A systematic review exploring potential relationships between dietary erythritol and human health outcomes

Summary Erythritol is a sweetener that is found naturally in many foods and is produced within our own bodies. Recently, there have been questions raised about the safety of erythritol, and whether it might lead to adverse cardiovascular events. With that in mind, we sought to critically evaluate the literature through a systematic review to answer specific questions: 1) What is the current state of the science regarding the absorption, distribution, metabolism, and excretion (ADME) of erythritol? 2) What is the current state of the science with respect to the toxicological profile of erythritol? 3) What are the mechanisms that endogenous and exogenous erythritol may play in blood clotting? 4) What is the expected exposure that people may have to endogenous erythritol? We found in our review that 60%–88.5% of exogenous erythritol is rapidly absorbed into the body, and blood levels peak around 60–90 minutes following administration. There is insufficient data to accurately estimate the elimination half-life. It also appears that erythritol is not substantially metabolized once it is absorbed. Based on our analysis of the existing literature, there is no reliable scientific evidence to conclude that erythritol causes adverse health outcomes in humans when used at human exposure levels found in food and beverages. Upon synthesis of the evidence, it appears that the association widely reported in the press of erythritol being associated with major adverse cardiovascular events (MACE) is actually a case of a shared upstream biological state/event (e.g., metabolic disorder, increased glycemia, increased central adiposity) driving the increase in erythritol and MACE. Statement of Significance This work provides an up-to-date review of the current safety science surrounding erythritol and addresses recent questions about the association between erythritol and major adverse cardiovascular events (MACE).