The use of sugar substitutes, including sugar alcohols and artificial sweeteners, has increased significantly in processed foods that are promoted as healthy alternatives. Xylitol is a common zero-calorie sweetener used as a sugar substitute found in sugar-free gum, candy, baked goods, and oral products.
The same team of researchers discovered a similar link between erythritol and cardiovascular risk last year. In America, xylitol is not as prevalent as erythritol in keto or sugar-free food products, but it is more common in other countries. This study confirmed the association in a large-scale patient analysis, and preclinical research models as well as a clinical intervention study.
“This study again shows the immediate need for investigating sugar alcohols and artificial sweeteners, especially as they continue to be recommended in combating conditions like obesity or diabetes,” said Dr. Stanley Hazen, M.D., Ph.D., 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. “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.”
This study revealed that high levels of circulating xylitol were associated with an elevated 3-year risk of cardiovascular events in an analysis including over 3,000 patients in America and Europe. Finding that one-third of those with the highest amounts of xylitol in their plasma were more likely to experience a cardiovascular event.
Pre-clinical testing found that xylitol caused platelets to clot and heightened the risk of thrombosis. Platelet activity was also tracked in those who ingested a xylitol-sweetened drink versus a glucose-sweetened drink and found that every measure of clotting ability significantly increased immediately following ingestion of xylitol but not glucose.
Based on their findings, the researchers suggest that further investigation should be conducted to assess the long-term cardiovascular safety of xylitol.
This work is part of an ongoing investigation into factors that could contribute to residual cardiovascular risk. The work follows patients over time to identify chemical signatures in the blood that could predict the future development of heart and metabolic disease.
The collective work has made pioneering discoveries in atherosclerosis and inflammatory disease research, including the seminal discovery linking gut microbial pathways to cardiovascular diseases and metabolic diseases.
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