Erythritol vs Sorbitol: which is worse?

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.

What is Sorbitol?

Sorbitol is a sugar alcohol (polyol) naturally found in some fruits, including apples, pears, and prunes. Commercially, it is produced by hydrogenation of glucose. It has approximately 60% of the sweetness of sucrose but provides fewer calories (2.6 kcal/g vs 4 kcal/g for sugar) and does not cause a significant immediate insulin response.

Documented risks

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.

Sorbitol: At doses above 20–50 g/day, sorbitol can cause osmotic diarrhea because it is incompletely absorbed in the small intestine and is fermented by colonic bacteria. EU regulations require products containing more than 10% added polyols to carry the label 'excessive consumption may produce laxative effects.' This is well-known and predictable. Sorbitol is not carcinogenic and does not raise blood glucose significantly, making it suitable for diabetics in controlled amounts.