Common sweetener linked to strokes and heart attacks

High blood levels of xylitol were associated with a greater risk of stroke, heart attack and death in the largest study of its kind.

Xylitol is a sugar alcohol found naturally in some foods in very low amounts. It is also added, often in amounts 1,000 times higher, to sweeten foods, drinks and oral care products.

Despite its growing use, the long-term health impacts of xylitol have never been widely studied.

Researchers analysed 17,710 people, comparing the 25 per cent with the highest blood levels of xylitol with the 25 per cent who had the lowest levels.

The findings, presented at the European Society of Cardiology annual congress in Munich, the world’s largest heart conference, showed those with the highest levels were 57 per cent more likely to die or suffer a heart attack or stroke within six years.

After 30 years, those with the highest levels were still 18 per cent more likely to have experienced one of these cardiovascular events.

Including data from the middle groups suggested a dose-dependent relationship, meaning higher xylitol blood levels were associated with higher rates of cardiovascular events.

Researchers also found a consistent increase in cardiovascular events associated with xylitol regardless of baseline characteristics including age and sex.

The association was independent of factors including body mass index, hypertension, diabetes and lipid levels, which might predispose people to consume low-calorie products.

Study author Dr Marco Witkowski, from Charité university hospital in Berlin, said the results built on earlier research that had raised concerns about xylitol.

“In previous studies, we showed that xylitol can enhance the ability of platelets to form clots,” he said.

Witkowski and his colleagues had also previously found that high blood levels of xylitol were linked to adverse heart events in high-risk people over a three-year period.

“Artificial sweeteners are consumed by people who think they are healthier than sugar and they are generally regarded as safe by regulatory agencies,” he said.

“Our long-term findings in the general population highlight how little we know about the cardiovascular safety of xylitol and indicate that further studies are warranted, especially as the amount of xylitol in products continues to increase.”

Prof Dan Atar, an expert member of the ESC communication committee who was not involved with the research, said: “Artificial sweeteners are widely embraced by modern society, and the safety ratings had been good and granted by regulatory authorities.

“In this observational work, however, it appears that xylitol has a negative long-term effect on cardiovascular events in the general population. As with all observational studies, causalities are difficult to infer, but this work shows that further studies are mandated into this societally important topic.”

Dell Stanford, a senior dietitian at the British Heart Foundation, said risks to heart health built up over time and it was vital to ensure that what was being added to foods did not contribute.

Stanford said: “Artificial sweeteners such as xylitol are found in many foods and drinks, and people may assume they are the healthier choice, so consume more than they realise. This study adds to growing evidence that artificial sweeteners could have an impact on our health.

“It is important to note that this was an observational study, meaning it can only show an association between higher xylitol levels and cardiovascular events, rather than proving that xylitol directly caused them, and further research is needed. But it is not a green light to have more sugar instead, as we still need to reduce our free sugar intake.

“This study is a reminder that we all need to reduce our intake of processed foods and drinks that are often high in sugar, salt or sweeteners, and focus on a balanced diet to help protect our hearts.”