Erythritol linked to brain cell damage and stroke risk
32 comments
·July 20, 2025duffpkg
casualscience
This sounds like a smart comment, but the main reason you shouldn't take in vitro studies as indicative of real medical outcomes is largely due to unknown bio availability when consuming realistic doses. However, this study shows that the concentration of erithritol is well above the concentration where they see negative effects in vitro when consuming a realistic dose.
In addition epidemiological studies have found associations between higher plasma erythritol and clotting/cardiovascular events. So, regular disclaimers about difficulty of establishing health science aside, I would disagree this should 'not influence behaviors'.
hollerith
>It should NOT be used to influence behaviors regarding human health.
It's not like erythritol is hard for a consumer to avoid. P(serious problems like brain cell damage) does not need to get very high for it to start to make sense to avoid it, and it seems to me that studies done on cell culture can raise P high enough.
Moto7451
The test setup ignores the digestive system. There are going to be a lot of substances you can pour on a culture of brain cells with negative affect that your body produces or happily consumes. That’s the point of the parent.
Add milk, an alcoholic beverage, or some lemon juice and those cells are unlikely to survive. Meanwhile the standard path of consumption handles the situation just fine before your brain is ever involved in metabolism.
bestouff
Alcoholic beverage, just fine ? I disagree.
ethan_smith
In vitro studies demonstrate potential mechanisms but cannot establish causality in humans due to differences in metabolism, bioavailability, and the blood-brain barrier's protective effects.
XorNot
If you poured distilled water on cells in culture they'd also all die.
jcynix
”Erythritol occurs naturally in some fruit and fermented foods." https://en.wikipedia.org/wiki/Erythritol
The German Wikipedia article says it appears naturally in cheese, funghi, plums, strawberries and pistachios. So maybe the lab experiment might be a bit artifial, or the dose much higher than from normal consumption if the above?
heavyset_go
The dose people use for sweetener can be 1,000x - 10,000x the amount you'd find in fruit. There's micro to milligrams of it in some foods, people eat anywhere between 3g to 20g+ if they're eating goods baked with it as a sugar replacement.
MichealCodes
The concern is more unnatural consumption. Some use it as a sugar replacement in drinks and foods.
jajko
There is also the topic of erythritol-induced diarrhea in higher consumption.
Its almost like these days people are desperately grasping for anything that will deliver weight loss, apart from changing their longterm unhealthy fucking eating habits. US is a long term champion but it has slowly crept into most cultures, just not at that scale yet.
Food portion size, its composition and breaking some sweat regularly works wonders but nobody ain't got time or willpower for that.
chaostheory
Going on a tangent, another natural sugar alternative called allulose also induces diarrhea in higher doses.
OutOfHere
In natural foods, there are other substances that balance out the harm, making it healthy overall. These other substances are absent when it's used as an additive.
burnt-resistor
No, I'm sorry but that's not correct. "Natural" is a meaningless health and wellness buzzword that handwaves away the details that each food comes with benefits and disadvantages. There are variable amounts of anti-nutrients almost every "natural" ingredient, some of which we process or cook to lessen them.
Indigenous people processed acorns to remove tanins.
Kidney beans (and many other legumes to variably lesser degree) naturally contain phytohaemagglutinins (PHA-E) which cause red blood cells to clump together. These can be reduces several orders of magnitude by repeated cooking, washing, and draining.
Men shouldn't eat too much soy or chia seeds. Small amounts of chia seeds are fine.
Most adults are lactose intolerant unless they have lactase persistence genes.
Spinach, pepper (the spice kind), rhubarb, almonds, and more contain oxalate that can lead to kidney stone formation. Excess vitamin C does also. Increasing citrate intake helps prevent calcium kidney stone formation, but doesn't help with oxalate kidney stones as much.
The list of antinutrients is long. Don't overdo eating one "natural" ingredient or another because that's the greatest risk of becoming a Chubbyemu video subject.
IcyWindows
Hmm, the dose seems odd.
Would the whole drink amount really all be given to those cells?
abeyer
I could be off, my molar math is pretty rusty, but a back of the envelope stab seems like 6mM concentration would be _way_ below the 30g "serving" in a drink so assume their "equivalent of" is taking into account the concentrations estimated in the body after consumption or some such.
MichealCodes
I've consumed large amounts of erythritol for probably 10+ years. What should I watch for? Blood pressure?
casualscience
blood clots: https://www.nature.com/articles/s41591-023-02223-9.
Evidence in vitro suggests enhanced platelet activity. Plasma levels of erythritol are sustained for >2d above thresholds associated with platelet hyper-reactivity after consumption of realistic doses.
I use artificial sweeteners, but prefer sucralose or anything else to erythritol. I actually don't understand why people still use it (often in 'health food' because it's seen as 'natural'), there are much safer options.
ryanmerket
Unless you're a cell, this study isn't super relevant to you.
* It does not show human harm, only cellular disruption.
* It uses an unnatural exposure method.
* It builds on epidemiological correlations that may be reverse causality.
* It does not account for systemic factors, metabolism, or adaptive responses.
seec
Yes the conclusion is baffling.
As you say I believe the correlation is reverse causality. It's much more likely that people who consume stuff with "artificial" sweetener are already at risk for stroke than the other way around.
If you don't have weight/cardio problems it is weird to consume "sugar-free" stuff and associated because they are almost always worse tasting than the real deal.
To have any importance they would need a big population sample and correct for already existing risks for stroke and I believe they would find that this stuff has very little impact, if any.
But as always, it doesn't cost much to limit consumption, so why not?
OutOfHere
I would discontinue it immediately, then focus on optimizing overall health, just as everyone else.
Eisenstein
Seeing as this is an in vitro study, they fall back on a specific human study (Witkowski et al., 2023) for many of the human effect claims. However the referenced study has a few issues:
- All study subjects had a "high prevalence of CVD [cardiovascular disease] and risk factor burden"
- Erythritol occurs naturally in the body and and this was not accounted for
- The study subjects were already suffering from cardiovascular disease and were likely to be consuming more artificial sweeteners than a general population, but this was not recognized or accounted for
- Erythritol's presence after a cardiovascular incident could be from consumption or from natural production but only baseline was measured despite data showing dramatic fluctuations after consumption
Another one of the studies cited for evidence of human claims (Khafagy et al., 2024) directly contradicts them. It stated said "we did not find supportive evidence from MR that erythritol increases cardiometabolic disease".
There are two more human studies referenced but I didn't read them.
mixwpl0j
Right but, what are the odds you aren't all that healthy to begin with if you decide to swap normal sweeteners for chemicals?
abeyer
and specifically in that high risk group, those chemicals are correlated with an even higher rate of cardiovascular issues than baseline
airstrike
Plenty of "fit" products like Quest protein bars use them
https://www.samsclub.com/p/quest-protein-bar-variety-chocola...
ben_w
"Normal sweeteners" are, in fact, chemicals.
For example erythritol itself occurs naturally in some fruit and fermented foods, making it a "normal sweetener".
sharifhsn
“Normal” sweeteners are also chemicals.
hilux
Probably a significant majority of Americans use sugar substitutes.
Of course, a significant majority of Americans aren't all that healthy - I guess I'm not sure what your point is.
This is a study done on cell cultures. It should NOT be used to influence behaviors regarding human health. The article linked makes a lot of leaps not supported by the study itself.
Link to actual study: https://journals.physiology.org/doi/full/10.1152/japplphysio...