Welcome to Straight Talk on Health.. I’m your host Dr. Chet Zelasko. Straight Talk on Health. is a joint production with WGVU in Grand Rapids MI. With a PhD in exercise physiology, I’ve been teaching people how to improve their health through diet, exercise, and supplementation for over 30 years. I look at the science behind all the headlines and social media, and let you know whether it’s something to consider or not. You can check out other things that I do on my website Drchet.com and sign up for my free emails.
Over the past few years, there have been a variety of research papers published that suggests 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. I covered the latest on erythritol on Straight Talk on Health Episode 138. The same research group as I referenced in that review recently presented a poster at the European Society of Cardiology conference that suggested that xylitol may do the same thing. I’m going to present some facts about what I’ve found and you can make your own decision.
Let’s begin with some facts on xylitol. Xylitol is a sugar alcohol. It is NOT an artificial sweetener. Some discussions have labeled it as such. That is wrong. If someone really understood the biochemistry or even just checked the metabolism of sugar alcohols in the body, they would know that. Of course the researchers did but many health writers I checked did not. That’s a bigger deal than has been acknowledged but more later.
Our body makes xylitol along other sugar alcohols. The amounts vary but on average, the amount is 5 – 15 grams per day. But what if someone has a genetic condition that allows them to make much more than that? Less than that amount? There are several genetic tests available for the four key enzymes in the endogenous production of xylitol and there are known single nucleotide polymorphisms of some of those genes. The researchers had access to the blood samples from the subjects in the latest studies but while they checked the blood for xylitol, they did not do any genetic testing to see if there were tendencies among specific genetic mutations. This was already an expensive study but it leaves one wondering if these or other mutations impact the rate of MACE they demonstrated in the study.
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. That seems to be a significant problem to me. In previous studies, the primary researchers claimed that there were products that could reach 30 grams of erythritol in a single serving. I did find one product sweetened with 20 grams in an ice cream if one ate the entire pint but it was much less if one ate the recommended serving. But we don’t know how much people ate because the FFQ used did not collect that type of data.
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. The research on xylitol and other sugar alcohols has been 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 see if there is any cause and effect. Those studies should include the aforementioned genetic testing I mentioned earlier. If they do not, we’re left with the same potential genetic issues.
In a prior study on erythritol, the subjects were given 30 grams of erythritol in a sweetened drink. This presents at least two problem. First, there is no product like that in the marketplace because it would cause severe gastric distress. I avoid all sugar alcohols except chewing gum because it causes severe gas. I’ve tried food bars and ice cream sweetened with sugar alcohols and to be blunt, even I didn’t want to be in the same closed area with myself. That’s why sugar alcohols are used in limited amounts in foods.
The second issue is that the research on blood clotting the research group has done used only the sweetened drink. How would the clotting values be impacted with other foods in the meal? Meat with fat and protein? Vegetables with fiber and phytonutrients? Even fruit that may have minute amounts of sugar alcohols in them? Whole grain? That’s the problem when trying to focus on a single factor that may contribute to a disease or condition: we don’t normally eat in a vacuum devoid of every other nutrient. We can’t really test that way either other than to point out that there may be a relationship.
One thing that is true is that xylitol can be lethal to dogs, even in small amounts like chewing gum! Make sure you keep any sugar alcohol products including gum away from all animals, domestic or wild.
I think that the research on sugar alcohols should continue but without the hyperbole—and there was plenty of that with the headlines that covered the press release. 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 those foods then pass the gas.
11 years ago, I got a birthday present no man wants: it was a phone call from my urologist telling me I had prostate cancer and that it was a pretty severe case. But here I am, 11 years later and I’m still alive and hopefully, still cancer free. I still have a yearly PSA test and am always nervous until I read the results. PSA less than .1. So as a prostate cancer survivor, I want to let every man know that you should get regular prostate exams every year.
Prostate cancer is diagnosed in about 330,000 men every year and every year, about 10% will die from prostate cancer. The problem is that based on stats from the ACS, diagnosis have increased by 3% over the past 10 years. Why? Men don’t get tested every year and they are not discussing it with their physicians.
Look men, and the women who love you, once you hit 50, get checked every year. It’s simple. A digital rectal exam and a PSA blood test. That’s it. Yes, I know it seems invasive but so is the surgery to have your prostate removed. Having experienced both, I’m glad I did. What I didn’t do was have a biopsy when my PSA started rising. Early diagnosis may have prevented the surgery and it could have been handled with radiation alone. I’m no different than anyone else; I delayed until there was a big jump in my PSA. You already know about the phone call so don’t do what I did: no matter what month it is, if you’re 50 and older, schedule your DRE and PSA blood test with your primary care physician today. With current treatments and continuing research, your odds for living, even with a prostate cancer diagnosis, improve every day. But you can’t treat it early unless you get regular tests. Having the experience, I’d take the tests over the treatment any day.
That’s all the time I have for this episode. If you like this podcast, hit the like button and share the link with your friends and colleagues about it. Until next time, this is Dr. Chet Zelasko saying health is a choice. Choose wisely today and every day.
Reference:
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
3. American Cancer Society.
