A recent publication in the European Heart Journal (Witkowski et al. 2024) suggests that sugar alcohols such as Xylitol used widely as low-calorie sweeteners significantly increase the risk of major adverse cardiovascular events. Evidence stems from a metabolomic (cohort) and a mechanistic approach. Platelet reactivity appears to be affected by the sugar alcohol.
Xylitol makes up a ca. $600 million global market and is widespread in foods (e.g. chewing gum, confectionery, bakery goods) and nutri- and pharmaceuticals. The low glycaemic index makes it attractive for populations with manifest or increased diabetes and cardiovascular risk.
Derived industrially from resource stocks such as corn cobs and birch barks, sugar alcohols are considered ‘natural’ sweeteners.
What is the appropriate regulatory response? More specific labelling on products, thresholds, bans?
High time to dust off your Mintz and Sahlins collections and set to work on the historical, economic, and cultural trajectories of sweetness through late industrialism.
Witkowski, M., I. Nemet, X. S. Li, J. Wilcox, M. Ferrell, H. Alamri, N. Gupta, Z. Wang, W. H. W. Tang and S. L. Hazen (2024). “Xylitol is prothrombotic and associated with cardiovascular risk.” European Heart Journal: ehae244.
Sahlins, M. (1996). “The Sadness of Sweetness. The native Anthropology of Western Cosmology.” Current Anthropology 37(3): 395–428.
Mintz, S. W. (1986). Sweetness and power : the place of sugar in modern history. New York, Penguin Books.
Knowledge After Progress 
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