Does erythritol cause stomach upset? What the sources say
Erythritol is a sugar alcohol you may meet on the ingredient list of a sugar-free chocolate. People ask whether it upsets the stomach and whether a 2023 heart study should worry them. This page reports what the sources say, and no more.
General information only. If you have diabetes or another medical condition, ask your doctor or dietitian before you change what you eat. Read on 2026-10-16.
Does erythritol cause stomach upset?
The European Food Safety Authority (EFSA), in its 2023 re-evaluation of erythritol (E 968) as a food additive, says that in the products it evaluated, erythritol is a polyol obtained by fermentation with Moniliella pollinis BC or Moniliella megachiliensis KW3-6, followed by purifications and drying. It adds that erythritol is readily and dose-dependently absorbed in humans and can be metabolised to erythronate to a small extent. It also says that the Panel considered that erythritol has the potential to cause diarrhoea in humans, which was considered adverse because of its potential association with electrolyte and water imbalance. The same page says that the Panel set an acceptable daily intake (ADI) of 0.5 g/kg body weight per day, at the lower bound of the range of no observed adverse effect levels (NOAELs) for diarrhoea. It adds that the Panel concluded that the exposure estimates for both acute and chronic dietary exposure to erythritol were above the ADI, indicating that individuals with high intake may be at risk of experiencing adverse effects after single and repeated exposure, while considering both dietary exposure assessments an overestimation. It also says that concerning an application for exemption from the laxative warning label requirement, the Panel concluded that the available data do not support the proposal for exemption.
What did the 2023 heart study find?
A 2023 paper in Nature Medicine on erythritol and cardiovascular event risk reports that in patients undergoing cardiac risk assessment (n = 1,157), circulating levels of multiple polyol sweeteners, especially erythritol, were associated with incident (3 year) risk for major adverse cardiovascular events (MACE). It adds that targeted metabolomics analyses in independent US (n = 2,149) and European (n = 833) validation cohorts of stable patients undergoing elective cardiac evaluation confirmed this association (fourth versus first quartile adjusted hazard ratio 1.80 and 2.21, respectively). It also says that at physiological levels, erythritol enhanced platelet reactivity in vitro and thrombosis formation in vivo. The same page says that in a prospective pilot intervention study in healthy volunteers (n = 8), erythritol ingestion induced marked and sustained (>2 d) increases in plasma erythritol levels well above thresholds associated with heightened platelet reactivity and thrombosis potential in in vitro and in vivo studies. It adds that the authors conclude that erythritol is both associated with incident MACE risk and fosters enhanced thrombosis, and that studies assessing the long-term safety of erythritol are warranted.
The people in the first part of that paper were patients having a cardiac evaluation, so the finding is about an association in that group. It is not a measurement of what erythritol in chocolate does to an average eater.
Does erythritol raise blood sugar?
A review in Nutrition Research Reviews (2003) on polyols says that the glycaemic index (GI) and insulinaemic index (II) values from the literature were 0 and 2 for erythritol, against 65 and 43 for sucrose.
A 2023 pilot trial in BMJ Nutrition, Prevention & Health says that forty-two participants with obesity were randomised to consume 36 g erythritol, 24 g xylitol, or no substance daily for 5 weeks. It adds that the 5-week intake of erythritol and xylitol showed no statistically significant effects on vascular function, abdominal fat, or glucose tolerance in people with obesity. It also says that gastrointestinal tolerance was good except for a few diarrhoea-related symptoms.
The passages above name diarrhoea and do not report bloating, so this page gives no bloating figure.
Sources
Checked on 2026-10-16 against EFSA 2023 re-evaluation of erythritol (E 968), EFSA Journal (PubMed), Nature Medicine 2023, erythritol and cardiovascular event risk (PubMed), Nutrition Research Reviews 2003, polyols as sugar replacers (PubMed), BMJ Nutrition, Prevention & Health 2023, erythritol and xylitol pilot trial (PubMed). Read the source again before you rely on a number, because rules and studies change.