CLEVELAND — A study published June 6 in the European Heart Journal finds an association between consuming the sweetener xylitol and a higher risk of cardiovascular disease.

A research team led by Stanley Hazen, MD, PhD, director of Cleveland Clinic’s Center for Microbiome and Human Health, identified a higher three-year risk of cardiovascular events in an analysis of over 3,000 patients in the United States and Europe. The third of patients with the highest amount of xylitol circulating in their plasma were more likely to experience a cardiovascular event.

“This study again shows the immediate need for investigating sugar alcohols and artificial sweeteners, especially as they continue to be recommended in combating conditions like obesity or diabetes,” Hazen said. “It does not mean throw out your toothpaste if it has xylitol in it, but we should be aware that consumption of a product containing high levels could increase the risk of blood clot-related events.”

Xylitol, a polyol/sugar alcohol, is found in sugar-free candy, low-sugar baked foods and oral products like toothpaste, according to the Cleveland Clinic. The sweetness of xylitol is similar to the sweetness of sucrose, but it has 2.4 calories per gram compared to 4 calories per gram for sucrose.

The US Food and Drug Administration considers xylitol to be Generally Recognized As Safe (GRAS). The European Union allows the use of xylitol but assigns it an E-number: E967.

“The results of this study are contrary to decades of scientific evidence substantiating the safety and efficacy of low-calorie sweeteners such as xylitol by global health and regulatory ‎agencies,” said Carla Saunders, president of the Calorie Control Council, an international association representing the low- and reduced-calorie food and beverage industry. “While the authors used multiple methods, it should be noted that the findings are limited in their ability to establish association only. Further, one phase of the study included individuals who were already at increased risk for adverse cardiovascular events.‎