Sweetener in your chewing gum may carry heart risk, study warns

Xylitol, a sugar alcohol widely used as a sweetener in chewing gum, toothpaste, jam, yoghurt and ice cream, has been associated with a higher long-term risk of heart attack, stroke and death, according to research presented at the European Society of Cardiology (ESC) annual congress in Munich.

Xylitol occurs naturally in some foods in very small quantities but is also added to food, beverages and oral-care products, sometimes at concentrations up to 1,000 times higher. Despite its growing use, its long-term effects on cardiovascular health have not been extensively studied, the Guardian reports, citing the research.

Researchers analysed data from 17,710 people, comparing participants in the highest quarter of blood xylitol concentrations with those in the lowest quarter. Over six years, people with the highest levels were 57% more likely to die or experience a heart attack or stroke. After 30 years, their risk of one of those cardiovascular events remained 18% higher.

Analysis of the intermediate groups also indicated a dose-dependent relationship: cardiovascular event rates rose as blood xylitol concentrations increased. The association remained consistent across baseline characteristics including age and sex and was independent of body mass index, hypertension, diabetes and lipid levels.

The study was led by Dr Marco Witkowski of Charité – Universitätsmedizin Berlin. He said the findings added to earlier research suggesting that xylitol could affect clot formation.

“In previous studies, we showed that xylitol can enhance the ability of platelets to form clots,” he said. Witkowski and colleagues had previously found that elevated blood xylitol levels were associated with adverse cardiovascular events among high-risk individuals over three years.

“Artificial sweeteners are consumed by people who think they are healthier than sugar and they are generally regarded as safe by regulatory agencies,” Witkowski said.

“Our long-term findings in the general population highlight how little we know about the cardiovascular safety of xylitol and indicate that further studies are warranted, especially as the amount of xylitol in products continues to increase.”

Prof Dan Atar, a member of the ESC communications committee who was not involved in the research, said artificial sweeteners were widely used and had generally received favourable safety assessments from regulators.

“In this observational work, however, it appears that xylitol has a negative long-term effect on cardiovascular events in the general population. As with all observational studies, causalities are difficult to infer, but this work shows that further studies are mandated into this societally important topic.”

Dell Stanford, a senior dietitian at the British Heart Foundation, said people should consider whether ingredients added to foods could contribute to long-term cardiovascular risks.

“Artificial sweeteners such as xylitol are found in many foods and drinks, and people may assume they are the healthier choice, so they consume more than they realise,” Stanford said.

She stressed that the observational study showed an association rather than proving that xylitol caused cardiovascular events, and that further research was needed.

“But it is not a green light to have more sugar instead, as we still need to reduce our free sugar intake,” she said.

“This study is a reminder that we all need to reduce our intake of processed foods and drinks that are often high in sugar, salt or sweeteners, and focus on a balanced diet to help protect our hearts.”

By Tamilla Hasanova