Artificial sweeteners are often promoted as a healthier alternative to sugar, but mounting research suggests that one of the most common additives may not be so benign.
Erythritol is so commonly used that it is contained in a huge range of different products, many of which are labelled as healthy alternatives to high sugar drinks. It is found in energy drinks, iced tea, zero sugar soda, protein shakes, keto beverages, and even flavoured sparkling water.
It is one of the world’s most widely used sweeteners for beverages, but recent research has bolstered the suggestions from previous findings that it may have a detrimental effect on brain blood vessels, potentially raising the risk of stroke, even at ‘normal’ consumption levels.
Erythritol naturally occurs in some foods, such as mushrooms, some fruits, soy sauce, and wine, for example, but only in miniscule amounts. For manufactured erythritol, starch is isolated from corn and converted to liquefied starch, and broken down into glucose. That’s a highly simplified version of what is quite a complex process.
The substance has become very widely used, as it contains few or no calories and does not raise blood sugar levels, making it an attractive addition to ‘zero sugar’ products like drinks. It also blends well with other sweetening additives and it technically fits with the common claims that drinks are ‘keto-friendly’ or ‘zero sugar’ and ‘low calorie’.
However, work in 2024 from the Cleveland Clinic suggested that consuming products containing erythritol increases the risk of cardiovascular events such as stroke or myocardial infarction, and stimulates platelets to be more active, raising the risk of blood clots. Similar effects were not observed with sugar. Erythritol was approved by the US Food and Drug Administration (FDA) in 2001.
“Combined with recent large-scale clinical observational studies and mechanistic cell-based and animal model studies, the present findings suggest that discussion of whether erythritol should be re-evaluated as a food additive with the ‘generally recognised as safe’ designation is warranted,” wrote the Cleveland Clinic authors. The paper was published in Arteriosclerosis, Thrombosis, and Vascular Biology.
Recently published research in the Journal of Applied Physiology reinforces these concerns. Erythritol has been found to disrupt brain blood vessel cells, impairing their ability to ‘relax’, which increases oxidative stress, and hampers the body’s ability to break down clots. Even at ‘normal’ consumption levels, this could raise the risk of stroke, write the authors.
The new study, conducted by researchers at the University of Colorado Boulder involved 4,000 participants from Europe and the US and among the conclusions was that those with elevated levels of erythritol in their blood were far more likely to suffer a stroke or heart attack within the next three years.
Specifically, in those with elevated levels, their cells produced far less nitric oxide to help blood vessels to expand, and increased endothelin-1, which causes these vessels to tighten. The cells studied were also more likely to produce higher levels of reactive oxygen species, which of course are known to trigger inflammation, speed up ageing, and damage cells.
Worryingly, the study participants received only a single serving of erythritol, so those consuming multiple products each day are at an even higher risk.
“… the results of this study demonstrate that erythritol (at a concentration typically contained in a standard size commercially available artificially sweetened beverage) adversely affects brain microvascular endothelial cell oxidative stress, eNOS activation and NO production, ET-1 expression, and t-PA release in vitro,” the researchers wrote in their conclusion.
“These changes in endothelial cell phenotype are known to underlie cerebrovascular dysfunction and contribute to heightened ischaemic stroke risk…. Moreover, these data provide novel mechanistic support for recent epidemiological studies reporting increased risk of cerebrovascular events associated with erythritol. Additional clinical studies are warranted on the potential long-term health effects of erythritol consumption.”
All things considered, the research suggests that the FDA and other health authorities may need to take another look at erythritol and, of course, more research is needed.
It’s an unfortunate aspect of modern society that some foods – many of them promoted as ‘healthy’ – may in fact do us more harm than good. Perhaps an awareness campaign to encourage people to ‘read the label’ and research ingredients of the product they consume is advised.
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