Erythritol, commonly found in items like protein bars and energy drinks, has long been considered a safer substitute for sugar. However, new research suggests it may actually compromise one of the body’s most essential protective systems, raising concerns about heart health and the risk of stroke.
A study from the University of Colorado indicates that erythritol might harm cells in the blood-brain barrier, which acts as a safeguard for the brain, blocking out harmful substances while allowing necessary nutrients in.
This study builds on earlier observational findings that linked erythritol intake to a heightened risk of heart attacks and strokes. Researchers examined blood-brain barrier cells exposed to erythritol levels typically found in sugar-sweetened soft drinks. They witnessed a cascade of cell damage that could increase the brain’s susceptibility to blood clots, a primary cause of strokes.
Erythritol caused oxidative stress, overwhelming cells with free radicals, which are highly reactive particles. At the same time, it diminished the body’s natural antioxidant defenses, impairing cell function and, in some instances, causing cell death.
More troubling was the discovery of erythritol’s interference with the blood vessels’ regulation of blood flow. Normally, healthy blood vessels function like traffic directors—expanding when more blood is needed, say, during exercise, and constricting when less is required. This balance relies on two vital molecules: nitric oxide, which dilates blood vessels, and endothelin-1, which contracts them.
The study revealed that erythritol disrupted this balance, decreasing nitric oxide while increasing endothelin-1 levels. Consequently, blood vessels could remain constricted, potentially depriving the brain of essential oxygen and nutrients.
This disruption is particularly concerning, as it serves as a warning sign for ischaemic strokes—those caused by blood clots blocking brain vessels.
Even more alarming, erythritol seemed to undermine the body’s natural ability to combat blood clots. Typically, when clots form, cells release a “clot buster” known as tissue plasminogen activator to dissolve the blockage before it can lead to a stroke. But the sweetener appeared to hinder this protective response, which could allow clots to cause significant damage.
Laboratory findings correspond with unsettling evidence from human studies. A number of large observational studies indicate that individuals who regularly consume erythritol face notably increased risks of cardiovascular illnesses, including heart attacks and strokes.
One significant study tracking thousands of participants found that those with the highest erythritol levels in their blood were nearly twice as likely to suffer a major cardiac event.
Nonetheless, this research is not without limitations. The tests were carried out on isolated cells in lab settings, which might not perfectly replicate how these cells behave within the human body. Researchers acknowledge the need for more advanced testing, possibly using “blood vessel on a chip” technologies that can replicate real physiological conditions more accurately.
The significance of these findings is heightened by erythritol’s unique position among sweeteners. Unlike artificial sweeteners such as aspartame or sucralose, erythritol is classified as a sugar alcohol—a naturally occurring compound produced by the body in small amounts.
This classification helped it escape recent guidelines from the World Health Organization that advised against using artificial sweeteners for weight control.
Erythritol has also gained traction among food manufacturers because it behaves more similarly to sugar than many alternatives. While sucralose is 320 times sweeter than sugar, erythritol offers about 80% of sugar’s sweetness, making it easier to incorporate into recipes without an overpowering flavor. As a result, it’s now included in countless products, especially those labeled as “sugar-free” or “keto-friendly.”
Trade-offs
While regulatory bodies like the European Food Standards Agency and the US Food and Drug Administration have deemed erythritol safe for consumption, this new research suggests that even “natural” sugar substitutes might carry unexpected health risks.
The findings prompt challenging questions about the trade-offs involved in sugar replacements. Sweeteners like erythritol can be beneficial for weight management and diabetes prevention by helping reduce caloric intake and manage blood sugar levels.
However, if regular consumption may undermine the brain’s protective barriers and elevate cardiovascular risks, the advantages might come with serious downsides.
This research highlights a broader challenge within nutritional science—grasping the long-term effects of relatively new food additives that have become commonplace in modern diets.
While erythritol might help individuals sidestep the immediate dangers of excessive sugar intake, its impact on the blood-brain barrier suggests that frequent use could gradually impair brain protection. As researchers continue to explore these concerning connections, consumers might want to rethink their use of this seemingly harmless sweetener—and possibly question whether any sugar substitute is truly without risks.
