There are many reasons why people choose products with artificial sweeteners. Some are diabetic and need to closely monitor their sugar intake to maintain stable blood sugar levels; others appreciate non-caloric options for weight management; and others just enjoy a sweeter taste experience that would be hard to achieve with regular table sugar.
As evidence of the potential adverse health effects of artificial and low-calorie sweeteners accumulates, researchers at Charit University Hospital in Berlin, Germany, took a closer look at the popular sweetener xylitol. Based on health data from over 17,000 people, they saw a link between high blood levels of the sweetener and increased risks of several major cardiovascular events, such as death, heart attack, and stroke.
The team presented their results at the annual congress of the European Society of Cardiology (ESC) in Munich and noted that future studies should further investigate the safety of xylitol and other artificial sweeteners, especially as the use of sugar alternatives is expected to rise.
“In this observational work […] it appears that xylitol has a negative long-term effect on cardiovascular events in the general population,” said Dan Atar, member of the ESC Communication Committee, in a statement. “As with all observational studies, causalities are difficult to infer, but this work shows that further studies are mandated into this societally important topic.”
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Why Studying Xylitol?
To provide low-calorie options that still deliver sweetness, artificial sweeteners are a common sugar alternative and can, for example, come in handy for people with diabetes. Besides other common sweeteners like aspartame and sucralose, xylitol is frequently added to food and beverages, as well as oral hygiene products such as toothpaste and mouthwash.
Technically, xylitol does occur naturally, in contrast to entirely human-made sweeteners such as aspartame and sucralose. But this particular sugar alcohol usually appears in commercial products at levels 1,000 times higher than it would naturally be found in our bodies or in fruits.
Although xylitol is a popular sugar substitute, its long-term impact on cardiovascular risk is not fully understood. Previous research hinted that xylitol could enable blood platelets to form clots and also showed a connection between high xylitol blood levels and cardiovascular events in people already at risk. Now, researchers from Charité University Hospital set out to collect data from a larger, more general population sample over a longer period to better understand whether xylitol could pose a cardiovascular risk.
Highest Xylitol Blood Levels Corresponded With Highest Cardiovascular Risks
The Canadian Longitudinal Study on Aging (CLSA) and the European Prospective Investigation into Cancer (EPIC)-Norfolk are the two cohort studies that provide data on more than 17,000 participants used in the analysis.
The research team found that people with the highest blood levels of xylitol also showed a significantly higher risk of death, heart attack, or stroke compared with people with the lowest levels. In the CLSA, after six years of follow-up, the experts calculated a 57 percent higher risk of having a major cardiovascular event for people with the highest blood levels of the sweetener compared with those with the lowest levels. The Norfolk cohort showed an 18 percent risk of major cardiovascular events after a 30-year period.
Based on these results, the research team suggests that under xylitol exposure, adverse cardiovascular risks increased in a dose-dependent manner — meaning the lowest doses were linked to the lowest cardiovascular risks, middle doses were associated with intermediate risks, and the highest doses were associated with the highest risks.
We Know Little About the Cardiovascular Safety of Xylitol
The research team further explains the consistency of their results by noting that the dose-dependent relationship persisted regardless of other factors, such as age, sex, body mass index, hypertension, and diabetes. This suggests that xylitol has an independent effect on the increased risk, rather than on other factors.
“Artificial sweeteners are consumed by people who think they are healthier than sugar and they are generally regarded as safe by regulatory agencies,” said presenter Marco Witkowski from the Charité University Hospital, in the statement. “Our long-term findings in the general population highlight how little we know about the cardiovascular safety of xylitol and indicate that further studies are warranted, especially as the amount of xylitol in products continues to increase.”
This article is not offering medical advice and should be used for informational purposes only.
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- This article references information from the European Society of Cardiology: Xylitol may increase the risk of cardiovascular events
