Tag Archive for: sugar alcohol

Is Xylitol Dangerous?

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Over the past few years, research papers have suggested that sugar alcohols, specifically erythritol, may increase blood clotting and potentially lead to a major adverse coronary event or MACE for short. It gave me pause — to the extent that I stopped using sugar-free gum when I work out. The same research group recently presented a paper at a major heart disease conference suggesting that xylitol may do the same. I’m going to present some facts about what I’ve found, and you can make your own decision.

The Facts on Xylitol

Xylitol is a sugar alcohol. It is not an artificial sweetener. Some discussions have labeled it as such, but that’s wrong.

Our body makes xylitol along with other sugar alcohols. The amounts vary, but on average, the amount is 5 to 10 grams per day.

Pure xylitol powder contains 4 grams of xylitol. The highest processed food source is sugar-free dark chocolate at 1.2 grams of xylitol per ounce of chocolate. None of the studies collected data on sugar alcohol intake.

The research on xylitol and other sugar alcohols is limited to large observational studies. No randomized controlled trial exists. Therefore, while the relationship proposed between MACE and sugar alcohol intake is curious, it’s going to take specific randomized controlled trials to determine any cause and effect.

The problem with the current state of research is that it doesn’t preclude that some people may naturally produce more endogenous xylitol than others. That has to be separated out at some point in time.

One thing is true: xylitol can be lethal for dogs, even in small amounts like chewing gum! Make sure you keep any sugar alcohol products including gum away from all animals.

The Current Bottom Line on Sweeteners

I think that the research on sugar alcohols should continue but without the hyperbole. What’s often not stated is the impact sugar alcohols can have on gut bacteria. Even if sugar alcohol can have some role in MACE, the gas production can keep consumers from using it in excessive amounts. As for me, I still chew gum while I work out, but my gut works overtime producing gas if I eat foods with sugar alcohols in them. I’d rather pass on the sugar alcohols than pass gas, so it’s regular old gum for me.

A Note on the Memo

While I love writing the Memos and helping you live a healthier life, drchet.com is still a business, so I’m hoping to increase product sales. If I have a product in the store that relates to the Memo’s subject, I’ll be highlighting it in a P.S., starting today with an option if you decide xylitol isn’t for you.

What are you prepared to do today?

        Dr. Chet

Bottom Line on Sucralose

P.S. If you’re going to stop using xylitol, you’re going to need another sweetener. Sucralose has been widely criticized, but is it warranted? Check out The Bottom Line on Sucralose at drchet.com; get the MP3 or PDF to learn more for only $1.99 (free for Insiders).

References:
1. CVD Res 2025. (121)1319–1329 https://doi.org/10.1093/cvr/cvaf091
2. Eur Soc Cardiology 365. 2026. Poster: The association of Xylitol and incident cardiovascular events: the CLSA and EPIC-Norfolk cohort studies

Erythritol: Reserve Judgment for Now

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The study published in Nature Medicine on erythritol is complex to say the least. I gave you three quarters of the results. There was one more part that I want to cover and then give you my primary issues with the study. As I said in Tuesday’s Memo, I’ve posted a Straight Talk on Health podcast for Members and Insiders that gives my complete thoughts on sugar alcohols, especially erythritol (remember to log in first).

Erythritol and Clotting

The final part of the study was actually a preliminary report on a much larger study. They had eight subjects drink 30 grams of erythritol mixed with 300 ml of water. That corresponds to estimates of what a high intake would be. Then they tracked serum erythritol levels in the subjects for seven days. They also tested for indicators of blood clotting factors and found that some were increased for a few days after consuming the erythritol drink. The implication is that high intake of erythritol might contribute to blood clots forming. The question is: who is at risk?

Primary Issues

My primary concern is the lack of adequate controls. This was an observational study, not a clinical trial, so no cause and effect can be determined. Researchers took measurements on several cohorts of subjects with diagnosed coronary artery disease (CAD). Those subjects had a host of risk factors including high blood pressure, type 2 diabetes, high LDL- cholesterol, and on and on. The ages in each cohort ranged from a median of 65 in the Discover cohort up to 75 in the European cohort.

They did not have a comparable cohort of apparently healthy controls in the same age group. They could have chosen a group of subjects who had blood drawn at their annual physical but no apparent diagnosis of CAD. While still not getting to cause and effect, it would have strengthened the basic observations if major adverse cardiovascular events (MACE) was seen or not seen in the controls.

The same is true for the study on the erythritol drink. Why not get a group with diagnosed CAD and see if the same clotting effect happened? If not that, why not just do a simple test that measures clotting time? That’s done for anyone who takes a blood thinner such as warfarin.

The Bottom Line

The researchers called for more research on erythritol to examine the increased adverse events in the present study, and I agree. Because erythritol is part of many low-carbohydrate foods and drinks designed for diabetics and those on a ketogenic diet, we need to know more about the risks. This was a good research paper but incomplete. The best we can say as to whether we should use sugar alcohols is that we must reserve judgment until a lot more research is done.

If you’re concerned about artificial sweeteners, try to cut back and use a variety of them to reduce the risks associated with any particular one. But for your health’s sake, don’t switch to sugar; the risks of high sugar consumption are even greater than those associated with artificial sweeteners. For ideas of asking the right questions in those future trials and more on sugar alcohols, check out the Straight Talk on Health just posted by becoming a Member or Insider.

What are you prepared to do today?

        Dr. Chet

Reference: Nature Medicine. 2023. https://www.nature.com/articles/s41591-023-02223-9

Is Erythritol Safe?

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Health writers have been talking pro and con about a new study that was published about erythritol, a commonly used sugar alcohol. The paper demonstrated an increased risk of major adverse cardiovascular events (MACE) if a person had too much of the sweetener in their bloodstream. In that sugar alcohols are found in more and more products, especially those geared toward the ketogenic diet, are people really at risk for a major cardiac event, or worse, death? Let’s take a look at the results of the study.

The researchers used data collected during consecutive heart catheterizations at the Cleveland Clinic, termed the Discovery cohort, a U.S. population extracted from a large genetic study conducted by the Cleveland Clinic, called U.S. validation cohort, and a European validation cohort similar to the one selected from the population in the Discovery cohort. The two key elements were that all subjects had blood samples drawn that could be studied and all were tracked for at least three years. Researchers developed tests to specifically identify the quantity of erythritol found in subjects’ blood.

The researchers separated the subjects into quartiles and compared those with the lowest levels of erythritol with those with the most. In all three cohorts, with blood samples taken in different parts of the U.S. and Europe and over different years, the highest quartile had a significant increased risk of MACE in over three years compared to the lowest quartile—two to three times as high.

In Saturday’s Memo, I’m going to review the major issue with the study. I’ll also post a Straight Talk on Health for Members and Insiders that takes a deeper dive into all the issues surrounding the study and whether this is something to be concerned about or not.

What are you prepared to do today?

        Dr. Chet

Reference: Nature Medicine. 2023. https://www.nature.com/articles/s41591-023-02223-9