Xylitol Used As Artificial Sweetener Can Double Risk of Heart Attacks and Strokes

Xylitol Artificial Sweetener (Photo: Getty Images)

A low-calorie sweetener known as xylitol, commonly found in reduced-sugar foods and products such as gum and toothpaste, may be associated with nearly double the risk of heart attacks, strokes, and death among individuals who consume it at the highest levels, according to a new study.

“We gave healthy volunteers a typical drink containing xylitol and observed that the levels of xylitol in their system increased by 1,000-fold,” stated Dr. Stanley Hazen, senior study author and director of the Center for Cardiovascular Diagnostics and Prevention at the Cleveland Clinic Lerner Research Institute.

Hazen, who also directs the Cleveland Clinic’s Center for Microbiome and Human Health, noted, “When you consume sugar, your glucose levels may increase by 10% or 20%, but they don’t rise by 1,000-fold as seen with xylitol.”

“Humankind has only encountered such high levels of xylitol in recent decades with the rise of processed foods and sugar substitutes,” Hazen added.

Similar results were found in 2023 for another low-calorie sweetener, erythritol, which is used as a bulking agent in stevia, monkfruit, and keto products.

Additional lab and animal research presented in both studies indicated that both erythritol and xylitol might increase the tendency for blood platelets to clot. These clots can potentially travel to the heart, causing a heart attack, or to the brain, causing a stroke.

In the study on xylitol, “differences in platelet behavior were observed even after consuming a modest amount of xylitol, similar to typical real-life portions,” said Dr. Matthew Tomey, a cardiologist at Mount Sinai Fuster Heart Hospital in New York City, who was not involved in the study.

Tomey, also an assistant professor of medicine at the Icahn School of Medicine at Mount Sinai, cautioned, “These experiments are intriguing but do not conclusively prove that platelet abnormalities account for the linkage between xylitol and clinical events.”

According to a recent prediction by the American Heart Association, about 61% of American adults will have cardiovascular disease by 2050.

Reducing clotting activity is a key treatment strategy used by cardiologists, making any additional clotting in platelets a concerning sign, noted Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver.

Freeman, who was not involved in the new research, said, “When someone suffers a heart attack, we use aspirin or drugs like clopidogrel, or Plavix, to counteract platelet activity. These sugar alcohols appear to enhance platelet activity, which is worrying.”

“This is another warning that we should consider switching to water or, at least, unsweetened tea or coffee,” he added.

Carla Saunders, president of the Calorie Control Council, an industry association, responded to the findings by stating,

“The study results contradict decades of scientific evidence supporting the safety and efficacy of low-calorie sweeteners like xylitol, as affirmed by global health and regulatory agencies.

These findings are detrimental to those who rely on alternative sweeteners for improving their health.”

 

Xylitol Linked to Heart Attack Risk (Photo: Jenny Kane)

Xylitol is a sugar alcohol that is as sweet as sugar but with less than half the calories. It is commonly used in sugar-free gum, breath mints, toothpaste, mouthwash, cough syrup, and chewable vitamins.

It is also added in larger quantities to candy, baked goods, cake mixes, barbecue sauces, ketchup, peanut butter, puddings, pancake syrup, and more.

Found naturally in foods such as cauliflower, eggplant, lettuce, mushrooms, spinach, plums, raspberries, and strawberries, xylitol is present in only tiny amounts in these natural sources, according to Hazen.

“To match the amount in a diabetic cookie with nine grams of xylitol, you would need to consume a large quantity of fruit, equivalent to a tonnage,” he said. For commercial purposes, xylitol is derived from corncobs, birch trees, or genetically engineered bacteria.

“It is marketed as a natural sweetener and is promoted as low carb and keto-friendly because it does not spike blood sugar levels,” Hazen noted.

Many professional associations also recommend xylitol as a sugar substitute for people with obesity, diabetes, or prediabetes to help improve glycemic control.

However, Hazen pointed out, “People at risk for diabetes are among the most susceptible to clotting events.” He added that the increase in xylitol use over the past two decades is due to the U.S. Food and Drug Administration recognizing sugar alcohols as GRAS (Generally Recognized As Safe).

“Xylitol is cheaper to produce than cane sugar, leading to its increased incorporation into foods. Some 12-ounce drinks containing xylitol as a major sweetener can have 30 grams or more, and it can even be bought in bulk for home use.”

Research has shown that some artificial sweeteners may disrupt the metabolic system, potentially making weight loss more challenging.

The study, published Thursday in the European Heart Journal, initially aimed to identify unknown chemicals or compounds in blood that could predict the risk of heart attack, stroke, or death within three years.

Hazen and his team analyzed 1,157 blood samples from individuals assessed for heart disease between 2004 and 2011 and another batch from over 2,100 high-risk individuals.

They discovered that alcohol sugars like xylitol and erythritol impacted cardiovascular function. Erythritol is a key ingredient in many stevia and monkfruit products.

The February 2023 study on erythritol found that people with the highest levels of erythritol in their blood had nearly double the risk of heart attack and stroke within three years.

The new study on xylitol revealed similar results: individuals with the highest levels of xylitol compared to those with the lowest levels had almost double the risk of heart attack, stroke, and death, according to Hazen.

“There is a receptor on our platelets that appears to recognize this molecule and makes the platelet more prone to clot,” he explained. “Our taste buds may not differentiate between sugar and these sweeteners, but our platelets clearly do.”

The World Health Organization issued a warning in 2023 to avoid artificial sweeteners for weight loss and has called for more research on the long-term toxicity of low- and no-calorie sweeteners.

“The investigators have highlighted the need for further research on the safety of sugar substitutes. In the meantime, it is essential to remember that sugar substitutes cannot replace a genuine commitment to a healthy diet and lifestyle,” said Mount Sinai’s Tomey.

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Evelyn Scott

By Evelyn Scott

Evelyn Scott is a skilled medical writer who works online, specializing in crafting precise and informative content for various health and medical platforms. With a solid foundation in medical science and a passion for clear communication, Evelyn excels in translating complex medical jargon into easily understandable language for a diverse audience.

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