Is erythritol safe during pregnancy?

What does the evidence say about erythritol during pregnancy?

1. Erythritol is one of the sugar alcohols the FDA permits as a sugar substitute, alongside sorbitol, xylitol, lactitol, mannitol, and maltitol, and these sweeteners do not promote tooth decay or cause a sudden increase in blood glucose. 1
2. The FDA reviewed the 2023 scientific paper on possible cardiovascular effects of erythritol and determined that the observational studies it cited did not establish a causal link, while committing to monitor new information. 1
3. The studies that raised the cardiovascular alarm were observational and can only show association, the human platelet trials used single 30 gram doses in just 10 subjects per group, and Mendelian randomisation analyses found no evidence of a causal link between circulating erythritol and coronary artery disease. 2
4. About 90 percent of a 20 gram dose of erythritol is recovered unchanged in urine within 24 hours, acute doses of 20 to 75 grams do not move blood glucose or insulin, and the reviewers judged it unlikely that dietary erythritol is driving the cardiometabolic associations seen in blood samples. 3
5. In a dose-ranging human study, erythritol absorption was dose-dependent and appeared to saturate around 50 grams, and gut symptoms tracked with dose: one participant reported diarrhea at 10 grams while four reported bloating at both 25 and 50 grams. 4

Is erythritol safe in each trimester?

• First trimester. Erythritol behaves unusually for a sugar alcohol: roughly 90 percent of a 20 gram dose is absorbed and passed out unchanged in urine rather than fermenting in the colon. That is why it tends to cause less gas than sorbitol or maltitol, which can matter when first-trimester digestion is already unhappy.
• Second trimester. Watch the dose, not the ingredient. Symptoms are uncommon at 10 grams, and bloating and audible gut noises turn up more often at 25 and 50 grams. A packet is a gram or two; a batch of keto baking can be 50 grams or more, which is where the difference shows up.
• Third trimester. Erythritol does not raise blood glucose or insulin, which is why it appears in gestational diabetes recipes. The unresolved question is the cardiovascular one raised in 2023, and neither the FDA nor the reviewers who examined it concluded that dietary erythritol was the cause. Bring heavy use to a prenatal visit.