Erythritol, a popular sugar substitute often found in sugar-free and keto products, has long been considered safe. However, according to new research, it may damage the blood vessels in the brain and increase the risk of stroke.
Scientists at the University of Colorado have studied how erythritol affects the cells lining the blood vessels of the brain. This discovery revealed the connection between high levels of erythritol in the blood and an increased risk of heart attack and stroke.
Knowing these risks is important because millions of people consume erythritol daily and consider it a safe sugar substitute. The research raises important questions and obliges us to better study the safety of artificial sweeteners and their impact on our health.
What Is Erythritol?
Erythritol is a sugar alcohol that has been actively used since 2001 (approved by the FDA). It is especially popular among those who control their weight and blood sugar levels, as it has a minimal effect on insulin levels.
It is naturally found in some fruits and fermented foods and is also produced in the human body. However, new research pointing to the possibility that high levels of erythritol may be associated with an increased risk of blood clotting is causing concern.
What Did the Research Find?
In laboratory experiments, researchers used cells from human brain microvessels. They meticulously checked for oxidative stress markers, the production of nitric oxide and endothelin-1 (a vasoconstrictor), and key enzymes involved in blood clot breakdown (fibrinolysis).
The blood vessel cells were then treated with an amount of erythritol equivalent to that in one can of a drink containing an artificial sweetener—about 30 grams. In just three hours, the following changes were observed in these cells:
The production of harmful free radicals (reactive oxygen species) that damage cells almost doubled.
The level of antioxidant enzymes increased, which means the cells were under oxidative stress.
The production of nitric oxide was significantly reduced. This is a necessary compound that helps blood vessels relax and allows blood to circulate without hindrance.
Previous large-scale studies linked high levels of erythritol in the blood to increased risks of heart attack and stroke. This new cellular research provides biological evidence for those observations.
What Are the Alternatives?
Experts recommend using erythritol in moderation. As for natural sweeteners, such as honey or date syrup, their consumption is safer because they also contain antioxidants. However, we must remember that their use can significantly affect blood sugar levels.
Among non-caloric sweeteners, stevia or monk fruit extract is a better alternative because it does not cause oxidative stress similar to erythritol.
More clinical research is needed in this area, but until then, it is better for those at high risk to limit erythritol and give preference to natural, relatively safe alternatives.
On this important issue, Medscriptum spoke with nutritionist Rusudan Gvamichava. In the interview, she shared recommendations on what alternatives we can use and, in general, what we should consider when eating healthy.
Salome Chkheidze: Erythritol has been considered a safe sugar substitute for years. Do we have reason for concern in the light of this new research, which points to potential risks?
Rusudan Gvamichava: This is indeed interesting news. Erythritol has been used for years as an artificial sweetener, and until now, there have been no particular problems with its safety. It is consumed quite often because it is very budget-friendly for companies that produce food. At the same time, it has a very low glycemic index and is especially comfortable for those with diabetes who need to regulate their sugar levels.
Recent studies have shown a link between high levels of erythritol in the blood and an increased risk of cardiovascular diseases. Although this is a reliable study, its authors also note that more long-term and large-scale studies are needed for a final conclusion. Therefore, we cannot yet confirm a direct cause-and-effect relationship. However, as the study showed, consuming 30 grams of erythritol can cause platelet aggregation, which, in turn, increases the risk of thrombosis. This discovery is especially important for those with a high risk of cardiovascular diseases. Thrombosis can be the cause of a heart attack, stroke, or other serious cardiovascular problems. This risk will be particularly noteworthy for the elderly. However, I hope that we will have even more research in the future and that other organizations—such as the FDA, which approved this sweetener—will review this issue.
Salome Chkheidze: Many people consume erythritol unknowingly and unintentionally in sugar-free and keto products. What factors (for example, dose, frequency, or health status) determine its potential harm?
Rusudan Gvamichava: In reality, erythritol is about 70% sweeter than sugar. Therefore, in terms of grams, it will always be used in smaller quantities in products than, for example, sugar, because it is very sweet. However, the frequency and amount of use are also very important. The 30 grams of erythritol mentioned in the study can easily accumulate if a person consumes several products containing this sweetener every day. However, it is probably important to wait for other types of research, because the fact is that, for now, regulatory bodies have not considered it necessary to issue any warnings about this product.
Salome Chkheidze: As you mentioned, due to its low glycemic index, erythritol was considered a safe alternative for people with diabetes. In this case, does the benefit outweigh the risk?
