A team of researchers including Dr. Stanley Hazen<\/a>, chair of cardiovascular and metabolic sciences<\/a> at the Cleveland Clinic Lerner Research Institute<\/a>, identified an association between high levels of circulating xylitol and an elevated three-year risk of cardiovascular events in an analysis of more than 3,300 patients. The findings were published last week in the European Heart Journal<\/em><\/a>.\u00a0<\/p>\n \u201cPeople whose levels of xylitol were in the top 25% of our population\u2014the top quarter\u2014they were at double the risk for a heart attack, stroke, and death than people whose levels were in the bottom quartile,\u201d Hazen tells Fortune<\/em>. \u201cOur data is entirely consistent with xylitol being a prothrombotic compound (prone to causing blood clots), and it enhances cardiovascular risk\u2014the very compound that we are often recommending to patients to use as a sugar substitute, particularly if they\u2019re diabetic.\u201d<\/p>\n In another part of the study, subjects were asked to drink xylitol-sweetened water. The amount of xylitol in each drink was comparable to that found in a serving of keto ice cream or diabetic cookies, Hazen says. Researchers then examined subjects\u2019 blood platelets, or thrombocytes<\/a>, the cell fragments that form clots.<\/p>\n \u201cAfter drinking this typical exposure, blood levels went up over 1,000-fold, to superphysiologic levels,\u201d Hazen says. \u201cThey stayed elevated into this high range\u2014which is associated with higher cardiovascular disease risk\u2014for the next four to six hours in every volunteer examined, and every platelet functional measure we looked at was substantially increased.\u201d<\/p>\n This discovery comes just over a year after Hazen and his colleagues found a similar relationship<\/a> between the artificial sweetener erythritol and cardiovascular event risk<\/a>. In the U.S., xylitol isn\u2019t as common as erythritol in keto or sugar-free foods, according to a Cleveland Clinic news release<\/a>. It is, however, abundant in other countries.<\/p>\n Xylitol<\/a> is sometimes labeled as sugar alcohol<\/a>, so named because parts of its chemical structure resemble those of sugar and alcohol. Also called polyols, sugar alcohols are carbohydrates that occur naturally in some fruits and vegetables. They don\u2019t contain ethanol<\/a>, the type of alcohol in alcoholic beverages.<\/p>\n Sugar alcohols are popular sugar substitutes because they taste sweet but have fewer calories per gram than sugar, according to the Food and Drug Administration (FDA)<\/a>. They\u2019re typically used in combination with artificial sweeteners, and can be commercially produced from sugars and starch.<\/p>\n Sugar alcohols prevent browning, help retain moisture, and add bulk and texture, per the FDA, making them an ideal ingredient in processed foods such as baked goods. Your body can\u2019t completely absorb sugar alcohols, which is why consuming them doesn\u2019t make your blood glucose spike like regular sugar does.<\/p>\n That cooling sensation in your mouth after brushing your teeth? It\u2019s an indication of high sugar alcohol concentrations. Because sugar alcohols don\u2019t cause cavities, they\u2019re popular in oral care products. Xylitol in particular is common in chewing gums.\u00a0<\/p>\n As demand for low-sugar, low-calorie foods increases, the sugar alcohol market continues to boom. It\u2019s expected to exceed $1.8 billion by 2033, according to Persistence Market Research<\/a>. Xylitol, also called birch or wood sugar, boasts low production costs that are another industry boon, Hazen says.<\/p>\n \u201c[Xylitol] is literally made out of wood pulp and sawdust. It\u2019s cheaper to make xylitol than to isolate cane sugar out of sugarcane,\u201d Hazen tells Fortune<\/em>. \u201cAnd it tastes just like sugar\u2014equal sweetness, it\u2019s granular\u2014so it has a lot of things going for it.\u201d<\/p>\n These factors are also what makes xylitol so dangerous, he says.<\/p>\n According to the FDA, the sugar substitute can be found in a number of food and other products, including:<\/p>\n Tatsiana Niamera\u2014Getty Images<\/p>\n<\/div>\n Last year, the World Health Organization<\/a> advised against using non-sugar sweeteners, particularly as a means of weight management. As calorie-containing sugar derivatives, sugar alcohols were excluded from the agency\u2019s new guidance. Still, the decree marked a shift in how consumers view their relationship with sugar<\/a> and its substitutes.<\/p>\n The nonprofit food watchdog Center for Science in the Public Interest<\/a> recommends cutting back on xylitol, citing the fact that large amounts may lead to diarrhea. (In humans, that is; xylitol is deadly for dogs<\/a>.) Hazen would rather you cut it out altogether.<\/p>\n \u201cIf [you] want to sweeten something, at this point I think it\u2019s better to use sugar or honey or fruit, and in moderation,\u201d he says. \u201cIf you\u2019re diabetic, you monitor your blood sugar.\u201d<\/p>\n Consult your doctor and\/or nutritionist before making any drastic changes to your diet.<\/p>\n Given the intricacies of cardiovascular disease and the limitations of Hazen\u2019s research, it would be a stretch to conclude that xylitol causes<\/em> events such as stroke and heart attack, he says. Additional long-term studies are warranted. For example, it\u2019s unclear whether adolescents who frequently consume sugar substitutes will develop a higher risk of a cardiovascular event than their peers who don\u2019t.<\/p>\n In the meantime, Hazen is concerned enough about the health hazards of xylitol that he\u2019s advocating for nutrition label overhauls.<\/p>\n \u201cIt\u2019s a big public health issue,\u201d he says. \u201cWe need to really be trying to lobby and get regulatory changes so that it\u2019s no longer generally recognized as safe.\u201d<\/p>\n For more on sugar substitutes:<\/strong><\/p>\n<\/div>\n Subscribe to Well Adjusted, our newsletter full of simple strategies to work smarter and live better, from the Fortune Well team. <\/span>Sign up<\/span><\/a> for free today.<\/span><\/p>\n<\/div>\nWhat is xylitol?<\/h2>\n
What foods contain xylitol?<\/h2>\n
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Is it safe to use sugar substitutes?<\/h2>\n