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Eating Foods With Xylitol Can Be a Risk to Your Heart

Xylitol in processed food can increase risk of heart attack and stroke — but there’s no danger in xylitol in oral care products

Bowl of artificial sweetener with a spoonful

If you’re watching your sugar intake, you’re probably already well-acquainted with sugar-free packaged snacks and sweets.

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All the taste, none of the sugar or calories! It’s like a miracle.

But how do they do it?

In many of these products, the answer is sugar alcohols. They’re manufactured sugar substitutes that give foods the sweet, sweet taste of sugar but without spiking your glucose levels — adding taste without any calories.

But what was once hailed as a major win for your sweet tooth is increasingly coming under scrutiny. Because recent research on xylitol, a frequent sugar substitute in processed foods, is showing that the full story on sugar alcohols may not be so sweet.

“Our studies show that elevated blood levels of xylitol contribute to heightened platelet reactivity and are associated with an enhanced risk for cardiovascular events, like heart attacks and strokes,” says physician-scientist Stanley Hazen, MD, PhD. He is the senior author of a study that’s bringing light to the dark side of xylitol.

Dr. Hazen shares what xylitol is, what the risks are to you and what to do about it.

What is xylitol?

Xylitol is a kind of sugar alcohol found most often in candies and desserts labeled as “keto-friendly,” “diabetes-friendly,” “sugar-free” or “calorie-free.” Sugar alcohols are compounds that are similar in chemical structure to sugar. They taste like sugar, but they don’t affect your body in the same way.

Xylitol isn’t one of those little packets of artificial sweeteners that are sitting on the table at restaurants. It’s an additive used in food manufacturing plants. It also can be found in grocery store bakery section sold as a sugar replacement.

“Food manufacturers use sugar alcohols as non-nutritive sweeteners in things like sugar-free candies and baked goods. To our tongues, xylitol tastes like sugar, but it doesn’t affect your blood sugar like glucose (sugar) does,” Dr. Hazen shares.

In addition to being found in food products, xylitol is often found in products for dental care, like toothpaste and mouthwash. That’s because, in addition to its sweet taste, xylitol can also help prevent cavities and lessen their severity.

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Xylitol is a natural compound that we make in our bodies in very low levels — much lower than is used in food production. And high levels of xylitol can cause big problems.

Risks of xylitol in food

Consuming sugar alcohols in large quantities as sugar substitutes has been noted to cause trouble in some people. Things like bloating, gas, upset stomach, diarrhea and weight gain. But Dr. Hazen’s research shows much more dangerous effects.

His team’s studies suggest that people whose bodies make high levels of xylitol can be at an increased risk for cardiovascular disease.

What’s more, consuming foods and beverages sweetened with xylitol can make the platelets in your blood more likely to clot — a recipe for serious heart events.

In studies performed by Dr Hazen’s team, healthy volunteers were given a drink sweetened with 30 grams of xylitol. That’s similar to the amount found in a single scoop of keto-friendly ice cream or several cookies marketed for people with diabetes.

In every volunteer studied, platelets were significantly more prone to clot after consuming xylitol.

“In the presence of xylitol, platelets become much more angry and ready to clot,” Dr. Hazen reports. “It’s as if our platelets have a kind of tastebud receptor for xylitol that makes them go into overdrive. And that’s very significant because enhanced clotting can stop blood flow.”

The result of stopped blood flow?

  • Heart attack.
  • Stroke.
  • Other life-threatening cardiovascular events.

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The team came across the risks of xylitol while searching for new pathways linked to heart disease risk. They examined blood samples from 3,000 people and looked to identify substances in blood that were elevated amongst people who went on to have serious heart events. Xylitol was near the top of the list.

But just because xylitol was in their blood didn’t necessarily mean that xylitol caused heart attacks. Additional research studies confirmed that elevating levels of xylitol enhances platelet responsiveness, and — in non-human model studies — clotting potential.

“We had healthy volunteers drink a xylitol-sweetened drink, and we examined blood from before versus after ingestion of the drink. For the next four to six hours xylitol levels remained elevated enough to enhance platelet responses and clotting risk in every person studied,” Dr. Hazen explains.

Platelet function returned to normal levels by the next day. But for people who consistently eat foods containing xylitol, the risk would stick around.

“It’s not hard to imagine that someone with diabetes could eat products containing xylitol every day, throughout the day,” Dr. Hazen elaborates. “So, that risk would remain if you continued to ingest xylitol. The very people who are most at risk for clotting events like heart attack and stroke — people with diabetes — are the very same people who are most likely to be ingesting xylitol in high levels and further increasing that risk without knowing it.”

The findings are similar to what Dr. Hazen and his team found in studies of erythritol, another common sugar alcohol. Taken together, the studies are causing some medical professionals to rethink the safety of all sugar alcohols. But more tests need to be done to know for sure.

What about xylitol in your toothpaste?

Importantly, Dr. Hazen notes that using toothpaste or mouthwash with xylitol isn’t likely to have the same risks.

“We know that xylitol in your oral care products can help fight cavities,” he acknowledges. “And since you don’t ingest those products in large amounts, they’re still OK to use.”

What foods contain xylitol?

Xylitol is most commonly found in sugar-free candies and other confections.

But unfortunately, knowing if your food contains xylitol isn’t as easy as just reading the nutrition label. That’s because food manufacturers aren’t always required to list sugar alcohols on their packaging. So, they can lurk in the background without you even knowing it.

The U.S. Food and Drug Administration’s (FDA) guidelines regarding sugar alcohols state that they only need to be included in the nutrition label if “a claim [is] made about sugar alcohols or sugar when sugar alcohols are present.”

In other words, if a package is touting its sugar-free status, it needs to include sugar alcohol content on the label.

But xylitol is just one sugar alcohol that food companies use in sugar-free foods. Others include:

  • Erythritol.
  • Sorbitol.
  • Maltitol.
  • Mannitol.
  • Isomalt.
  • Lactitol.

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Even if a food says it contains sugar alcohol, it won’t necessarily state which one.

Should you avoid xylitol?

That’s the million-dollar question, and a tough one to answer. Because you have to weigh the risks of xylitol and other sugar alcohols with the risks of consuming sugar. For people with diabetes or insulin resistance in particular, neither is likely totally safe for you.

And considering that you don’t necessarily know which foods contain xylitol, it’s even harder to know what to avoid.

Dr. Hazen’s advice? “We need to practice moderation in what we’re consuming. I would argue sugar or honey are actually better alternatives, even for people with diabetes. But if you have diabetes, you need to be vigilant about your glucose levels and keep your intake low.”

Even better: Satisfy your sweet tooth with natural sources of sugar, like fruits. They’re less likely to cause blood sugar spikes. And they nourish your body with vitamins and minerals in a way that no packaged snack or dessert can.

And for his part, Dr. Hazen is calling for further studies and regulations that will help both healthcare providers and their patients understand what’s in their foods and what the risks are.

“This is a health concern on a population scale,” Dr. Hazen emphasizes. “I hope this research and future studies will trigger a reappraisal of the regulatory guidelines around artificial sweeteners. We need more research on this topic so we can make sure we’re not inadvertently having people reach for something that they think is a healthy choice if it’s not.”

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