A sweetener found in sugar-free gum, low-calorie snacks, and toothpaste may carry a hidden cost for your heart.
New research presented at the European Society of Cardiology Congress meeting in Munich, Germany, in late August suggests that people with high blood levels of xylitol face a greater risk of serious cardiovascular problems, including heart attack and stroke.1
The findings are worth attention, but also context. Here’s what you need to know...To Read The Full Content; Tap Here Now .
Xylitol is a sugar alcohol used widely as a low-calorie substitute for sugar. Your body actually makes small amounts of it naturally as a byproduct of glucose metabolism, and it shows up in tiny quantities in some fruits and vegetables.
But the xylitol in the food supply is a different story. Manufacturers add it, often in amounts more than 1,000 times higher than what occurs naturally, to sweeten drinks, baked goods, candy, and dental products. Because it doesn’t spike blood sugar the way regular sugar does, it’s a popular choice for people managing diabetes or their weight, or limiting their sugar intake while navigating a sweet tooth.
To determine whether xylitol levels are linked to heart health outcomes, a research team analyzed data from 17,710 participants across two long-running observational studies: the Canadian Longitudinal Study on Aging (CLSA) and the European Prospective Investigation into Cancer (EPIC)-Norfolk.
The researchers compared people with the highest blood levels of xylitol to those with the lowest and tracked major adverse cardiovascular events (MACE), defined as death, heart attack, or stroke.
The results were striking. In the CLSA group, people in the highest xylitol group had a 57% greater risk of a major cardiovascular event over six years compared with those in the lowest group.
The EPIC-Norfolk cohort, which followed participants for even longer, 30 years, revealed an 18% higher risk among those with the highest xylitol levels.
Those figures held even after researchers accounted for known risk factors like age, sex, smoking, cholesterol, diabetes, and high blood pressure.
In a press release, study author Marco Witkowski, a doctor with the Charité University Hospital, Berlin, Germany, noted that previous studies have suggested that xylitol may harm heart health. Specifically, research has shown that the sugar substitute can enhance the ability of platelets to form clots and has linked it to cardiovascular events in high-risk individuals over a three-year period.
But for this research, Witkowski added, “we studied if xylitol increases cardiovascular events in a larger sample of the general population over much longer follow-up.”1
The study has some notable limitations to keep in mind. As an observational study, it can show an association but cannot prove that xylitol causes heart problems. Something else could be driving the connection.
It’s also worth noting that this research has not yet been peer-reviewed, so experts cautioned against making too much of the findings until more studies confirm the results.
There’s another wrinkle to keep in mind, too. Elevated blood xylitol doesn’t necessarily reflect how much xylitol someone consumes.2 Because the body can also produce xylitol during normal metabolism, blood levels may capture more than dietary intake alone. That means the study can’t show whether consuming more xylitol itself drove the increased risk.
Cardiologists who reviewed the findings said this study alone shouldn’t keep you away from xylitol. For some people, xylitol can offset sugar consumption when used in moderation and judiciously, which may benefit cardiometabolic health, said Deepak Talreja, MD, FACC, chief of cardiology at Sentara Health.
“This data does not force us to exclude use of xylitol,” he told HEALTH. “But it does highlight potential risks of cardiovascular disease, especially in patients at high risk.” For that reason, he said the findings are worth discussing with your doctor.
Jamie Lee McIntyre, MS, RDN, a Florida-based registered dietitian, agreed that for most people, the takeaway isn’t to panic about one ingredient. “Instead, it’s to look at the bigger picture,” she said. “Like most things, moderation is key.”