Recent research published in the European Heart Journal suggests that xylitol, a low-calorie sweetener found in various processed foods, may increase the risk of thrombosis — potentially leading to serious cardiovascular events. This groundbreaking study conducted by the Cleveland Clinic examined the correlation between xylitol levels in the body and the occurrence of major adverse cardiovascular events (MACE).
Elevated Xylitol Levels and Heart Risks
The study involved a two-part analysis: the "discovery cohort" and the "validation cohort." The former identified potential cardiovascular risks using untargeted metabolomics, while the latter confirmed these findings through targeted analysis.
Researchers found higher fasting plasma levels of xylitol were associated with a greater risk of MACE such as heart attack, stroke, or death. This relationship persisted after adjusting for conventional cardiovascular risk factors and inflammatory markers.
Extended studies showed xylitol could amplify platelet responsiveness, a known contributor to thrombosis. Healthy volunteers were given drinks sweetened with xylitol, leading to plasma levels a thousand times more than fasting levels. This acute spike in xylitol resulted in increased platelet activity in all participants.
A Call for Reevaluation
Given the broad use of xylitol in food production, experts urge a thorough reevaluation of its cardiovascular safety. The current GRAS (Generally Recognized As Safe) status afforded to artificial sweeteners like xylitol may need revision in light of these alarming findings.
This significant research has laid the foundation for additional studies to determine the long-term safety of artificial sweeteners, particularly for patients with pre-existing metabolic or cardiovascular conditions.
For a detailed look at the study, refer to the original article titled "Xylitol is prothrombotic and associated with cardiovascular risk" published in the European Heart Journal, or visit this link.
Public Health Implications
As the food industry grapples with this information and regulators revisit labeling mandates, the researchers stress the importance of informing the public of the potential risks associated with sugar substitutes.
This article is built with the help of Buoy Health.
Hear what 1 other is saying
Required field
Required field
Required field
Required field
Once your story receives approval from our editors, it will exist on Buoy as a helpful resource for others who may experience something similar.
Request sent successfully
An error occurred, please try again later
The stories shared below are not written by Buoy employees. Buoy does not endorse any of the information in these stories. Whenever you have questions or concerns about a medical condition, you should always contact your doctor or a healthcare provider.
Cardiac and Stroke Risk Increase with Xylitol? Adding some additional perspectivePosted July 7, 2024 by D.
CARDIAC AND STROKE RISK USING XYLITOL SWEETENER? NOTES RELEVANT TO CLEVLAND CLINIC STUDY
Ideally, understanding safe limits is a primary directive to clarify the ingestion of sugar alcohols, or any nutrient for that matter, before individuals inadvertently stumble into a "red zone" of potential health risks and harm of overconsumption.
A notable axiom in biochemistry is that "Poison is in the Dose."
However, the field of nutrition and product development certainly needs better guidelines and dose/response curves for more enlightened recommendations and clarifications regarding the amounts, types, and frequencies of sugar alcohols in the diet so that one can more fully, confidently, and safely exploit its numerous beneficial functional health merits while minimizing potential risks.
Notably, the Cleveland Clinic pioneering study under Dr. Hazen has begun to uniquely identify a challenge to the industry's unlimited casual use outside of the abundant and well-established conventional safety standards and metrics.
This opens the door to stimulate awareness, pursuing more enlightened and balanced solutions, and advocating research to clarify safe usage levels in the area of cardiovascular health, focused primarily and narrowly on thrombin markers and MACE ( Major Cardiovascular Event) risk, that heretofore was not really noted.
Both xylitol, a five-carbon, and erythritol, a four-carbon sugar, are created endogenously by our metabolism. They are no strangers to our biochemistry, evolution, purpose, and physiology.
Also, sugar alcohols and other polyols are ubiquitous in health-i.e., fruits and vegetables, though in relatively small percentages compared with other accompanying sugars.
In my philosophy and use of ingredients, I have formulated sugar alcohols in prudent, calculated, and restricted amounts to capture some of the sweetness but, even more importantly, its functional health contributions in functional food products.
