Alarm has been raised over a widely used sweetener found in a range of convenience store staples, including chewing gum, toothpaste, jam, yoghurt and ice cream, after new research linked higher levels of xylitol in the blood to an increased risk of heart attacks, strokes and death.
Researchers found that people with the highest levels of xylitol in their blood were significantly more likely to experience a major cardiovascular event than those with the lowest levels. The findings could have implications for food and drink manufacturers and retailers as demand for sugar-free and reduced-sugar products continues.
Xylitol is a sugar alcohol that occurs naturally in small quantities in some foods but is also added to products as a sugar substitute, sometimes at concentrations around 1,000 times higher than naturally occurring levels.
In what researchers described as the largest study of its kind, the team analysed data from 17,710 people, comparing those in the highest quarter for blood xylitol levels with those in the lowest quarter.
Over a six-year period, people with the highest levels were 57% more likely to die or suffer a heart attack or stroke than those with the lowest levels. Even over a 30-year period, they remained 18% more likely to experience one of these cardiovascular events.
The researchers also found a dose-dependent relationship, with cardiovascular event rates increasing as blood xylitol levels rose. The association remained consistent regardless of factors including age, sex, body mass index, hypertension, diabetes and lipid levels.
The findings were presented at the European Society of Cardiology annual congress in Munich.
Dr Marco Witkowski of Charité university hospital in Berlin said the research builds on previous work suggesting xylitol could affect blood clotting.
“In previous studies, we showed that xylitol can enhance the ability of platelets to form clots,” he said.
He added that artificial sweeteners are often consumed by people who believe they are healthier than sugar and are generally considered safe by regulators.
“Our long-term findings in the general population highlight how little we know about the cardiovascular safety of xylitol and indicate that further studies are warranted, especially as the amount of xylitol in products continues to increase,” Witkowski said.
Prof Dan Atar, a member of the ESC communication committee who was not involved in the research, said the findings suggested xylitol could have a negative long-term association with cardiovascular events, but stressed that the study could not establish causation.
“This was observational work,” he said, adding that further research was needed into the issue.
The British Heart Foundation also urged caution in interpreting the findings.
Senior dietitian Dell Stanford said consumers could assume products containing artificial sweeteners were automatically healthier and potentially consume more of them as a result.
However, she stressed that the research showed an association rather than proving that xylitol directly caused cardiovascular events.
For convenience retailers, the findings come as sugar-free and reduced-sugar products continue to form an important part of the health and wellness offer, particularly across confectionery, gum and other impulse categories.
The research does not mean retailers should replace xylitol-containing products with higher-sugar alternatives. Instead, the researchers and health experts stressed that more evidence is needed and that consumers should focus on a balanced diet and reducing overall consumption of highly processed foods and drinks.