Not So Sweet: Erythritol's Hidden Dangers
BRMI Staff
Erythritol has become a popular sugar substitute in keto, low-carb, and sugar-free foods. With virtually no calories and minimal impact on blood glucose, it is widely marketed as a healthier alternative to sugar. However, emerging research suggests that erythritol may have unintended consequences for cardiovascular and brain health.
A 2025 laboratory study examining human brain microvascular endothelial cells—the cells that help form the blood-brain barrier—identified three concerning effects:
1. Increased Oxidative Stress
Erythritol exposure increased oxidative stress in laboratory-grown cells, potentially disrupting normal cellular function and contributing to vascular injury.
2. Decreased Nitric Oxide Production
Nitric oxide is essential for healthy blood vessel dilation and circulation. Researchers observed reduced nitric oxide production following erythritol exposure, suggesting a possible mechanism for impaired blood vessel function.
3. Disruption of Blood-Brain Barrier Function and Clot Clearance
Erythritol exposure impaired protective functions of brain endothelial cells, including mechanisms involved in maintaining the blood-brain barrier and regulating blood clot breakdown. These findings raise concerns about the brain's ability to maintain healthy circulation and protect against vascular injury.
What About Stroke Risk?
A separate 2023 study published in Nature Medicine found that individuals with the highest circulating erythritol levels had approximately twice the risk of major cardiovascular events, including heart attack and stroke, compared with those with the lowest levels.
Importantly, this was an association, not proof that dietary erythritol caused these events. The 2025 findings were also obtained in laboratory-grown cells rather than clinical studies of stroke outcomes.
The Bottom Line
Sugar-free does not necessarily mean risk-free. Take a closer look at food labels, particularly on products marketed as keto-friendly, low-carb, or sugar-free, as erythritol may be hiding in foods you consider healthy.
References:
1. Berry, Auburn R., Samuel T. Ruzzene, Emily I. Ostrander, et al. “The Non-Nutritive Sweetener Erythritol Adversely Affects Brain Microvascular Endothelial Cell Function.” Journal of Applied Physiology 138, no. 6 (2025): 1571–1577.
2. Witkowski, Marco, Ina Nemet, Hassan Alamri, et al. “The Artificial Sweetener Erythritol and Cardiovascular Event Risk.” Nature Medicine 29, no. 3 (2023): 710–718.
Bioregulatory medicine is a total body (and mind) approach to health and healing that aims to help facilitate and restore natural human biological processes. It is a proven, safe, gentle, highly effective, drugless, and side-effect-free medical model designed to naturally support the body to regulate, adapt, regenerate, and self-heal. BRMI is a non-commercial 501(c)(3) foundation and will expand and flourish with your support. Our goal is to make bioregulatory medicine a household term.
This article is for informational purposes only and is not intended to be a substitute for the direct care of a qualified health practitioner who oversees and provides unique and individualized care. The information provided here is to broaden our different perspectives and should not be construed as medical advice, diagnosis, or treatment.
