Artificial sweeteners, particularly xylitol, may pose health risks by affecting platelets and blood clotting, leading to cardiovascular events, according to a recent study published in the European Heart Journal. Xylitol, commonly found in sugar-free chewing gums, low-sugar baked goods, mints, and even toothpaste, is a popular sugar substitute due to its lower calorie content. However, new research highlights potential dangers associated with its consumption.
"Xylitol is often promoted as a safe sugar substitute, but these results highlight the need for caution, especially for individuals at risk of cardiovascular diseases," noted Dr. Nityanand Tripathi, head of cardiology and electrophysiology at Fortis Shalimar Bagh. He emphasized the necessity for further research to fully understand the mechanisms and establish clear guidelines for its consumption.
High consumption of xylitol can cause a state of hypercoagulability, where the blood has an increased tendency to clot. "This effect is mediated through xylitol’s ability to enhance the aggregation and activity of platelets, small blood cells that play a crucial role in the clotting process," explained Dr. Amar Singhal, director of interventional cardiology at Sri Balaji Action Medical Institute. "The heightened platelet reactivity induced by xylitol can result in the development of clots within blood vessels, leading to serious cardiovascular events."
A study conducted by the Cleveland Clinic in the US found that every measure of clotting ability significantly increased immediately after the ingestion of a xylitol-sweetened drink, a reaction not observed with a glucose-sweetened drink. Dr. AK Sahani, director and chief of neurology at the Indian Spinal Injuries Centre, suggested that this difference could be due to xylitol’s specific metabolic pathway, which influences platelet function and vascular response differently.
Dr. Bharat Kukreti, director and unit head of cardiology at Paras Health, Gurgaon, advised using natural sweeteners like honey, maple syrup, and fruits in moderation. "Patients, especially those with cardiovascular risk factors, should be cautious with sugar substitutes and prioritize a balanced diet. For products like toothpaste and gum, the occasional use is likely to be safe due to the minimal amount of xylitol ingested," he added.
Choosing natural items over artificial ones can offer several benefits. "Saunf is a great wholesome option. By making such a switch, you can improve your overall well-being," said Prof. Vinay Goyal, chairman of neurology at Medanta Hospital, Gurgaon.
In addition to these findings, the World Health Organization (WHO) recently recommended against using non-sugar sweeteners, such as saccharin and stevia, to control body weight. This recommendation encompasses all synthetic and naturally occurring or modified sweeteners not classified as sugars. Sweeteners like acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, and stevia are commonly marketed as low- or no-calorie alternatives to sugar, purportedly aiding in weight loss or weight maintenance. However, WHO's guideline advises against their use for these purposes, except for individuals with pre-existing diabetes. The advisory also warns against using such sweeteners to reduce the risk of noncommunicable diseases like hypertension and heart disease.
The research team also found a similar connection between erythritol and cardiovascular risk last year. Although xylitol is not as prevalent as erythritol in keto or sugar-free food products in the US, it is common in other countries, according to the researchers.