Sugar-free drinks, keto-friendly desserts, protein bars, and low-calorie snacks have become popular alternatives to traditional sugary foods. Many contain erythritol, a sugar substitute that provides sweetness with very few calories and has little immediate effect on blood glucose levels.
For years, erythritol has been promoted as a convenient option for people trying to reduce sugar intake.
However, emerging research has raised queries about its possible effects on blood vessels, blood clotting, and cardiovascular health.
A laboratory study published in June 2025 in the Journal of Applied Physiology found that erythritol exposure altered several important functions in human brain blood-vessel cells.
Researchers observed increased oxidative stress, reduced nitric oxide production, higher levels of endothelin-1, and impaired release of a protein involved in breaking down blood clots.
These data suggest possible mechanisms whereby which erythritol might affect vascular health.
Other research has also reported associations between higher blood concentrations of erythritol and cardiovascular events, including heart attacks and strokes.
But an important question remains: Does consuming erythritol actually increase the risk of stroke in humans?
The answer is not yet established.
Laboratory experiments, observational studies, and short-term human trials offer useful evidence, but they cannot independently prove that erythritol consumption causes strokes.
Here is what the research reveals, what scientists still do not know, and how consumers can make informed dietary decisions.
- Erythritol is a sugar alcohol used in many sugar-free and reduced-calorie products.
- A 2025 laboratory study found that erythritol altered several functions of human brain microvascular endothelial cells.
- The researchers reported increased oxidative stress, reduced nitric oxide production, increased endothelin-1 production, and impaired tissue-type plasminogen activator release.
- A 2023 observational study associated higher circulating erythritol concentrations with greater cardiovascular event risk.
- A small 2024 clinical intervention study found that consuming 30 grams of erythritol increased laboratory measures of platelet reactivity.
- These data raise legitimate questions about vascular safety but do not prove that dietary erythritol causes strokes.
- Regulatory reviews have emphasised that a causal relationship between erythritol consumption and cardiovascular disease remains unestablished.
- Larger, longer-term human studies are needed to clarify the risks and benefits of erythritol consumption.
What Is Erythritol?
Erythritol is a four-carbon sugar alcohol, also called a polyol.
It belongs to the same broad family of sugar substitutes as xylitol, sorbitol, and maltitol.
Although classified chemically as a sugar alcohol, erythritol does not contain the type of alcohol found in alcoholic beverages.
It provides approximately 60–80% of the sweetness of ordinary table sugar while supplying very little energy.
Erythritol occurs naturally in small amounts in certain fruits and fermented foods. Commercial erythritol is generally produced by fermenting carbohydrates, then purifying the product.
It is commonly found in:
- Sugar-free confectionery and chewing gum.
- Keto and low-carbohydrate desserts.
- Reduced-sugar baked goods.
- Certain sugar-free drinks.
- Tabletop sweetener blends.
- Products marketed as low-calorie or diabetic-friendly.
Unlike ordinary sugar, erythritol has relatively little immediate effect on blood glucose and insulin levels.
Most absorbed erythritol is eliminated in the urine, although a small proportion may be metabolised.
The body can also produce erythritol naturally via metabolic pathways.
This last point matters when interpreting cardiovascular studies: a high erythritol concentration in someone’s blood does not necessarily mean they recently consumed large quantities of the sweetener.
Source: European Food Safety Authority – Re-evaluation of erythritol (E 968)
The 2025 Study: What Happens When Erythritol Is Applied to Brain Blood-Vessel Cells?
The study most directly relevant to brain health was published in the Journal of Applied Physiology in June 2025.
Its title was:
The non-nutritive sweetener erythritol adversely affects brain microvascular endothelial cell function.
The research was conducted by Auburn R. Berry and colleagues at the University of Colorado Boulder.
The scientists focused on endothelial cells, which line the inside of blood vessels.
These cells help regulate blood-vessel relaxation and constriction, protect the vascular system, and influence the balance between clot formation and clot breakdown.
In the brain, endothelial cells are also important components of the blood-brain barrier.
How the Experiment Worked
Researchers cultured human cerebral microvascular endothelial cells in a laboratory.
They exposed the cells to erythritol at a concentration of 6 millimoles per litre (6 mM) for three hours.
The researchers chose this concentration because it reflects blood levels associated with ingesting about 30 grams of erythritol.
They then measured several indicators of endothelial function, including:
- Reactive oxygen species.
- Nitric oxide production.
