A low-calorie sugar substitute commonly found in toothpaste and chewing gum may be linked to an increased risk of cardiovascular events such as heart attacks and strokes.
More future research should examine the cardiovascular safety of xylitol, a natural sugar alcohol found in plants but considered an artificial sweetener because it does not contain sugar, a large study suggests.
“Xylitol is associated with the risk of MACE (major adverse cardiovascular events),” write the authors, led by Stanley Hazen, PhD, of the Cleveland Clinic Lerner Research Institute and the Ohio State University Heart, Vascular, and Thoracic Institute.
Xylitol is a common ingredient in sugar-free candies, chewing gum, and oral care products such as toothpaste. Over the past decade, xylitol and other sugar substitutes have become increasingly popular and are promoted as healthy alternatives for people with obesity and diabetes.
To examine factors that contribute to residual cardiovascular risk, an analysis of more than 3,000 patients in the United States and Europe was conducted. Untargeted metabolomics studies were performed on patients undergoing cardiac evaluation, and liquid chromatography-mass spectrometry analyses were performed on an independent, non-overlapping cohort. According to the study, human and animal blood studies were conducted to examine the effect of the sugar substitute on platelet response and thrombus formation in vivo.
High levels of circulating xylitol were associated with an increased three-year risk of cardiovascular events. In addition, the third of patients with the highest plasma xylitol levels had an increased risk of cardiovascular events, according to the press release.
In addition, xylitol causes platelet clotting and increases the risk of thrombosis. In addition, platelet activity in patients who drank a xylitol-sweetened beverage was found to have a blood-clotting ability that was markedly increased compared to those who drank a glucose-sweetened beverage, according to the authors.
The study had a number of limitations, including that clinical observations show correlation, not causation. The study, supported by the U.S. National Institutes of Health and the Office of Dietary Supplements, highlights the need for further study of sugar alcohols and artificial sweeteners.
“This doesn't mean we should throw away our toothpaste if it contains xylitol, but we should be aware that consuming a product high in xylitol may increase the risk of blood clots,” Hazen concluded.