Cleveland Clinic study: Sugar alcohol xylitol tied to increased risk of heart attack, stroke

The research team including Dr. Stanley Hazen, chairman of cardiovascular science at the Cleveland Clinic Lerner Research Institute, identified a correlation between high levels of circulating xylitol and a higher three-year risk of cardiovascular events in an analysis of more than 3,300. patients. The findings were published last week in the European Heart Journal.

“People with xylitol levels in the top 25% of our population—the top quartile—had twice the risk of heart attack, stroke, and death than people with levels in the lowest quartile,” Hazen said. Good luck. “Our data completely agree that xylitol is a prothrombotic compound (which tends to cause blood clots), and improves cardiovascular risk—the very thing that we often recommend to patients to use instead of sugar, especially if they have diabetes. “

In one part of the study, subjects were asked to drink xylitol-sweetened water. The amount of xylitol in each drink was comparable to that found in a serving of keto ice cream or diabetes cookies, Hazen said. The researchers then examined blood platelets, or thrombocytes, the cell fragments that form clots.

“After drinking this standard exposure, blood levels rise more than 1,000 times, to superphysiologic levels,” Hazen said. “They remained elevated in this high range – associated with a high risk of heart disease – for the next four to six hours in all the volunteers tested, and all the measures of platelet function we looked at increased significantly.”

This discovery comes more than a year after Hazen and his colleagues found a similar relationship between the artificial sweetener erythritol and the risk of a cardiovascular event. In the US, xylitol is not as common as erythritol in keto or sugar-free diets, according to a Cleveland Clinic news release. However, there are many in other countries.

What is xylitol?

Xylitol is sometimes called a sugar alcohol, so named because its chemical components are similar to sugar and alcohol. Also called polyols, sugar alcohols are carbohydrates that occur naturally in some fruits and vegetables. They do not contain ethanol, the type of alcohol found in alcoholic beverages.

Sugar alcohols are popular substitutes for sugar because they taste great but have fewer calories per gram than sugar, according to the Food and Drug Administration (FDA). They are often used in combination with artificial sweeteners, and can be sold with sugar and starch.

Sugar alcohols prevent browning, help retain moisture, and add bulk and texture, according to the FDA, making them an ideal ingredient in processed foods such as baked goods. Your body can’t fully absorb sugar alcohols, so consuming them doesn’t make your glucose rise like regular sugar does.

That cooling sensation in your mouth after brushing your teeth? It is an indication of the concentration of alcohol in sugar. Because sugar alcohols do not cause cavities, they are popular in oral care products. Xylitol is especially common in chewing gums.

As demand for low-sugar, low-calorie foods increases, the sugar alcohol market continues to grow. It is expected to exceed $1.8 billion by 2033, according to Persistence Market Research. Xylitol, also called birch or wood sugar, has low production costs that are another advantage for the industry, Hazen said.

“[Xylitol] it is literally made from wood pulp and sawdust. “It’s cheaper to make xylitol than to separate cane sugar from sugar cane,” Hazen said. Good luck. “And it tastes like sugar—even sweetness, it’s grainy—so it has a lot going for it.”

These factors are also what make xylitol so dangerous, he says.

What foods contain xylitol?

According to the FDA, sugar substitutes can be found in many foods and other products, including:

• the winds of the air
• baked goods
• cough syrup
• to wash the mouth
• toothpaste
• other peanuts and tree nuts
• food ingredients
• sugar-free desserts

Is it safe to use as a sugar substitute?

Last year, the World Health Organization advised against the use of non-sugar, especially as a way to control weight. Like sugar-based products that contain calories, sugar alcohols are not included in the agency’s new guidelines. However, the order marked a change in the way consumers view their relationship with sugar and its substitutes.

The nonprofit food watchdog Center for Science in the Public Interest recommends limiting xylitol, citing the fact that large amounts can cause diarrhea. (For humans, that is; xylitol kills dogs.) Hazen prefers you cut it out entirely.

“If [you] I want to make something sweet, for now I think it’s better to use sugar or honey or fruits, and in moderation,” he said. “If you have diabetes, you check your blood sugar.”

Consult your doctor and/or nutritionist before making major changes to your diet.

Given the complexity of heart disease and the limitations of Hazen’s study, it would be a stretch to conclude that xylitol causes Events such as stroke and heart disease, he says. Additional long-term studies are warranted. For example, it is not clear whether teenagers who regularly consume sugar substitutes will have a higher risk of cardiovascular events than their peers who do not use them.

Meanwhile, Hazen is concerned enough about xylitol’s health risks that he’s advocating for a food label change.

“It is a major public health problem,” he said. “We have to really try to lobby and get regulatory changes so that it’s no longer considered safe.”

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