Sugar Substitute Erythritol Linked to Increased Stroke Risk, Study Finds

Erythritol, a sugar substitute widely used in sugar-free beverages and low-calorie foods, may increase the risk of stroke, according to new research.

A research team led by Professor Christopher DeSouza at the University of Colorado's Integrative Vascular Biology Research Institute published findings in the Journal of Applied Physiology after exposing human brain microvascular endothelial cells to erythritol. The concentration used in the experiment was set at levels that could occur in the body after consuming one can of sugar-free soda (approximately 30 grams).

The study found complex changes in blood-brain barrier cells—the brain's key defense system that blocks harmful substances while allowing essential nutrients through—within just three hours. Damage to this barrier increases the risk of cerebrovascular disease.

Specifically, production of nitric oxide (NO), which relaxes blood vessels, decreased, while secretion of endothelin-1, a protein that constricts blood vessels, increased by approximately 30%. Secretion of tissue plasminogen activator (t-PA), a key protein that breaks down blood clots, also decreased significantly, indicating reduced clot-clearing capability. Additionally, production of reactive oxygen species (ROS), which cause cellular aging and tissue inflammation, increased substantially.

The research team noted these changes could potentially contribute to increased ischemic stroke risk but emphasized that large-scale follow-up studies are needed to confirm effects in the human body, as this was a cell-level experiment.

The study has drawn attention amid a surge in strokes among younger populations. According to a 2024 report from the U.S. Centers for Disease Control and Prevention (CDC), stroke incidence among young adults has increased approximately 15% since 2011.

Lead author Auburn Berry said, "Erythritol is being marketed as a healthy alternative, but more research is needed on its effects on vascular health. Consumers should be vigilant about their daily intake."

Previous research has also warned of erythritol's potential harms. A 2023 Cleveland Clinic study analyzing approximately 4,000 patients found that those with high blood erythritol levels had roughly twice the risk of severe cardiovascular events, including heart attack and stroke, compared to those with lower levels.

Erythritol received FDA approval in 2001 and has since been used in hundreds of low-calorie and sugar-free products worldwide, touted for having virtually no calories and minimal impact on insulin levels.