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A widely used sugar substitute found in chewing gum, jams, toothpaste, yoghurt, ice cream and other products has been associated with a higher risk of heart attack, stroke and death, according to a large long-term study.
The findings were presented at the European Society of Cardiology (ESC) annual congress in Munich.
Xylitol is a type of sugar alcohol. Although small quantities occur naturally in some foods, much larger amounts are added to manufactured foods, drinks and oral-care products as a low-calorie alternative to sugar.
Researchers examined data from 17,710 people to investigate the relationship between blood xylitol levels and cardiovascular outcomes. Participants with the highest concentrations of xylitol in their blood were compared with those who had the lowest concentrations.
The study found that people in the highest quarter for blood xylitol levels were 57% more likely to die or experience a heart attack or stroke within six years than those in the lowest quarter. Even after 30 years, those with the highest levels were still 18% more likely to have experienced one of these major cardiovascular events.
Researchers also observed what appeared to be a dose-dependent relationship, meaning that higher blood xylitol levels were associated with higher rates of cardiovascular events. The association remained even after factors such as age, sex, body mass index, high blood pressure, diabetes and blood lipid levels were taken into account.
One possible explanation involves blood clotting. Witkowski and his colleagues had previously found evidence suggesting that xylitol may increase the ability of platelets to form clots. Abnormal blood clot formation can block blood flow to the heart or brain, potentially contributing to heart attacks or strokes.
However, the researchers stressed that the latest study was observational. This means it identified an association between high xylitol levels and cardiovascular events but did not prove that xylitol directly caused them.
Prof Dan Atar, an expert member of the European Society of Cardiology’s communication committee who was not involved in the study, said the findings raised important questions about the long-term cardiovascular effects of xylitol and supported the need for further research.
The British Heart Foundation also commented on the findings. Senior dietitian Dell Stanford noted that sweeteners such as xylitol are present in many foods and drinks and may sometimes be consumed in larger quantities than people realise. She also emphasised that the study does not prove causation and should not be taken as a reason to increase sugar consumption.
Overall, the research from Charité – Universitätsmedizin Berlin, presented at the European Society of Cardiology annual congress, adds to growing scientific concern about the long-term health effects of some alternative sweeteners. Further studies will be needed to determine whether xylitol itself contributes to cardiovascular disease or whether high blood levels are linked to other underlying risk factors.
