In recent years, the use of low-calorie sweeteners like xylitol has dramatically increased, driven by consumer demand for “healthier” alternatives to sugar. Xylitol, a sugar alcohol, is commonly found in a variety of processed foods and dental products due to its sweetening properties and dental benefits. However, emerging evidence published in the European Heart Journal suggests that xylitol may have significant implications for cardiovascular health, warranting a closer examination of its effects.
The consumption of xylitol and other low-calorie sweeteners has surged, as confirmed by numerous studies, including data from the National Health and Nutrition Examination Survey (NHANES). However, actual consumption levels may be underestimated due to inadequate labeling practices. The FDA and EU do not require specific listing of these sweeteners on food labels, nor do they mandate disclosure of the quantities used. This lack of transparency complicates efforts to monitor and assess the health impacts of xylitol consumption.
The metabolism and absorption of sugar alcohols like xylitol vary significantly across species, complicating the extrapolation of animal study results to humans. For instance, while xylitol is poorly absorbed in mice, leading to most of it being excreted in feces, it is readily absorbed in humans, resulting in substantial postprandial (post-meal) increases in plasma levels. Such differences necessitate careful monitoring of circulating levels in studies to ensure accurate assessments of health impacts.
One of the most significant findings regarding xylitol's impact on cardiovascular health is its direct effect on platelet function. Xylitol has been shown to enhance stimulus-dependent intracellular calcium release and platelet aggregation in response to various agonists such as ADP, thrombin, and collagen. This increased platelet responsiveness contributes to heightened thrombosis potential, as demonstrated in both in vitro and in vivo studies.
“It’s sold as a so-called natural sweetener, and because xylitol doesn’t spike blood sugar levels, it’s also marketed as low carb and keto friendly, Yet people at risk for diabetes are among the most vulnerable for clotting events,” said Hazen, the principal investigator of this study, in an interview to CNN.
Both dietary and endogenous xylitol can influence thrombosis risk, raising concerns about its safety, particularly for individuals at higher risk of cardiovascular events, such as those with diabetes, obesity, or pre-existing cardiovascular conditions.
The findings from recent studies suggest that xylitol consumption could significantly enhance thrombotic risk, particularly in vulnerable populations. Given the rapid rise in xylitol use and its potential health impacts, further research is essential to fully understand its long-term effects on cardiovascular health.
Sources: European Heart Journal, CNN
