Sugar substitute linked to increased risk of heart attack

Artificial sweeteners are often marketed as a healthier alternative to natural sugar and are popular with many people looking for a safer substitute to sugar. But growing evidence suggests that they may harm multiple body systems.

A new study by researchers at Cleveland Clinic in the United States has found that xylitol, a popular zero-calorie sugar substitute used in processed foods like peanut butter, chewing gum, baked goods, and candies, could be linked to a greater risk of cardiovascular diseases (CVD), including heart attack and stroke.

Cardiovascular disease includes heart disease, heart attack, stroke, heart failure, abnormal heart rhythm such as atrial fibrillation or AFib, and heart valve problems. High blood pressure is also a type of cardiovascular disease, as well as a major risk factor for heart disease and stroke.

According to the World Health Organization, CVDs are the leading cause of death globally, taking an estimated 17.9 million lives each year.

Another report by the American Heart Association (AHA), notes that more than 61 percent of American adults are expected to have some type of CVD by 2050, with the trend being driven by an older, more diverse population and a large increase in risk factors such as high blood pressure and obesity.

Considering the growth in elderly population, as well as the existence of risk factors such as obesity, are prevalent in many other countries, the expected increase in CVD rate could very likely be applicable to other parts of the world.

Xylitol is found in small amounts in many fruits and vegetables and is therefore considered natural, and is usually processed from trees like birch or from a plant fiber called xylan. Humans even produce small quantities of it via normal metabolism.

Xylitol has a similar sweetness as regular sugar but contains 40 percent fewer calories — 2.4 calories per gram compared to 4 calories per gram for regular sugar — so it is considered a weight-loss friendly sweetener.

Xylitol’s glycemic index (GI) — a measure of how quickly a food raises blood sugar — is also only 7, whereas it is 60–70 in regular sugar. However, since xylitol is a refined sweetener, it does not contain any vitamins, minerals or protein, and is considered to provide empty calories.

As such, it is usually found in many supposedly healthier sugar-free alternatives such as in sugar-free chewing gums, candies, mints, diabetes-friendly foods and oral-care products.

The Food and Drug Administration in the United States has classified Xylitol as a ‘Generally Recognized as Safe’ (GRAS) product, indicating that the substance is currently thought to be harmless.

Researchers behind the new study hope their finding will serves as a calling for new regulatory guidelines to improve labeling mandates and remove sugar substitutes like xylitol from GRAS status

The study also surmised that sugar substitutes may impair clotting activity. For their study, the researchers analyzed blood samples of over 3,000 people who were being assessed for heart disease.

They found that, over a 3-year period, people with the highest levels of xylitol in their blood had double the risk of heart attack, stroke, and death compared to those with the lowest levels.

The researchers surmised that there could be a receptor on our platelets that responds and interacts with sugar alcohols like xylitol, increasing the clumping ability of platelets in the bloodstream, and, as a result, increase the risk of clotting in the brain and heart, which could trigger cardiovascular events such as a heart attack or stroke.

However, the researchers caution that their findings are from an observational study and hence does not decisively prove that xylitol directly causes cardiovascular problems.

The new study underlines the need for further research on the health-risk aspects of sugar substitutes such as xylitol, as well as to better understand the impact of their consumption, especially at varying doses, on cardiovascular function. Meanwhile, healthcare experts are recommending limiting the use of sugar substitutes until their health implications are fully studied and understood.

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