Erythritol and Cardiovascular Risks: The Emerging Evidence
Following the 2023 study connecting elevated blood erythritol levels to a higher risk of major adverse cardiovascular events, further research has explored the potential mechanisms behind this link. In August 2024, researchers from the Cleveland Clinic released updated findings showing that consuming foods with erythritol can make blood platelets more active, significantly increasing the risk of blood clot formation. This heightened clotting potential could contribute directly to heart attacks and strokes, raising serious red flags about the safety of this seemingly benign sweetener.
Furthermore, cellular-level studies from the University of Colorado Boulder, presented in April 2025, suggest that erythritol may harm brain cells and impair crucial blood vessel functions. These lab experiments showed that exposing brain blood vessel cells to erythritol caused a reduction in nitric oxide, which helps relax blood vessels, and an increase in endothelin-1, which constricts them. The combination of vessel constriction and potential blunted clot-dissolving ability could significantly increase stroke risk.
Other Sugar Substitutes Under Scrutiny
Erythritol is not the only non-nutritive sweetener facing updated concerns. The scientific community continues to uncover new information about the long-term effects of many popular sugar alternatives, challenging the long-held assumption that they are universally harmless. Research is increasingly focusing on effects beyond simple caloric reduction, such as impact on the gut microbiome and neurological function.
- Sucralose (Splenda): Traditionally viewed as one of the safest options, recent research has indicated potential risks. A 2024 study suggests that long-term exposure to high concentrations of sucralose may induce neuroinflammation and ferroptosis (iron-dependent cell death) in human microglial cells. The study found that prolonged sucralose treatment decreased cell viability and inhibited proliferation in a time- and concentration-dependent manner, raising new questions about its long-term effects on brain health. A September 2025 study also explored links between sucralose consumption and cognitive decline.
- Aspartame: Classified as "possibly carcinogenic to humans" (Group 2B) by the International Agency for Research on Cancer (IARC) in 2023, aspartame continues to be a subject of public health debate. While regulatory bodies like the FDA and JECFA maintain its safety within acceptable daily intake levels, citing flaws in the underlying studies, new network toxicology studies are attempting to model potential mechanisms of carcinogenicity. A February 2025 petition from advocacy groups and cancer leagues called for a ban on the sweetener in the EU, citing recent research and the IARC classification.
- Allulose: While initial studies show promising benefits for blood glucose management, allulose is also subject to cautious new research. The Cleveland Clinic has issued a warning suggesting avoiding allulose until more data is available, noting potential chemical similarities to other sugar alcohols like erythritol. Additionally, potential gastrointestinal side effects at high doses remain a concern, and it is still undergoing safety assessments in major markets like Europe.
Comparison of New Concerns for Popular Sugar Substitutes
| Sugar Substitute | Primary New Concerns | Scientific Basis | Status & Caveats |
|---|---|---|---|
| Erythritol | Increased risk of heart attack, stroke, and blood clots. | Clinical and lab studies show high blood levels correlate with cardiovascular events and increase platelet activity. | Conflicting findings exist. Concerns may be highest for individuals with pre-existing cardiovascular issues. |
| Sucralose | Potential neurotoxicity, neuroinflammation, and cognitive decline. | Lab studies on human microglial cells show decreased viability and increased inflammation markers with prolonged exposure. Epidemiological studies exploring links to cognitive decline. | Early-stage research; more long-term human studies needed to confirm effects at normal consumption levels. |
| Aspartame | Possible carcinogen. | IARC classified as Group 2B in 2023. Network toxicology models suggest potential mechanisms affecting cancer-related proteins. | Major regulatory bodies like FDA and JECFA disagree with IARC classification, citing insufficient evidence and study flaws. |
| Allulose | Potential for GI upset, uncertain long-term effects. | Large doses may cause bloating, gas, and diarrhea. Still undergoing safety assessment in some regions. | Considered promising for blood glucose control, but long-term human data is limited. |
Strategies for Navigating the Changing Landscape
As research continues to evolve, a clear consensus emerges on minimizing dependence on non-nutritive sweeteners. Health experts increasingly recommend focusing on whole foods and moderation, rather than simply swapping one sweetener for another.
- Rely on Natural Sweetness: Incorporate natural sugars found in whole fruits to satisfy sweet cravings. Options like berries, bananas, and dates provide fiber, vitamins, and minerals that processed sweeteners lack.
- Embrace Water and Unsweetened Beverages: Water is the best choice for hydration. Sparkling water with a squeeze of citrus or a natural fruit slice can replace diet sodas and other sweetened beverages. Studies show that replacing artificially sweetened drinks with water significantly reduces health risks like liver fat accumulation.
- Read Labels Carefully: Many processed foods, including baked goods, candies, and sauces, contain sugar substitutes like erythritol and aspartame. Checking ingredient lists is crucial, especially for those with existing health conditions.
- Consult a Healthcare Professional: For individuals with specific health concerns like diabetes or cardiovascular disease, consulting a doctor or registered dietitian is vital for personalized dietary advice. They can help navigate the risks and benefits of various sweeteners based on individual health needs.
Conclusion: A Shift Towards Natural Choices
Recent scientific findings have prompted a re-evaluation of the safety of many popular sugar substitutes, particularly erythritol due to its potential link to cardiovascular risks. While many questions remain and research is ongoing for sweeteners like sucralose and aspartame, the overall trend in expert recommendations is shifting away from heavy reliance on all non-nutritive sweeteners. The evidence points toward a cautious, moderate approach, emphasizing whole foods, natural sweetness, and plain water as the safest long-term strategy for promoting health and well-being. Ultimately, the best path forward is to question the "sugar-free" label and prioritize minimally processed, nutrient-dense foods. https://www.nature.com/articles/s41591-023-02223-9
