Researchers noted that while xylitol is not as commonly used in keto or sugar-free food products in the United States, it is prevalent in other countries. “We were trying to discover the next cholesterol, another pathway that contributes to heart disease that occurs naturally in our bodies,” said Hazen, also chair of cardiovascular and metabolic sciences at the Lerner Research Institute at the Cleveland Clinic. “And we think that’s what we have, is that erythritol or xylitol, these sugar alcohols, are linked to the onset of heart disease, or at least they are linked to the future development of cardiac events.”
The same research team discovered a similar link between erythritol and cardiovascular risk last year.
Use of sugar substitutes is on the rise
The results arrive as The use of sugar alcohols such as xylitol is trending upward as trends in keto and low-carb diets drive growth in alternative sweeteners touted as “natural.” Some $1.19 billion worth of xylitol products were sold in 2021, and that market is expected to reach about $1.48 billion by 2030, according to research firm Custom Market Insights.
“There has been this unusual situation over the last one or two decades where people are experiencing levels of xylitol that have never been seen in our evolution before,” Hazen said.
The findings challenge the popular understanding of sugar alcohols such as xylitol and erythritol as healthy, natural alternatives to sugar. People consider them natural because our bodies produce them as part of our energy metabolism; however, our cells produce them at much lower levels. When these sugar alcohols are made, they are prepared industrially, using bacteria or yeast that undergo brewing and fermentation processes to create a chemical that tricks our taste buds, Hazen said.
“Even though it is a natural compound, it is used in a very unnatural way, at a massively higher level than would ever appear under normal conditions” in our bodies, Hazen said.
Researchers also found that high levels of xylitol may be worse for the heart than cholesterol. By eating a high-cholesterol diet, we could increase our blood cholesterol levels by 10 to 30 percent, Hazen said.
By eating a product high in xylitol, the researchers found, levels of the chemical in the blood increased 1,000-fold, or 100,000 percent, and remained elevated for four to six hours.
Another way of putting it is that, among the thousands of people Hazen sees in his preventive cardiology clinic, those with cholesterol levels in the highest 25 percent have a 30 percent increased risk of developing cardiovascular disease compared to those with high cholesterol levels. are in the bottom 25 percent. But those with blood xylitol levels in the top 25 percent had a 200 percent higher risk of cardiovascular disease compared to those with xylitol levels in the lowest 25 percent. .
The Calorie Control Council, which represents manufacturers and suppliers of low-calorie foods and beverages, rejected the study’s findings.
“The results of this study are contrary to decades of scientific evidence demonstrating the safety and effectiveness of low-calorie sweeteners such as xylitol by global health and regulatory agencies,” said Carla Saunders, chair of the board, in a press release.
“Xylitol has been recognized for over 60 years as a great-tasting, low-calorie sweetener. It has proven dental benefits, including preventing plaque buildup and tooth decay, and is naturally found in foods such as strawberries, lettuce and oats,” she said.
“This study adds to a growing body of literature on potential physiological problems caused by artificial sweeteners,” Marion Nestle, professor emeritus of nutrition at New York University, wrote in an email. “Researchers are discovering problems one after another, now with xylitol.”
Although she believes the study needs to be repeated, she suggests that xylitol may not be harmless. The benefits of artificial sweeteners in general are uncertain, she writes.
“More and more we are starting to think that they present risks,” she wrote. “I prefer to avoid them, but I don’t like the taste anyway.”
Rob van Dam, professor of exercise and nutrition sciences at George Washington University, said that while the paper’s findings are compelling and add to existing research on the risks of artificial sweeteners, Scientists may not have been able to properly test the link between xylitol consumption and heart risk, given that they used blood from fasting people, meaning the blood likely contained xylitol. produced in the body itself, metabolically.
“So the question is: do these high xylitol levels really reflect that dietary xylitol intake is bad? » asked Van Dam. “Or does it just mean something is wrong with people’s metabolism, leading to higher xylitol levels?”
The researchers recognized this problem and conducted a follow-up experiment, in which they gave xylitol and water to 10 people to see what was happening with their blood platelets, and they observed that the platelets seemed aggregate more.
“I think in itself it wouldn’t be very alarming, but there is growing evidence that some of these artificial sweeteners may not be as harmless as we would have thought,” van said. Damn. “If it was just something that people didn’t consume much, no one would really care. But the context is this: It’s something that hundreds of millions of people are exposed to, sometimes every day, so every piece of evidence that raises some concern is entirely relevant to public health.
Given that the medical community widely recommends the use of sugar substitutes instead of sugar as an option for those who are obese or trying to lose weight, or for diabetics or those suffering from metabolic syndrome, this study should be a signal alarm, Hazen said.
“I hope this is a call to arms, for other researchers to start studying this, because this is a huge public health problem, given the amount of stuff we’re putting into our food pyramid, thinking it’s a sure thing,” Hazen said.
