Sugar substitute, Xylitol, linked to higher risk of stroke, Study finds

An artificial sweetener known as sugar alcohol might not be as healthy as it sounds.

In a study published in the European Heart Journal, researchers from the Cleveland Clinic found that higher amounts of xylitol, a type of sugar alcohol, can increase the risk of heart attack, stroke, and other cardiovascular events.

As a type of sugar alcohol, xylitol occurs naturally in small amounts in fibrous fruits and vegetables, corn cobs, trees, and even the human body. It is commonly used as a sugar substitute because it tastes similar to sugar but has fewer calories. Found in a variety of products such as sugar-free candy, gum, and toothpaste, xylitol is also frequently used as a sweetener and in baking.

Research has discovered that over the past decade that sugar substitutes such as sugar alcohols and artificial sweeteners have significantly increased in processed foods promoted as healthy alternatives.

In the study, researchers analysed more than 3,000 subjects and revealed that high levels of circulating xylitol were associated with an elevated three-year risk of cardiovascular events. A third of the subjects with the highest amount of xylitol in their plasma were more likely to experience a cardiovascular event.

The research team further conducted pre-clinical testing to confirm these findings and discovered that xylitol caused clotting in platelets and heightened the risk of thrombosis. Additionally, the researchers tracked platelet activity in subjects who ingested a xylitol-sweetened drink versus a glucose-sweetened drink.

They found that every measure of clotting ability significantly increased immediately following the ingestion of xylitol, but not glucose.

“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. This heightened activity could raise the risk of clots forming unexpectedly, potentially leading to cardiovascular events like heart attack or stroke. This 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,” said the authors.

Reference: Marco Witkowski, Ina Nemet, Xinmin S Li, Jennifer Wilcox, Marc Ferrell, Hassan Alamri, Nilaksh Gupta, Zeneng Wang, Wai Hong Wilson Tang, Stanley L Hazen, Xylitol is prothrombotic and associated with cardiovascular risk, European Heart Journal, 2024;, ehae244, https://doi.org/10.1093/eurheartj/ehae244