A widely used sugar substitute, erythritol, commonly recommended for people with obesity or diabetes and found in an array of “sugar-free” products, is at the center of fresh health warnings after recent research linked it to damaging effects on brain cells and an increased risk of stroke SciTechDaily.
This finding, from a new study by researchers at the University of Colorado Boulder, raises important questions for Thai consumers who increasingly turn to artificial sweeteners in their efforts to manage weight, diabetes, and blood sugar—problems that are highly prevalent in Thailand and have changed consumption habits nationwide. As health-conscious lifestyles prompt a shift toward “no sugar” or “sugar-free” foods, the safety of these sugar alternatives is becoming a matter of significant public interest.
Erythritol, a sugar alcohol approved by the US Food and Drug Administration in 2001, is now present in hundreds of products, from low-carb ice creams and baked goods to sodas and protein snacks labeled “keto-friendly” or “diabetic-friendly.” Its appeal lies in its almost zero calorie content, its 80% sweetness compared to sugar, and its minimal effect on blood sugar or insulin levels. As such, it has become a common ingredient for those following weight loss programs, those with diabetes, and those subscribing to global and local diet trends such as keto and low-carb regimens. In Thailand, these market trends are reflected in the growing availability of “no sugar added” sweets, drinks, and snacks in supermarkets, convenience stores, and even local dessert shops.
However, the new study, published in the Journal of Applied Physiology, adds weight to previous research questioning the safety of non-nutritive sweeteners. In laboratory experiments, scientists treated human brain microvascular endothelial cells—cells that line the blood vessels in the brain—with levels of erythritol equivalent to what a person might ingest from a typical sugar-free beverage. They observed that the treated cells produced less nitric oxide, a molecule vital for relaxing and widening blood vessels. At the same time, the cells showed increased levels of endothelin-1, a protein that causes vessels to constrict, and produced less of a naturally occurring clot-busting compound, while generating higher levels of damaging reactive oxygen species (free radicals).
According to the study’s senior author, a professor of integrative physiology and director of the Integrative Vascular Biology Lab at the University of Colorado Boulder, these changes significantly impair the cells’ ability to maintain healthy blood flow. “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,” the lead researcher emphasized.
The concern is not only theoretical. A recent epidemiological study involving more than 4,000 people in the US and Europe found that higher blood erythritol levels were associated with a significantly increased risk of heart attack and stroke over the subsequent three years. The current laboratory findings demonstrate how consumption of erythritol might trigger biological changes that make blood vessels more likely to constrict and less able to dissolve dangerous blood clots—both of which are key risk factors for stroke.
“These results show not only that erythritol is associated with a higher risk of stroke, but also reveal how it may be causing that risk at the cellular level,” explained the study’s first author, a graduate student in the same lab. Importantly, the damaging effects were observed at amounts of erythritol typically found in a single serving of a sugar-free beverage. For those who consume multiple servings per day, the potential risk could be greater.
The researchers stressed that their experiment was conducted in a lab, not in live human subjects, and that further, large-scale studies are needed to confirm the impact of real-world erythritol consumption on human health. Nevertheless, the evidence is strong enough that experts urge caution. “Given the epidemiological study that inspired our work, and now our cellular findings, we believe it would be prudent for people to monitor their consumption of non-nutritive sweeteners such as this one,” the senior researcher advised, noting that it is wise for consumers to read product labels for “erythritol” or “sugar alcohol.”
For Thai consumers, the implications could be far-reaching. Thailand has experienced a steady increase in diabetes, with the Thai National Health Examination Survey reporting that over 8.3% of adults were diabetic as of 2019, a number likely even higher today World Health Organization. The push for “sugar-free” living is reinforced by government initiatives such as the “Sweet Enough Network” and excise taxes on sugar-sweetened beverages, both of which have promoted a surge in sugar alternative use.
The widespread availability and marketing of erythritol-containing products in Thailand—from 7-Eleven convenience stores to high-end bakeries—reflect global dietary trends but also point to a need for local research and regulation in this area. In the Thai context, where desserts and sweet drinks are cultural staples, and where urban wellness trends increasingly dictate food and beverage choices, understanding the potential risks behind popular substitutes like erythritol is essential for informed decision-making, especially given Thailand’s rapidly aging population and rising rates of stroke and cardiovascular disease.
Culinary adaptation is at the heart of Thailand’s relationship with sweetness. Traditional Thai desserts such as “lod chong,” “khanom chan,” and sweet drinks like “cha yen” have historically relied on natural sugars. The contemporary wave of healthier, “modernized” versions has seen erythritol and similar sweeteners widely used in their preparation—a practice likely to increase as bakeries and beverage startups respond to new demand. However, this research suggests that the notion of “sugar-free” equating to “risk-free” may not be accurate, particularly in populations already at risk for heart disease and stroke.
Looking forward, experts internationally and in Thailand are likely to call for more research specifically focused on the health impacts of non-nutritive sweeteners in Southeast Asian populations, given potential differences in genetics, diet, and baseline health compared to Western populations where most of the current studies are conducted. Policy makers and public health professionals may also need to reassess guidelines on acceptable daily intake levels and product labeling, particularly with respect to foods targeted at children, diabetics, and older adults.
What should concerned readers do now? The expert advice is clear: moderation is key. Those who have turned to “sugar-free” products as part of a health regimen should re-examine their overall dietary patterns, limit reliance on processed foods containing erythritol, and focus on whole, minimally processed foods such as fresh fruits, whole grains, and legumes. When consuming packaged foods and beverages, check ingredient labels for erythritol or “sugar alcohol” and avoid excessive consumption. Policy makers and educators might also consider ramping up public awareness campaigns about the risks associated with excessive use of non-nutritive sweeteners.
In conclusion, while erythritol remains approved by the US FDA and is widely perceived as a safer alternative to sugar, emerging science suggests that it is not risk-free, particularly for individuals who consume it regularly or in significant amounts. As with many health innovations, a balanced, informed approach is essential. Thai readers invested in their health should opt for moderation, pay attention to product labels, and stay tuned for new findings as further research on erythritol’s long-term effects unfolds.
Sources: SciTechDaily, Journal of Applied Physiology (DOI: 10.1152/japplphysiol.00276.2025), WHO Thailand