Experts say there are a number of health concerns with artificial sweeteners.
- Xyltol
is a sugar alcohol added to many products, ranging from sugar-free candy
and gum to toothpaste.
- Researchers
say high levels of circulating xylitol are associated with an elevated
three-year risk of cardiovascular events.
- They
noted their study had several limitations, including clinical observation
studies demonstrate association and not causation.
An
artificial sweetener known as sugar alcohol has never sounded like the
healthiest thing for people. Turns out, it may not be.
In a study published in the European
Heart Journal, Cleveland Clinic researchers report that higher amounts
of xylitol, a type of sugar alcohol, can increase risk of heart attack, stroke, and other cardiovascular events.
The
researchers said they found the associations in a large-scale patient analysis,
a clinical intervention study, and preclinical research models.
Xylitol is
a lower-calorie sugar substitute with a low glycemic index. Sugar alcohols
are carbohydrates that don’t actually contain
alcohol.
Xylitol
occurs naturally in small amounts in fibrous fruits and vegetables, corn cobs,
trees, and the human body. It’s used as a sugar substitute because its taste is
comparable to sugar but has fewer calories.
Xylitol is
found in many products, ranging from sugar-free candy and gum to toothpaste.
People also use it as a sweetener and for baking.
Sugar
alcohol and cardiovascular risks
The research
team said over the past decade, sugar substitutes such as sugar alcohols and
artificial sweeteners have significantly increased in processed foods promoted
as healthy alternatives.
The
Cleveland Clinic team found a similar link between another sugar alcohol, erythritol, and cardiovascular risk last year. They said in a statement that xylitol isn’t as common as
erythritol in keto or sugar-free products in the United States, but they noted
it is common in other countries.
“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, the chairperson of Cardiovascular
and Metabolic Sciences at Cleveland Clinic’s Lerner Research Institute as well
as the co-section head of preventive cardiology in the Heart, Vascular and
Thoracic Institute, in the statement.
“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,” Hazen added.
Details
on the study of xylitol and heart health
In an
analysis of more than 3,000 subjects in the United States and Europe, the
researchers reported that high levels of circulating xylitol were associated
with an elevated three-year risk of cardiovascular events.
A third of
subjects with the highest amount of xylitol in their plasma were found more
likely to experience a cardiovascular event.
The team
conducted pre-clinical testing to confirm the findings. They discovered xylitol
caused clotting in platelets and heightened risk of thrombosis.
The
researchers also tracked platelet activity from subjects who ingested a
xylitol-sweetened drink versus a glucose-sweetened drink. They found every
measure of clotting ability significantly increased immediately following
ingestion of xylitol but not glucose.
The team
said the study had several limitations, including that clinical observation
studies demonstrate association and not causation. They said more studies are
needed to assess the long-term cardiovascular safety of xylitol.
What
experts think about artificial sweeteners
Dr. Cheng-Han Chen, an interventional cardiologist and
medical director of the structural heart program at MemorialCare Saddleback
Medical Center in California, told Medical News Today that
people should consider avoiding large amounts of xylitol until its effects are
better understood.
“Based on
this study, it is thought that xylitol affects the ‘stickiness’ of platelets in
the bloodstream, potentially increasing the risk of forming a blood clot in the
heart or in the brain,” said Chen, who was not involved in the research.
Dr. Rigved
Tadwalkar, a
consultative cardiologist at Providence Saint John’s Health Center in
California, told Medical News Today it’s important to
remember the study was observational and doesn’t definitively prove xylitol
directly causes cardiovascular problems.
“However,
the findings raise enough concern to warrant further investigation,” Tadwalkar,
who was not involved in the research, said. “This new study adds another
chapter to the evolving story of sugar substitutes and heart health. In recent
years, there has been a growing awareness that these alternatives might not be
as risk-free as once believed.”
Tadwalkar
added it’s also important to note erythritol is more prominent in the United
States within keto and sugar-free products, whereas xylitol finds wider use in
other countries as well as in some sugar-free candies and chewing gums.
“This new
research prompts consideration of the long-term cardiovascular safety of
various sugar substitutes,” Tadwalkar said. “This new study on xylitol has
significant implications for both consumers and healthcare professionals.”
He added
that xylitol may have this impact on the heart because, according to the study,
xylitol may increase platelet activity and enhance blood clot formation.
“This
heightened activity could raise the risk of clots forming unexpectedly, potentially
leading to cardiovascular events like heart attack or stroke,” Tadwalkar said.
“It is important to note, however, that this is ultimately just a theory. More
research is needed to definitively understand the exact biological processes at
play.
Health
effects of sugar substitutes
Dr. Bradley Serwer, a cardiologist and chief medical
officer at VitalSolution, which provides cardiovascular and anesthesiology
services to hospitals nationwide, told Medical News Today that
problems with sugar substitutes go back more than a century.
“Saccharin
was first discovered in 1879 and widely introduced as an artificial sweetener
in the early 20th century,” Serwer said. “There was notable concern that saccharin could cause cancer in the 1970s,
but this was later clarified in the early 2000s when the National Toxicology
Program removed saccharin from its list of potential carcinogens.
Serwer
said the health value of sugar substitutes depends on someone’s medical
conditions.
“Ideally,
one would avoid them altogether and maintain a healthy balanced diet with a low
glycemic index,” said Serwer, who was not involved in the research. “I would
encourage patients to consider their desire for sweets over their overall
health. The natural options such as monk fruit extract may be reasonable.”
“Take caution. Even products such as Stevia, which is derived from the Stevia rebaudiana plant, is mixed with erythritol, which may also increase the risk of platelet clumping and was associated with higher cardiovascular events,” he added.
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