Nature repeatedly presents and proves the map and model when and if constructing a formulation—sugar alcohols, remarkable bioactive molecules, are never alone, always proportionally minimal, and always in conjunction with other sugars and nutrients, such as those found in apples and other healthy fruits and vegetables.
Human subjects were tested with a single "in vivo" 30 g dose of xylitol (apparently the assumed average daily xylitol intake from all sources). The dose was quickly consumed in a drink to ascertain its immediate and acute impact on various platelet and thrombin biomarkers.
However, I consider that dose closer to a “mega dose,” virtually tantamount to a pharmacological amount consumed simultaneously rapidly.
The narrow, data-filled, and conjecture-rich study determined effects on platelet aggregation and thrombin markers.
It extrapolated data from various in vitro findings and retrospective population studies in recognizing, as an opinion, potentially higher fatal cardiac and stroke risks in consuming excess xylitol molecules.
This amount and this rapid consumption rate could inadvertently and prematurely alarm and jolt an outcome, especially with those not adapted to the use of xylitol, which was not described in stratifying or qualifying these subjects.
We were left with a partial parting general message and advice: better to stick with sugar if you have to sweeten, echoed throughout the media, that could, for the time being, obscure more nuanced conversations and incentives about its potential benefits if these polyol molecules were used intelligently and in balance as found healthfully in Nature.
Suppose this topic and observations were left here briefly with no further discussion. Feedback and insights would be an unfortunate missed opportunity. However, the study urges more research on these considerations—this is positive and sensible.
The reality is that sugar and its overconsumption are far more scientifically established and have primarily proven life-shortening, health-damaging, and untoward outcomes than our present and limited understanding of polyols in human health.
So, with these facts on the table, what are some significant additional merits of xylitol and erythritol if used modestly, carefully, intelligently, and not excessively, which are absent with sucrose ( sugar)?
--GLP-1 agonist in the face of hyperglycemia
--Bacterial biofilm disruption--significant for immune and dental health
--Erythritol enhances vascular endothelial elasticity and lowers BP in several studies
--Xylitol promotes bone remineralization; xylitol is considered an ally in fighting osteoporosis in many bone reserach studies
--Xylitol and erythritol act as alpha-glucosidase-Inhibitors--thus helping to slow down and blunt the absorption of sugar and to manage blood sugar better
--Anti-inflammation properties--erythritol helps reduce gut inflammation in high-fat diets
--Erythritol antioxidant properties again OH radical, xylitol appears to raise intracellular glutathione
--Some early and limited studies demonstrated that erythritol lowered HbA1C.
These facts beg the question: Can sugar be improved for a "safer" composition and made more healthful by mixing sucrose with some proportion of sugar alcohols, other synergistic compounds, and rare sugars, as found closer to Nature?
Does this have to be an "all or nothing" scenario for its dietary use? Based on the broader swath of facts and its prolific scientific and health research, would abandoning the use of sugar alcohols make sense?
As with many others, I'm looking forward to objective, reasoned, and competent research that can yield many additional insights and practical guidelines yearning to be identified.
My opinion letter is not to find the Cleveland study wrong or to criticize specific issues and study limitations too harshly but to establish, on the other hand, that my premise of following Nature as a blueprint in use, consumption, and formulation has value and is worth further study, for I feel it is accurate and correctly balanced in principle.
Jeff brings to Buoy over 20 years of clinical experience as a physician assistant in urgent care and internal medicine. He also has extensive experience in healthcare administration, most recently as developer and director of an urgent care center. While completing his doctorate in Health Sciences at A.T. Still University, Jeff studied population health, healthcare systems, and evidence-based medi...
Witkowski, M., Nemet, I., Li, X. S., Wilcox, J., Ferrell, M., Alamri, H., Gupta, N., Wang, Z., Tang, W. H. W., & Hazen, S. L. (2024). Xylitol is prothrombotic and associated with cardiovascular risk. European Heart Journal, 00(00), 1-14. https://doi.org/10.1093/eurheartj/ehae244