A new study reveals troubling news about the popular “healthy” sweetener erythritol. A single serving—the amount found in a typical zero-sugar beverage—can damage brain blood vessels.
It spikes oxidative stress by 75%. It also cripples the body’s natural clot-busting defense. These findings raise serious questions about its safety.
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Introduction
For years, the advice has been simple: to improve your health, swap out sugar for artificial sweeteners. Among these, a sugar alcohol called erythritol rose to fame as a seemingly perfect solution. It tastes like sugar, has almost no calories, doesn’t spike blood sugar, and is often marketed as a natural, heart-friendly option.
It’s a key ingredient in many “keto-friendly” desserts, protein bars, and zero-sugar beverages.
But a growing body of evidence is challenging this healthy reputation. A new study published in a leading scientific journal adds to the concern, revealing that a single serving of erythritol—the amount found in a typical artificially sweetened beverage—can cause direct, harmful effects on the cells that line the brain’s blood vessels.
Let’s break down what the researchers found, why it matters for your health, and what you can do about it.
The Study: A Closer Look at the Brain’s Protective Barrier
Researchers at the University of Colorado, Boulder, wanted to understand how erythritol affects the brain’s vascular system. They focused on human cerebral microvascular endothelial cells (hCMECs).
Think of these cells as the highly specialized gatekeepers of your brain. They form a crucial barrier called the blood-brain barrier, which protects your brain from harmful substances in your bloodstream while allowing essential nutrients to pass through. When these cells are healthy, your brain is protected. When they become damaged or dysfunctional, it’s a major step toward conditions like stroke and dementia.
In the study, scientists treated these brain cells with a single dose of 6mM of erythritol. This concentration is equivalent to what you would find in your bloodstream after consuming a standard 30-gram serving of erythritol—the amount in a typical can of a zero-sugar, erythritol-sweetened soda.
The results were alarming.
Key Finding #1: A Surge in Cellular “Rust” (Oxidative Stress)
The first thing the researchers noticed was a dramatic increase in reactive oxygen species (ROS), more commonly known as free radicals or oxidative stress.
Imagine rust forming on a car. Oxidative stress is like rust for your cells. It damages their structure, DNA, and ability to function. In the brain’s endothelial cells, the study found that ROS production spiked by a staggering 75% after exposure to erythritol.
This is a critical issue because the brain’s blood vessels are particularly vulnerable to oxidative stress. This kind of damage can make the blood-brain barrier “leaky,” allowing unwanted substances to enter the brain and cause inflammation, tissue damage, and cell death.
Key Finding #2: Disrupting the Brain’s Blood Flow “On/Off” Switch
Your body has a delicate system to control blood flow to the brain. It’s managed by two key substances produced by the cells lining your blood vessels:
- Nitric Oxide (NO): This is the “relax” signal. It tells blood vessels to widen, allowing more blood—and therefore more oxygen and nutrients—to flow to your brain. Healthy NO production is vital for preventing clots and maintaining good circulation.
- Endothelin-1 (ET-1): This is the “constrict” signal. It tells blood vessels to narrow.
A healthy vascular system maintains a perfect balance between these two signals. The study found that erythritol completely tipped the scales.
The treated cells showed a 35% reduction in the activation of the enzyme that makes NO, leading to a 20% drop in actual NO production. At the same time, the production of Big ET-1 (the precursor to the constricting molecule) and ET-1 itself increased significantly.
In short, erythritol created an environment where the brain’s blood vessels lost their ability to relax and open up, while simultaneously gaining a stronger signal to constrict.
This imbalance reduces blood flow and is a classic hallmark of vascular dysfunction, significantly increasing the risk of ischemic stroke (a stroke caused by a blockage).
Key Finding #3: Impairing the Brain’s Natural “Clot-Busting” System
Perhaps one of the most concerning findings relates to how the body clears blood clots. When a clot forms, the lining of your blood vessels releases a substance called tissue-type plasminogen activator (t-PA).
Think of t-PA as your body’s natural “plumber,” working to dissolve clots before they can block a vessel and cause a stroke.
In the study, researchers stimulated the cells with thrombin, a natural clotting agent that normally triggers a robust release of t-PA to prevent excessive clotting.
In healthy cells, t-PA release increased by about 25%, as expected.
However, in cells exposed to erythritol, this critical clot-busting response was completely blunted. There was no increase in t-PA release at all.
This means that if you consume a beverage sweetened with erythritol, your vascular system may not just be losing its ability to keep blood vessels open—it’s also losing its primary defense mechanism to break down dangerous blood clots.
Putting It All Together: What This Means for You
This study is in vitro, meaning it was conducted on cells in a lab, not on living humans. However, it provides powerful evidence for the biological mechanisms that explain recent large-scale human studies.
Previous research has linked high levels of erythritol in the blood to an increased risk of heart attack and stroke. This new study shows how that might be happening: erythritol directly damages the cells that line our brain’s blood vessels, impairing their ability to regulate blood flow, resist oxidative stress, and prevent dangerous clots.
For individuals with existing risk factors—such as diabetes, high blood pressure, or a history of heart disease—the potential harm from erythritol could be even more pronounced, as their vascular systems may already be compromised.
A Note on Limitations: Why We Should Still Be Wary
It is important to acknowledge the limitations of this research. This was a cell culture study, not a clinical trial in humans. The experiments were conducted on isolated cells in a laboratory setting, which does not fully replicate the complex environment of a living human body.
