Health
Sugar substitutes linked to increased risk of heart attack and stroke, study finds
Researchers at the Cleveland Clinic found that high intake of xylitol, a sugar alcohol, increases the risk of cardiovascular disease, including heart attack and stroke.
A research team led by Stanley Hazen, M.D., Ph.D., confirmed this association in a large-scale patient analysis, preclinical research models, and clinical intervention studies. European Heart Journal.
Xylitol is a sugar substitute commonly found in sugar-free candy, gum, baked goods, and oral care products such as toothpaste. Over the past decade, the use of sugar substitutes such as sugar alcohols and artificial sweeteners has increased significantly in processed foods, where they are promoted as healthy alternatives.
The same research team found a similar association between erythritol and cardiovascular disease risk last year. Xylitol is less prevalent in ketogenic and sugar-free foods in the United States, but it is common in other countries.
“This study reiterates the need for urgent investigation of sugar alcohols and artificial sweeteners, especially as they continue to be recommended to combat conditions such as obesity and diabetes,” said Dr. Hazen, director of cardiovascular and metabolic sciences at Cleveland Clinic's Lerner Research Institute and co-director of preventive cardiology at the Heart, Vascular and Thoracic Institute. “While there's no need to throw away your toothpaste just because it contains xylitol, it's important to keep in mind that consuming products high in xylitol may increase your risk of blood clot-related events.”
In the new study, researchers analyzed more than 3,000 patients from the United States and Europe and found that high blood xylitol levels were associated with an increased three-year risk of cardiovascular events. One-third of patients with the highest plasma xylitol levels were more likely to experience a cardiovascular event. To confirm their findings, the team conducted preclinical testing and found that xylitol causes platelets to clot, increasing the risk of thrombosis. The researchers also tracked platelet activity in people who consumed drinks with xylitol and glucose and found that all indicators of clotting ability were significantly elevated immediately after xylitol consumption, but not with glucose.
The authors note that further research is needed to evaluate the long-term cardiovascular safety of xylitol. The study has several limitations, including that clinical observational studies show associations rather than causation. They recommend consulting a physician or certified dietitian to learn more about healthy food choices and for personalized advice.
This study is part of Dr. Hazen's continuing investigation into factors that contribute to residual cardiovascular risk. His team follows patients over time to find chemical signatures in their blood that can predict the future development of cardiac and metabolic diseases. He has made pioneering discoveries in the study of atherosclerosis and inflammatory diseases, including the groundbreaking discovery showing a link between gut microbial pathways and cardiovascular and metabolic disease.
Dr. Hazen also serves as director of the Center for Microbiome and Human Health at Cleveland Clinic and is the Jan Bleeksma Professor of Vascular Cell Biology and Atherosclerosis.
This research was supported by the National Institutes of Health and the Office of Dietary Supplements.
Disclosure: Dr. Hazen is listed as a co-inventor on pending and issued patents held by Cleveland Clinic related to cardiovascular diagnosis and treatment.
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