The safety of sugar substitutes is once again being questioned.
Researchers led by the Cleveland Clinic have linked the low-calorie sugar substitute xylitol to an increased risk of heart attack, stroke or cardiovascular-related death, according to a study published today in the European Heart Journal.
Xylitol is a sugar alcohol found in small amounts in fruits and vegetables and also produced by the human body. As an additive, it looks and tastes like sugar but contains 40% fewer calories. It is used in sugarless gum, candy, toothpaste and baked goods in much higher concentrations than found in nature. It can also be found in products labeled “keto-friendly,” especially in Europe.
The same research team discovered last year that Popular sugar substitute erythritol. this Significant increase in use of sugar substitutes Over the past decade, concerns have grown over rising obesity rates.
“We put these things into our food pyramid, and the people who are most likely to eat it are the people who are most likely to be at risk for heart disease and stroke, such as people with diabetes,” Lead said. By Stanely Hazen, Ph.D., Cleveland Clinic Chair, Department of Cardiovascular and Metabolic Sciences, Nano Research Institute.
Many heart attacks and strokes occur For people without known risk factors (such as diabetes, high blood pressure, or elevated cholesterol levels). The research team set out to study naturally occurring sugar alcohols in the human body to see if these compounds could predict cardiovascular risk in these individuals.
For the study, researchers measured naturally occurring xylitol levels in the blood of more than 3,000 participants after fasting overnight. They found that people in the top 25% of the study group for xylitol levels had about twice the risk of a heart attack, stroke or death over the next three years as those in the bottom 25%.
The researchers also wanted to understand the mechanism of action, so they fed xylitol to mice, added it to their blood and plasma in the lab, and gave 10 healthy volunteers a drink containing xylitol. In all of these cases, Hasson said, xylitol appeared to activate platelets, the blood component that controls clotting. blood clot Is a leading cause of heart attacks and strokes.
“All it takes is for xylitol to interact with platelets alone for a very short period of time – a few minutes – and the platelets become overcharged and more likely to clot,” Hazen said.
The next question is what causes the disease in some people, said Dr. Sadiya Khan, a cardiologist at Northwestern Medicine’s Broome Cardiovascular Institute and professor of cardiovascular epidemiology at Northwestern Feinberg School of Medicine. Naturally occurring elevated levels of xylitol, and how to lower it.
Hasson said more research is needed. In the meantime, he tells patients to avoid xylitol and other sugar alcohols, which are spelled with the ending “itol.” Instead, he recommends using moderate amounts of sugar, honey or fruit to sweeten foods, adding that toothpaste and a stick of gum may not be a problem because so little xylitol is consumed.
The report has some key limitations.
First, studies of xylitol, which occurs naturally in people’s blood, are observational and can only show an association between sugar alcohols and heart disease risk. It did not show that xylitol causes higher rates of heart disease, stroke or death.
Still, given all the evidence presented in the paper, “limiting the intake of artificial sweeteners may be reasonable,” Khan said. “Perhaps the answer is not to replace sugar with artificial sweeteners but to consider more high-quality dietary ingredients such as vegetables and fruits as natural sugars.”
Artificial sweeteners shouldn’t be difficult to avoid, said Dr. Joanne Slavin, a professor of food science and nutrition at the University of Minnesota-Twin Cities. They are listed in the ingredient list of packaged goods.
“Would I say never take xylitol?” asked Slavin, who was not associated with the study. Sugar substitutes are a tool for some people who are trying to reduce sugar in their diets, and it comes down to personal choice, she said.
While Slavin found the study interesting and raised some concerns, she noted that sugar alcohols are expensive and typically used in small amounts in gum and sugar-free candies.
Another limitation of the study is that the participants whose blood levels of xylitol were measured were at high risk for or had documented heart disease, so the results may not apply to healthy individuals.
Still, many people in the public share the characteristics of the study participants, Hazen said.
“Obesity, diabetes, high cholesterol or high blood pressure are common among middle-aged or older Americans,” he said.
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