Artificial Sweetener Xylitol Linked to Increased Stroke, Heart Attack Risk

• A new report, published on June 6, suggests xylitol might impair the body’s clotting abilities.
• Artificial sweeteners like xylitol are often marketed as a healthier alternative to natural sugar, but growing evidence suggests they may harm multiple body systems.
• Xylitol is found in items like chewing gum, peanut butter and some baked goods.

Xylitol, the zero-calorie sugar substitute used in processed foods like peanut butter, gum, baked goods, and candies, has been linked to a greater risk of heart attack and stroke , a new study has found.

The report , published in the European Heart Journal on Thursday, suggests the sweetener might impair the body’s clotting abilities.

Xylitol has received a stamp of approval — the Generally Recognized as Safe (GRAS) status — from the Food and Drug Administration, which indicates a substance is thought to be harmless.

Artificial sweeteners like xylitol are often marketed as a healthier alternative to natural sugar, but growing evidence suggests they may harm multiple body systems.

“I hope this serves as a calling for new regulatory guidelines to improve labeling mandates and remove sugar substitutes like xylitol from GRAS status,” senior study author Stanley Hazen , MD, PhD, Chair of Cardiovascular and Metabolic Sciences at Cleveland Clinic’s Lerner Research Institute and Co-Section Head of Preventive Cardiology in the Heart, Vascular & Thoracic Institute, told Healthline.

Sugar substitutes may impair clotting activity

The researchers analyzed blood samples of over 3,000 people who were being assessed for heart disease.

They found that, over a 3-year period, people with the highest levels of xylitol in their blood had double the risk of heart attack, stroke, and death compared to those with the lowest levels.

The investigators also conducted in vivo, interventional, and rodent experiments to understand how xylitol impacts cardiovascular function and found that the sweetener appears to impact platelet function.

Hazel says that while the current evidence identified an association between xylitol and cardiovascular events, there may be a causal relationship at play.

He suspects there may be a receptor on our platelets that responds and interacts with sugar alcohols like xylitol.

Platelets, a type of blood cell, play an important role in clotting, explains Cheng-Han Chen, MD , a board-certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA.

They clump “together to form plugs that seal wounds and prevent excessive bleeding,” he said.

Per the new findings, xylitol might increase the stickiness of platelets in the bloodstream and increase the risk of clotting in the brain and heart, and trigger cardiovascular events like a heart attack or stroke.

The growing body of literature shows artificial sweeteners, including another sugar alcohol sweetener called erythritol , are linked to worse cardiovascular outcomes.

“Xylitol was not previously proven to have this association, but this new study suggests that it may have similar effects on the body,” Rigved Tadwalkar , MD, a board-certified consultative cardiologist at Providence Saint John’s Health Center in Santa Monica, CA, said.

More studies are needed to better understand the impact xylitol consumption, especially at varying doses, has on cardiovascular function.

“It is important to remember that this is an observational study, so it does not definitively prove xylitol directly causes cardiovascular problems ,” Tadwalker said.

Doctors recommend limiting the use of sugar substitutes

Hazen says the findings highlight a potentially significant public health concern.

“The very same people most likely to be targeted for taking sugar substitutes — those with obesity, diabetes, metabolic syndrome — are the most vulnerable,” he said.

By reaching for what appears to be a healthier option, he says, people wind up increasing their cardiovascular risks.

Chen’s advice: Limit how much xylitol you use.

“People should consider avoiding consuming large amounts of xylitol until more is understood about its adverse effects,” Chen said.

Tadwalker hopes the findings motivate clinicians to have comprehensive conversations with their patients about the potential risks of xylitol.

“This knowledge can be used to tailor dietary recommendations for individual patients,” he said.

The bottom line:

Consuming a lot of xylitol, the zero-calorie sugar substitute used in processed foods like peanut butter, gum, baked goods, and candies, may boost your risk of heart attack and stroke, a new study has found. The new study suggests the sweetener may impair platelet activity and increase the risk of clotting, which could trigger a cardiovascular event.