Mounting Concerns Over Erythritol
Erythritol, a sugar alcohol, has long been a favorite sweetener for its clean taste and minimal impact on blood sugar. Found in many keto-friendly foods, sugar-free candies, and some stevia or monk fruit blends, it has been widely regarded as a safe alternative for those managing their weight or diabetes. However, a growing body of research, including a landmark study from the Cleveland Clinic, has raised significant concerns about its potential links to serious cardiovascular and cerebrovascular events.
The Cleveland Clinic Study: Connecting Erythritol to Cardiovascular Events
A 2023 study, led by Dr. Stanley Hazen at the Cleveland Clinic, accidentally discovered a correlation between high levels of erythritol in the blood and an elevated risk of heart attack, stroke, and death. The researchers initially set out to identify unknown compounds in blood that could predict cardiovascular risks and unexpectedly found erythritol to be a powerful predictor. The study, involving over 4,000 individuals across the U.S. and Europe, revealed that participants with higher erythritol levels were significantly more likely to experience a major adverse cardiovascular event over the next three years.
The Mechanism: Blood Clot Formation
The mechanism behind this association was further explored through lab tests. Researchers discovered that adding erythritol to platelets, which are blood fragments essential for clotting, made them more prone to clumping together. This heightened blood clot formation, or enhanced thrombosis, poses a particular risk for individuals with pre-existing heart conditions or a history of diabetes, as clots can travel to the heart or brain, triggering a heart attack or stroke. A subsequent intervention study on healthy volunteers further confirmed this, showing that consuming a beverage with 30 grams of erythritol led to a dramatic and sustained increase in blood erythritol levels, remaining elevated for several days above the threshold for heightened clotting risk.
Impact on Brain Health
Beyond the heart, erythritol's potential effects on the brain have also been investigated. Recent research, including a 2025 study from the University of Colorado Boulder, suggests erythritol can impair the function of cells lining blood vessels in the brain.
Specifically, the findings included:
- Reduced production of nitric oxide, a molecule that helps blood vessels relax and widen.
- Increased production of endothelin-1, a protein that constricts blood vessels.
- Higher levels of damaging metabolic byproducts known as free radicals.
- Impaired production of the body's natural clot-busting compound, t-PA.
These combined effects of constricted blood vessels and reduced clot-busting ability could significantly increase the risk of ischemic stroke. The researchers caution that this laboratory finding warrants further investigation into the long-term impact on human brain health.
Erythritol vs. Other Popular Sweeteners
While erythritol has come under recent scrutiny for its specific cardiovascular and cerebrovascular risks, it's not the only sugar substitute linked to potential health concerns. The broader landscape of non-nutritive sweeteners continues to be a subject of ongoing research. Here is a comparison of erythritol and other common alternatives.
| Feature | Erythritol (Sugar Alcohol) | Aspartame (Artificial Sweetener) | Sucralose (Artificial Sweetener) |
|---|---|---|---|
| Risks Identified | Increased risk of heart attack, stroke, and heightened blood clotting; potential brain vessel impairment. | Potential neurophysiological symptoms (headaches, mood changes); associated with increased risk of stroke in some studies. | Associated with increased coronary heart disease risk in some studies; potential negative impact on gut health and blood sugar regulation. |
| Type | Sugar Alcohol | Dipeptide (protein-based) | Chlorinated sugar molecule |
| Sweetness Level | ~70% as sweet as sugar. | ~200 times sweeter than sugar. | ~600 times sweeter than sugar. |
| Primary Use | Adds bulk and sweetness to keto and low-carb products, ice creams, and baked goods; often combined with other sweeteners. | Found in diet sodas, gum, and other 'diet' food products. | Used in thousands of products like diet soda, baked goods, and as a tabletop sweetener (Splenda). |
The Need for Prudent Consumption
It is crucial to acknowledge that many studies suggesting links between these sweeteners and adverse health effects are observational, meaning they can only show an association, not definitive causation. Confounding factors, such as consumers already having pre-existing health conditions like obesity or diabetes, can complicate the interpretation of results. For instance, people who switch to artificial sweeteners may already have risk factors that contribute to heart issues.
However, the recent erythritol findings, backed by both epidemiological and controlled laboratory studies showing specific biological mechanisms (like enhanced platelet aggregation), provide stronger evidence for caution. Organizations like the World Health Organization (WHO) have also advised against the long-term use of non-sugar sweeteners for weight control due to inconclusive evidence regarding their benefits and potential for negative long-term health effects.
How to Proceed: Practical Recommendations
Given the emerging data, a cautious approach to erythritol and other sugar substitutes is advisable, especially for those at higher risk for cardiovascular disease. For the general public, moderation is key, and opting for whole foods with naturally occurring sugars is a healthier alternative.
Here are some practical steps:
- Read labels carefully: Look for erythritol listed as an ingredient, especially in products marketed as 'sugar-free' or 'keto'. It's often found in stevia and monk fruit blends to add bulk.
- Minimize consumption: If you frequently consume products containing erythritol, consider reducing your intake or switching to unsweetened alternatives like water.
- Consult a healthcare provider: Individuals with existing heart conditions, diabetes, or other risk factors should speak with their doctor or a registered dietitian about their sugar and sweetener consumption.
- Prioritize whole foods: Fruits, vegetables, and other whole foods provide natural sweetness along with a wealth of other nutrients and fiber, offering the best overall health benefits.
Conclusion
The link between the popular sugar substitute erythritol and increased brain and heart risks highlights the need for a more nuanced understanding of non-nutritive sweeteners. While initially viewed as a benign alternative to sugar, recent findings concerning increased blood clotting and impaired brain vessel function necessitate a cautious approach. While more long-term research is needed, especially in clinical settings, the current evidence suggests that a reliance on erythritol may carry unexpected health consequences, particularly for high-risk individuals. As the science evolves, prioritizing whole, unprocessed foods and seeking medical advice remains the safest strategy for managing dietary choices. For more on this, you can refer to the Journal of Applied Physiology article on erythritol's effect on brain vessel cells.
