Sugar Substitute Xylitol Linked to Increased Stroke, Heart Attack Risks: Study

Researchers warn side effects of xylitol may increase blood platelet activity, leading to blood flow concerns.

The findings of a new study suggests that the the low-calorie diet sweetener Xylitol may increase the odds of a person suffering from blood clots and cardiovascular-related deaths, adding to the growing body of research published in recent months that raise concerns about the safety of alternative and artificial sweeteners.

Xylitol is a low-calorie sugar replacement made from a sugar alcohol found in fruits and vegetables. It is often used to sweeten food as an alternative to sugar or high-fructose corn syrup, and is often used as an ingredient in diet food products, especially those labeled as “keto” or “keto-friendly.”

The sweetener tastes like sugar but is similar to sucrose and has 40% fewer calories. It is often recommended for people with diabetes but is used in much higher concentrations than found in nature.

The U.S. Food and Drug Administration (FDA) labels xylitol as “generally recognized as safe” or GRAS, and it is also widely found in sugar-free gum, candies, toothpaste, and baked goods.

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However, in findings published last week in the European Heart Journal, researchers from the Cleveland Clinic warn that the sweetener appears to be linked to an increased risk of strokes and heart attacks.

Dr. Marco Witkowski, of the Department if Cardiovascular & Metabolic Sciences at the Lerner Research Institute, and his team studied levels of xylitol in more than 3,000 participants undergoing elective heart evaluations following an overnight fast. According to the findings, those who had the highest levels of xylitol in their blood faced twice the risk of suffering heart attack, stroke, or death within three years compared to people with the lowest levels.

Researchers also examined xylitol consumption among 10 healthy volunteers. They gave them a xylitol-containing drink and took blood samples. They also gave xylitol to mice and added it to blood in the lab.

In each case, xylitol activated the platelets in the blood, which causes clotting to stop excessive bleeding. However, by affecting the part of the blood that controls clotting, side effects of xyiltol also increase the risk of stroke and heart attack. Blood clots are the leading cause of heart attack and stroke because they prevent proper blood flow.

“Complementary mechanistic studies showed xylitol-enhanced multiple indices of platelet reactivity and in vivo thrombosis formation at levels observed in fasting plasma,” Witkowski warned in the report. “In interventional studies, consumption of a xylitol-sweetened drink markedly raised plasma levels and enhanced multiple functional measures of platelet responsiveness in all subjects.”

The team of researchers determined that more studies are needed to fully determine the safety or the risk xylitol may pose to users.

Artificial Sweetener Concerns

This is the latest in a string of studies in recent years, which have warned that some artificial and alternative sweeteners appear to carry potentially serious health risks.

A 2023 statement made by the World Health Organization recommended against using non-sugar sweeteners to control body weight or to reduce the risk of diabetes, including sweeteners such as Splenda and Equal.

WHO declared aspartame, also sold under the brand name Equal, is a possible carcinogen and warned against using the sugar substitute. However, U.S. food officials quickly denounced the determination and said they believe the sweetener is safe to use.

Another study published in 2023, conducted by researchers from North Carolina State University and the University of North Carolina, indicated Sucralose, commonly known as Splenda, may cause DNA damage, and increase a person’s risk of cancer and other health conditions.

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