Dr Marco Witkowski and researchers reported that people with the highest blood levels of xylitol were more likely to die or suffer a heart attack or stroke, a finding tied to xylitol chewing gum and other products. The study was presented in Munich at the European Society of Cardiology annual congress.
The researchers looked at 17,710 people and compared the 25% with the highest xylitol blood levels against the 25% with the lowest. Within six years, the higher group was 57% more likely to face one of those cardiac events, and after 30 years the same group was still 18% more likely to have suffered one.
Dr Marco Witkowski in Munich
Witkowski, at Charité university hospital in Berlin, said earlier research showed that xylitol can enhance the ability of platelets to form clots. He said: "In previous studies, we showed that xylitol can enhance the ability of platelets to form clots".
He also said: "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." The researchers said the long-term health impacts of xylitol had never been widely studied.
ESC annual congress
Prof Dan Atar, an expert member of the ESC communication committee, said: "Artificial sweeteners are widely embraced by modern society, and the safety ratings had been good and granted by regulatory authorities." He added: "In this observational work, however, it appears that xylitol has a negative long-term effect on cardiovascular events in the general population. As with all observational studies, causalities are difficult to infer, but this work shows that further studies are mandated into this societally important topic."
The results from both cohorts suggested a dose-dependent relationship between xylitol blood levels and cardiovascular event rate, with a consistent increase regardless of age and sex. The association was also independent of body mass index, hypertension, diabetes and lipid levels.
British Heart Foundation
Dell Stanford, a senior dietitian at the British Heart Foundation, said artificial sweeteners such as xylitol are fo and that risks to heart health built up over time. He said it was vital to ensure that what was being added to foods did not contribute. Xylitol is used in chewing gum, toothpaste, jam, yoghurts and ice-cream, and researchers said it is added in amounts 1,000 times higher than the trace amounts found in some natural foods.
The study adds a long-term warning to a sweetener already present in everyday products, but it does not show that xylitol itself caused the events. For readers using products with xylitol, the immediate question is not whether to read a new label rule, but to recognize that the strongest risk signal in this study came from people with the highest blood levels, and the mechanism still needs further study.
