Trendy sweetener xylitol increases risk of stroke

Eating healthy means, among other things, reducing your sugar intake, which, according to WHO, should not exceed 25 grams per day, which is equivalent to about 6 tablespoons of coffee for an adult with a normal body mass index. But of course, no one is bitter about sweets, and we all want cookies with our coffee, candy at noon, an ounce of chocolate at night…

Therefore, in order to follow the recommendations, but not to give up sweetening our lives, supposedly healthier sugar replacement products have come into fashion. One of these is xylitol, a polyalcohol that can sweeten any food, cold or hot, without adding calories. So far there have been no known side effects other than a laxative effect if we took it in large quantities or were intolerant. However, researchers from the Cleveland Clinic in the US found that large amounts of xylitol are associated with an increased risk of heart attacks and strokes.

Consumption of this ingredient, which is also found in products such as toothpaste, has grown exponentially over the past decade. Spaniards will consume an average of 100 grams of sweeteners in 2022, up 20 grams from 2019, just before the pandemic, according to the Ministry of Agriculture, Fisheries and Food.

And that’s not just because we use it as a sugar substitute at home (we also use other versions of similar polyalcohols), but because the industry has done it too. It was considered an ideal ingredient for creating healthier or supposedly healthier versions of processed foods that were demonized. Therefore, scientists focused on this additive to analyze its seams. And they saw a stitch that they didn’t like.

Sample of 3000 patients

A team led by Stanley Hazen confirmed the link this week through a full study of 3,000 patients in the US and Europe and published in the European Journal of Cardiology. “This study once again shows the urgent need to study sugar alcohols and artificial sweeteners, especially since they continue to be recommended to combat diseases such as obesity or diabetes,” says the doctor, who is also president of the Division of Cardiovascular and Metabolic Sciences at the Institute. Lerner at the Cleveland Clinic and director of preventive cardiology at the Heart, Vascular and Thoracic Institute.

The use of xylitol became widespread during World War II in Finland due to a sugar shortage. This is how its industrial production began, although the product was discovered at the end of the 19th century by the German chemist Hermann Emil Fischer. It has 40% fewer calories than sugar and does not require insulin to be metabolized, making it ideal for diabetics.

Despite this link to a higher risk of strokes, researchers also urge reassurance. “This doesn’t mean throwing away toothpaste if it contains xylitol, but we should be aware that consuming a product high in xylitol may increase the risk of blood clots,” warns Hazen. The same team found a similar connection with erythritol last year.

Need for more research

To reach this conclusion, the research team conducted preclinical trials and found that xylitol causes platelet clotting and increases the risk of thrombosis. The researchers also tracked platelet activity in people who drank a xylitol-sweetened drink versus a glucose-sweetened drink and found that each measure of clotting ability increased significantly immediately after taking xylitol, but not glucose.

The authors note that this justifies the need for additional studies to evaluate the long-term cardiovascular safety of xylitol. And the study had several limitations, including the fact that observational studies demonstrate association rather than causation. That’s why they also recommend talking to your doctor or registered dietitian to learn more about healthy eating options and personalized recommendations.