Xylitol - Natural Sugar Substitute Linked to Heart Disease and Stroke
Let's read past the headlines - Guest post from Sara Sousi -Your Medical Data Scientist
Headlines are meant to grab your attention. That is why they are called headlines. But do they tell all the truth? In today’s world of scrolling, how many of us actually read the whole article? And there are so many new studies coming out with new health and wellness information with warning signals to avoid them due to certain findings.
So let’s take a look at a headline that recently crossed over the newsfeed.
Xylitol - a natural sugar alternative found in plants, is now, according to this recent study, linked to heart disease and stroke. I felt this needed a closer look, being that Xylitol is a sugar alternative used in many diets when avoiding refined sugars and natural health products. And for that I enlisted my new Substack friend Sara. Sara (which you will learn about further down) is a medical data scientist with an interest in holistic health and wellbeing. I starting reading Sara’s Substack because I really liked the fact that she intersected her medical data background with holistic health to say yes there is scientific data to the holistic health lifestyle and is isn’t all WooWoo. Some of her articles that I particularly enjoyed are:
Reconnect with Nature - How Grounding (Earthing) Can Boost Your Health & Well-being (substack.com)
The Power of Creatine - by Sara Sousi (substack.com)
The Deodorant Debate - Could this daily item be putting you at risk for cancer? (substack.com)
Subscribe to her Substack below..
Now over to Sara….
Hi everyone! My name is Sara, I was born and raised in the lovely and sunny Greece until age 18 where I moved to the UK for university. I read mathematics for my bachelor’s and then did a masters of research in bioinformatics (with a focus in oncology) at Imperial College London. I always had a love for mathematics, sciences, and medicine - so that felt like a good intersection of all my loves & skills. I’ve carried out various research project across London’s main universities, and hold research positions with them. Namely, Imperial College London, King’s College London (KCL) and University College London (UCL). My research is quite varied, from public health, to wearable data to predict disease, medical education, fertility, oncology, and more. Academia aside, I’m a corporate consultant with a focus in the healthcare and life-sciences space (go to market strategies, opportunity sizing, algorithm reviews etc). And why I started Substack? Well, I love learning but I am also a very creative person, and considering I spend a fair chunk of working hours writing manuscripts it just made sense to do it on a medium such as Substack to pass on knowledge in a more fun and creative way! I write weekly articles here on Substack, under Your Medical Data Scientist, on topics like longevity, nutrition, and medicine. Ultimately discovering holistic health and wellbeing using science, the evidence out there, and my personal experiences.
Your Medical Data Scientist
Xylitol & Heart Disease
Earlier in June, a new study was published in the European Heart Journal by Witkowski et al. looking at the connection of Xylitol consumption and cardiovascular disease.1 They compared more than 3,000 people based on their blood circulating Xylitol levels and found that higher levels are associated with the incident risk of major adverse cardiovascular events. This could be a heart attack, a stroke, or even death. When looking at mouse models, they saw that the xylitol had an effect on the platelet count and blood clotting properties - it was classified as prothrombotic, which simply means that is it associated with higher frequency of thrombosis, i.e., blood clots.
But what exactly is Xylitol? It simply is a naturally occuring sugar alcohol found in various plants. It’s sweet like sugar but has around 40% less calories than it, and does not cause your blood sugar to spike as much. It’s considered an artificial sweetener, just like stevia is.
There has been a lot of controversy around artificial sweeteners and their effect on our health. For example, aspartame being classified as possibly carcinogenic especially for liver cancer.2 That being said, it’s a true statement is that artificial sweeteners don’t raise your blood sugar levels as much as normal sugar due to their glycemic index (GI). Technically speaking this holds as those sweeteners have a GI of 0 or near zero, while sugar has a GI of 63. However, both literature and the WHO have linked artificial sweetener consumption with obesity and type 2 diabetes, as well as increased adipose tissue - aka body fat. 3
Quite surprisingly sugar consumption has declined in the US which seems a bit contradictory considering what the standard american diet (SAD) is, but instead artificial sweetener consumption has increased. Of course, correlation is not causation, and the obesity epidemic is definitely not only due to the consumption of such items, but also the UPF, lack of exercise, hormonal disruptors, and more. But evidently, considering that the number of products containing such sweeteners is increasing year on year, naturally so is the consumption too. A long-term study of over 3.6k participants concluded that artificial sweeteners are do contribute to the obesity issue, with an increased BMI of 48% in those consuming them compared to those who don’t.4
Another bad consequence with regards to the gut health is their impact on the gut microbiome5, which is super important for one’s overall physical and mental health. What they actually do is alter the gut microbial communities, leading to glucose intolerance - this was shown for both mice and humans.
