High blood levels of xylitol sweetener were associated with a 57% higher risk of death, heart attack or stroke over six years in a study of 17,710 people. Researchers presented the findings at the European Society of Cardiology annual congress in Munich and said the signal appeared strongest in the quarter with the highest blood levels.
Dr Marco Witkowski, a study author at Charité university hospital in Berlin, said earlier research had shown that xylitol can enhance the ability of platelets to form clots. He said the new findings add to that work and warrant more studies as xylitol in products continues to increase.
Munich ESC annual congress
The researchers compared the 25% of participants with the highest xylitol blood levels with the 25% with the lowest levels. After six years, the highest group was 57% more likely to die or suffer a heart attack or stroke. After 30 years, that same group was still 18% more likely to have had one of those events.
The study also found a dose-dependent relationship between blood xylitol levels and cardiovascular event rates. The association held across age and sex and remained after accounting for body mass index, hypertension, diabetes and lipid levels.
Prof Dan Atar and Dell Stanford
Prof Dan Atar, an expert member of the ESC communication committee, said xylitol appeared to have a negative long-term effect on cardiovascular events in the general population in this observational work. He added that causality is difficult to infer from observational studies, even though the data point toward a long-term cardiovascular effect.
Dell Stanford, a senior dietitian at the British Heart Foundation, said artificial sweeteners such as xylitol are widely used by people who think they are healthier than sugar and are generally regarded as safe by regulatory agencies. The study leaves one practical question for readers: whether the xylitol levels tied to risk reflect ordinary product use or unusually high exposure from multiple sources.
Charité university hospital
Xylitol is a sugar alcohol present in some natural foods in very low amounts, but it is also added at levels about 1,000 times higher to sweeten foods, beverages and oral care products. The current study is the largest of its kind the researchers described, and they said long-term health impacts had not been widely studied before.
Witkowski said previous studies had already linked high blood xylitol levels to adverse heart events in high-risk people over a three-year period. This study extends that concern into a broader population and points to the same clinical question: how much exposure is too much.
