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Science

Artificial Sweetener Xylitol May Also Be Linked To Heart Attack and Stroke, Study Finds (cnn.com) 67

CNN reports that the low-calorie sweetener xylitol used "may be linked to nearly twice the risk of heart attacks, stroke and death in people who consume the highest levels of the sweetener, a new study found..." In 2023, the same researchers found similar results for another low-calorie sweetener called erythritol, which is used as a bulking sugar in stevia, monkfruit and keto reduced-sugar products. Additional lab and animal research presented in both papers revealed erythritol and xylitol may cause blood platelets to clot more readily. Clots can break off and travel to the heart, triggering a heart attack, or to the brain, triggering a stroke.

In the new study on xylitol, "differences in platelet behavior were seen even after a person consumed a modest quantity of xylitol in a drink typical of a portion consumed in real life," said Dr. Matthew Tomey, a cardiologist at Mount Sinai Fuster Heart Hospital in New York City, who was not involved in the study... "Through their work, the investigators have shined a light on the safety of sugar substitutes. There is more to learn," Mount Sinai's Tomey said. "In the meantime, it is worth remembering that sugar substitutes are no substitute for a sincere commitment to the several elements of a healthy diet and lifestyle."

Tomey added that the experiments "are interesting but alone do not prove that platelet abnormalities are to account for a linkage between xylitol and clinical events." But CNN notes that the researchers began by analyzing over 3,200 blood samples — and then also gave volunteers a typical xylitol-sweetened drink to see how much in increased their glucose levels. "They went up 1,000-fold," senior study author Dr. Stanley Hazen told CNN.

His study adds that the World Health Organization warned consumers in 2023 to avoid artificial sweeteners for weight loss and called for additional research on the long-term toxicity of low- and no-calorie sweeteners.
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Artificial Sweetener Xylitol May Also Be Linked To Heart Attack and Stroke, Study Finds

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  • Google tells me blood glucose levels range from 4 to 9 mmol/L in controlled diabetes. I wonder if those test subjects survived with 10% of their blood turning to low-calorie glucose.

    • the articles linked are all extremely vague and provide conflicting information- guess someone gave a very vague prompt to what ever AI platform
      they use to write articles for them

      • If only we knew for certain that the sugar industry has been paying scientists to vilify everything but sugar since at least 1976, including "landmark" Harvard studies that told Americans to stop eating eggs and put sugar on wheat instead ("low-fat craze").

        Then we would wonder why a dominant sweetener isn't causing massive die offs in Japan.

        But nobody "trusts the experts" anymore so it doesn't matter.

        • by Rei ( 128717 )

          This isn't about stevia, it's about xylitol.

          I for one cheer any news that means they're likely to ditch these sugar alcohols. They're horrible. In addition to all of the other problems with them, they're extreme FODMAPs to anyone with FODMAP sensitivity (aka, including myself). Even non-FODMAP-sensitive people can get bloating and gas, whereas for sensitive people I'm left miserable for the next 24 hours (not just digestive problems but headaches as well).

          I'm happy with stevia. I'm happy with aspartame,

          • by markdavis ( 642305 ) on Saturday June 08, 2024 @10:52PM (#64534657)

            Xylitol is very rarely used in food. It is expensive and less sweet, and almost only found in dental-related products because it is fantastic for dental health. So that means toothpastes and mouthwashes, which are never swallowed. And gum and mints, of which one doesn't usually consume much volume.

            As for other sugar alcohols, yeah, they can be pretty yucky.

            • by Rei ( 128717 )

              Xylitol is very rarely used in food

              "Xylitol is present in many products and foods" [fda.gov] - FDA

              Gum isn’t the only product containing xylitol. Slightly lower in calories than sugar, this sugar substitute is also often used to sweeten sugar-free candy, such as mints and chocolate bars, as well as sugar-free chewing gum. Other products that may contain xylitol include:

              breath mints
              baked goods
              cough syrup
              children’s and adult chewable vitamins
              mouthwash
              toothpaste
              some peanut and nut butters
              over-the-counter medi

              • >""Xylitol is present in many products and foods" [fda.gov] - FDA"

                Curious use of the word "many" when it is probably less than 0.01% of foods, or less than 1% of sugar-free foods. I read ingredients of everything I consider, buy, or eat. And I often buy sugar-free things. I have never seen Xylitol in any food. Only in the things I already listed that are not "food"... breath mints, gum, medications, and dental products.