- Endothelin-1 production.
- Antioxidant protein expression.
- Tissue-type plasminogen activator release.
The results showed changes in multiple processes involved in vascular regulation.
Importantly, this was an in vitro experiment involving cultured cells, not a dietary trial measuring strokes in people.
The researchers did not show that consuming erythritol damaged the brain blood vessels of living participants.
Nevertheless, the experiment provided a potential biological explanation for concerns raised by earlier cardiovascular studies.
Original research: Berry et al., Journal of Applied Physiology (2025)
Finding 1: Erythritol Increased Oxidative Stress
One remarkable finding involved oxidative stress.
Oxidative stress occurs when the production of reactive molecules exceeds the capacity of cellular protective systems to control them.
These molecules, known as reactive oxygen species (ROS), participate in normal cellular signalling.
However, excessive ROS activity can contribute to cellular dysfunction and damage.
In the 2025 laboratory experiment, erythritol-treated endothelial cells showed substantially higher levels of reactive oxygen species than untreated cells.
The researchers also observed increased expression of antioxidant proteins, including superoxide dismutase-1 and catalase.
These changes suggest that the cells were responding to an altered oxidative environment.
Why This Matters for Brain Blood Vessels
Healthy blood vessels depend on a fine balance between oxidative and protective signalling.
Excessive oxidative stress may interfere with endothelial function and contribute to vascular disease.
However, observing increased oxidative stress in cultured cells does not automatically mean that the same degree of damage occurs in a living human after eating an erythritol-containing product.
The body contains additional regulatory systems, and actual exposure varies.
The study therefore identifies a potential mechanism that human research needs to confirm.
Finding 2: Erythritol Reduced Nitric Oxide Production
Nitric oxide is a signalling molecule that helps blood vessels relax.
Endothelial cells produce nitric oxide through an enzyme called endothelial nitric oxide synthase (eNOS).
Nitric oxide supports normal vascular function by helping regulate blood flow and vascular tone.
In the 2025 experiment, erythritol-treated cells produced approximately 20% less nitric oxide than untreated cells.
The researchers also observed changes in the activation-related phosphorylation of eNOS.
These results suggested that erythritol exposure altered the cells’ ability to regulate nitric oxide production.
Why Lower Nitric Oxide Can Be Important
Reduced nitric oxide availability is associated with endothelial dysfunction.
Endothelial dysfunction is relevant to cardiovascular conditions such as atherosclerosis, hypertension, and vascular disease.
However, the laboratory findings cannot establish whether typical dietary erythritol intake produces clinically meaningful reductions in nitric oxide in humans.
Researchers would need to assess vascular function directly in people and determine whether any changes persist over time.
Finding 3: Erythritol Increased Endothelin-1
Endothelin-1 is a powerful signalling molecule that promotes blood vessel constriction.
In a healthy vascular system, vasodilators such as nitric oxide and vasoconstrictors such as endothelin-1 are regulated to maintain appropriate blood flow.
The researchers found that endothelin-1 production was approximately 30% higher in erythritol-treated cells.
This result was particularly interesting because nitric oxide production decreased at the same time.
Together, these changes suggest a shift in the balance of signals involved in vascular relaxation and constriction.
In theory, such a shift should contribute to impaired vascular function.
But the experiment did not directly measure changes in cerebral blood flow, blood pressure, or stroke occurrence.
Therefore, it would be inaccurate to conclude that eating erythritol has been proven to constrict brain blood vessels.
The finding instead provides another reason to investigate potential vascular effects in human studies.
Finding 4: Erythritol Impaired a Clot-Dissolving Response
The fourth major finding involved tissue-type plasminogen activator, commonly called t-PA.
This protein helps the body break down fibrin, an important structural component of blood clots.
The process of dissolving clots is known as fibrinolysis.
In the laboratory study, untreated endothelial cells released more t-PA when stimulated with thrombin.
However, cells exposed to erythritol showed a markedly reduced response.
Why This Finding Matters
The body’s clotting system must keep a balance between forming clots to prevent bleeding and breaking them down when appropriate.
Disruption of this homeostasis can contribute to thrombotic disorders.
An ischemic stroke occurs when a blockage interrupts blood supply to part of the brain.
Because t-PA participates in clot breakdown, impaired t-PA responses could theoretically affect the body’s ability to clear certain clots.
However, this experiment measured a cellular response rather than actual clot formation or clot dissolution in human blood vessels.
It does not prove that erythritol consumption causes ischemic stroke.
