A study published in the European Heart Journal has raised critical concerns about xylitol, a sugar alcohol commonly used as a sweetener in processed foods,. Xylitol has been lauded for its low glycemic index and potential benefits in dental health, but emerging research suggests it may carry significant cardiovascular risks, especially in populations already vulnerable to cardiometabolic diseases.
"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," Stanley Hazen, MD, chair of the Department of Cardiovascular and Metabolic Sciences at Cleveland Clinic's Lerner Research Institute, said in a news release.
Xylitol is naturally produced in the body as part of the glucuronic acid pathway, which functions as an alternative route of glucose metabolism. This pathway provides biosynthetic precursors and aids in detoxification. Endogenously, humans produce approximately 15 grams of xylitol daily. Plasma levels of xylitol in fasting states are thought to reflect a balance between its production and excretion.
However, dietary intake of xylitol—primarily from processed foods—has surged in recent decades due to advancements in industrial production methods. These methods, which use microbial and enzymatic fermentation of substrates like xylose, have dramatically lowered costs, enabling the widespread inclusion of xylitol in sugar-free and diabetic-friendly products such as baked goods, ice cream, and chewing gum. As a result, plasma xylitol levels can spike dramatically in the postprandial period, compounding potential health risks.
Observational studies have revealed an alarming association between elevated plasma xylitol levels and an increased risk of major adverse cardiovascular events (MACE). Researchers hypothesize that even fasting xylitol levels, representing endogenous production, may contribute to thrombosis potential. Animal models have shown that plasma xylitol concentrations as low as 19 µM—levels commonly observed in humans—significantly enhance platelet activation and coagulation.
The rise of artificial sweeteners like xylitol has been fueled by their perceived health benefits, particularly in managing obesity and diabetes. Xylitol, for instance, is marketed as a natural and safe alternative to sugar, with few guidelines on appropriate daily intake. While the World Health Organization (WHO) recently advised against using artificial sweeteners for weight loss, it has yet to impose specific restrictions on xylitol consumption.
As xylitol continues to gain traction in the food industry, particularly as a component of “health-conscious” products, it is imperative to balance its benefits with a thorough understanding of its risks. Studies like these serve as a crucial reminder that dietary interventions, even those marketed as beneficial, must be scrutinized through the lens of comprehensive scientific evidence.
Sources: European Heart Journal, MedScape