A familiar sugar substitute found across Thai supermarkets, bakeries, and bubble tea shops is drawing renewed scrutiny. Erythritol, popular in sugar-free and “health” products, may trigger immediate changes in blood vessels and platelets that increase the risk of heart attack and stroke. With many Thais turning to sugar-free and keto options, these findings carry significant implications for millions who view erythritol as harmless.
Erythritol is a sugar alcohol produced by fermenting corn or wheat starch. It is marketed as a natural, low-calorie option suitable for people with diabetes or those following low-carb regimens. Regulators in the United States and Southeast Asia have approved its use, helping it become widespread in beverages, snacks, toothpaste, and personal care items. Unlike some sugar alcohols, it typically causes little digestive upset, which adds to its popularity.
Recent laboratory work raises concerns about its safety. In a study published in a physiology journal, researchers exposed human brain blood vessel cells to erythritol levels similar to those found in common sugar-free drinks. Within hours, cells showed increased stress, higher production of free radicals, and diminished antioxidant defenses. Notably, nitric oxide production—vital for vessel dilation—fell by about 20 percent, while endothelin-1, a constrictor, rose. The result is stiffer, less adaptable arteries, a combination that could elevate stroke risk.
The study also found that erythritol could blunt the brain’s natural clot-dissolving response. When simulating a clotting event, the cells treated with erythritol failed to release the clot-busting enzyme t-PA. In real life, this could mean that brain clots are less likely to dissolve promptly, potentially worsening outcomes after a stroke.
Epidemiological data from large-scale studies in the United States and Europe align with these laboratory findings. A major study linked higher blood erythritol levels with increased risks of heart attacks and strokes over three years. The research also noted that consuming an erythritol-sweetened product could dramatically boost blood levels within a few hours, illustrating a previously underappreciated exposure risk.
Experts urge caution about sugar substitutes overall. While many clinicians previously recommended sugar substitutes for people at high cardiovascular risk, recent findings underscore the need for long-term clinical trials to confirm safety. A review in a leading cardiovascular journal likewise highlights evidence that erythritol may promote platelet stickiness, a key factor in clot formation.
Why this matters in Thailand is clear. The local market now includes a wide range of sugar-free desserts, teas, and baked goods labeled with erythritol. In Bangkok, Chiang Mai, and popular tourist hubs, bubble tea shops and cafés frequently promote low-calorie or “healthy” choices that rely on sugar alcohols. With rising rates of diabetes and hypertension, Thais are increasingly seeking alternative sweets, sometimes without full awareness of potential risks.
Thai culture has long embraced sweets, from palm sugar to cane sugar, as part of daily life and celebrations. Public health campaigns have urged reducing sugar intake amid rising obesity and dental decay. The shift toward sugar substitutes was driven by both industry changes and consumer demand. Now, better understanding of sugar substitutes’ health effects is essential to avoid trading one risk for another.
Experts stress the need for more human studies to determine the long-term cardiovascular effects of daily erythritol consumption, especially for high-risk groups. Health professionals, policymakers, and consumers should consider cautious use of erythritol-containing products. For policymakers, this could mean clearer labeling and tighter oversight of sugar-alcohol products. For clinicians, it means discussing risks and benefits with patients who rely on sugar substitutes. For families, moderation remains prudent, and traditional, less-processed sweeteners used sparingly may pose fewer uncertainties.
Consumers should check labels for erythritol and related terms, and reduce overall intake of processed sweets, whether they contain sugar or sugar alcohols. Staying informed and prioritizing a balanced, whole-foods-based diet will help protect heart and brain health in Thailand’s modern food environment.
For those seeking further guidance, consult national health authorities and trusted medical institutions, along with peer-reviewed research on sugar substitutes and cardiovascular health. Data from leading institutions emphasize the importance of cautious, informed choices rather than assuming all sugar substitutes are risk-free.