A new study presented at the 2025 American Physiology Summit has reignited concerns over the safety of artificial sweeteners—specifically erythritol, a popular sugar substitute found in countless sugar-free and “diet” products worldwide. Researchers report that erythritol may trigger cellular changes that heighten the risk of stroke and heart attack—an alarming development for consumers and health officials alike as the use of sugar substitutes remains widespread, including in Thailand’s urban and health-conscious communities.
Artificial sweeteners such as erythritol have surged in popularity due to their low-calorie profile and negligible effect on blood sugar, making them a common choice among those managing diabetes or seeking to limit sugar intake. In Thailand, awareness of high sugar consumption’s link to obesity and diabetes has led to a proliferation of sugar-free beverages, snacks, and even oral care products sweetened with erythritol. While previously regarded as one of the safer alternatives, the new findings seriously challenge that assumption, underscoring the urgent public health significance for consumers in Thailand and around the world.
The study, led by a graduate researcher at the University of Colorado Boulder, investigated the impact of erythritol on cerebral microvascular endothelial cells—the delicate cells lining the brain’s micro-vessels. Researchers found that exposure to quantities of erythritol equivalent to a single serving of a sweetened drink caused a spike in oxidative stress, a damaging process linked to cellular aging and elevated risk of cancer and chronic illness. Furthermore, the cells produced less nitric oxide, a compound crucial for vessel dilation and healthy blood flow. Decreased nitric oxide availability, experts warn, can “mess with blood flow, make it hard for blood vessels to widen, and increase the risk of heart attack and stroke,” as summarized by the lead study author in the article (Women’s Health Magazine, 2025).
Commenting on the findings, a registered dietitian at Keatley Medical Nutrition Therapy reiterated that erythritol is often billed as a ‘natural’ and ‘healthy’ sweetener due to its low glycemic index. However, he emphasized growing evidence pointing to cardiovascular risks—particularly with substantial or frequent consumption. A vascular surgeon at MemorialCare Orange Coast Medical Center explained the biological mechanisms at play: erythritol may induce oxidative stress in brain cells by “overwhelming their antioxidant defenses,” and by reducing nitric oxide, further disrupts vascular protection. “This imbalance leads to the buildup of harmful molecules—reactive oxygen species—which can damage cells and contribute to heart and blood vessel problems,” he told Women’s Health Magazine.
These findings carry profound implications for millions of Thai consumers who regularly ingest artificially sweetened products, from energy drinks and protein bars to low-calorie ice creams and diet sodas. Erythritol isn’t only present in obvious “diet” snacks; it often appears in toothpaste and mouthwash—a fact not widely recognized in Thailand. The mounting health alert also intersects with local efforts to curb sugar intake due to Thailand’s high rates of non-communicable diseases, as well as the increasing popularity of imported wellness products.
Globally, scientific scrutiny of artificial sweeteners is intensifying. Studies in recent years have raised red flags about erythritol’s possible links to cardiovascular disease and ischemic stroke (Nature Medicine, 2023). However, biological pathways underlying these associations have remained partly mysterious—making the new research particularly significant for advancing understanding. The study’s focus on direct effects in brain endothelial cells helps bridge this gap, but as emphasized by a cardiologist and medical director at MemorialCare Saddleback Medical Center, “more research is needed to understand why the sweetener causes these changes.”
Despite the concerning findings, erythritol remains classified as “generally recognized as safe” (GRAS) by the U.S. Food and Drug Administration (FDA, 2023). Consumers in Thailand should be aware that this regulatory status is based primarily on short-term toxicity and digestive safety—not comprehensive understanding of long-term vascular or neurological consequences.
Thai context deepens the relevance of this issue. The country’s “sweet tooth” is a well-known cultural trait, with traditional desserts and drinks laden with sugar. More recently, campaigns by the Public Health Ministry and other agencies have sounded alarms over soaring rates of obesity and Type 2 diabetes—leading many Thais to swap regular sugar for artificial alternatives. Market research reports document robust growth in “low-sugar” or “sugar-free” product sales, particularly in Bangkok and major tourist hubs. In this context, the new study’s findings may challenge public health messaging and consumer education initiatives that have, until now, largely focused on the evils of sugar itself rather than the hidden risks of its replacements (Thai Ministry of Public Health, 2022).
Historical attitudes toward sugar substitutes in Thailand have been complex, shaped by global marketing, urbanization, and changing health trends. While older generations may remain loyal to cane sugar—an ingredient tightly woven into festival cuisine—middle-class and younger urban consumers frequently purchase sugar-free gum, beverages, and weight-loss products. Foreign brands and health influencers have helped normalize these alternatives, though product labels and consumer awareness of ingredient lists remain limited compared to Western markets.
Looking ahead, experts encourage “moderation” and increased vigilance. The registered dietitian cited in the Women’s Health Magazine article advised, “Like any sweetener, moderation is key. It’s important to be aware of how much erythritol is consumed, especially considering its potential effects on vascular health.” The cardiologist echoed this, recommending that consumers scrutinize ingredient lists and choose products thoughtfully: “Until we learn more about the negative health effects of erythritol, we should try to understand how much erythritol we are consuming from our food products, and attempt to limit our intake as much as possible.”
In light of the emerging science, Thai health authorities, product regulators, and the food industry may need to reassess guidelines for “safe” sweetener use, strengthen food labeling rules, and expand consumer education. For individuals, the practical next step is clear: read ingredient labels carefully, minimize routine consumption of highly sweetened foods—natural or artificial—and prioritize a balanced, whole-foods diet rich in fruits, vegetables, and traditional Thai ingredients.
As artificial sweeteners increasingly shape global and Thai diets, ongoing research and transparent public conversation remain vital. “Consumers need full information to make the healthiest choices,” summarized a senior nutrition official at the Ministry of Public Health (source: https://www.moph.go.th/). Practically, this means: check the labels, limit both added sugars and sugar substitutes, and tune into updates from reliable medical and regulatory sources as new evidence emerges.