors to consider include the nutritional quality of the food or drink, as well as its impact on your blood glucose, heart health, blood pressure, cholesterol, and weight.
So, Should You Avoid Erythritol and Xylitol?
If you have diabetes, heart disease, or metabolic syndrome and consume foods or drinks containing erythritol or xylitol, it is recommended that you reduce your intake until more research is done to determine their safety. Some researchers even suggest stopping consumption entirely until more is known about their potential risks.
Currently, if you crave something sweet, reach for fresh fruit. Don't forget to pair your fruit with lean protein like fat-free Greek yogurt or cottage cheese, to lessen the blood glucose spike from the fruit.
If you want something sweeter than fruit for a special occasion, remember to have just a taste (a small portion) as an occasional treat.
If it's difficult to stop consuming foods and beverages with erythritol or xylitol cold turkey, try to wean yourself off them. By consuming less each day, your taste buds will soon adjust.
The Bottom Line
Erythritol and xylitol can reduce the blood-glucose spike for some people when compared to eating and drinking foods and beverages with added sugar, but they may not be entirely safe. Current research has raised legitimate questions about their consumption and the risks of developing gastrointestinal symptoms and experiencing dangerous cardiovascular events.
The science is still evolving. More research needs to be done...
In the interim, the evidence-based approach is to avoid excessive consumption of erythritol and xylitol, aiming to eliminate them from your diet until more is known about their safety.
Your diabetes self-care can be more effective if you monitor how your blood glucose and body respond to the foods you eat and the beverages you drink. Also, it's helpful to focus on an overall eating pattern that supports your goals for blood glucose control and supports your cardiovascular health.
*Always contact your personal physician or other licensed healthcare provider for questions and concerns about your health. This article and website are for informational purposes only, and not a substitute for medical care or medical advice.
References