                The overwhelming vast majority of sugar-free foods use aspartame, sucralose, ascs

                • by Rei ( 128717 )

                  I have never seen Xylitol in any food.

                  Your experience differs from mine (and the FDAs).

                  But honestly it doesn't matter much to me. They're all problematic for me. If it ends in -itol, I can't eat it.

            • by kackle ( 910159 )
              An aside: My doctor just reminded me that chemicals DO get absorbed into the bloodstream directly via the mouth. I seem to have some sort of intolerance where mid-sleep symptoms occur if I use toothpaste or mouthwash. If I use a "hippie" toothpaste (having less weird chemicals), the symptoms don't appear. There aren't many chemicals in each, and I suspect the sweetener/sugar alcohol.
              • >"An aside: My doctor just reminded me that chemicals DO get absorbed into the bloodstream directly via the mouth."

                Oh, this is absolutely true, of course. My point was that the amount typically consumed (absorbed) with things like toothpaste, mouthwash, etc, is extremely minor compared to actual ingestion (swallowing and digesting). If you put a few grams of X into a drink and drink it compared to gargling with that liquid and spitting it out, the amount absorbed is drastically lower (just how low depe

                • by kackle ( 910159 )
                  I understand what you're saying. It's odd that I can turn my symptoms on/off like a switch, just by abstaining from my toothpaste and mouthwash, which both contain sorbitol. I'm still investigating...
                  • Interestingly, although I have no problem with Xylitol, I have lots of digestive issues with Sorbitol. I can't use that at all. Different people might have different reactions to different sugar alcohols.

          • I for one cheer any news that means they're likely to ditch these sugar alcohols. They're horrible.

            Full agree. It's so hard to lead a low carb lifestyle with food variety (particular in desserts). Because you're either buying full sugar American food, or "keto"-labeled food which is always laden with these sugar alcohols. Finding stuff in the middle (which is low carb, say without a ton of added sugar, but ALSO without a ton of these sugar alcohols) is freakin impossible.

    • by ceoyoyo ( 59147 ) on Saturday June 08, 2024 @07:52PM (#64534389)

      The x1000 increase is for blood xylitol not glucose. EditorDavid appears to have skimmed the first few paragraphs and picked up on the third:

      “When you eat sugar, your glucose level may go up 10% or 20% but it doesn’t go up a 1,000-fold,” said Hazen, who also directs the Cleveland Clinic’s Center for Microbiome and Human Health.

      but missed the one immediately prior:

      “We gave healthy volunteers a typical drink with xylitol to see how high the levels would get and they went up 1,000-fold,” said senior study author Dr. Stanley Hazen, director of the Center for Cardiovascular Diagnostics and Prevention at the Cleveland Clinic Lerner Research Institute.

  • Don't replace it with anything. Everything is too sweet, because sweet sells. You get used to things not being as sweet.

    • You get used to things not being as sweet.

      Yeah, you can learn to tolerate unsweetened flavored seltzer water and I'm sure some people have even convinced themselves they like the stuff. It'd still taste a lot better with some sweetener added to it. That's just years of evolution which hasn't caught up with the fact that in developed nations with abundant, easily accessible food, you're more likely to shorten your life by consuming too many calories, rather than too few.

      • I actually prefer unsweetened seltzer water, flavored or otherwise.

        Cookies are another matter. You'll get my cane sugar when you pry it out of my cold, diabetic fingers.
      • by Rei ( 128717 )

        Speaking of evolution, there's a theory (though it's disputed) that the reason that so many plants have evolved a wide range of non-caloric sweeteners (the vast majority of which aren't on the market and you've almost surely never heard of them) is to game the system. Animals evolve to crave sweet things for the calories; plants evolve to put non-caloric sweeteners in their fruits so that they don't have to invest the energy to make sugar.

