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Study links sugar substitute to increased risk of stroke

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Higher amounts of sugar substitute xylitol are associated with increased risk of cardiovascular events like heart attack and stroke, a new study from the US has found. 

The Cleveland Clinic team, led by Stanley Hazen, M.D., Ph.D., confirmed the association in a large-scale patient analysis, preclinical research models and a clinical intervention study.

Xylitol is a common sugar substitute used in sugar-free sweets, gums, baked goods and oral products like toothpaste.

Over the past decade, the use of sugar substitutes, including sugar alcohols and artificial sweeteners, has increased significantly in processed foods promoted as healthy alternatives.

The same research team found a similar link between erythritol and cardiovascular risk in 2023.

Dr Hazen is 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.

The researcher said: “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.

“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.”

In this new study, researchers identified that high levels of circulating xylitol were associated with an elevated three-year risk of cardiovascular events in an analysis of more than 3,000 patients in the US and Europe.

A third of patients with the highest amount of xylitol in their plasma were more likely to experience a cardiovascular event such as a stroke.

To confirm these findings, the research team conducted pre-clinical testing and found that xylitol caused platelets to clot and heightened the risk of thrombosis.

They also tracked platelet activity from people who ingested a xylitol-sweetened drink versus a glucose-sweetened drink and found that every measure of clotting ability significantly increased immediately following ingestion of xylitol but not glucose.

The researchers note that further studies assessing the long-term cardiovascular safety of xylitol are warranted.

The research also had several limitations, including that clinical observation studies demonstrate association and not causation.

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