Study Finds Sugar Substitute Raises Heart Attack and Stroke Risk

Recent research conducted by Cleveland Clinic has revealed a significant association between high levels of the sugar alcohol xylitol and an increased risk of cardiovascular events such as heart attacks and strokes. This discovery was confirmed through extensive patient analysis, preclinical research models, and a clinical intervention study, with findings published in the European Heart Journal.

Xylitol, commonly found in sugar-free products like candy, gum, baked goods, and oral hygiene products, has seen increased usage over the past decade. This trend is part of a broader shift towards sugar substitutes and artificial sweeteners in processed foods marketed as healthier options.

The research team, led by Dr. Stanley Hazen, M.D., Ph.D., identified that higher circulating levels of xylitol in the bloodstream correlated with a heightened three-year risk of cardiovascular events. The analysis, which involved over 3,000 patients from the U.S. and Europe, showed that individuals with the highest plasma xylitol levels were more prone to experiencing cardiovascular issues. Preclinical testing further confirmed that xylitol induced platelet clotting, thereby increasing the risk of thrombosis. A comparative study observed enhanced clotting activity in individuals who consumed xylitol-sweetened beverages versus those who consumed glucose-sweetened drinks.

Dr. Hazen, 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, emphasized the importance of this finding. He noted that while it is not necessary to completely eliminate xylitol-containing products like toothpaste, consumers should be cautious about high-level consumption due to the potential risks.

The findings mirror previous research by the same team, which had identified a similar link between another sugar alcohol, erythritol, and cardiovascular risk. Although xylitol is not as widespread in keto or sugar-free products in the U.S. as erythritol, it remains a common ingredient in many other countries.

The study highlights the urgent need for further investigation into the cardiovascular safety of sugar alcohols and artificial sweeteners, especially as they are often recommended for managing conditions like obesity and diabetes. The researchers pointed out the limitations of clinical observation studies, which can show associations but not causation. They advised consulting healthcare professionals for personalized dietary recommendations.

This research is part of Dr. Hazen's broader efforts to understand factors contributing to residual cardiovascular risk. His work involves long-term patient tracking to identify blood chemical signatures that can predict heart and metabolic disease development. Dr. Hazen has made groundbreaking discoveries in atherosclerosis and inflammatory disease, including a crucial link between gut microbial pathways and cardiovascular and metabolic diseases.

In addition to leading this research, Dr. Hazen heads Cleveland Clinic’s Center for Microbiome and Human Health and holds the Jan Bleeksma Chair in Vascular Cell Biology and Atherosclerosis. The study received partial funding from the National Institutes of Health and the Office of Dietary Supplements.

While the study underscores a potential risk associated with xylitol consumption, further research is needed to fully understand its long-term cardiovascular implications. In the meantime, individuals should seek professional medical advice to make informed dietary choices.

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