        It sounds logical, but there are some hitches in it - the evidence f

        • The problem with that theory is that non-caloric sweetners aren't non-caloric. Humans can't digest them, so we don't get calories from them, but they still store energy and have a cost to produce. In many cases, that production cost is significantly higher than the simpler glucose-fructose sugars that we can digest.

          • by Rei ( 128717 )

            In many cases, that production cost is significantly higher than the simpler glucose-fructose sugars that we can digest.

            This is simply not true. The amount of most non-caloric sweeteners needed to make a fruit sweet is microscopic compared to the amount of sugar to do so.

        • Animals evolve to crave sweet things for the calories; plants evolve to put non-caloric sweeteners in their fruits so that they don't have to invest the energy to make sugar.

          Why would plants evolve to be tasty to animals in the first place?

          • by Rei ( 128717 )

            In their fruits? For seed dispersal. That's the reason why most fruits exist. They're there to be eaten, or at least carried around with intent to eat (and occasionally dropped / lost / hidden and forgotten).

            As a general rule, plants can't walk, fly, swim, etc. Moving their descendants around is a challenge for a sessile organism.

            It's when sweeteners are found in parts of the plant other than fruits and flowers that the theory starts to break down.

    • You include the fact that our sense of 'sweet' changes based on what we eat, and claim 'everything is too sweet'.

      Congrats on winning the lottery for being able to want to eat food with zero sugar, but many of us can't. That's after forcing super low sugar/starch intake, even trying water fasts for longer than I probably should have.

      Stop assuming because something works for your particular genetics it'll work in general... especially for a problem that's called an 'epidemic'. That points me to you being t

      • Sugar is a bad habit. Many bad habits have roots in evolutionary drives, and sugar is no exception. That doesn't mean you can't learn to not binge on sugar. "Getting used to things not being so sweet" doesn't mean you have to learn to "do without" in the sense that you miss it every time you eat or drink something not as sweet. You get used to the taste. It tastes sweet, just less so. It tastes naturally sweet, and the expectation of sweetness changes. It's not a matter of "willpower", unless you think brus

    • Don't replace it with anything. Everything is too sweet, because sweet sells. You get used to things not being as sweet.

      Consuming too much sugar helps to elevate your triglycerides (or VLDLs), unless you lead a very active lifestyle where you burn it all off. The overabundance of sugar in our food is what's giving people a lot of problems. What we call bread would be considered a cake in some European countries because of the amount of sugar in them. Yes, you need a little bit of sugar to activate the yeast and help the bread rise... but the amount you need in order for this to occur is nowhere near the levels actually in

    • by sad_ ( 7868 )

      same with salt, seems like everything is just sweet or salty. there is no need for the over-use of these two, people need to learn to taste again!

  • Xylitol isn't artificial, it's a naturally occurring sugar alcohol. It's typically used as a sugar substitute in products where sugar provides bulk in addition to sweetness, such as sugar free candies. Xylitol (in addition to several other similar sugar alcohols) is already rather infamous for the rather unpleasant gastrointestinal side effects when consumed in "excess" (which typically ends up actually meaning the amount of sugar-free candy the average American would consume in one serving). This has le

    • by ArmoredDragon ( 3450605 ) on Saturday June 08, 2024 @01:02PM (#64533663)

      Xylitol isn't artificial, it's a naturally occurring sugar alcohol.

      More than that, it's an intermediary molecule made while metabolizing different sugars, and it's a totally naturally occurring chemical in various fruits. But don't say the word "chemical" to the food religion, it scares them. Not that they'll eat anything containing xylitol anyways, because they won't eat anything with an ingredient they can't pronounce. But it's not all bad -- the good news is we can starve them all out simply by showing them the ingredients of basically everything. Like natural organic bananas for example:

      https://i.kinja-img.com/gawker... [kinja-img.com]

      Just look at all of the food dyes in it -- they know that stuff is bad for them. Oh and it has all three of the ingredients that make up aspartame. Show them this and they'll never eat a banana again. Just don't tell them that all of these stupid rules they follow are really just marketing crap made up by the very food industry they despise, generally they pay pop culture magazines to invent completely meaningless shit terms, like the word superfood, which has no scientific basis at all and none of those assholes can even agree on what the word means.

