Dr Marco Witkowski presented artificial sweetener cardiovascular effects research in Munich linking high blood xylitol levels to more heart attacks, strokes and deaths. In the largest study of its kind, people in the highest xylitol quartile had a 57% higher risk of dying or having a heart attack or stroke within six years.
The findings were presented at the European Society of Cardiology annual congress and compared 17,710 people by blood xylitol level. Xylitol is a sugar alcohol used in chewing gum, toothpaste, jam, yoghurts and ice-cream, and it is added in amounts 1,000 times higher than the tiny amounts found in some natural foods.
ESC annual congress in Munich
Researchers compared the 25% of participants with the highest blood xylitol levels with the 25% with the lowest. After 30 years, the highest group was still 18% more likely to have suffered one of the cardiac events. The results from both cohorts suggested a dose-dependent relationship between blood xylitol levels and cardiovascular event rates.
Dr Marco Witkowski said the work showed how little is known about the cardiovascular safety of xylitol and that further studies are warranted as use continues to increase. He also said xylitol can enhance the ability of platelets to form clots, which fits the earlier three-year period findings in high-risk people.
Prof Dan Atar and causality
Prof Dan Atar said the work shows that further studies are mandated, but he also said causalities are difficult to infer from observational studies. He said the study showed a negative long-term effect on cardiovascular events in the general population, while also pointing to the limits of drawing cause and effect from this design.
The association remained independent of baseline characteristics such as age and sex, and it was independent of body mass index, hypertension, diabetes and lipid levels. That leaves the practical concern for readers using xylitol in foods and oral care products: the study links higher blood levels with higher event rates, but it does not prove the sweetener itself caused those outcomes.
British Heart Foundation view
Dell Stanford, senior dietitian at the British Heart Foundation, said risks to heart health built up over time and that it was vital to ensure that what was being added to foods did not contribute. Her comment fits the scale of the exposure question now facing people who use products containing xylitol every day.
For readers, the immediate takeaway is to treat the finding as a signal, not a final verdict. The strongest evidence here is the 17,710-person comparison showing a 57% higher risk in the top blood xylitol quartile, with the open question being whether those levels come from ordinary product use or unusually high exposure.
