Credit:Werner100359, CC0, via Wikimedia Commons.

Xylitol, a widely used sweetener in sugar-free foods, frequently appears in our daily lives. It can be obtained naturally from fruits and vegetables, or synthetically produced through chemical reactions involving plant materials.

Due to its ability to inhibit bacterial growth in the mouth, reduce the production of acidic substances, and stimulate saliva secretion, xylitol is commonly found in oral care products such as toothpaste, chewing gum, and mouthwash.

With lower calories than sugar and the advantage of not triggering insulin secretion, many manufacturers incorporate xylitol into their products to reduce calorie intake without significantly affecting taste. Therefore, xylitol is also used in various weight-loss products.

Despite the benefits of sweeteners, there have been reports highlighting potential harms, such as the carcinogenicity of aspartame and the risk of hypoglycemia associated with some sweeteners. Recent studies have discovered potential links between certain sweeteners and cardiovascular diseases. Last year, Stanley Hazen from the Cleveland Clinic in Ohio and his colleagues found an association between erythritol, another sweetener, and an increased risk of cardiovascular issues. Xylitol has now become Hazen's next research target. A study involving 3,306 adults from the United States and Europe is currently underway under his leadership.

Researchers analyzed single fasting blood samples from participants to examine their xylitol levels. During a three-year follow-up, it was found that the one-third of participants with the highest circulating xylitol levels were more likely to develop cardiovascular diseases. Concurrently, researchers conducted laboratory experiments on the effects of xylitol on platelets. Results showed that human platelets cultured with xylitol clotted more readily compared to those cultured with saline. In experiments with mice, xylitol injections significantly accelerated venous thrombosis.

In the final part of the study, researchers gave 10 randomly selected individuals sweetened water with an equivalent amount of xylitol and tracked their platelet activity. Within 30 minutes, the xylitol levels in their plasma increased 1000-fold, and various indicators of platelet coagulation moved closer to those observed during clotting. The participant with the highest xylitol levels showed even more pronounced changes in these indicators.

"This study underscores the urgent need to research sugar alcohols and artificial sweeteners," Hazen said. "This doesn’t mean people should throw away their xylitol-containing toothpaste, but we should be aware that consuming products high in xylitol might increase the risk of thrombotic events."

Silvia Radenkovic from the University Medical Center Utrecht in the Netherlands commented that, combined with previous findings on erythritol, these discoveries "emphasize the necessity for systematic studies on the cardiovascular risks associated with artificial sweeteners."

Reference:

Witkowski M, Nemet I, Li XS, Wilcox J, Ferrell M, Alamri H, Gupta N, Wang Z, Tang WHW, Hazen SL. Xylitol is prothrombotic and associated with cardiovascular risk. Eur Heart J. 2024 Jun 6:ehae244. doi: 10.1093/eurheartj/ehae244. Epub ahead of print. PMID: 38842092.