Researchers at the Cleveland Clinic have discovered a troubling connection between the sugar alcohol xylitol and an increased risk of cardiovascular events such as heart attacks and strokes.
The findings, published in the European Heart Journal, underscore the need for further investigation into the long-term safety of sugar substitutes, which have gained popularity in recent years as healthier alternatives to traditional sugars.
Led by Dr. Stanley Hazen, the research team confirmed the association between xylitol and cardiovascular risk through a comprehensive analysis of over 3,000 patients in the United States and Europe, as well as preclinical research models and a clinical intervention study. The results showed that individuals with the highest levels of xylitol in their blood were 33% more likely to experience a cardiovascular event within a three-year period.
Xylitol’s Prevalence in Sugar-Free Products
Xylitol, a common sugar substitute, is widely used in sugar-free candies, gums, baked goods, and oral care products like toothpaste. While not as prevalent as erythritol in keto or sugar-free food products in the U.S., xylitol is commonly used in other countries. The increasing use of sugar substitutes, including sugar alcohols and artificial sweeteners, in processed foods marketed as healthy alternatives has raised concerns among health experts.
Dr. Hazen, who chairs the Department of Cardiovascular and Metabolic Sciences at Cleveland Clinic’s Lerner Research Institute and co-leads the Section of Preventive Cardiology in the Heart, Vascular & Thoracic Institute, emphasizes the urgent need for further research into sugar alcohols and artificial sweeteners, particularly as they continue to be recommended for managing conditions like obesity and diabetes. While the findings do not necessarily warrant discarding xylitol-containing products like toothpaste, Dr. Hazen advises awareness that consuming products with high levels of xylitol could potentially increase the risk of blood clot-related events.
Confirming the Link Between Xylitol and Cardiovascular Risk
To confirm the initial findings, the research team conducted preclinical testing, which revealed that xylitol caused platelets to clot and increased the risk of thrombosis. Additionally, the researchers monitored platelet activity in individuals who consumed either a xylitol-sweetened or glucose-sweetened drink. The results showed a significant increase in all measures of clotting ability immediately following the ingestion of xylitol, but not glucose.
While the study provides compelling evidence linking xylitol to cardiovascular risk, the authors acknowledge that further research is needed to assess the long-term cardiovascular safety of xylitol. They also note that clinical observation studies demonstrate association rather than causation. For personalized recommendations and guidance on healthy food choices, individuals are encouraged to consult with their healthcare provider or a certified dietitian.
The research is part of Dr. Hazen’s ongoing work investigating factors that contribute to residual cardiovascular risk. His team tracks patients over time, identifying chemical signatures in the blood that can predict the future development of heart and metabolic diseases. Dr. Hazen’s pioneering discoveries in atherosclerosis and inflammatory disease research, including the groundbreaking discovery linking gut microbial pathways to cardiovascular and metabolic diseases, have greatly advanced the field.
The study was supported in part by the National Institutes of Health and the Office of Dietary Supplements.
