A common sugar substitute may increase the risk of a heart attack or stroke. Cleveland Clinic researchers report that higher amounts of the sugar substitute xylitol are associated with an increased risk of cardiovascular events. Processed foods, sugar-free confectionery, and toothpaste contain xylitol. Should we sound the alarm?
Study Highlights Dangers Of A Common Sugar Substitute
The Cleveland Clinic issued a media brief on the study on 10th June 2024. The research team, led by Stanley Hazen, M.D., Ph.D., confirmed the association in large-scale patient analysis, preclinical research models, and a clinical intervention study. The European Heart Journal published the findings.
Admittedly, reading this research summary almost made my own heart skip a beat. Products using some form of a sugar substitute have increased significantly over the years. We use them because people tout them as healthier alternatives.
The research raises another red flag
This is not the first time someone has raised a red flag about sugar substitute products. Last year, the same research team found a similar link between erythritol and cardiovascular risk. Xylitol is not as prevalent as erythritol in keto or sugar-free food products in the U.S. However, it is common in other countries.
“This study again shows the immediate need for investigating sugar alcohols and artificial sweeteners, especially as they continue to be recommended in combatting conditions like obesity or diabetes,” said Dr. Hazen. He is the Chair of Cardiovascular and Metabolic Sciences at Cleveland Clinic’s Lerner Research Institute and Co-Section Head of Preventive Cardiology in the Heart, Vascular & Thoracic Institute.
Stanley Hazen, M.D., Ph.D.
The risk
The researchers identified high levels of circulating xylitol associated with an elevated three-year risk of cardiovascular events in an analysis of more than 3,000 patients in the U.S. and Europe.
A third of patients with the highest amount of xylitol in their plasma were more likely to experience a cardiovascular event.
To confirm the findings, the research team conducted pre-clinical testing. They found that xylitol caused platelets to clot and heightened the risk of thrombosis.
Researchers also tracked platelet activity from people who ingested a xylitol-sweetened drink versus a glucose-sweetened drink. They found that each measure of clotting ability significantly increased immediately following ingestion of xylitol, but not glucose.
Blood Clot-Related Events
Cleveland Clinic has a long track record of health excellence. This information is important to consider. Especially if you are a heavy consumer of this particular sugar substitute.
Dr Hazen confirmed in his findings that, “It does not mean throw out your toothpaste if it has xylitol in it, but we should be aware that consumption of a product containing high levels could increase the risk of blood clot related events.”
Do you need to exclude this sugar substitute from your diet?
The authors state that further studies are warranted to assess the long-term cardiovascular safety of xylitol. The research had several limitations, including that clinical observation studies demonstrate association and not causation.
The Cleveland Clinic is a respected global institution and the study size is robust. Therefore, these findings carry weight. It would be critical to consider your usage against your own health profile.
If you are concerned, read up more on the subject from credible sources. Consult a doctor or certified dietitian to learn more about healthy food choices and for personalized recommendations.
Reference notes
The research is part of Dr. Hazen’s ongoing investigation into factors that contribute to residual cardiovascular risk. His team follows patients over time. They look for and find chemical signatures in the blood that can predict the future development of heart and metabolic disease. He has made pioneering discoveries in atherosclerosis and inflammatory disease research. These include the seminal discovery linking gut microbial pathways to cardiovascular and metabolic diseases.
Dr. Hazen also directs Cleveland Clinic’s Center for Microbiome and Human Health. He holds the Jan Bleeksma Chair in Vascular Cell Biology and Atherosclerosis. The U.S. National Institutes of Health and the Office of Dietary Supplements supported the study in part.
Disclosures: Dr. Hazen has been named as co-inventor on pending and issued patents held by the Cleveland Clinic in relation to cardiovascular diagnostics and therapeutics.
About Cleveland Clinic
Cleveland Clinic is a nonprofit multi-specialty academic medical center that integrates clinical and hospital care with research and education. Four renowned physicians founded it in 1921 in Cleveland, Ohio. They had a vision of providing outstanding patient care based on the principles of cooperation, compassion, and innovation.
References
Marco Witkowski, Ina Nemet, Xinmin S Li, Jennifer Wilcox, Marc Ferrell, Hassan Alamri, Nilaksh Gupta, Zeneng Wang, Wai Hong Wilson Tang, Stanley L Hazen, Xylitol is prothrombotic and associated with cardiovascular risk, European Heart Journal, 2024;, ehae244, https://doi.org/10.1093/eurheartj/ehae244
