Sweet Jeopardy: The risks of using artificial sweetener xylitol

Xylitol has been linked to greater chance of heart attack and stroke

Have you ever wondered where the sweetness in your chewing-gum and toothpaste comes from? No – for once, it’s not our favorite punching bag, sugar; rather it’s an artificial sweetener called xylitol. Also known as ‘wood sugar’, xylitol is a sugar alcohol (a type of sugar substitute) that is used to sweeten sugar-free candies, chewing gums, dental products like toothpastes and baking goods.
 
A lot of us may not know this, but about 38% of urban Indians consume artificial sweeteners every month. This is not hard to believe, considering that low-calorie or zero-calorie sweeteners are commonly used to replace sugar in many processed foods, especially diet soda and other soft drinks. Besides, those of us seeking to curb our sugar intake are invariably drawn towards foods marketed as ‘low sugar’, ‘no sugar’ or ‘sugar free’. Who doesn't know that the easiest way to enjoy sweet tea without using sugar is to pop in a packet of stevia or aspartame? Some practitioners also advise the use of artificial sweeteners in a bid to combat obesity and diabetes.
 
Not surprisingly, the production of sweeteners like xylitol has increased manifold in the past 10 to 20 years. As responsible consumers, it is incumbent upon us to ascertain whether or not these artificial sweeteners are as healthy as they appear to be. Although they were previously considered safe, recent evidence to the contrary has made them targets of scrutiny and opposition.
 
 Sugar Alcohols
 
The term ‘sugar alcohol’ is a misnomer, meaning a very misleading name, because these compounds are neither sugars nor alcohols. They are type of carbohydrates mostly derived from nature but also synthetically produced in certain situations. Sugar alcohols are commonly extracted from oats, birch , berries, sugarcane bagasse or corn husk. One can find them in many low-calorie  or sugar-free foods like snack bars, ice creams, frostings, cakes, cookies and jams. Sugar alcohols are not included in the category of ‘added sugars’, which means that manufacturers are free to brand products containing sugar alcohols as ‘sugar free’. It is, however, easy to spot them on food labels (which, by the way, none of us read) as they always end with the suffix ‘-ol’, like lactitol, sorbitol, xylitol etc.
 
Sugar alcohols differ from other groups of non-nutritive sweeteners (NNS) in the sense that they are metabolized in the body. However, these are only partially absorbed by the small intestine. Consequently, the amount of calories per gram obtained from sugar alcohols is up to 75% lesser than that of table sugar, while the intensity of sweetness is about the same. Additionally, they are broken down slowly during digestion, preventing sudden spikes in blood glucose and insulin levels.
 
As stated earlier, until recently, sugar alcohols were generally regarded as safe, as they were mostly ‘natural’. In fact, the only objections against them were that they could potentially cause gastrointestinal problems. The slow digestion process allows gut bacteria more time to feed on carbohydrates, resulting in fermentation and excessive gas formation. This draws water into the large intestine, causing loose stools, diarrhea and abdominal pain.
 
A serious eye-opener came with the  2023 study that linked high levels of erythritol in the blood to cardiac arrest, stroke and early death. Now, a new report published in the European Heart Journal shows similar findings related to xylitol.
 
 Xylitol found to increase risk of MACE
 
The Cleveland Clinic conducted a survey on 3,000 people to analyze the  effect of xylitol on our body. The subjects were asked to consume separately a xylitol-sweetened drink and another containing sugar. Their blood samples were then studied to compare the after-effects.
 
It was observed that the platelet reactivity of a person was significantly enhanced immediately after downing the drink containing xylitol. A similar change was not seen in case of the sugar sweetened product.
 
Platelets are tiny cells in our body that prevent blood loss by helping to clot blood at the points of injury. There seems to be some sort of a receptor on our platelets that instructs them to be more susceptible to clotting when it senses xylitol. The blood samples taken showed an abnormal increase in the efficiency of platelets. Xylitol had caused them to cluster together, leading to thrombosis (the fancy term for blood clots). These seemingly harmless blood clots could then travel up the blood vessels leading to the heart muscles, triggering a heart attack. Or they could travel to the arteries and veins in the brain, thereby obstructing blood flow and causing a stroke.
 
It was concluded that large amounts of xylitol consumption heightened the risk of a major adverse cardiac event (MACE) within a period of three years. In view of such reports, the World Health Organization (WHO) has cautioned consumers against the use of artificial sweeteners for weight loss. These findings remind us of the need for more extensive research on the long term toxicity of low-calorie sweeteners that are increasingly becoming a part of our diets. At all times, it is best to consult a certified healthcare  professional or dietitian before making any significant food choices.
 
 If not artificial sweeteners, then what?
 
First sugar was bad. Now artificial sweeteners are bad too. So what do we do? There is no point in turning to jaggery, maple syrup, agave or honey; they’re just as bad as refined sugar when it comes to calories. Cutting down completely on everything sweet certainly seems like an ideal option, but it may not be realistic enough for many of us to implement. If you have an overactive sweet tooth the absolutely must be indulged sometimes, then fresh or frozen fruits make an excellent choice. Unlike refined sugar, which gives nothing but empty calories, fruits are loaded with benefits – fiber and vitamins, while also containing some amount of natural sugar. Combining a handful of  cut mangoes or strawberries with yogurt, infusing water with slices of sweet lime or freezing cubes of pineapple for a chilled treat doesn’t sound like a bad option!