In the real world, factors such as digestion, metabolism, and the presence of other nutrients and compounds could potentially influence how erythritol affects the body. Additionally, the study examined only a single 24-hour exposure to erythritol, leaving unanswered questions about the effects of long-term, repeated consumption.
So, why should we take these findings seriously?
First, the dose matters. The concentration of erythritol used in this study was not an extreme or unrealistic amount. It was carefully chosen to mirror the levels observed in human blood after consuming a standard serving of an erythritol-sweetened beverage. This means the findings are directly relevant to real-world consumption patterns.
Second, this study aligns with a growing body of human evidence. The cell-level findings in this study do not exist in a vacuum. They provide a plausible biological explanation for recent large-scale human studies that have found a strong association between circulating erythritol levels and increased risk of heart attack, stroke, and even death. When lab-based mechanisms line up with real-world human outcomes, the overall case for concern becomes much stronger.
Third, the cell type used is highly significant. The researchers specifically chose brain microvascular endothelial cells—the very cells that form the blood-brain barrier. These cells are among the most sensitive and critical in the body. Damage to them has immediate and serious implications for neurological health. If a substance shows clear toxicity to these cells in a controlled setting, it warrants serious caution, even before long-term human trials are completed.
Finally, there is a precautionary principle. When it comes to substances we consume regularly, waiting for definitive proof of harm in humans can take decades—decades during which millions of people may be exposed to potential risks. Given that erythritol is not an essential nutrient and that safer alternatives exist, a cautious approach is entirely reasonable.
Recommendations: What to Do Now
This doesn’t mean you should rush back to high-sugar sodas. The goal is still to reduce your intake of both sugar and potentially harmful substitutes. Here are some evidence-based recommendations to help you navigate the confusing world of sweeteners.
1. Rethink “Zero-Sugar” Products
Don’t assume a product is automatically healthy because it’s sugar-free. Make it a habit to read ingredient labels. If you see erythritol listed, especially as one of the first ingredients, it’s wise to limit or avoid it. This is particularly common in:
- “Keto” and low-carb ice creams, cookies, and cakes.
- Protein bars and powders.
- Some zero-calorie sodas and flavored sparkling waters.
2. A Better Alternative: Allulose
If you are looking for a low-calorie sweetener that doesn’t appear to carry the same risks as erythritol, consider allulose.
- What it is: A rare sugar found naturally in small amounts in figs, raisins, and jackfruit.
- Why it’s different: Allulose tastes and bakes like sugar, doesn’t spike blood glucose or insulin, and early research suggests it may actually have anti-inflammatory and anti-diabetic properties.
- A word of caution: While promising, allulose is newer to the market, so long-term studies are still ongoing. However, the current mechanistic research is much more favorable than that on erythritol.
- Learn more about allulose below.
What You Need to Know Before Trying Allulose Sweetener
3. Be Wary of Maltodextrin
Maltodextrin is another common additive that deserves scrutiny. While it is not a non-nutritive sweetener like erythritol, it is often added to “sugar-free” and “low-calorie” products to provide bulk and texture.
- What it is: A white powder made from corn, rice, or potato starch.
- The problem: Maltodextrin has a very high glycemic index (higher than table sugar). It can spike blood sugar and insulin levels dramatically, promoting weight gain, insulin resistance, and disruption of the gut microbiome. It is essentially a highly processed starch that functions like sugar in the body.
Maltodextrin Exposed: The Hidden Sugar Found in Sugar-Free Sweeteners
4. Embrace Unsweetened
The safest approach is to gradually train your palate to enjoy foods and beverages without added sweeteners.
- Drinks: Try unsweetened iced tea, sparkling water with a squeeze of lemon or lime, or high-quality black coffee.
- Foods: Choose plain yogurt and add fresh berries. Opt for dark chocolate (70% cocoa or higher) with minimal added sugar or sweeteners.
The Bottom Line
The era of assuming all artificial and non-nutritive sweeteners are benign is over. This study on erythritol adds to a compelling narrative: these substances are not biologically inert. They actively interact with—and in the case of erythritol, appear to harm—our most sensitive and critical biological systems.
While regulatory bodies like the FDA have approved erythritol, these approvals are often based on older, less comprehensive data. New research is revealing a more complex and concerning picture, particularly for cardiovascular and cerebrovascular health.
Until more definitive long-term human trials are completed, a cautious approach is wise. Prioritize whole, unprocessed foods, stay hydrated with water and unsweetened beverages, and if you choose to use a sweetener, allulose currently appears to be a safer option than erythritol, while maltodextrin is best avoided altogether. Your brain’s blood vessels will thank you.
Don’t Get Sick!
About Dr. Jesse Santiano, MD
Dr. Santiano is a retired internist and emergency physician with extensive clinical experience in metabolic health, cardiovascular prevention, and lifestyle medicine. He reviews all medical content on this site to ensure accuracy, clarity, and safe application for readers. This article is for educational purposes and is not a substitute for personal medical care.
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References:
- The non-nutritive sweetener erythritol adversely affects brain microvascular endothelial cell function
- Auburn R. Berry, Samuel T. Ruzzene, Emily I. Ostrander, Kendra N. Wegerson, Nathalie C. Orozco-Fersiva, Madeleine F. Stone, Whitney B. Valenti, Joao E. Izaias, Joshua P. Holzer, Jared J. Greiner, Vinicius P. Garcia, and Christopher A. DeSouza. Journal of Applied Physiology 2025 138:6, 1571-1577
Disclaimer:
This article is for educational purposes and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your physician before making health decisions based on the TyG Index or other biomarkers.
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