A ubiquitous sugar substitute found in Thai supermarkets, bakeries, bubble tea shops, and increasingly in “health” products, erythritol, has emerged as a fresh concern for heart health. Recent scientific studies—including a major investigation led by the University of Colorado Boulder—reveal that consuming even a typical serving of erythritol may rapidly trigger changes in blood vessels and platelets that set the stage for heart attack and stroke. With sugar-free and “keto” diets growing in popularity across Thailand, these findings carry weighty implications for millions of Thai consumers who have long considered erythritol as a harmless alternative to sugar.
Erythritol, a sugar alcohol produced by fermenting corn or wheat starch, is marketed as a “natural” and healthy sweetener suitable for people with diabetes, those following low-carb regimes, and anyone looking to reduce calories. Since its approval by the U.S. Food and Drug Administration in 2001 and similar assessments by Thai and ASEAN food safety agencies, erythritol has pervaded both global and local food chains, from diet sodas to toothpaste Colorado.edu. Unlike some other sugar alcohols, it seldom causes digestive upset, adding to its widespread appeal.
But evidence is mounting that erythritol may not be as benign as previously thought. The latest lab-based research, published in the Journal of Applied Physiology, examined the effects of erythritol at levels akin to those in one sugar-free beverage. Human brain vascular cells exposed to this dose for only three hours experienced significant stress. The cells’ production of free radicals—unstable molecules that can damage DNA, proteins, and cellular membranes—soared, while their natural antioxidant defenses struggled to keep up. Strikingly, the cells produced about 20% less nitric oxide, a key molecule enabling blood vessels to dilate and ensure steady brain blood flow. At the same time, these cells generated higher levels of endothelin-1, a compound that signals blood vessels to constrict, resulting in tighter, less flexible arteries Earth.com.
This “double whammy”—blood vessels both losing ability to widen and simultaneously receiving stronger signals to tighten—was described by the research team as a mechanism primed to raise stroke risk. “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 the study’s first author, a University of Colorado Boulder graduate researcher. Senior researcher at the same institution elaborated, “Our study adds to the evidence suggesting that non-nutritive sweeteners that have generally been purported to be safe, may not come without negative health consequences” Colorado.edu.
What made these findings especially alarming is how swiftly erythritol changes vascular behavior—mere hours after consumption. When the researchers simulated a “clotting event” in these blood vessel cells (using a chemical called thrombin), the normal production of the clot-busting enzyme t-PA flatlined; the erythritol-treated cells simply did not respond. In practice, this could mean that blood clots in the brain—primary triggers of ischemic stroke—may be less likely to dissolve, further hiking the risk for catastrophic outcomes.
Epidemiological data backs up these observations. A major Cleveland Clinic study involving more than 4,000 people in the United States and Europe found that those with higher blood concentrations of erythritol faced greater risks of heart attacks and strokes over a three-year period, including men and women across different health backgrounds. The researchers confirmed that ingesting a standard erythritol-sweetened beverage or snack could rapidly increase blood levels by up to 1,000 times, creating a potent—and previously underappreciated—exposure risk Cleveland Clinic Newsroom.
Leading experts caution against assuming all sugar alternatives are safe. “Many professional societies and clinicians routinely recommend that people at high cardiovascular risk—those with obesity, diabetes or metabolic syndrome—consume foods that contain sugar substitutes rather than sugar,” said the Cleveland Clinic’s lead preventive cardiology researcher. “These findings underscore the importance of further long-term clinical studies to assess the cardiovascular safety of erythritol and other sugar substitutes.” Supporting this, a review in the journal Cardiovascular Research also highlighted evidence that erythritol can make platelets more “sticky”—raising the odds of clot formation, a root cause of heart attacks and strokes Cardiovascular Research.
So, why does this matter for Thai readers? The Thai food landscape has in recent years become saturated with sugar-free desserts, teas, and baked goods, many explicitly labeled as containing erythritol. In Bangkok and popular tourist towns, bubble tea shops and dessert cafés routinely market “healthy” or “keto” options sweetened with sugar alcohols. Even some brands of toothpaste and mouthwash now list erythritol as a key component. The growing number of Thais diagnosed with non-communicable diseases like diabetes and hypertension—the leading causes of death in Thailand—means millions are actively seeking out low-calorie “healthier” sweets, and may unknowingly be raising their risk of the very conditions they hope to avoid.
Historically, sweeteners have played a vital role in Thai cuisine and culture, with palm sugar, coconut sugar, and cane sugar underpinning everything from street snacks to festive desserts. Public health campaigns in recent years have sought to cut back sugar intake, given rising obesity rates and the high national prevalence of childhood tooth decay. This gave impetus to a nationwide “war on sugar,” spurring both the food industry and consumers to pivot to sugar substitutes. However, as new scientific findings emerge, it’s clear that a simplistic replacement of one sweetener with another—without considering health impacts—could be trading one risk for another.
Looking ahead, researchers stress the need for caution until long-term, large-scale human studies can clarify whether daily erythritol consumption indeed causes more harm than good, especially among high-risk groups. “While erythritol is widely used in sugar-free products marketed as healthier alternatives, more research is needed to fully understand its impact on vascular health,” emphasized the graduate researcher from Colorado, speaking at the 2025 American Physiology Summit Physiology.org.
In practical terms, Thai health professionals, food regulatory authorities, and ordinary consumers are advised to take a cautionary stance. For policymakers, that could involve updated food labeling guidelines, closer monitoring of erythritol-containing products, and clearer public health messaging. For healthcare providers, it means discussing the risks and benefits of various sugar substitutes with patients—especially for those already at risk of heart disease or stroke. And for Thai families, it may be wise to moderate intake of foods and drinks containing erythritol, while remembering that traditional sources of sweetness, used sparingly, may carry less uncertainty.
For those concerned about their own consumption, checking food labels for ingredients like “erythritol,” “sugar alcohol,” or their Thai equivalents is a first line of defense. Reducing overall intake of processed sweets—whether containing sugar or sugar alcohols—remains a cornerstone of disease prevention. As the body of research grows, staying informed and maintaining a balanced, whole-foods-based diet will be essential for Thai individuals seeking to protect their heart and brain health in the modern food environment.
For further reading and to stay updated on evolving sweetener science, consult reputable sources such as the Food and Drug Administration of Thailand, leading Thai hospitals, and peer-reviewed journals like the Journal of Applied Physiology and Cardiovascular Research.
Sources: Earth.com, Colorado.edu, Physiology.org, Cleveland Clinic Newsroom, Cardiovascular Research.