Last Updated on July 20, 2025 by Bertrand Clarke

In a world obsessed with cutting calories and managing blood sugar, artificial sweeteners like erythritol have become a go-to for millions. From keto-friendly protein bars to sugar-free sodas, this zero-calorie sugar alcohol, derived from fermented corn, has been marketed as a guilt-free way to satisfy sweet cravings. But a wave of recent research is casting a shadow over erythritol’s “healthy” reputation, suggesting it may pose serious risks to heart and brain health. Could this popular sweetener be a ticking time bomb for your vascular system?

A Sweet Solution with a Bitter Twist

Erythritol, approved by the U.S. Food and Drug Administration (FDA) in 2001, has surged in popularity due to its near-zero calorie count and minimal impact on insulin levels. At about 70-80% as sweet as table sugar, it’s a staple in low-carb diets, diabetes-friendly snacks, and even dental products like sugar-free gum. Unlike other sugar alcohols, such as sorbitol or xylitol, erythritol is absorbed into the bloodstream before reaching the colon, reducing digestive side effects. This made it a darling of the health-conscious crowd—until now.

Recent studies, including one from the University of Colorado Boulder published in the Journal of Applied Physiology in July 2025, are raising red flags. The research suggests that erythritol may disrupt the delicate balance of brain blood vessel cells, potentially increasing the risk of stroke. Senior author Christopher DeSouza, a professor of integrative physiology, told Newsweek, “Our study adds to the evidence suggesting that non-nutritive sweeteners that have generally been purported to be safe, may not come without negative health consequences.”

This isn’t the first time erythritol has come under scrutiny. A 2023 study from the Cleveland Clinic, published in Nature Medicine, found that people with higher blood levels of erythritol were up to twice as likely to suffer heart attacks or strokes within three years. The study, which analyzed over 4,000 individuals in the U.S. and Europe, also showed that erythritol could make blood platelets more reactive, , increasing the likelihood of clot formation—a key factor in cardiovascular events.

The Science Behind the Scare

The University of Colorado Boulder study took a closer look at how erythritol affects human brain blood vessel cells, known as endothelial cells. Researchers exposed these cells to erythritol levels equivalent to those found in a single sugar-free beverage (about 30 grams). Within just three hours, the cells showed alarming changes:

• Reduced Nitric Oxide Production: Nitric oxide helps blood vessels relax and maintain healthy blood flow. Erythritol-treated cells produced significantly less of this protective molecule.
• Increased Endothelin-1: This protein causes blood vessels to constrict, raising blood pressure and stress on the vascular system. Erythritol exposure led to a 30% increase in endothelin-1 and its precursor, Big ET-1.
• Suppressed Clot-Busting Signals: The cells’ production of tissue-type plasminogen activator (t-PA), a natural compound that breaks down blood clots, was “markedly blunted.”
• Surge in Free Radicals: Erythritol triggered a flood of reactive oxygen species (ROS), unstable molecules that can damage DNA, proteins, and cell membranes, accelerating cellular aging and inflammation.

Auburn Berry, the study’s lead author, explained to Medical News Today, “Big picture, if your vessels are more constricted and your ability to break down blood clots is lowered, your risk of stroke goes up.” These cellular changes align with patterns observed in real-world stroke cases, suggesting a plausible mechanism for erythritol’s potential harm.

A follow-up study from the Cleveland Clinic in 2024, published in Arteriosclerosis, Thrombosis and Vascular Biology, reinforced these concerns. In a controlled trial, 20 healthy volunteers consumed a drink containing 30 grams of erythritol. Within 30 minutes, their blood levels of the sweetener spiked over 1,000-fold, and their platelets became significantly more prone to clotting. In contrast, a sugar-sweetened drink had no such effect.

A Growing Body of Evidence

The concerns don’t stop at the lab. Observational data from large-scale studies paint a troubling picture. A 2023 study in Nature Medicine tracked 4,000 people across the U.S. and Europe, finding that those with the highest blood erythritol levels had a two-fold higher risk of major adverse cardiovascular events (MACE), including heart attack, stroke, or death. Another study, reported by CBS News in August 2024, noted that erythritol levels in the blood remained elevated for days after consumption, potentially amplifying its effects.

Dr. Stanley Hazen, a cardiologist at the Cleveland Clinic, emphasized the urgency of further research: “Cardiovascular disease builds over time, and heart disease is the leading cause of death globally. We need to make sure the foods we eat aren’t hidden contributors.” Hazen’s team also found that erythritol is unique among sugar alcohols because it’s poorly metabolized, lingering in the bloodstream and potentially accumulating with repeated consumption.

The Other Side: Is Erythritol Being Unfairly Targeted?

Not everyone is ready to vilify erythritol. The Calorie Control Council, an industry group, argues that decades of research support erythritol’s safety, as evidenced by its “generally recognized as safe” (GRAS) status from the FDA and the European Food Safety Authority. In a statement to CNN, the council noted that the 2023 Cleveland Clinic study focused on high-risk individuals, and its findings shouldn’t be applied to the general population.

Critics also point out that observational studies, like those linking erythritol to cardiovascular events, don’t prove causation. For example, people with obesity or diabetes—conditions already tied to higher heart disease risk—are more likely to consume erythritol-heavy products. Could their underlying health issues, rather than the sweetener itself, explain the elevated risks?

Moreover, the human body naturally produces small amounts of erythritol during glucose metabolism, complicating the picture. Some researchers suggest that high blood levels of erythritol might reflect excessive sugar consumption, as the body converts excess glucose into erythritol. This raises the question: is erythritol a cause of harm, or merely a marker of other dietary issues?

What’s in Your Pantry?

Erythritol’s ubiquity makes it hard to avoid. It’s a key ingredient in popular sweeteners like Truvia and Splenda, and it’s found in everything from energy drinks to gummy vitamins. A single pint of keto-friendly ice cream can contain 26-45 grams of erythritol, while some diabetic-friendly confections pack up to 75 grams. Unlike other sweeteners, erythritol often appears on labels simply as “sugar alcohol,” making it tricky for consumers to spot.

For those concerned about vascular health, experts like Dr. Daniel Miller, a stroke neurologist at Henry Ford Health, recommend reading labels carefully and minimizing erythritol intake. “The fact that these products are interpreted by many to be a healthier option unknowingly puts many high-risk individuals at an even higher risk for clotting events,” he said.

Alternatives and the Path Forward

So, what’s a sweet-tooth to do? Health experts suggest exploring natural, non-caloric sweeteners like stevia or monk fruit extract, which have not shown the same adverse effects on blood vessel health. Dr. Thomas M. Holland of Rush University Medical Center also advocates for reducing overall sweetener reliance, emphasizing whole foods like fruits for natural sweetness.

The FDA, for its part, has not changed erythritol’s GRAS status but is monitoring emerging research. In 2023, the agency reviewed studies suggesting a link to cardiovascular events but concluded that the data didn’t establish causation. Meanwhile, the European Food Safety Authority is reevaluating erythritol and other sweeteners, with results expected in the coming years.

A Call for Caution

As the debate over erythritol heats up, one thing is clear: what was once considered a safe sugar substitute may not be as harmless as it seems. While the sweetener offers undeniable benefits for weight management and blood sugar control, its potential to disrupt vascular health can’t be ignored. For now, consumers are left to weigh the risks and rewards, armed with the knowledge that even “healthy” choices can come with hidden dangers.

The next time you reach for that sugar-free soda or keto snack, check the label. It might just be a matter of protecting your heart and brain. As research continues to evolve, moderation—and a critical eye on emerging science—may be the sweetest strategy of all.