Erythritol Does Not Spike Blood Glucose or Insulin
Erythritol does not increase blood glucose or insulin levels in healthy individuals or people with diabetes. This sugar alcohol is absorbed from the small intestine but not metabolized systemically, and is excreted unchanged in urine, making it metabolically inert with respect to glycemic control 1, 2.
Evidence from Clinical Studies
Acute Effects on Glucose and Insulin
Single-dose administration of erythritol (20g) to patients with diabetes showed no change in serum glucose or insulin levels until food was consumed 3 hours later 3.
In healthy subjects, erythritol (0.3 g/kg body weight) did not increase serum glucose or insulin levels, while the same dose of glucose rapidly increased both within 30 minutes 4.
The lack of glycemic response occurs because erythritol is readily absorbed from the small intestine but not systemically metabolized, with over 90% excreted unchanged in urine within 48 hours 4.
Chronic Administration Studies
Daily administration of 20g erythritol for 14 days in diabetic patients showed no adverse effects on blood glucose control, and actually demonstrated decreased mean serum glucose and hemoglobin A1c levels over the study period 3.
Long-term studies confirm that erythritol produces a lower postprandial glucose response than sucrose or glucose 1, 5.
Guideline Recommendations
FDA and Professional Society Positions
The American Diabetes Association confirms that sugar alcohols, including erythritol, produce a lower postprandial glucose response than sucrose or glucose and have lower available energy 1.
Erythritol has been designated as GRAS (Generally Recognized as Safe) by the FDA and has undergone rigorous regulatory scrutiny 1, 6.
The American Diabetes Association states that erythritol is safe for use by people with diabetes and can be used as an acceptable alternative to sugar for glycemic control 6.
Caloric Content and Metabolic Profile
Erythritol provides only 0.2 kcal/g, compared to 4 kcal/g for sucrose, making it essentially noncaloric 1.
This minimal caloric value reflects the fact that erythritol is not systemically metabolized and provides negligible available energy to the body 2, 4.
Practical Clinical Application
For Patients with Diabetes
Erythritol can be used as a sugar substitute without concern for glycemic spikes, making it particularly beneficial for people with diabetes or prediabetes 6.
When calculating carbohydrate content of foods containing sugar alcohols, subtraction of half the sugar alcohol grams from total carbohydrate grams is appropriate for most sugar alcohols, though erythritol's minimal absorption makes this conservative 1.
Safety Considerations
The use of sugar alcohols including erythritol appears to be safe, though they may cause diarrhea, especially in children, due to osmotic effects in the colon 1, 6.
Erythritol is better tolerated than other sugar alcohols because it is almost fully absorbed in the small intestine rather than reaching the colon 7.
During pregnancy, erythritol should be consumed with moderation within FDA acceptable daily intake levels, though it is considered safe 6.
Important Caveats
Recent Cardiovascular Concerns
While erythritol does not affect glucose or insulin, recent observational studies have shown associations between plasma erythritol levels and cardiovascular disease 1, 6.
However, it is unlikely that dietary erythritol mediates these associations; rather, elevated plasma erythritol likely reflects dysregulated endogenous production via the pentose phosphate pathway due to impaired glycemia 7.
Optimal Use Strategy
The most prudent approach is to use erythritol as a transitional tool to reduce added sugar consumption, while gradually working toward a diet that depends less on intensely sweet flavors 6.
Healthcare professionals should assure patients that erythritol has undergone extensive safety evaluation and can allay unnecessary concerns about harm, while recommending moderation 1.