Citric Acid vs Erythritol: which is worse?

What is Citric Acid?

Citric acid is a weak organic acid naturally occurring in citrus fruits. Commercial citric acid is produced almost entirely by fermentation of sugar substrates (typically molasses or corn syrup) using the mold Aspergillus niger. It is the most widely used food acidulant and preservative globally, also functioning as a chelating agent and flavor enhancer.

What is Erythritol?

Erythritol is a four-carbon sugar alcohol naturally occurring in small amounts in fruits, fermented foods, and mushrooms. Commercially produced via fermentation of glucose by yeasts such as Moniliella pollinis, it has approximately 70% of sucrose's sweetness, provides 0.24 kcal/g, and has a glycemic index of 0. It is nearly completely absorbed in the small intestine and excreted unchanged in urine, which explains its unusually low laxative effect compared to other polyols.

Documented risks

Citric Acid: Generally recognized as safe. Excessive consumption can erode tooth enamel due to its acidic nature — dentists recommend rinsing with water after consuming highly citric drinks. A 2018 report in the journal BMJ Case Reports described a cluster of inflammatory reactions (joint pain, muscle weakness) in individuals who reported reactions specifically to industrially produced citric acid, hypothesizing residual Aspergillus proteins from the fermentation process as a potential cause. This remains a hypothesis without controlled clinical evidence, and regulatory agencies maintain its safety status.

Erythritol: A 2023 observational study published in Nature Medicine (Hazen et al., Cleveland Clinic) found that elevated blood erythritol levels were associated with increased risk of major adverse cardiovascular events (MACE), including heart attack and stroke. Additionally, erythritol was found to enhance platelet aggregation in vitro. This study was widely reported and has generated significant scientific debate; critics note that it was observational (not causational), and that the study population had pre-existing cardiovascular risk factors. Regulatory agencies have not changed their approval status. The long-term cardiovascular implications require further research.