The result is a mechanistic observation that justifies further investigation.
What Earlier Human Studies Found About Erythritol and Cardiovascular Risk
The 2025 brain endothelial cell experiment did not emerge in isolation.
It followed several investigations into erythritol and cardiovascular health.
The 2023 Nature Medicine Study
In February 2023, researchers published an influential study in Nature Medicine titled:
The artificial sweetener erythritol and cardiovascular event risk.
The researchers examined circulating erythritol concentrations and cardiovascular outcomes in several patient cohorts.
The study included a discovery cohort and separate validation groups in the United States and Europe.
Researchers found that participants with higher circulating erythritol levels had greater rates of major adverse cardiovascular events during follow-up.
These events included death, nonfatal heart attack, and nonfatal stroke.
In the validation cohorts, the highest erythritol quartile was associated with an adjusted hazard ratio of approximately 1.80 in the United States and 2.21 in Europe, compared with the lowest quartile.
These numbers describe associations with a combined cardiovascular outcome, not proof of a corresponding increase in stroke risk from dietary erythritol.
Why the Results Require Caution
The observational study involved patients undergoing cardiovascular evaluation, many of whom already had relevant health risks.
It did not randomly assign participants to consume erythritol for several years.
Furthermore, the body produces erythritol naturally.
Elevated circulating erythritol could therefore reflect metabolic disturbances or preexisting health conditions rather than dietary sweetener exposure alone.
These possibilities complicate attempts to establish cause and effect.
Original study: Witkowski et al., Nature Medicine (2023)
The 2024 Human Study: Did Erythritol Affect Blood Clotting?
In August 2024, researchers published a small clinical intervention study in Arteriosclerosis, Thrombosis, and Vascular Biology.
The study examined whether consuming erythritol affected platelet activity.
Platelets are blood components that help form clots after injury.
Excessive platelet activation can contribute to unwanted clot formation.
What Researchers Did
Twenty healthy volunteers participated, with ten assigned to an erythritol group and ten to a glucose comparison group.
Participants consumed 30 grams of either erythritol or glucose dissolved in water.
Researchers measured blood markers before consumption and approximately 30 minutes afterwards.
What They Found
After erythritol consumption, circulating erythritol concentrations increased dramatically.
The researchers also observed increased platelet responsiveness to activating stimuli.
The glucose group did not show the same pattern of increased platelet reactivity.
These results raised concerns that erythritol could influence biological processes associated with thrombosis.
However, the study had several limitations:
- It included only 20 healthy participants.
- The exposure involved a single 30-gram dose.
- Measurements focused on short-term laboratory outcomes.
- The investigators did not measure actual heart attacks, strokes, or long-term cardiovascular events.
The study demonstrated an acute effect on platelet-related measurements, not that erythritol causes blood clots in everyday use.
Original study: Witkowski et al., Arteriosclerosis, Thrombosis, and Vascular Biology (2024)
Additional Evidence Published After the First Article
Research published after July 2025 has continued to investigate whether circulating erythritol is related to vascular disease.
October 2025: A Mendelian Randomisation Analysis
A study published in Medicine on October 24, 2025, examined relationships between genetically predicted circulating erythritol levels and several cardiovascular outcomes.
The researchers used a method called Mendelian randomisation, which examines genetic variants linked to a biological measurement.
The analysis reported associations between genetically predicted higher erythritol levels and coronary heart disease and ischemic stroke.
For ischemic stroke, the reported odds ratio was approximately 1.16.
Although the authors interpreted the findings as potentially supportive of a harmful relationship, important doubts persist.
Genetically predicted erythritol levels are not equivalent to experimentally assigned dietary erythritol consumption.
The analysis therefore cannot establish that eating erythritol causes stroke.
Mendelian randomisation also depends on assumptions about the genetic instruments used, and violations of those assumptions can bias estimates.
The authors concluded that further investigation was warranted.
Original study: Role of erythritol in coronary heart disease, ischemic stroke, and venous thromboembolism – Medicine (2025)
What Do Health Regulators Say About Erythritol?
Regulatory assessments provide important context because a worrisome research finding does not automatically establish that a food additive causes harm at ordinary dietary exposures.
US Food and Drug Administration
Erythritol is permitted for use in foods in the United States under the applicable regulatory framework for food ingredients.
The FDA discusses erythritol among sugar alcohols used as sugar substitutes.
The agency has acknowledged studies examining possible cardiovascular effects.
