Cleveland Clinic-led study links sugar substitute to higher risk of heart attack and stroke
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- Xylitol is a common zero-calorie sweetener found in sugar-free sweets and toothpaste.
June 2024, Cleveland: Cleveland Clinic researchers found that higher amounts of the sugar alcohol xylitol are associated with a higher risk of cardiovascular events such as heart attacks and strokes.
The team, led by Stanley Hazen, M.D., Ph.D., confirmed the association in a large-scale patient analysis, preclinical research models and a clinical intervention study. The findings were published in the European Heart Journal.
Xylitol is a common sugar substitute used in sugar-free sweets, chewing gum, baked goods and oral care products such as toothpaste. Over the last decade, the use of sugar substitutes, including sugar alcohols and artificial sweeteners, has increased significantly in processed foods promoted as healthy alternatives.
The same research team found a similar link between erythritol and cardiovascular risk last year. Xylitol is not as common as erythritol in keto or sugar-free food products in the U.S., but it is common in other countries.
“This study again shows the immediate need to investigate sugar alcohols and artificial sweeteners, especially as they continue to be recommended for conditions such as obesity or diabetes,” said Dr. Hazen, chair of Cardiovascular and Metabolic Sciences at Cleveland Clinic’s Lerner Research Institute and section head of preventive cardiology at the Heart, Vascular & Thoracic Institute. “It doesn’t mean throwing out your toothpaste if it contains xylitol, but we should be aware that consuming a product with high levels could increase the risk of blood clot-related events.”
In this new study, the researchers found that high levels of circulating xylitol were associated with a raised three-year risk of cardiovascular events in an analysis of more than 3,000 patients in the U.S. and Europe. The third of patients with the most xylitol in their plasma were more likely to have a cardiovascular event. To confirm the findings, the research team carried out preclinical tests and found that xylitol caused platelets to clot and increased the risk of thrombosis. The researchers also tracked platelet activity in people who drank a xylitol-sweetened drink compared with a glucose-sweetened drink and found that every measure of clotting ability rose significantly immediately after taking xylitol, but not glucose.
The authors note that further studies assessing the long-term cardiovascular safety of xylitol are warranted. The research had several limitations, including that clinical observation studies show association rather than causation. They recommend talking to your doctor or a registered dietitian to learn more about healthy food choices and get personalised recommendations.
The research is part of Dr. Hazen’s ongoing work on the factors that contribute to residual cardiovascular risk. His team follows patients over time and looks for chemical signatures in the blood that can predict the future development of heart and metabolic diseases. He has made pioneering discoveries in atherosclerosis and inflammatory disease research, including the seminal discovery linking gut microbial pathways with cardiovascular and metabolic diseases.
Dr. Hazen also directs Cleveland Clinic’s Center for Microbiome and Human Health and holds the Jan Bleeksma Chair in Vascular Cell Biology and Atherosclerosis.
The study was funded in part by the National Institutes of Health and the Office of Dietary Supplements.
Disclosures: Dr. Hazen is named as co-inventor on pending and issued patents held by Cleveland Clinic relating to cardiovascular diagnostics and therapeutics.
About Cleveland Clinic
Cleveland Clinic is a nonprofit multispecialty academic medical centre that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based on the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. Cleveland Clinic is consistently recognised in the U.S. and throughout the world for its expertise and care. Among Cleveland Clinic’s 81,000 employees worldwide are more than 5,743 salaried physicians and researchers, and 20,160 registered nurses and advanced practice providers, representing 140 medical specialties and subspecialties. Cleveland Clinic is a 6,690-bed health system that includes a 173-acre main campus near downtown Cleveland, 23 hospitals, 276 outpatient facilities, including locations in northeast Ohio; Florida; Las Vegas, Nevada; Toronto, Canada; Abu Dhabi, UAE; and London, England. In 2023, there were 13.7 million outpatient encounters, 323,000 hospital admissions and observations, and 301,000 surgeries and procedures throughout Cleveland Clinic’s health system. Patients came for treatment from every state and 132 countries. Visit us at clevelandclinic.org. Follow us at twitter.com/ClevelandClinic. News and resources available at newsroom.clevelandclinic.org.