Study reveals potential link between frequent use of low-calorie sweeteners and increased risk of heart attack and stroke.
"Healthy volunteers had their xylitol levels spike 1,000 times higher after consuming a regular drink containing the sweetener, claims Dr. Stanley Hazen, director of the Cleveland Clinic's Center for Cardiovascular Diagnostics and Prevention and the main author of the study. Comparatively, our blood sugar level might increase by just 10% to 20% after sugar consumption.
"Xylitol, a sugar substitute found in various processed foods, is an anomaly in human history," Dr. Hazen adds, emphasizing that we hadn't experienced such high levels until the last few decades. His research also revealed that another low-calorie sweetener, erythritol, could induce blood platelets to clot more rapidly. These clots can potentially dislodge and travel to the heart or brain, leading to heart attacks or strokes.
In 2023, a similar finding was made for erythritol, used in numerous low-calorie products. Additional laboratory and animal studies carried out by Dr. Hazen's team showed that erythritol and xylitol may increase the risk of blood clots. In the study on xylitol, even moderate consumption caused noticeable changes in platelet function.
Dr. Matthew Tomey, a cardiologist at Mount Sinai Fuster Heart Hospital, commented on the experiments, stating they are interesting but don't confirm the link between xylitol-induced platelet abnormalities and clinical events.
Considering that around 61% of American adults might develop cardiovascular disease by 2050, per the American Heart Association, any additional clotting risks should be a matter of concern for cardiologists. Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health, shared his insecurities. Reducing clotting activity is an integral part of many cardiologists' treatment strategies. Since the sugar alcohols seem to enhance platelet activity, it's worrying.
"When someone suffers a heart attack, we prescribe them aspirin or drugs like clopidogrel to inhibit platelet function. However, these sugar alcohols, such as xylitol, seem to accelerate platelet activity, which is disconcerting," said Dr. Freeman, unrelated to the new xylitol study.
"All these tips for switching to water, or unsweetened tea or coffee, seem like rational advice right now," he concluded."
CNN contacted the Calorie Control Council, an industry group, but received no response prior to this publication.
When erythritol was the focus of a study in 2023, the Council released a statement saying that the evidence "goes against decades of scientific research demonstrating that reduced-calorie sweeteners, including erythritol, are safe, as evident by global regulatory permissions for their use in foods and beverages."
What is xylitol?
Xylitol, nearly as sweet as sugar with fewer than half the calories, is often incorporated into sugarless gum, breath mints, toothpaste, mouthwash, cough syrup, and chewable vitamins. It's also commonly found in candies, baked goods, mixes for cakes, BBQ sauces, ketchup, peanut butter, puddings, pancake syrup, and more.
Xylitol is a sugar alcohol, a type of carbohydrate naturally present in foods such as cauliflower, eggplant, lettuce, mushrooms, spinach, plums, raspberries, and strawberries. Nevertheless, the natural occurrence of xylitol is so minute that around 10 tons of these fruits would only be equal to a single diabetic cookie's 9 grams of xylitol. "It's as if you're eating salt at the level of a salt block," comments Dr. Hazen.
For commercial usage, xylitol is cultivated from corn cobs, birch trees, or genetically modified bacteria. Some health organizations promote it as an alternative to sugar for individuals with obesity or diabetes to better regulate blood sugar levels. However, people who are vulnerable to diabetes are more likely to face clotting events, Dr. Hazen notes.
As the use of xylitol has surged in the last few decades, primarily due to its classification as GRAS (Generally Recognized As Safe) by the US Food and Drug Administration, it has become more widespread in our diets. Some 12-ounce drinks that employ xylitol as their primary artificial sweetener could contain as much as 30 grams or more. You can even purchase xylitol in large quantities at grocery stores and replace sugar with it in your home cooking.
Research has suggested that artificial sweeteners may disrupt the metabolic system, prompting the body to anticipate more calories and making the process of losing weight more complicated."
A study released on Thursday in the European Heart Journal aimed to discover hidden chemicals or substances in people's blood that could indicate an increased risk of heart attack, stroke, or death within the next three years. To accomplish this, Hazen and his team analyzed 1,157 blood samples from individuals undergoing heart disease evaluations between 2004 and 2011, as well as a separate collection of blood samples from over 2,100 people who might have been at high risk for heart disease.
The researchers identified several alcohol sugars that seemed to affect cardiovascular function, such as xylitol and erythritol. Erythritol, which is the primary ingredient in many stevia and monkfruit products by weight, was particularly noteworthy. The February 2023 research observed that people with the highest levels of erythritol had a nearly doubled risk of heart attack and stroke within three years.
When it came to xylitol, the outcomes were similar—individuals with the highest levels of xylitol compared to those with the lowest levels had nearly twice the risk of heart attack, stroke, and death, according to Hazen.
"There's a receptor on our platelets that we don't yet understand which is recognizing this molecule and signaling the platelet to be more likely to clot," he explained. "Our taste buds can't tell the difference between sugar and these other sweeteners, but our platelets sure can."
The World Health Organization issued a warning to consumers in 2023 to avoid artificial sweeteners for weight loss and emphasized the need for further research on the long-term toxicity of low-calorie and sugar-free sweeteners, according to the study.
"Through their work, the investigators have shed light on the safety of sugar substitutes," stated Mount Sinai's Tomey. "There's still more to learn, but in the meantime, it's worth remembering that sugar substitutes are no replacement for a genuine dedication to various aspects of a healthy diet and lifestyle."
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People looking to improve their health might want to consider reducing their consumption of products containing xylitol, given the new findings linking its frequent use to an increased risk of heart attack and stroke. Moreover, regular wellness practices, such as eating a balanced diet and exercising regularly, can help lower the risk of developing cardiovascular disease.
