If sugar-free soda or low-calorie candy seem too good to be true, there's actually a reason for that.

In recent years, studies of artificial sweeteners have linked them to everything from increased appetite to cancer. And while the sugar alcohol erythritol is generally considered one of the healthier artificial sweeteners, it has recently been linked to a higher risk of stroke.

Now, new research suggests that erythritol's negative impact on health may be even more profound. The study, presented at the 2025 American Physiological Society Meeting, found that the sweetener may trigger changes in cells that could increase the risk of heart attack and stroke.

Erythritol is found in a huge number of sugar-free foods, raising questions about how safe it is to consume. Here's what two leading doctors and a dietitian want you to know about the sweetener and the potential risks it poses to your health.

For the purposes of the study, the researchers treated cells from small blood vessels in the brain (known as brain microvascular endothelial cells) with erythritol. They found that cells exposed to the amount of sweetener contained in one serving of the drink had higher levels of oxidative stress. (Oxidative stress is an imbalance in the body that can damage cells, lead to aging, and increase the risk of cancer and other diseases).

The researchers also found that cells exposed to erythritol produced less nitric oxide, a compound that helps blood vessels dilate. Lower levels of nitric oxide can disrupt blood flow, make it harder for blood vessels to expand, and increase the risk of heart attack and stroke.

"We decided to investigate erythritol because it is widely available on the market and consumed as a 'safe' alternative to sugar," said Auburn Berry, lead author of the study and a graduate student at the University of Colorado Boulder. "However, emerging data links erythritol intake to an increased risk of cardiovascular and cerebrovascular events, particularly ischemic stroke. Despite these associations, the direct biological effects of erythritol on brain endothelial cell function, which is critical for maintaining brain-vascular health, are poorly understood."

Erythritol is a low-calorie sugar substitute, explains Scott Keatley, co-owner of Keatley Medical Nutrition Therapy. It is popular because it does not affect blood glucose and insulin levels (a hormone that helps transport glucose to cells to be used for energy) as much as table sugar.

"It's often marketed as a 'natural' sugar substitute because of its lower glycemic index and minimal calorie content," Keatley says.

Although it is considered safe in moderate amounts, the expert said there is growing research showing that it may not be entirely risk-free, especially when consumed in larger quantities. | BGNES