A recently published study in the Journal of Applied Physiology suggests that erythritol, a widely used non-nutritive sweetener in sugar-free and low-calorie foods, may impair brain vascular cell function and potentially increase the risk of stroke.
The findings, published June 3, add to a growing body of research raising questions about the long-term safety of erythritol, an ingredient commonly found in keto-friendly and diabetic-friendly products. The sweetener has the approval of the Food and Drug Administration.
Conducted by researchers at the University of Colorado’s Integrative Vascular Biology Laboratory, the study exposed human cerebral microvascular endothelial cells (hCMECs) to erythritol in vitro. The researchers tested a level of exposure that reflects what could be consumed across multiple servings of erythritol-containing products in a day.
The results revealed biological changes that may raise concerns about vascular and neurological health. Erythritol increased reactive oxygen species (ROS) production by approximately 75 percent, which can damage cells and weaken the blood-brain barrier. It also reduced nitric oxide (NO) production by about 20 percent and increased endothelin-1 (ET-1), a potent vasoconstrictor, by roughly 30 percent—changes that may disrupt cerebral blood flow and contribute to stroke risk. Additionally, erythritol impaired the release of tissue-type plasminogen activator (t-PA) in response to thrombin, which could hinder the body’s ability to dissolve blood clots and elevate thrombotic risks.
These vascular changes are especially concerning given their potential to contribute to ischemic strokes, which occur when blood flow to the brain is blocked, often by clots or narrowed vessels.
Other health concerns linked to erythritol
Erythritol has also been linked to other vascular concerns. Several studies published in 2024 reported associations between elevated erythritol levels and increased platelet reactivity, higher thrombogenic potential, and increased risk of cardiovascular events, including heart attacks. One study found a positive association between erythritol and heart disease and overall mortality in men, while another raised concerns about its contribution to both cardiovascular and hemorrhagic disease.
Scientists say that collectively, these studies suggest that erythritol may not be as metabolically benign as once thought.
Implications for food safety
The University of Colorado study’s findings align with prior research, offering a potential mechanistic explanation for observed epidemiological trends linking erythritol to cardiovascular and cerebrovascular risks. Because erythritol can cross the blood-brain barrier, the study also heightens concern about its neurological effects, particularly with chronic consumption. Many consumers regularly use erythritol-containing products such as sugar-free sodas, energy drinks, and low-carb snacks, often unaware of these potential risks.
The study noted that while acute exposure produced significant cellular changes in the lab, the long-term effects of repeated or chronic exposure remain unknown. The study calls for further research, particularly human studies, to better understand the implications.
The Food and Drug Administration has not yet commented on the study.
The full study can be found here.
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