Written by: Ronald Grisanti D.C., D.A.B.C.O., DACBN, MS, CFMP

Xylitol and erythritol are commonly used by individuals aiming to lose weight or manage diabetes. Many people turn to artificial, low-calorie sweeteners to reduce their sugar intake. These sweeteners are found in products such as chewing gum, toothpaste, sugar-free candy, baked goods, and more.

A study published in June 2024 has linked high levels of xylitol and erythritol—sugar alcohols and low-calorie sweeteners found in many foods and products—with an increased risk of major cardiovascular events, such as heart attacks, strokes, and death.

Researchers analyzed the impact of xylitol on heart health in over 3,000 patients across the U.S. and Europe. Led by Dr. Stanley Hazen at the Cleveland Clinic, the study was published in the European Heart Journal on June 6, 2024. The findings revealed that patients with the highest blood levels of xylitol had a 57% increased risk of experiencing a major cardiovascular event compared to those with lower levels.

The Reason Why Xylitol and Erythritol May Pose a Cardiovascular Risk?

Platelets, which help blood to clot, were found to be more sensitive to clotting signals in the presence of erythritol and xylitol. Furthermore, a single 30-gram dose of xylitol can increase blood levels 1000-fold within 30 minutes, potentially stimulating blood clotting—a significant concern for individuals with existing heart disease.

These findings suggest that consuming erythritol and xylitol may enhance blood clot formation, thereby increasing the risk of heart attacks or strokes.

What Products Commonly Include Erythritol and Xylitol?

• Chewing gum
• Candy
• Ice Cream
• Breath mints
• Some Dietary supplements
• Mouthwash
• Toothpaste
• Sugar-Free Desserts
• Liquid compounded medications
• Commercially produced: Baked goods, beverages, candies, chewing gums, chocolates, tabletop sweetener packets, ice cream, puddings, jams and jellies, fruit preparations, biscuits, and sauces

For now, it is recommended being cautious with products containing xylitol and erythritol, especially for those with cardiovascular risk factors. While some may argue that the research is flawed, we wonder if those opposing the new study have an agenda that puts the public at risk.

In summary, why take the risk? We prefer to err on the side of caution and avoid food items with erythritol and xylitol.

Using xylitol and erythritol in small amounts, like those typically found in chewing gum, toothpaste, and mouth rinses, seems to be safe. However, using them in very high doses and long-term is not advisable.

This doesn’t mean you should throw out your toothpaste if it contains xylitol, but we should be aware that consuming products with high levels could increase the risk of blood clot-related events.

If you’re looking for a sweet treat, I recommend sticking to organic, 100 percent stevia or monk fruit extracts.

Remember to read the labels of the items you eat or drink to check for the presence of xylitol and erythritol.

References:

https://www.nih.gov/news-events/nih-research-matters/xylitol-may-affect-cardiovascular-health
https://www.nbcnews.com/health/heart-health/xylitol-linked-increased-heart-risk-reconsider-sugar-substitutes-rcna155688
https://www.nhlbi.nih.gov/news/2024/common-sweetener-linked-potential-cardiovascular-risks
https://academic.oup.com/eurheartj/article/45/27/2439/7683453
https://www.washingtonpost.com/wellness/2024/06/06/xylitol-sugar-artificial-sweetener-heart/
https://www.nih.gov/news-events/nih-research-matters/erythritol-cardiovascular-events
https://www.nature.com/articles/s41591-023-02223-9
https://academic.oup.com/eurheartj/article/45/27/2439/7683453
https://academic.oup.com/eurheartj/article/45/27/2439/7683453

** Always consult with a physician or healthcare practitioner with significant integrative or functional medicine training before starting any of the above recommendations.

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The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Dr. Aleksander Kanevsky and his functional medicine community. Dr. Aleksander Kanevsky encourages you to make your own health care decisions based upon your research and in partnership with a qualified health care professional.