Rusudan Gvamichava: It is really difficult to say at this point, but an individual approach is very important. We know that erythritol does not increase glucose/insulin levels, which is a very positive property in diabetes management. However, with this new data, we can talk about other harm that, for example, has no connection with the glycemic index. I mean the activation of platelets and the stimulation of the inflammatory process, which may turn out to be a very bad side of erythritol. It is definitely worth waiting for the final results, but at this stage, it is difficult to confirm this.
Salome Chkheidze: Which natural or artificial sweeteners would you recommend instead of erythritol and why? What should we consider when choosing alternative products?
Rusudan Gvamichava: From natural options, I would single out stevia and monk fruit. Both have a very low glycemic index, and there is no research on their harmful effects so far. However, here, too, it is very important to pay attention to the quality of processing and the composition of the product. Some products contain only a pure extract, but options mixed with other ingredients are also often found on the market. For example, a product may be labeled “stevia” on the outside, but when you read the composition, it turns out that the stevia content is 20% and another sweetener is 80%. Unlike erythritol, monk fruit and stevia are more expensive for the manufacturer. Therefore, it is important not to trust only the outer label of the product. It is necessary to pay attention to the composition, especially if it is a mixture of different sweeteners. This way, we will know exactly what type of product we are buying.
Salome Chkheidze: When ingredients approved by the FDA reveal unexpected risks years later, it is natural for consumers to become skeptical. How should we make the right decisions about nutrition when there are constant changes in nutrition science?
Rusudan Gvamichava: It is important to understand exactly that science, especially when it comes to nutrition and health in general, is dynamic and constantly evolving. This means that research may reveal facts that were not detected in the past. Therefore, consumers should rely, first of all, on high-level scientific sources and not on social media. It would be very good if people in general had a minimal, basic education on healthy eating, for example, knowing how to read a food label. This will help them make an informed choice. It is also important not to follow food trends just because they are popular or because they were effective for someone else. We should try our best to consider our personal health challenges and make more reasonable decisions based on them.
Salome Chkheidze: What practical advice would you give to Medscriptum’s readers who want to reduce risks but are not ready to give up foods or drinks containing sweeteners?
Rusudan Gvamichava: I would probably say that if you use different products containing sweeteners daily or several times a day, you should consider that the frequency of consumption is one of the main factors. It is important to remember that the absence of sugar does not automatically mean that a product is necessarily healthy. Often, the label “sugar-free” means that a lot of unhealthy fat has been added to improve the taste.
As for sweeteners, first of all, we can review the composition of the products we have been consuming and check how many of them contain erythritol. Stevia produced in different countries is also actively found on the Georgian market, so it is possible to replace erythritol with stevia, which is definitely safe at this stage.
As for other ingredients, it is important not to focus only on sweeteners. Knowing how to read a label also means understanding other ingredients. In my opinion, the most important thing is to understand that avoiding sugar alone and replacing it with artificial sweeteners is not the solution. The main thing is to change the perception of the taste of sweets and to reduce the sweet taste in general. The less often we eat sweets (which does not mean completely removing them from the diet), the easier it will be to control our craving for sweets. With this change, sweets will no longer become a necessary part of our daily diet. If we can do this, it really means changing a habit, which is the best guarantee of our desired result.
Another fact about artificial sweeteners is that they often cause changes in the functioning of the digestive system, specifically bloating, discomfort, or diarrhea. These side effects are individual, but they are not that rare. Therefore, it is important to pay attention to how we feel after consuming a specific product, because we ourselves can best observe our feelings.
Salome Chkheidze: And finally, as a nutrition expert, has this new evidence changed your personal approach or recommendations regarding sugar substitutes?
Rusudan Gvamichava: As I mentioned, new information appears in this field every day, so it is important to constantly follow the news. This research was interesting for me too and made me think. Personally, I always favor moderation and having more real, whole foods in our diet. For example, a source of sweetness can be fruit, which is not a processed food and, in addition to sugar, contains fiber and other nutrients.
Instead of depending on erythritol and other sweeteners, I would advise you to have more real food in your diet. Moderate consumption of processed food is not a problem, but it should not be the main part of the diet. We always try to tailor recommendations to the individual and not divide food into clear “good” and “forbidden” categories. People need both the food and nutrients that are essential for our body’s various processes, as well as to derive pleasure, which is not excluded in a healthy diet. Therefore, nutritional pleasure can fit into all of this very naturally.
Source: Journal of Applied Physiology
