Higher Blood Levels of the Sweetener Xylitol Linked to 1.57 Times the Risk of Cardiovascular Events, Analysis of 3,306 Finds

A study published in the European Heart Journal reports that xylitol, a sugar alcohol used as a sugar substitute, increases platelet reactivity and is associated with major cardiovascular events. The results come from the team of Stanley Hazen at the Cleveland Clinic in the United States and are part of a line of research that checks the common belief that low-calorie sweeteners are good for health.

The researchers analysed fasting plasma from 1,157 stable patients who underwent cardiac evaluation (discovery cohort) and 2,149 separate patients (validation cohort). In 3 years of follow-up, people in the top tertile of blood xylitol in the validation cohort had a 1.57 times higher risk (95% confidence interval 1.12 to 2.21) of major adverse cardiovascular events (MACE), covering heart attack, stroke and death, than those in the bottom tertile. In human platelets and animal experiments, xylitol promoted clot formation. When 10 healthy adults drank water with 30 g of xylitol dissolved in it, their blood levels jumped about 1,000-fold and all platelet reactivity measures rose.

A Single Blood Level, Not Intake

The cohort analysis is an observational study with a single measurement of fasting blood levels, has no dietary intake information, and cannot prove causation. Many of the participants were patients with cardiovascular risk factors, so applying the findings to the general population is also difficult. The intervention experiment involved 10 people with no control group, and blood xylitol returned to low levels within 4 to 6 hours. The effect of long-term intake is not yet known, and the researchers also concluded that further safety studies are needed.