NEW YORK, June 6: A new study has found that xylitol, a low-calorie sweetener commonly used in reduced-sugar foods and consumer products such as gum and toothpaste, may be linked to nearly double the risk of heart attacks, strokes, and death among those who consume the highest levels of the sweetener.

“We gave healthy volunteers a typical drink with xylitol to see how high the levels would get, and they went up 1,000-fold,” explained Dr. Stanley Hazen, the senior study author and director of the Center for Cardiovascular Diagnostics and Prevention at the Cleveland Clinic Lerner Research Institute. “When you eat sugar, your glucose level may go up 10% or 20%, but it doesn’t go up 1,000-fold,” added Hazen, who also directs the Cleveland Clinic’s Center for Microbiome and Human Health.

Dr. Hazen emphasized that humans have not experienced such high levels of xylitol until recent decades, coinciding with the rise of sugar-substituted processed foods. This study follows similar findings by the same researchers in 2023, which showed that another low-calorie sweetener, erythritol, might also increase the risk of cardiovascular events.

Additional laboratory and animal research indicated that both erythritol and xylitol could cause blood platelets to clot more easily, potentially leading to heart attacks or strokes if clots travel to the heart or brain.

Dr. Matthew Tomey, a cardiologist at Mount Sinai Fuster Heart Hospital in New York City, noted that the study showed significant differences in platelet behavior even after a modest intake of xylitol. However, he cautioned that these findings alone do not prove a direct link between platelet abnormalities and clinical events.

The American Heart Association has predicted that 61% of American adults will have cardiovascular disease by 2050. Reducing clotting activity is a crucial treatment for cardiologists, making any increase in platelet clotting activity concerning. Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver, expressed alarm, stating that these findings suggest sugar alcohols might enhance platelet activity.

In response to these findings, Freeman advised, “This is another warning we ought to switch to water, with a close second being unsweetened tea or coffee.”

The Calorie Control Council, an industry association, did not respond to CNN's request for comment before publication. However, in response to the earlier study on erythritol, the association maintained that reduced-calorie sweeteners like erythritol are safe, as supported by global regulatory permissions.

Xylitol, as sweet as sugar but with less than half the calories, is widely used in products like sugarless gum, breath mints, toothpaste, mouthwash, cough syrup, and chewable vitamins. It is also added to various foods such as candy, baked goods, cake mixes, barbecue sauces, ketchup, peanut butter, puddings, and pancake syrup. Despite being found naturally in small amounts in certain fruits and vegetables, the commercial production of xylitol typically involves corncobs, birch trees, or genetically engineered bacteria.

Hazen noted that professional associations often recommend xylitol as a sugar substitute for patients with obesity, diabetes, or prediabetes to improve glycemic control. However, he warned that these individuals are among the most vulnerable to clotting events.

Xylitol has become more prevalent over the last two decades due to its recognition by the US Food and Drug Administration as “generally recognized as safe” (GRAS). Its lower production cost compared to cane sugar has led to its widespread use in sugar-substituted foods, sometimes in significant amounts.

The study, published in the European Heart Journal, aimed to identify unknown chemicals or compounds in the blood that might predict the risk of heart attack, stroke, or death within three years. Hazen and his team analyzed blood samples from over 3,000 people, discovering that high levels of xylitol and erythritol were associated with nearly double the risk of cardiovascular events.

“There’s a receptor on our platelets that recognizes this molecule and signals the platelet to be more prone to clot,” Hazen explained. “Our taste buds can’t tell the difference between sugar and these sweeteners, but our platelets can.”

The World Health Organization (WHO) has advised consumers to avoid artificial sweeteners for weight loss and called for more research on their long-term toxicity. Dr. Tomey of Mount Sinai emphasized that while the study sheds light on the potential dangers of sugar substitutes, it is crucial to maintain a balanced diet and healthy lifestyle.

“Sugar substitutes are no substitute for a sincere commitment to the several elements of a healthy diet and lifestyle,” Tomey said.