This study is not the first study to link artificial sweeteners to risk of cardiovascular disease (CVD). A 2023 study showed that overall, higher consumption of sugar-sweetened and artificially sweetened beverages was associated with greater cardiovascular outcomes; more specifically an increase of 27% (HR = 1.27). Similarly, a higher consumption of artificially sweetened beverages was associated with greater cardiovascular outcomes (HR = 1.32). Here high versus low consumption was compared, meaning that both the consumption as well as the amount play a factor in risk and health outcomes. These results were also exhibited in a BMJ study, where they examined each artificial sweetener against overall cardiovascular, coronary heart, and cerebrovascular disease.6 A nature publication in 2023, linked another artificial sweetener erythritol to CVD risk too, as well as the clotting aspect, and was found to enhance thrombosis.7
So, evidently artificial sweeteners are not the best when it comes to potential disease risk. Yes, there’s some evidence that’s not conclusive and of course it is difficult to fully account for the food and drink consumption to be accurate in such studies especially when the data is collected retrospectively. That being said, there is also the perspective that these artificial sweeteners are highly addictive, and have even surpassed cocaine rewards in rat models.8 This may also be another reason why companies add artificial sweeteners to their foods, in order to make people ‘addicted to them’. A bit like how UPF messes with the reward system in your brain and makes you crave it more.
How to avoid xylitol? Quite simply read the ingredients list of the items when you’re shopping. Typically xylitol is found in gum, mints, toothpaste & mouthwash (unsure of the why here…), and some medications like cough syrups. Even if you happen to consume it once in a while it won’t directly cause disease, just like having a glass of wine won’t either.
1 Marco Witkowski, Ina Nemet, Xinmin S Li, Jennifer Wilcox, Marc Ferrell, Hassan Alamri, Nilaksh Gupta, Zeneng Wang, Wai Hong Wilson Tang, Stanley L Hazen, Xylitol is prothrombotic and associated with cardiovascular risk, European Heart Journal, 2024; https://doi.org/10.1093/eurheartj/ehae244
2
Aspartame hazard and risk assessment results released, WHO
3
Steffen, B.T., Jacobs, D.R., Yi, SY. et al. Long-term aspartame and saccharin intakes are related to greater volumes of visceral, intermuscular, and subcutaneous adipose tissue: the CARDIA study. Int J Obes 47, 939–947 (2023). https://doi.org/10.1038/s41366-023-01336-y
4
Fowler, S. P., Williams, K., Resendez, R. G., Hunt, K. J., Hazuda, H. P., & Stern, M. P. (2008). Fueling the obesity epidemic? artificially sweetened beverage use and long‐term weight gain. Obesity, 16(8), 1894-1900. https://doi.org/10.1038/oby.2008.284
5
Bokulich, N. A. (2014). A bitter aftertaste: unintended effects of artificial sweeteners on the gut microbiome. Cell Metabolism, 20(5), 701-703. https://doi.org/10.1016/j.cmet.2014.10.012
6
Debras, C., Chazelas, E., Sellem, L., Porcher, R., Druesne-Pecollo, N., Esseddik, Y., … & Touvier, M. (2022). Artificial sweeteners and risk of cardiovascular diseases: results from the prospective nutrinet-santé cohort. BMJ, e071204. https://doi.org/10.1136/bmj-2022-071204
7
Witkowski, M., Nemet, I., Alamri, H. S., Wilcox, J., Gupta, N., Nimer, N., … & Hazen, S. L. (2023). The artificial sweetener erythritol and cardiovascular event risk. Nature Medicine, 29(3), 710-718. https://doi.org/10.1038/s41591-023-02223-9
8
Lenoir, M., Serre, F., Cantin, L., & Ahmed, S. H. (2007). Intense sweetness surpasses cocaine reward. PloS one, 2(8), e698. https://doi.org/10.1371/journal.pone.0000698
Thank you Sara for all the amazing information. So basically, the little amount of xylitol that you may be ingesting is nothing to be worried about.
The importance of reading beyond the headline.