Erythritol, a popular sugar substitute found in everything from low-carb snacks to diet sodas, is facing new scrutiny following research suggesting a potential link to increased risk of cardiovascular events, including stroke. While marketed as a healthy alternative to sugar, particularly for individuals managing diabetes or seeking weight loss, emerging evidence raises questions about the long-term effects of regular erythritol consumption. Understanding the potential risks associated with sugar substitutes like erythritol is becoming increasingly vital for consumers.
A recent study published in the Journal of Applied Physiology details how erythritol impacts human cells that line blood vessels. Researchers at the University of Colorado Boulder found that exposure to erythritol, at levels comparable to those found in a typical sugar-free beverage, can impair blood vessel function and potentially increase the likelihood of blood clot formation. This research builds upon a larger epidemiological study published in Nature Medicine in February 2023, which linked higher blood levels of erythritol to a significantly increased risk of major adverse cardiac events – including heart attack, stroke, and death – over a three-year period.
The initial Nature Medicine study analyzed data from over 4,000 individuals in the United States and Europe. Participants with the highest erythritol levels in their blood were found to have a 2x higher risk of experiencing a cardiovascular event compared to those with the lowest levels. Researchers emphasized that this association doesn’t prove causation, but it prompted further investigation into the mechanisms by which erythritol might affect the cardiovascular system. The University of Colorado Boulder study aimed to explore those mechanisms at a cellular level.
How Erythritol Impacts Blood Vessel Function
The research team, led by Professor Christopher DeSouza, focused on the effects of erythritol on endothelial cells – the cells that line the interior of blood vessels. According to the study, exposing these cells to erythritol concentrations similar to those found in a standard sugar-free drink for three hours resulted in several concerning changes. The cells produced less nitric oxide, a molecule crucial for blood vessel dilation and healthy blood flow. Simultaneously, they produced more endothelin-1, a potent vasoconstrictor that narrows blood vessels.
“Nitric oxide is like the signal that tells your blood vessels to relax and widen, allowing blood to flow freely,” explains Auburn Berry, a graduate student in DeSouza’s lab and lead author of the Journal of Applied Physiology study. “When that signal is diminished, and you have increased constriction, it creates a less favorable environment for cardiovascular health.”
Further analysis revealed that erythritol exposure as well impaired the cells’ ability to produce tissue plasminogen activator (t-PA), a vital enzyme responsible for breaking down blood clots. The treated cells exhibited increased levels of reactive oxygen species (ROS), commonly known as “free radicals,” which can cause cellular damage and inflammation. These combined effects suggest that erythritol could contribute to both the formation of blood clots and a reduced capacity to dissolve them, potentially elevating stroke risk.
Erythritol: A Brief History and Current Use
Erythritol is a sugar alcohol, a class of compounds chemically related to both sugars and alcohols. It’s naturally found in some fruits and fermented foods, but the erythritol used in food production is typically manufactured through the fermentation of corn, according to the Food and Drug Administration (FDA). Approved for use in food in 2001, erythritol gained popularity due to its near-zero calorie content and minimal impact on blood sugar and insulin levels.
This makes it a common ingredient in a wide range of products marketed towards individuals following low-carbohydrate diets, managing diabetes, or simply seeking to reduce their sugar intake. Erythritol is frequently found in “keto” snacks, sugar-free candies, protein bars, and diet beverages. It’s often blended with other sweeteners, like stevia or monk fruit, to improve taste and texture.
What Does This Signify for Consumers?
Researchers emphasize that the current findings are based on laboratory experiments using human cells, and more research is needed to confirm these effects in living organisms. “Our study doesn’t definitively prove that erythritol causes strokes,” clarifies DeSouza. “However, it provides a plausible mechanism for how it could contribute to increased cardiovascular risk, especially with regular, high-level consumption.”
DeSouza recommends that consumers be mindful of their intake of erythritol and other sugar alcohols, paying attention to ingredient labels. He notes that individuals who consume multiple servings of products containing erythritol daily may be at greater risk. The FDA has not issued any warnings or recalls related to erythritol at this time, but the agency continues to monitor emerging research on the safety of food additives.
The American Heart Association recommends limiting added sugars, including sugar alcohols, as part of a heart-healthy diet. For individuals with pre-existing cardiovascular conditions or risk factors, consulting with a healthcare professional about the potential risks and benefits of using sugar substitutes is advisable.
Further research is planned to investigate the effects of erythritol in animal models and to assess the long-term health consequences of chronic exposure. The results of these studies will be crucial in determining whether regulatory action is needed to protect public health. The next phase of research will also focus on identifying potential individual vulnerabilities to the effects of erythritol.
This developing story underscores the importance of staying informed about the potential health impacts of food additives and making informed choices about dietary habits. Share your thoughts and questions in the comments below.
