Xylitol associated with high risk of cardiovascular events

A Cleveland Clinic study found that participants with the highest amount of xylitol in their plasma were more likely to experience cardiovascular events, with the sweetener also causing platelets to clot and increase the risk of thrombosis.Xylitol is a sugar alcohol from the polyol family. It is present naturally in small quantities in certain fruits and vegetables, such as strawberries, spinach, cauliflower and plums. This sweetener, also called birch sugar, is commonly used in sugar-free gum, breath lozenges, toothpaste and processed foods. It is particularly popular with people with diabetes, because it has a very low glycemic index and is easily used in baking where it replaces regular sugar.However, this sugar substitute may have negative health effects, according to the results of a study recently published in the European Heart Journal. The team led by Dr. Stanley Hazen, director of the department of cardiology and metabolic sciences at the Lerner Research Institute, showed that xylitol is associated with an increased risk of major cardiovascular events (MACE) such as heart attacks. and cerebrovascular accidents (CVA). “Our study once again shows the immediate need to study sugar substitutes and sweeteners, especially as they continue to be recommended to combat diseases like obesity or diabetes,” said Dr. Hazen in a press release. “This doesn’t mean throwing away your toothpaste if it contains xylitol, but we need to be aware that consuming a product containing high levels (of xylitol) could increase the risk of blood clot-related events.”To reach these conclusions, the Cleveland Clinic research team performed metabolomic analyses on fasting plasma samples taken from 1,157 people who underwent cardiac evaluations. Additional analyses, coupling liquid chromatography and mass spectrometry, were then carried out on an independent and non-overlapping validation cohort composed of 2,149 individuals. One-third of participants with the highest amount of xylitol in their plasma were more likely to experience a cardiovascular event (myocardial infarction or stroke) within three years, with an adjusted hazard ratio of 1.57 (confidence interval at 95% 1.12-2.21; P < 0.01). The researchers conducted additional tests on human platelets, plasma and blood to examine the effect of xylitol on platelet reactivity and blood clot formation. They found that the sweetener caused platelets to clot and increased the risk of thrombosis. To confirm these results, they also monitored the platelet activity of people who ingested a drink sweetened with xylitol compared to a glucose drink. The scientists found that every measure of clotting capacity increased significantly immediately after ingesting xylitol, but not glucose. Finally, they conducted mechanistic studies on animal models, which showed that xylitol increased platelet reactivity and thrombosis formation in vivo.Scientists specify, however, that it is “high amounts of xylitol” that increases the risk of MACE. They also point out that the results of their observational cohort do not make it possible to establish a causal link between xylitol and cardiovascular events, nor did they have any information on the diet of the participants. Last year, Dr. Hazen's team had already established a similar link between another sweetener, erythritol and cardiovascular risk. “Xylitol is not as common as erythritol in ketogenic or sugar-free food products in the United States, but it is common in other countries,” their recent study reads.This article was translated from its original French and was first published on our sister site Profession Santé.

Xylitol associated with high risk of cardiovascular events

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