Common sugar substitute linked to increased risk of heart attack and stroke

The security of sugar substitutes is once more being called into query.

Researchers led by the Cleveland Clinic linked the low-calorie sugar substitute xylitol to an increased risk of heart attack, stroke or cardiovascular-related deaths, in response to a study published today within the European Heart Journal.

Xylitol is a sugar alcohol that’s present in small amounts in fruit and vegetables, and the human body also produces it. As an additive, it looks and tastes like sugar but has 40% fewer calories. It’s used, at much higher concentrations than present in nature, in sugar-free gum, candies, toothpaste and baked goods. It may even be present in products labeled “keto-friendly,” particularly in Europe.

The identical research team found an identical association last yr to the popular sugar substitute erythritol. The use of sugar substitutes has increased significantly over the past decade as concerns about rising obesity rates mount.

“We’re throwing these items into our food pyramid, and the very people who find themselves almost certainly to be consuming it are those who’re almost certainly to be in danger” of heart attack and stroke, corresponding to individuals with diabetes, said lead creator Dr. Stanely Hazen, chair of cardiovascular and metabolic sciences at Cleveland Clinic’s Lerner Research Institute.

Many heart attacks and strokes occur in individuals who wouldn’t have known risk aspects, like diabetes, hypertension or elevated levels of cholesterol. The research team began studying sugar alcohols found naturally within the human body to see if the compounds might predict cardiovascular risk in these people.

Within the study, the investigators measured the extent of naturally occurring xylitol within the blood of greater than 3,000 participants after overnight fasting. They found that individuals whose xylitol levels put them in the highest 25% of the study group had roughly double the danger for heart attack, stroke or death over the following three years in comparison with people in the underside quarter.

The researchers also wanted to know the mechanism at work, in order that they fed xylitol to mice, added it to blood and plasma in a lab and gave a xylitol-containing drink to 10 healthy volunteers. In all these cases, xylitol looked as if it would activate platelets, that are the blood component that controls clotting, said Hazen. Blood clots are the leading explanation for heart attack and stroke.

 “All it takes is xylitol to interact with platelets alone for a really temporary time frame, a matter of minutes, and the platelet becomes supercharged and rather more vulnerable to clot,” Hazen said.

The following query is what causes naturally-occurring xylitol to be elevated in some people and the way do you lower it, said Dr. Sadiya Khan, a cardiologist at Northwestern Medicine Bluhm Cardiovascular Institute and a professor of cardiovascular epidemiology at Northwestern Feinberg School of Medicine who was not involved in the brand new study.

Rather more research must be done, said Hazen. Within the meantime, he’s telling patients to avoid eating xylitol and other sugar alcohols, whose spelling all end in ‘itol.’ As a substitute, he recommends using modest amounts of sugar, honey or fruit to sweeten food, adding that toothpaste and one stick of gum are probably not an issue because so little xylitol is ingested.

The report had key limitations. 

First, the study of naturally occurring xylitol in people’s blood was observational and may show only an association between the sugar alcohol and heart risk. It doesn’t show that xylitol caused the upper incidence of heart attack, stroke or death.

Nevertheless, given the totality of the evidence presented within the paper, “it’s probably reasonable to limit intake of artificial sweeteners,” said Khan. “Perhaps the reply is not replacing sugar with artificial sweeteners but desirous about more prime quality dietary components, like vegetables and fruits, as natural sugars.”

Artificial sweeteners should not be difficult to avoid, said Joanne Slavin, PhD, RDN, a professor of food science and nutrition on the University of Minnesota-Twin Cities. They’re listed on the ingredient list of packaged goods.

“Would I say never eat xylitol?” asked Slavin, who had no connection to the study. For some individuals who struggle to scale back sugar of their weight loss program, sugar substitutes are one tool, and it comes all the way down to personal alternative, she said. 

While Slavin found the study interesting and cause for some concern, she noted that sugar alcohols are expensive and are generally utilized in very small amounts in gum and sugar-free candies.

One other limitation of the study is that the participants whose xylitol levels within the blood were measured were at high risk for or had documented heart disease, and so the outcomes may not apply to healthy individuals.

Still, many individuals in most people share the characteristics of the study participants, said Hazen. 

“In middle-aged or older America, it’s normal to have obesity and diabetes or high cholesterol or hypertension,” he said.