A new study is linking a common low-calorie sweetener, xylitol, to heart attack and stroke.
The research, conducted by the Center for Cardiovascular Diagnostics and Prevention at the Cleveland Clinic Lerner Research Institute, focuses on the effects of xylitol, an ingredient commonly found in reduced-sugar foods and consumer products like gum and toothpaste.
“We gave healthy volunteers a typical drink with xylitol to see how high the levels would get, and they went up 1,000-fold,” said senior study author and director of the institute, Dr. Stanley Hazen.
Published in the European Heart Journal on Thursday (June 6), the study started as a way of “finding unknown chemicals or compounds in a person’s blood that might predict the risk for a heart attack, stroke, or death within the next three years.”
The research, conducted by Hazen and his team, analyzed 1,157 blood samples from people undergoing assessment for heart disease. The samples were collected between 2004 and 2011. Another batch of blood samples from over 2,100 people at high risk for heart disease was also studied.
“When you eat sugar, your glucose level may go up 10% or 20%, but it doesn’t go up 1,000-fold,” said Hazen. “Humankind has not experienced levels of xylitol this high except within the last couple of decades when we began ingesting completely contrived and sugar-substituted processed foods.”
In 2023, similar results were found for another low-calorie sweetener, erythritol, used as a bulking agent in stevia, monk fruit, and keto-reduced-sugar products. The findings also determined that both xylitol and erythritol have the potential to cause blood platelets to clot more readily. Clots can then “break off and travel to the heart, triggering a heart attack, or to the brain, triggering a stroke.”
Xylitol, as sweet as sugar but with less than half the calories, is used in everything from mouthwash to cough syrup, chewable vitamins, breath mints, and beyond. Large quantities are typically used to make candy, cake mixes, pancake syrup, peanut butter, puddings, and more.
Although in small amounts, xylitol, a sugar alcohol and carbohydrate, is also found in natural foods like eggplant, lettuce, mushrooms, spinach, plums, raspberries, strawberries, and other fruits and vegetables.
“If you actually do the calculation, it literally takes a tonnage of fruit to be equivalent to one diabetic cookie that can have nine grams of xylitol, which is a typical label amount,” said Hazen. “It would be like eating salt at the level of a salt lick.”
Xylitol, created from birch trees, corncobs, or even genetically engineered bacteria, is commercially used as a substitute for sugar in low-carb and keto-friendly products.
“It’s sold as a so-called natural sweetener, and because xylitol doesn’t spike blood sugar levels, it’s also marketed as low carb and keto-friendly,” said Hazen.
Still, the product is recommended as a sugar substitute for patients living with health conditions like diabetes, obesity, and prediabetes to “improve glycemic control,” per the report.
Hazen says, “We’re targeting the wrong people,” especially with people at risk for diabetes being at high risk for clotting events.
Moreover, the exposure to food made with xylitol is higher because the US Food and Drug Administration labels sugar alcohols as GRAS, which stands for “generally recognized as safe.”
“Xylitol is cheaper to make than cane sugar, and so more and more keeps getting incorporated as a sugar substitute into food. Some 12-ounce drinks that use xylitol as a major artificial sweetener can contain 30 grams or more,” Hazen explained. “You can even buy it in bulk at the grocery store where you’re told to use it as a one-to-one substitute for sugar in home cooking.”
In 2023, the World Health Organization (WHO) warned consumers to avoid artificial sweeteners marketed for weight loss. Now, additional research is required to determine the long-term toxicity of low- and no-calorie sweeteners.
According to researchers, the findings are just another “warning we ought to switch to water, with a close second being unsweetened tea or coffee.”
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