Study Finds Popular Artificial Sweetener Increases Risk of Heart Disease

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• Xylitol is a common low-calorie sweetener used in gums, candies, and oral care products.

• New research links xylitol to increased risk of heart attack and stroke.

• Experts share what you need to know about the artificial sweetener.

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Artificial sweeteners can be useful for some people who need to manage their blood sugar levels, but these sugar substitutes can pose some serious health risks. New research shows that low-calorie sweetener Xylitol may be linked to an increased risk of heart attack and stroke. But what is xylitol? And how might consuming it impact your overall health?

A study published in the European Heart Journal, led by the Cleveland Clinic, found a link between the low-calorie sugar substitute and an increased risk of heart attack, stroke, or cardiovascular-related deaths.

Meet the Experts: Grace A. Derocha, M.B.A., R.D., C.D.C.E.S., spokesperson for the Academy of Nutrition and Dietetics; Adedapo Iluyomade, M.D., preventative cardiologist with Baptist Health Miami Cardiac & Vascular Institute; Jackie Newgent, R.D.N., C.D.N., chef, nutritionist, and author of The Plant-Based Diabetes Cookbook.

Researchers measured the level of xylitol in the blood of more than 3,000 participants and found that people whose xylitol levels put them in the top 25% of the study group had approximately double the risk for heart attack, stroke, or death over the next three years compared to those in the bottom quarter.

Additionally, the researchers wanted to understand how xylitol could have this effect on heart health, so they conducted three experiments: fed xylitol to mice, added it to blood and plasma in a lab, and gave a xylitol-containing drink to 10 healthy volunteers. In all three tests, xylitol seemed to activate platelets, which are the blood component that controls clotting—blood clots are the leading cause of heart attack and stroke.

So, what is xylitol, and is it safe to eat? Here, experts explain everything you need to know about the low-calorie sweetener.

What is xylitol?

Xylitol is a sugar alcohol used as a sweetener, says Grace A. Derocha, M.B.A., R.D., C.D.C.E.S., spokesperson for the Academy of Nutrition and Dietetics. “It is found naturally in small amounts in various fruits and vegetables and is also produced by the human body during normal metabolism,” she explains.

Xylitol has about the same sweetness as sucrose (table sugar) but with fewer calories, says Derocha. Per Derocha, xylitol is commonly used in:

Xylitol uses

Xylitol may be useful in place of traditional sugar for people who need to manage their total carbohydrate intake or blood glucose levels, like people with type 2 diabetes, says Jackie Newgent, R.D.N., C.D.N., chef, nutritionist, and author of The Plant-Based Diabetes Cookbook. “Providing 2.4 calories per gram instead of the typical 4 calories per gram [in table sugar], it can be useful within the diet for people with obesity or overweight,” notes Newgent. Plus, research suggests it may be beneficial for boosting satiety, she says.

People might also use xylitol for its sweetening properties while seeking to improve dental health, adds Derocha.

Does xylitol affect teeth?

Yes, xylitol can have a positive impact on dental health, says Adedapo Iluyomade, M.D., preventative cardiologist with Baptist Health Miami Cardiac & Vascular Institute. “It reduces the growth of harmful bacteria in the mouth, thereby lowering the risk of cavities and tooth decay, which is why it is frequently included in toothpaste and mouthwash,” he explains.

Along with reducing risk of tooth decay, xylitol promotes saliva production, which helps neutralize acids and repair tooth enamel, says Derocha. “Chewing xylitol gum can help maintain oral hygiene by increasing saliva flow and reducing plaque formation,” she advises.

Is xylitol toxic to dogs?

Yes. Don’t let your pup eat any of your food scraps that contain xylitol—it can be toxic for dogs, says Newgent. “But it’s not a serious issue if your cat (or ferret!) takes a lick,” she points out.

Anyone who uses xylitol should know it is highly toxic to dogs, says Dr. Iluyomade. “Even a small amount accidentally ingested can kill them.” Derocha agrees, saying that even tiny amounts of xylitol can cause severe health issues for pups, including:

• Hypoglycemia: Xylitol causes a rapid release of insulin in dogs, leading to a sudden and significant drop in blood sugar levels (hypoglycemia). Symptoms of hypoglycemia include vomiting, weakness, lethargy, loss of coordination, seizures, and in severe cases, coma, or death.

• Liver Damage: Ingesting larger amounts of xylitol can cause acute liver failure in dogs, which can be fatal. Symptoms of liver failure might not appear immediately but can include jaundice, vomiting, diarrhea, and lethargy.

If you suspect your dog has ingested xylitol, it’s crucial to seek veterinary care immediately, says Derocha. “Early intervention can significantly improve the chances of recovery,” she says.

Side effects of xylitol

For humans, consuming xylitol is generally safe, but it may cause some side effects, especially when eaten in large amounts, says Derocha. According to Derocha, these may include:

• Gastrointestinal issues: The most common side effects include digestive problems such as bloating, gas, and diarrhea. Xylitol is a sugar alcohol that can be fermented by gut bacteria, leading to these symptoms.

• Laxative effect: High doses of xylitol can have a laxative effect, leading to increased bowel movements, and potentially diarrhea.

• Allergic reactions: Though rare, some people might experience allergic reactions to xylitol, including skin rashes or respiratory issues.

• Interference with nutrient absorption: Excessive consumption of sugar alcohols, including xylitol, may interfere with the absorption of certain nutrients and electrolytes.

Most people tolerate xylitol well when consumed in moderate amounts, such as those found in sugar-free gum and candies, says Derocha. However, individuals with irritable bowel syndrome (IBS) or other gastrointestinal sensitivities might experience more pronounced side effects, she notes.

The bottom line

In general, it may be advisable to enjoy one daily serving of a food or beverage that contains this sugar alcohol, not two or more, for instance, says Newgent. However, if you have, or are at risk for, cardiovascular disease, it may be best to discuss the use of xylitol with your doctor, she advises. “Just because something may have benefits in small amounts, doesn’t mean more is better. And based on this study, a higher intake of xylitol may carry more risks in terms of cardiovascular health,” Newgent notes.

This new research highlights a potential association between xylitol consumption and an increased risk of heart attack and stroke, says Dr. Iluyomade. “This is a crucial finding, emphasizing the need for moderation and further research.” While xylitol offers benefits, such as a low glycemic index (low effect on blood sugar) and dental health advantages, it’s essential to be mindful of its consumption in light of potential cardiovascular risks, says Dr. Iluyomade. Patients should be aware of these potential risks and consult their healthcare providers when considering dietary changes involving xylitol, he advises.

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