    • Lead is naturally occurring too. Sounds like an odd comparison BUT: We know that ideally we consume no lead in our lives, too much is a bad thing; Xylitol is also natural, ok, but perhaps consuming any significant amount is bad for you too. Salt is also a natural product but you must control your intake or bad things happen there too.

      Calling something a natural product doesn't mean anything at all.

      Our entire food manufacturing processes are all about substitutes. We are at the point one has to ask, i
      • by Powercntrl ( 458442 ) on Saturday June 08, 2024 @01:48PM (#64533751) Homepage

        I wasn't playing the "natural is healthy" card, I was playing the "Slashdot editors don't do their job" card. Referring to Xylitol as an artificial sweetener is incorrect.

        • So I can easily make Xylitol at home by harvesting my birch tree or corn cob? (google search can't decide which is the main source commercially) It is ultra processed using other chemicals, something standard Sugar does not need.
          • by Sique ( 173459 )
            Yes. You can extract the Xylitol (or Xylose) with hydrogenic cyanide - at least that's how Emil Fischer & Co. did it in 1891, when they discovered Xylitol in birch tree bark.
    • by skam240 ( 789197 )

      Sure, it's "natural" but consuming large amounts of it, just as with sugar itself, is definitely not.

      In other words, swapping out one food item which we have refined (thus removing qualities that mitigate it's worst properties healthwise) and consume in extremely unnatural quantities for another for which we have done the same has never seemed like a winner idea to me.

    • Fact check: Haribo Sugarfree Gummi Bears contained the following [noveltystreet.com]:

      Hydrogenated Glucose Syrup (LYCASIN), Gelatin, Citric Acid, Natural and Artificial Flavors, Artificial Colors: Yellow 5, Blue 1, Red 40, Fractionated Coconut Oil, Beeswax, Carnauba Wax, Starch

      Lycasin [roquette.com] is a brand of maltitol sweetener.

      The gummy bears of which you speak did not contain xylitol.

  • obvious (Score:5, Insightful)

    by kencurry ( 471519 ) on Saturday June 08, 2024 @12:30PM (#64533587)
    High cholesterol means higher risk of heart attack and stroke
    Doc will tell you to cut down on sugar, so you will use artificial sweeteners
    No surprise that the two would correlate in patients.
    • Complementary mechanistic studies showed xylitol-enhanced multiple indices of platelet reactivity and in vivo thrombosis formation at levels observed in fasting plasma. In interventional studies, consumption of a xylitol-sweetened drink markedly raised plasma levels and enhanced multiple functional measures of platelet responsiveness in all subjects. Conclusions Xylitol is associated with incident MACE risk. Moreover, xylitol both enhanced platelet reactivity and thrombosis potential in vivo. Further studies examining the cardiovascular safety of xylitol are warranted.

  • Most artificial sweeteners disrupt your gut microbiome:

    Artificial sweeteners cause a “breakdown in communication” among gut bacteria, changing the microbiome and potentially increasing the risk of disease, Israeli scientists say. https://www.timesofisrael.com/sweeteners-hurt-the-ability-of-gut-bacteria-to-keep-us-well-israeli-study [timesofisrael.com]

    Your best bet is probably Stevia.

    The Slashdot post talks about xylitol and erythiol. I was not aware that they are used a lot as artificial sweeteners, since

    • >"The Slashdot post talks about xylitol and erythiol. I was not aware that they are used a lot as artificial sweeteners, since they are much less sweet than sucrose"

      Xylitol is very rarely used in food. It is expensive and less sweet, and almost only found in dental-related products because it is fantastic for dental health. So that means toothpastes and mouthwashes, which are never swallowed. And gum and mints, of which one doesn't usually consume much volume.

      So even if there is a "scare", it really d

  • There is a companion article to the paper, titled Xylitol: bitter cardiovascular data for a successful sweetener [oup.com].

    See the graphic summary for the scoop ...

  • by TeknoHog ( 164938 ) on Saturday June 08, 2024 @02:22PM (#64533785) Homepage Journal

    In Finland, xylitol isn't used so much as a sugar substitute / sweetener, but rather an after-meal “drug” to fight dental caries in the form of chewing gum or tablets. Its effects were studied here extensively in the 1970s, and we now know it works best in pure form, i.e. not mixed with other sweeteners.

