A common sugar substitute, erythritol, is facing increased scrutiny following research suggesting a potential link to cardiovascular problems and stroke risk. Even as long considered a safe alternative to sugar, recent studies indicate the sweetener may negatively impact heart health and brain blood vessel function.
Researchers at the University of Colorado published findings in the Journal of Applied Physiology detailing how erythritol can damage cells within the blood-brain barrier. This protective barrier controls the passage of substances into the brain and its compromise could increase vulnerability to blood clots – a major cause of stroke. The study exposed blood-brain barrier cells to erythritol levels comparable to those resulting from consuming a sweetened beverage, observing a cascade of cellular damage. This damage was characterized by oxidative stress, an overload of harmful molecules called free radicals, and a reduction in the body’s natural antioxidant defenses, ultimately impairing cell function and, in some cases, leading to cell death.
Beyond the blood-brain barrier, the research also revealed erythritol’s impact on blood vessel regulation. Healthy blood vessels expand to increase blood flow when needed and constrict to reduce it. Erythritol disrupts this process, potentially causing vessels to remain dangerously narrowed, restricting oxygen and nutrient supply to the brain. The sweetener appeared to interfere with the body’s natural clot-busting mechanisms, hindering the production of substances that dissolve blood clots.
These findings build upon earlier research. In February 2023, a study led by Dr. Stanley Hazen at the Cleveland Clinic, published in Nature Medicine, found that higher blood levels of erythritol were associated with an increased risk of heart attack and stroke. A subsequent study by the Cleveland Clinic, released in August 2024 and published in Arteriosclerosis, Thrombosis and Vascular Biology, demonstrated that erythritol can activate platelets, increasing the risk of blood clot formation. This research indicated that, unlike glucose, erythritol had this effect. The National Institutes of Health (NIH) highlighted these findings, emphasizing the demand for further investigation into the long-term cardiovascular risks associated with erythritol consumption.
Erythritol, a sugar alcohol, is found in a variety of products including baked goods, beverages, gum, and candy. It contains approximately 70 percent of the sweetness of sugar and occurs naturally in tiny amounts in fruits like melons and grapes, as well as fermented foods like cheese and wine. Yet, when used as a sweetener, erythritol levels are typically far higher than those found naturally. Notably, erythritol is not required to be listed individually on nutrition labels as it falls under the broader category of “sugar alcohols.”
Researchers acknowledge that the University of Colorado study was conducted on isolated cells in a laboratory setting, and the behavior of these cells may not perfectly replicate conditions within the human body. Further clinical studies are warranted to assess the long-term cardiovascular safety of erythritol, as noted by the Cleveland Clinic researchers.