Sweet tooth: Sugar substitutes and your heart


Sweet tooth: Sugar substitutes and your heart

In 1963, the FDA approved the sugar substitute xylitol as a food additive to help patients with diabetes. Xylitol has been approved in 35 countries as a replacement for sugar. Xylitol is a 5-carbon sugar alcohol found naturally in small quantities in fruits and vegetables. When xylitol is used to enhance the sweetness of food, the levels can be 1000-fold higher than those found in nature. 

In 1970, Finnish researchers discovered xylitol’s benefits in dental health. Additional research has confirmed the benefit of xylitol for oral health. Due to this evidence, numerous dental products contain xylitol such as toothpastes and mouth rinses. Xylitol can be found in sugar-free gums to promote dental health. Xylitol kits are promoted to improve oral health with the recommendation to use 5-10 grams per day for six months for best results. 

Xylitol does not break down to sugar and therefore, it raises the pH of the saliva stopping acid formation. Acid formation from consuming sugars can damage the tooth enamel and result in depletion of important minerals. Xylitol stimulates saliva production allowing for repairing of damaged enamel and replacing essential minerals.  

Xylitol studies have demonstrated a reduction in plaque formation with a decrease in cavities.  Another benefit is its ability to stop bacteria from adhering to the teeth. Research has reported that xylitol stops common mouth bacteria from attacking teeth preventing tooth decay. This is the reason sugar-free gums often contain xylitol.  

Despite this positive news for your teeth, a study from the Cleveland Clinic provides evidence of damage to the cardiovascular system and the heart from xylitol consumption. The study was published on June 6, 2024 in the European Heart Journal.  The study evaluated 3,000 people in both Europe and the United States over a 3-year time frame.  The researchers used a dose of xylitol commonly found in foods and drinks.  

At the completion of the study, the researchers reported an increased risk of cardiovascular events including heart attacks and strokes. The xylitol group had a 1.5 times higher risk of these events. Additional testing showed an increase in platelet aggregation with xylitol. The blood platelets are usually slippery and do not stick together unless there is an injury or a provoking event. With a cut, the platelets will stick together forming a glue to stop the bleeding. The platelets are the clear liquid forming a clot.  This is often called a “white” clot. Within the blood vessels, platelets when provoked can form white clots blocking essential blood flow to the heart and brain resulting in heart attacks and strokes. We often give antiplatelet drugs such as aspirin and clopidogrel (Plavix) to stop white clots. The scientists recommended additional research to evaluate the risks of xylitol to our hearts.  

In addition to caution with xylitol, the FDA issued a warning on July 7, 2021 titled Paws Off Xylitol.  The warning communicated the dangers of xylitol to dogs. Very small amounts are extremely toxic to dogs causing low blood sugars, seizures, liver failure and possibly death.  It is important to keep xylitol products away from dogs.  

Read product labels for xylitol and talk to your healthcare professional.

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