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CLEVELAND — You may have heard of xylitol, a popular sugar substitute found in everything from sugar-free gum to baked goods and even toothpaste. This low-calorie sweetener, part of a class of compounds called sugar alcohols, has been touted as a healthier alternative to sugar. However, new research from the Cleveland Clinic suggests that consuming high levels of xylitol may lead to the formation of blood clots, increasing your risk of serious cardiovascular events like heart attack and stroke.

What is Xylitol?

Xylitol is a naturally occurring sugar alcohol found in small amounts in many fruits and vegetables. It has a chemical structure similar to sugar but with fewer calories. Over the past decade, the use of xylitol and other sugar substitutes has skyrocketed as consumers seek out healthier options.

Food manufacturers often promote products containing xylitol as a better choice for those looking to manage their weight or control blood sugar levels.

Not so sweet after all?

Led by Dr. Stanley Hazen, the Cleveland Clinic research team analyzed data from over 3,000 patients in the U.S. and Europe. They discovered that individuals with the highest levels of xylitol in their blood had a 33% greater risk of experiencing a cardiovascular event within three years compared to those with the lowest levels.

To confirm these findings, the researchers conducted laboratory tests which showed that xylitol caused platelets, the blood cells responsible for clotting, to become more reactive. This heightened platelet activity can lead to the formation of blood clots, increasing the risk of heart attack and stroke. In a clinical trial, participants who consumed a xylitol-sweetened drink experienced an immediate increase in platelet reactivity compared to those who drank a glucose-sweetened beverage.

“This study again shows the immediate need for investigating sugar alcohols and artificial sweeteners, especially as they continue to be recommended in combatting conditions like obesity or diabetes,” said Dr. Hazen. “It does not mean throw out your toothpaste if it has xylitol in it, but we should be aware that consumption of a product containing high levels could increase the risk of blood clot related events.”

Digging Deeper: Study methodology and results

To uncover the link between xylitol and cardiovascular risk, the Cleveland Clinic researchers employed a multi-faceted approach. First, they performed untargeted metabolomics studies on fasting plasma samples from 1,157 stable subjects undergoing cardiac evaluations. This initial discovery cohort revealed an association between circulating levels of xylitol and the risk of experiencing a major adverse cardiovascular event (MACE) within three years.

Next, the team validated their findings using liquid chromatography-tandem mass spectrometry (LC-MS/MS) analyses on an independent group of 2,149 subjects. This technique allowed them to specifically measure xylitol levels, confirming that higher concentrations were indeed associated with an increased risk of MACE.

To explore the mechanisms behind this association, the researchers conducted experiments on isolated human platelets, platelet-rich plasma, whole blood, and animal models. These studies demonstrated that xylitol enhanced multiple measures of platelet reactivity and promoted thrombosis (blood clot) formation in vivo at levels observed in fasting plasma.

Finally, in an interventional study involving 10 healthy volunteers, consuming a xylitol-sweetened drink significantly increased plasma xylitol levels and enhanced several functional measures of platelet responsiveness in all participants.

What This Means for You

While this study provides important insights into the potential heart risks associated with xylitol consumption, it’s essential to note that the research demonstrates an association rather than a direct cause-and-effect relationship. More studies are needed to assess the long-term safety of xylitol.

If you regularly consume products containing xylitol or other sugar substitutes, it’s a good idea to discuss your dietary habits with your doctor or a registered dietitian. They can provide personalized recommendations and help you make informed choices about your food intake to support your overall health and well-being.

As the popularity of sugar substitutes continues to rise, it’s crucial to remain mindful of their potential health impacts. While xylitol may seem like a tempting alternative to sugar, consuming high levels could increase your risk of serious cardiovascular events. By staying informed and making smart dietary choices in consultation with healthcare professionals, you can take proactive steps to protect your heart health.

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