However, its published consumer guidance states that the observational evidence reviewed in 2023 did not establish a causal relationship between consuming erythritol and the reported cardiovascular effects.
The agency also says it keeps monitoring scientific evidence on sweeteners.
Source: FDA – Aspartame and Other Sweeteners in Food
European Food Safety Authority
The European Food Safety Authority (EFSA) published a comprehensive re-evaluation of erythritol in 2023.
Its assessment concluded that the available evidence had not demonstrated a causal relationship between dietary erythritol exposure and cardiovascular disease.
The assessment also recognised uncertainty around the observational findings and the possibility that blood erythritol concentrations reflect metabolic disturbances.
EFSA identified gastrointestinal effects, particularly diarrhoea, as the clearest established adverse effect at higher intakes.
It established an acceptable daily intake of 0.5 grams per kilogram of body weight per day, based on protection against laxative effects.
This intake value was not developed as a cardiovascular safety threshold.
It should not be interpreted as proof that consuming quantities below this level eliminates any possible vascular risk.
Sources: EFSA – Erythritol Re-evaluation and Full EFSA Scientific Opinion
How Strong Is the Scientific Evidence?
The different studies answer different questions.
| Evidence | Main finding | What it cannot prove |
| 2023 observational cohorts | Higher blood erythritol associated with cardiovascular events | That eating erythritol caused those events |
| 2024 human intervention | A single 30 g dose increased laboratory platelet reactivity | That repeated intake causes heart attacks or strokes |
| 2025 endothelial cell experiment | Erythritol altered oxidative stress, nitric oxide, endothelin-1, and t-PA responses | That the same effects occur in living human brain vessels |
| 2025 genetic analysis | Genetically predicted erythritol levels associated with certain vascular outcomes | That dietary erythritol is causally responsible |
| EFSA regulatory assessment | Causal cardiovascular harm from dietary exposure not established | That every potential long-term risk has been excluded |
Overall, the results raise biologically plausible concerns.
However, the evidence is still insufficient to determine how much, if any, ordinary erythritol consumption changes long-term stroke risk in the general population.
Is Erythritol More Dangerous Than Regular Sugar?
It would be misleading to conclude that ordinary table sugar is automatically a healthier choice.
Excessive added-sugar consumption is associated with multiple established health concerns, including excess calorie intake, dental problems, and adverse metabolic effects.
Erythritol has a different nutritional profile.
It contains very few calories and produces little immediate blood glucose response.
These properties can be useful when reducing added sugar.
At the same time, questions surrounding erythritol’s potential vascular effects deserve further research.
The right choice depends on overall dietary habits, amounts consumed, existing health conditions, and available alternatives.
For example, lessening reliance on highly sweetened foods and beverages may be preferable to replacing large amounts of added sugar with equally large amounts of sugar substitutes.
There is currently insufficient evidence to recommend switching from erythritol to regular sugar specifically to prevent stroke.
Should People With Diabetes Avoid Erythritol?
People with diabetes often use sugar substitutes to reduce carbohydrate intake.
Because erythritol generally has little immediate effect on blood glucose levels, it may be included in some diabetes-oriented foods.
However, the cardiovascular questions raised by recent studies may be particularly relevant to people who already have risk factors such as diabetes, hypertension, or established cardiovascular disease.
Current evidence does not show that every person with diabetes must avoid erythritol.
Nor does it justify replacing erythritol with large quantities of sugar.
A better approach is to assess comprehensive nutrition and particular health needs.
People with diabetes or cardiovascular disease who frequently consume erythritol, especially in substantial quantities, can discuss their diet choices with a qualified healthcare professional.
How Much Erythritol Is Too Much?
There is no scientifically established threshold at which dietary erythritol begins to increase stroke risk.
The 2025 laboratory experiment used a 6 mM concentration for three hours.
The 2024 personnel intervention involved a single 30-gram dose.
Neither experiment established a long-term cardiovascular safety limit.
EFSA’s acceptable daily intake of 0.5 grams per kilogram of body weight is based on gastrointestinal tolerance.
For illustration, this corresponds to approximately 35 grams per day for a 70-kilogram adult.
That figure is not a recommended consumption target, and it is not a validated cardiovascular safety limit.
The amount of erythritol present in commercial products varies.
Consumers should check ingredient lists and nutritional information where available.
It is also important to distinguish concentrated, commercially added erythritol from the much smaller amounts naturally present in foods.
