Xylitol, a sugar alcohol added to foods, beverages and oral care products as a sweetener, has been linked to an increased risk of stroke and heart attack, a new study has found.

The sweetener is commonly found in products such as chewing gum, toothpaste, jam, yoghurt and ice cream.

This was revealed in a press release published by the European Society of Cardiology (ESC) ahead of their annual congress in Munich, Germany, which runs from 28 to 31 August.

Researchers found that people with higher levels of xylitol in their blood had a greater risk of major cardiovascular events – defined as death, heart attack or stroke, compared with those with the lowest levels.

According to the ESC, the study examined data from 17,710 participants in two prospective observational studies: the Canadian Longitudinal Study on Ageing and the European Prospective Investigation into Cancer-Norfolk.

Over six years of follow-up in the Canadian study, the risk of a major cardiovascular event was 57 per cent higher among participants with the highest xylitol levels, while the risk was 18 per cent higher over 30 years in the European study.

“Taken together with data from the middle quartiles, the results from both cohorts suggested a dose-dependent relationship: the higher the xylitol blood levels, the higher the cardiovascular event rate,” it noted.

What is xylitol?

Xylitol is a sugar alcohol that occurs naturally in the body as a byproduct of glucose metabolism and is present in some natural foods in very small amounts.

It is also added to foods, beverages and oral care products as a sweetener, sometimes in amounts more than 1,000 times higher than naturally occurring levels, according to the ESC.

Marco Witkowski of Charite University Hospital, Berlin, Germany, who is presenting the research, said previous studies had shown that xylitol could enhance the ability of blood platelets to form clots.

“Artificial sweeteners are consumed by people who think they are healthier than sugar and they are generally regarded as safe by regulatory agencies,” Mr Witkowski was quoted to have said.

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He said the long-term findings highlighted “how little we know about the cardiovascular safety of xylitol” and indicated that further studies were needed, particularly as the amount of xylitol used in products continues to increase.

Dan Atar, a member of the ESC Communication Committee, said the findings suggested a negative long-term effect of xylitol on cardiovascular events.

Mr Atar, however, cautioned that the study is observational.

“As with all observational studies, casualties are difficult to infer, but this work shows that further studies are mandated into this societally important topic,” he said.

Nigeria has recorded more than 65,000 suspected cases of cholera across 35 states and approximately 195 local government areas this year, according to the Nigeria Centre for Disease Control and Prevention (NCDC).

The NCDC Director-General, Jide Idris, disclosed this on Friday at a press briefing in Abuja, noting that weekly cholera cases had declined substantially from the peak recorded earlier in the year.

However, Mr Idris said the decline in cases should not be interpreted as the end of the outbreak.

“The encouraging news is that weekly cases have declined substantially from the peak recorded earlier in the season. The proportion of reported cases resulting in death is also considerably lower than it was at the same time last year,” he said.

“This is important progress. But I want to be very clear: the outbreak is not over.

Cholera transmission

Mr Idris said the country is still in the rainy season, when cholera transmission can increase because flooding may contaminate water sources and overwhelm sanitation systems.

He said one of the clearest lessons from the outbreak is the importance of early access to treatment, noting that people who seek care early have better outcomes.

“In Borno State, where the majority of this year’s cases have occurred, outcomes have been better where treatment has been brought closer to affected communities,” he said.

However, he said treatment alone could not end the outbreak. “But the data are telling us something equally important: while treatment saves lives, we cannot treat our way out of cholera.”

According to the NCDC boss, unsafe water, open defecation, damaged water distribution systems, poor hygiene infrastructure, and inadequate sanitation in schools, markets, and other public institutions remain among the underlying problems driving transmission.

He called on state and local governments to improve access to safe water and sanitation, strengthen water-quality monitoring, repair critical water infrastructure and address open defecation.

He also urged authorities to ensure that high-risk local government areas have functional treatment and rapid-response capacity.

Diphtheria

Mr Idris also disclosed that Nigeria has recorded more than 10,000 confirmed cases of diphtheria this year.

He said while the disease remains a substantial burden, the proportion of confirmed cases resulting in death has declined considerably compared with the same period last year.

He said most confirmed cases are concentrated in a few states, particularly Kano, Borno and Bauchi.

“The central issue is that too many children remain unvaccinated or incompletely vaccinated,” Mr Idris said.

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He identified vaccine hesitancy, insecurity, hard-to-reach communities, displacement, and population movement as factors that make it difficult to reach every child who needs protection.

He stressed that diphtheria is vaccine-preventable and called for improved vaccination coverage, particularly in affected, underserved and hard-to-reach communities.

NCDC response

The NCDC said it was coordinating the public health response to both outbreaks with state governments and partners, including strengthening surveillance and laboratory capacity, supporting healthcare workers and deploying National Rapid Response Teams to affected states.

For cholera, the response includes oral cholera vaccination in high-burden areas, water chlorination, rehabilitation of water sources and hygiene promotion.

The agency said its teams had investigated transmission sources and assessed water supply points in Borno, while in Bauchi, oral rehydration points had been established, treatment capacity strengthened, and active case search intensified.

For diphtheria, the response is focused on strengthening vaccination coverage and rapidly identifying and managing cases. Reactive vaccination is also being conducted in affected areas.

Mr Idris said the federal government’s efforts alone would not be enough to bring the outbreaks under control, urging state and local governments, healthcare workers, communities and families to sustain their response.

He also advised Nigerians to seek medical attention early if they develop frequent watery diarrhoea, with or without vomiting.

“Do not wait until the illness becomes severe,” he said, advising people to start oral rehydration solution immediately and proceed to the nearest health facility.

The NCDC also urged parents and caregivers to ensure that children who have missed recommended doses of the diphtheria vaccine complete their routine immunisation.