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A widely-used sugar substitute found in products marketed to people with diabetes may involve more risks than rewards.
In a new study published in the Journal of Applied Physiology, researchers from the University of Colorado Boulder found that erythritol — an organic compound used for so-called "stevia" products sold by the brands Wholesome, Truvia, and Splenda — can harm brain cells and increase the risk of stroke and heart attack.
Created during the corn fermentation process, erythritol, which was approved by the US Food and Drug Administration back in 2001, has long been considered one of the best sweeteners on the market because of its near-sugar-level sweetness that barely affects insulin or blood sugar in diabetics.
Unfortunately, the sugar alcohol seems, per the new study from Boulder, to be nearly as harmful as the artificial sweetener aspartame, which is used in many diet sodas, has been labeled "carcinogenic" by the World Health Organization, and has been linked to increased heart attack and stroke risk.
Following up on a 2023 study that linked increased stroke and heart attack risk with higher erythritol circulation in the bloodstream, integrative physiology professor Christopher DeSouza and graduate student Auburn Berry, both coauthors on the new paper, sought to learn more about this unsettling correlation.
In a lab, the researchers saturated the kind of cells that line our brain's blood vessels with the amount of erythritol that comes in the average sugar-free drink. As they found, the treated cells were both lower in the molecule nitric oxide, which widens and relaxes blood vessels, and contained higher-than-normal levels of endothelin-1, a protein that causes blood vessels to constrict.
The sweetened cells also spat out a bunch of so-called "free radicals," which inflame and age cells and tissues, and had a "markedly blunted" reaction to the clot-forming compound thrombin. Essentially, the cells that had been treated with erythritol worked the opposite way they were supposed to.
"Big picture, if your vessels are more constricted and your ability to break down blood clots is lowered, your risk of stroke goes up," explained Berry in a press release about the new study.
Notably, those stark effects were found in cells that had been doused with enough erythritol for one sugar-free drink. For people consuming more than one per day, that inflammatory effect could, as research lead DeSouza warned, be even worse.
"Given the epidemiological study that inspired our work, and now our cellular findings, we believe it would be prudent for people to monitor their consumption of non-nutrient-sweeteners such as this one," the professor explained.
DeSouza went on to add that people should check labels for erythritol, or "sugar alcohol," as it's sometimes called — a prudent piece of advice, especially considering that people with diabetes are already at double the risk of having a stroke as their non-diabetic counterparts.
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