Sugar Alcohols: Understanding the warnings about erythritol for people with diabetes
This article will help you navigate the world of sugar substitutes for someone with diabetes from a weight-inclusive perspective.
Having diabetes and navigating the world of sugar substitutes is challenging because there is a lot of new research to sort out. This is the second post in a two-post series that looks at sugar substitutes from a weight-inclusive perspective for people with diabetes. This post will focus on sugar alcohol, reviewing the current research and the pros and cons of this sweetener.
To start out sugar alcohols, also known as polyols, are carbohydrates that occur naturally in fruits and vegetables but can also be produced commercially. Some common sugar alcohols include erythritol, xylitol, sorbitol, and maltitol. Three of these sweeteners have a low glycemic index and are often used in low-carb and sugar-free products. Maltitol isn’t considered a low GI food, having a similar GI score as sugar, which is 60.
Erythritol: Calories: 0.2 per g | GI: 1
Xylitol: Calories: 2.4 per g | GI: 13
Sorbitol: Calories: 2.6 per g | GI: 4
Maltitol: Calories: 2.1 per g | GI: 52
Erythritol is a sugar alcohol with a very low caloric value, providing only 0.2 calories per gram. It is about 70% as sweet as sugar and does not cause a significant increase in blood sugar levels. It is often used with other sweeteners to improve taste and reduce overall calorie content. 2023 research put erythritol into the spotlight because of new health risks.
Research Summary. 1000 people were tracked for heart attacks or stroke, and after three years, there was evidence that elevated levels of erythritol were associated with the risk for cardiovascular events. To confirm the results, 3000 people were studied to understand the association between erythritol and cardiovascular events. This study found that people with the highest erythritol levels (top 25%) were about twice as likely to have cardiovascular events as those with the lowest (bottom 25%). While compelling, the researchers asked how diet affects erythritol levels after drinking a beverage sweetened with erythritol. The study used a very small sample size but found blood erythritol levels increased 1,000-fold and remained substantially elevated after drinking one soda sweetened with erythritol. Remember, the original study found that elevated levels of erythritol were associated with an increased risk of heart attacks and strokes.
Some familiar items that contain erythritol include Truvia®, Splenda®, Vitamin Water Zero®, and Halo Top Ice Cream®, but any chewing gum, jelly, chocolate, hard candy, ice cream, yogurt, diet drink, or flavored water could contain this ingredient.
Is Erythritol in Diet Coke or Diet Pepsi?
Finding erythritol on a food label is challenging because it is not a sugar but a “sugar alcohol,” which is not required to be listed on the Nutrition Facts Panel. Look in the Ingredient List to determine if your food contains this substance. And to answer the question, is it in diet Coke/Pepsi - no. Seeing “sugar alcohols” in the ingredient list may be the only clue that erythritol is present in the food.1 The RDA hasn’t published guidelines about the amount of erythritol considered safe for consumption.
What should you do?
It is helpful to remember that these health concerns are relatively new, and while there are risks associated with Erythritol, it is still considered safe to eat. The best advice is to use your judgment. Start by focusing on what you are doing that is good. It is good that you are considering how to moderate your carbohydrate intake. A table from the Canadian government listing foods that typically contain erythritol is provided at the end of this article. It is great that you are curious if and how sugar substitutes could be part of your diet. Understanding that many of us grew up drinking diet soda and chewing sugar-free gum makes this a familiar choice. Sugar-free products were marketed as a healthier alternative; it is normal if learning about new health risks is upsetting. Give yourself space and grace to process this information.
Take a step back.
It is also helpful to consider how the concerns about sugar are part of fatphobia and wellness culture. People with diabetes can and have every right to eat sugar. The article Reading labels without getting triggered provides more information on how to be aware of carbohydrates vs. sugar. Focusing on moderating the total carbohydrates has been helpful for my clients. Like you, they discovered that stepping away from diet culture and accepting their body allows them to eat various foods regularly, stabilizing blood sugar!
Candian Table of Erythritol2
https://www.steponefoods.com/blogs/news/erythritol-proves-we-should-never-get-cute-with-our-food#:~:text=Foods%20that%20contain%20erythritol,water%20could%20contain%20this%20ingredient.
https://www.canada.ca/en/health-canada/services/food-nutrition/food-safety/food-additives/lists-permitted/9-sweeteners.html