    Growing up in the 1980s, the chewing gum format was quite popular due to extensive campaigning, but I personally didn't like chewing things that much. In the late 00s I started taking xylitol tablets after meals, and since then my teeth have been in much better shape. The tablet also works as a psychological marker for the end of a meal, so it helps maintain a discipline of a few solid meals per day instead of continued snacking.

    Like a lot of sugar alcohols, xylitol has a laxative effect, but it's not noticeable with the recommended doses, which is about 5 g per day. So the 30-gram dose mentioned in this study isn't very realistic.

    I would also note that dental caries (and other infections of the mouth such as gingivitis) is linked to wider health problems including heart issues. So I won't be giving up my xylitol tabs any time soon.

    • For Dental health -I made a water mix. Swish after meals, and spit... Better safe than sorry. (I don't need sweeteners, that's just an addiction that can be flicked off)
  • ... to be more dangerous than obesity is on those fronts.
  • Full version is not yet on "scihub" "In interventional studies, consumption of a xylitol-sweetened drink markedly raised plasma levels and enhanced multiple functional measures of platelet responsiveness in all subjects." How much xylitol [g] was in the drink?
  • Or is it the people who absolutely want to eat 15 cakes per day just switching to a different sweetener?

  • by OneOfMany07 ( 4921667 ) on Saturday June 08, 2024 @03:40PM (#64533943)

    I'm having trouble finding the page again in my browser history, but I was researching mouthwash ingredients and found a paper guessing that a statistically significant increase in hospital deaths after a certain mouthwash ingredient was used was due to NO regenerating bacteria being destroyed in the mouth. It was just a theory in the paper that someone else needs to investigate.

    Think nitrates/nitrites to nitrous oxide (saliva and digestive tract being involved) which is a blood vessel dilator and is used as a medication for heart conditions ('nitro pills'). If we suddenly drop the incoming levels, in a person already sick in other ways (being put on a ventilator, or other reasons to be in a hospital)... it's not too surprising they're more likely to have bad heart problems just afterward.

    This might be the same thing. With bacteria not able to eat the Xylitol being a reason it prevents tooth decay. Remove all food for something and it'll die. Any ancillary things it helped with will stop too.

  • The sugar industry is notorious for sponsoring studies of artificial or alternative sweeteners that proport to show bad health effects. They, of course, ignore all the studies about the bad effects of their own products. It is easy to make a study of a food additive show negative effects if you manipulate the data by choosing the test groups or effects until you get the result you want.
  • Artificial sweeteners have always been tied either rightly or wrongly to massive health problems. If one looks closely at the history of saccharin this is easy to see. Or the history of cyclamates or the history of NutriSuite. Basically you can't have fun without sugar. BS
  • A couple of weeks ago, I was trying out some Xylitol gum. Soon, I ended up with some obvious side effects. Mainly, I had really bad swollen feet and ankles, which I assumed were an allergic reaction, even though it seemed like exactly like the classic effects of type 2 diabetes. I stopped using the gum, and the symptoms soon vanished (no other change in behavior or diet). Now I realize that Xylitol really was giving me instant type 2 diabetes, it wasn't an allergy. Yikes! I'm throwing my remaining gum

  • Every time we bring some dessert of our country to our American friends to sample, they say it is too sweet. I guess they do not notice everything they consume in this country is either sweet or sweeter than what the rest of the world consumes. There is no sweetness in our beans, tomatoes or corn. We do not mix marshmallows in a salad (a Midwestern staple, it seems). We do not use meat dressings (because our meat tastes like actual meat and not like corn syrup) and most of our salad dressings are either vin

  • "The day they find that yoga mats are carcinogenic will be happiest day of my life." - Tim Minchin

    The most self-righteous bunch of twats I ever met were proponents of erythritol who had a hate on for all things aspartame or sucralose. Hah.

    I don't use Stevia or the other products listed here. But I don't avoid aspartame or sucralose. And given the wide variety of questionable things this 53 year old body has ingested, I'm not going to start worrying about them now.

  • A lot of these studies revolve around the word "may". Once again, correlation does not imply causation.

    I'm sure this is a glorious day for lawyers in California.

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