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New study links high use of artificial sweetener xylitol to stroke and heart attack

Helpful sugar-free xylitol gum for teeth in a woman's hand on a white background.
Xylitol is a sugar alcohol found in small amounts of fruits and vegetables and used in sugar-free gum, toothpaste, and baked goods.

Xylitol is a sugar alcohol found in small amounts of fruits and vegetables and used in sugar-free gum, toothpaste, and baked goods.

But a new study links high consumption of xylitol to increased risk of stroke, heart attack, or even death.

KERA’s Sam Baker discusses the link with Dr. Ashesh Parikh, a cardiologist with Texas Health Plano.

What they found in this study was that xylitol activates platelets. Think of them as our glue. When you fall off the bike and bruise your knee, you bleed initially, but you hold pressure, and eventually, the bleeding stops.

What happens is that in our bloodstream there are platelets. And whenever there's a cut or a bruise, the platelets activate. And then they clump up that area to close up the wound.

What they found was that higher levels of xylitol activated these platelets. So they start clumping. And big clumps of platelets can clog up our arteries. And so that is what leads to a stroke and, and heart attack. They start clumping inside the artery, essentially going from a 0% blockage to a 100% blockage, which leads to a lack of blood flow to the vital organs like our brain and heart.

Would it simply be enough to just eat or consume less xylitol to avoid that. Or should some people stay away from it altogether?

The study doesn't show causation. It showed an association. That's one of the biggest things to take away from this study. It doesn't cause a heart attack or stroke to occur. For the average person, this is not a concern as of yet. But it is for people who are at higher risk for heart disease to begin with, like diabetics, smokers, and people on dialysis.

Trying to eat and consume natural sugars like honey, for example, or fruit sugars are probably the better way to go, or unfortunately, avoid sugars all together.

I was going to ask if you had patients like that and if so, what do you tell them?

Unfortunately, the golden rule is if it tastes good, it's not good for you. Right? The patients don't like to hear that, but, you know, when they've had a stroke already or if they've got heart disease or their hemoglobin A1C, which is a parameter for diabetes, is high. Besides obviously insulin and medication, it's a very sort of a bland, essentially zero carbohydrate type of diet that they have to consume to remain healthy.

So, they should stay away from xylitol and other artificial sweeteners?

Artificial sweeteners like Stevia, saccharin, and Splenda in low quantities are safe. A packet or two of Splenda is not going to increase the risk for cardiovascular disease. But if you're a person who consumes a lot of artificial sweeteners, that's where you're going to trouble.

The debate over artificial sweeteners has been going on for some time. And still, their use continues and so does consumption. So what needs to happen here? An outright ban or maybe ongoing raising of awareness?

I don't think we'll ever get an outright ban necessarily. But I think it's raising more awareness. And I think when studies like these come out we highlight the importance of healthier diet choices.

There was another sugar alcohol called erythritol, which was published just last year in 2023. And that one is another naturally occurring sugar. And, you know, most of us wouldn't even have known about it, but that one is seen much more in the U.S. In new diets like keto diets, those sugars are higher in those diets. So, it's more about raising awareness. And, I guess, physicians and dietitians are out there discussing what sort of sugars and carbohydrates are healthy so that it's safe for our patients and minimize future risks.


Study: Xylitol is prothrombotic and associated with cardiovascular risk

Common low-calorie sweetener linked to heart attack and stroke, study finds

Sam Baker is KERA's senior editor and local host for Morning Edition. The native of Beaumont, Texas, also edits and produces radio commentaries and Vital Signs, a series that's part of the station's Breakthroughs initiative. He also was the longtime host of KERA 13’s Emmy Award-winning public affairs program On the Record. He also won an Emmy in 2008 for KERA’s Sharing the Power: A Voter’s Voice Special, and has earned honors from the Associated Press and the Public Radio News Directors Inc.