Erythritol study raises health concerns

A recent study published in the Journal of Applied Physiology by researchers from the University of Colorado at Boulder has raised new questions about the long-term effects of erythritol, a common sugar substitute, on cardiovascular health. Erythritol, which belongs to the polyol family and is labeled E968 in the European Union, is widely used in products labeled "sugar-free," candies, chewing gums, protein bars, low-carbohydrate preparations, and in many tabletop sweeteners based on stevia, where it serves as a filler. It is appreciated for its low caloric content, its sweetening power reaching 60 to 80 percent of that of table sugar, and its lack of effect on blood sugar or insulin secretion.

Lab findings suggest vascular risks

In the study, researchers exposed brain endothelial cells cultivated in the laboratory to erythritol and observed four changes: a decrease in the production of nitric oxide, a molecule that causes the dilation and relaxation of blood vessels; an increase in the production of endothelin-1, a protein that tightens blood vessels; a reduction in the stimulated release of tissue plasminogen activator, a compound central to clot dissolution; and an increase in the number of reactive oxygen species, which can damage tissues. These changes suggest that tighter blood vessels and a reduced ability to dissolve clots may increase the risk of stroke.

Study builds on earlier observations

The study was conducted following an epidemiological study that associated high blood concentrations of erythritol with an increased risk of heart attack and stroke. The authors present their results as an experimental extension of this observation, capable of explaining its mechanism, and call for clinical studies on long-term effects.

Limitations and uncertainties remain

However, several reservations surround these conclusions. The study used cultured cells, and the concentrations and exposure conditions may not reflect what happens in a living organism. The scope is limited to brain cells related to ischemic strokes, and the extension to other blood vessels is a hypothesis. The question of increased brain exposure related to damage to these cells has not been studied.

Erythritol's natural presence and consumer factors

Erythritol is naturally produced by the body, and high blood concentrations could constitute a marker of a pre-existing metabolic disorder rather than a consequence of dietary consumption. Additionally, consumers of these products often have overweight, diabetes, or cardiovascular risk factors, which may explain both their use of sweeteners and their vascular risk. Some studies have described a favorable effect of erythritol on vascular health.

Expert advice and broader implications

Christopher DeSouza, a physiologist, believes it would be prudent to monitor the consumption of this type of sweetener, given the epidemiological study that led to these studies and their own cellular observations. He also highlights a point that goes beyond this molecule: sweeteners with no nutritional value, presented as safe, may not be without consequences.

Xylitol linked to similar risks

Xylitol, another zero-calorie sugar substitute, is often presented as a healthy alternative and recommended for people with diabetes or obesity. However, a recent study reveals a correlation between a high amount of xylitol and an increased risk of heart attack and stroke.

Regulatory status and consumer guidance

These results do not change the current authorizations, as erythritol remains an authorized additive in Europe and evaluated by health authorities. They do not justify returning to sugar either, the effects of which on cardiovascular and metabolic health are well established. The most defensible lesson is methodological: a molecule validated for a long time can be subject to re-evaluations, and the status of a calorie-free alternative does not constitute in itself a guarantee of safety. People with vascular risk factors can discuss this question with their doctor, without any data imposing a particular change at this stage.