The available evidence does not justify avoiding ordinary fruits or fermented foods because they contain trace amounts of erythritol.
Practical Steps for Consumers
Until the cardiovascular evidence becomes clearer, a moderate approach is reasonable.
Read ingredient lists. Look for erythritol or its European additive designation, E 968, particularly in reduced-sugar products.
Consider total exposure. Regularly consuming several products containing erythritol may produce greater intake than using a small amount occasionally.
Reduce dependence on intensely sweet foods. Water, unsweetened beverages, and minimally processed foods can help lessen reliance on both added sugars and sugar substitutes.
Avoid unwarranted alarm. A laboratory finding does not mean that occasional erythritol consumption will cause a stroke.
Consider individual medical circumstances. People with established cardiovascular disease, diabetes, or a history of stroke may benefit from discussing their overall diet with a medical professional.
Do not change prescribed treatment. Avoid stopping medications or altering a medically recommended dietary plan solely because of preliminary research.
These are precautionary suggestions, not evidence that avoiding erythritol specifically reduces cardiovascular events.
What Research Is Still Needed?
To determine whether erythritol consumption causes cardiovascular harm, researchers need studies that connect dietary exposure with meaningful health outcomes.
Several questions are particularly important.
1. Long-Term Randomised Trials
Researchers need controlled studies examining whether sustained erythritol consumption alters cardiovascular risk factors over time.
Large trials evaluating actual clinical events would provide stronger evidence, although they may be difficult and expensive to conduct.
2. Better Dietary Exposure Measurements
Because the body produces erythritol naturally, measuring blood erythritol alone may not accurately reflect how much a person consumes.
Future research needs reliable ways to distinguish dietary exposure from endogenous production.
3. Dose-Response Relationships
Researchers must determine whether vascular effects depend on the amount consumed, intake frequency, and length of exposure.
4. Studies in Different Populations
People with diabetes, kidney disease, existing cardiovascular conditions, or different metabolic profiles may respond differently.
Research covering diverse populations is necessary.
5. Confirmation of Brain Blood-Vessel Findings
The 2025 cell experiment should be followed by studies examining whether similar biological effects occur in humans under realistic dietary conditions.
These questions will be essential for determining whether current regulatory recommendations need to change.
Conclusion: A Reason for Further Research, Not Panic
Erythritol has become popular because it provides sweetness with very few calories and minimal immediate effects on blood glucose.
However, research published between 2023 and 2025 has raised issues about its relationship with cardiovascular health.
The 2025 brain endothelial cell study identified changes in oxidative stress, nitric oxide production, endothelin-1 signalling, and clot-related responses.
A separate human experiment found increased platelet activity after a single dose of erythritol.
Observational and genetic studies have also reported associations involving circulating erythritol and cardiovascular outcomes.
Together, these findings show investigating potential vascular effects more closely.
But they do not establish that eating erythritol causes strokes or that avoiding it prevents cardiovascular disease.
The most scientifically accurate conclusion is that erythritol’s possible cardiovascular effects justify further investigation, while its long-term impact on stroke risk is still unclear.
For consumers, focusing on balanced nutrition, limiting excessive sweetness, and considering individual wellness needs is a practical approach.
Subsequent research will help clarify whether erythritol should continue to be used in the same way or whether more specific nutritional advice is necessary.
References
1. Berry, A. R., et al. (2025). The non-nutritive sweetener erythritol adversely affects brain microvascular endothelial cell function. Journal of Applied Physiology, 138(6), 1571–1577.
Published online June 3, 2025.
2. Witkowski, M., et al. (2023). The artificial sweetener erythritol and cardiovascular event risk. Nature Medicine, 29, 710–718.
3. Witkowski, M., et al. (2024). Ingestion of the Non-Nutritive Sweetener Erythritol, but Not Glucose, Enhances Platelet Reactivity and Thrombosis Potential in Healthy Volunteers. Arteriosclerosis, Thrombosis, and Vascular Biology, 44(9), 2136–2141.
Free full text at PubMed Central
4. (2025). Role of erythritol in coronary heart disease, ischemic stroke, and venous thromboembolism: A Mendelian randomisation analysis. Medicine, 104(43), e45187.
5. European Food Safety Authority (2023). Re-evaluation of erythritol (E 968) as a food additive. EFSA Journal.
Read the scientific assessment.
Read the accessible EFSA summary.
6. US Food and Drug Administration. Aspartame and Other Sweeteners in Food.