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Cardiovascular Risk FactorCOSETTENCT04731363

Consumption of Oral Artificial Sweeteners on Platelet Aggregation and Polyol Excretion

A study testing xylitol, 30g, erythritol, 30g and xylitol, 5g in people with Cardiovascular Risk Factor, run by The Cleveland Clinic at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The principal goal for the study is to examine whether ingestion of a beverage containing artificial sweeteners alters in vitro platelet aggregation. Because of the increasing number of cardiometabolic diseases, such as diabetes mellitus, in the population, the use of artificial sweeteners to replace free sugars has… Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
Conditions the study is for
Cardiovascular Risk Factor
What is being tested?
xylitol, 30g, erythritol, 30g and xylitol, 5g
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
50 participants
Where
1 siteUnited States
Study dates
10 Mar 2021to 1 Apr 2026
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Cohort 1 Inclusion Criteria:

  • Age 18 years or above.
  • Willing and able to sign the consent form.

Cohort 1 Exclusion Criteria:

  • Use of anti-platelet medications within 14 days of study enrollment.
  • Active infection or received antibiotics within 1 month of study enrollment.
  • Use of over-the-counter probiotic within 1 month of study enrollment.
  • Diabetes mellitus
  • Ulcerative colitis, Crohn's disease, or other chronic gastrointestinal disorder.
  • Past history of bariatric procedures or surgeries (e.g. gastric banding or bypass).
  • Pregnancy.
  • Significant chronic illness.

Cohort 2 Inclusion Criteria:

  • Men and women age 18 years or above.
  • Able to provide informed consent and comply with study protocol.
  • Diabetes Mellitus Type II

Cohort 2 Exclusion Criteria:

  • Use of anti-platelet medications within 14 days of study enrollment.
  • Active infection or received antibiotics within 1 month of study enrollment.
  • Use of over-the-counter probiotic within 1 month of study enrollment.
  • Ulcerative colitis, Crohn's disease, or other chronic gastrointestinal disorder.
  • Past history of bariatric procedures or surgeries (e.g. gastric banding or bypass).
  • Pregnancy.
  • Any condition that, in the judgment of the Investigator, would place a subject at undue risk by being enrolled in the trial or cause inability to comply with the trial.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Cleveland Clinic

    Cleveland, Ohio, 44195

Other trials in United States

About this study

The principal goal for the study is to examine whether ingestion of a beverage containing artificial sweeteners alters in vitro platelet aggregation.

Because of the increasing number of cardiometabolic diseases, such as diabetes mellitus, in the population, the use of artificial sweeteners to replace free sugars has been gaining popularity. Two popular artificial sweeteners are erythritol and xylitol. Erythritol and xylitol are both naturally occurring polyols found in fruits and vegetables. They are potent artificial sweeteners with a higher sweetening intensity and lower calorie content than table sugar.

Previous research has shown that the higher levels of sugar alcohols, like those used as artificial sweeteners, in the blood are related to a higher risk of cardiovascular complications, like heart attacks and strokes, and death. This may be because higher levels of sugar alcohols in one's blood may increase the activity of platelets, which would then increase the risk of heart attack and stroke. The investigators therefore want to find if consuming a single beverage that contains an artificial sweetener can raise the levels of sugar alcohols in the blood and if it can alter platelet function or aggregation.

Read the detailed description

The purpose of this study is to examine if drinking a single beverage that contains an artificial sweetener can perceptibly alter the activity of platelets in the body. Platelets are a component of blood that are primarily responsible for helping to stop bleeding and repair damaged blood vessels by grouping together, a process known as aggregation, to form clots.

Artificial sweeteners are popular because they have a lower calorie content than table sugar while still making food and beverages sweet. Their use as a sugar substitute is especially attractive for people with heart disease or diabetes, or for people who are trying to lose weight.

Two popular artificial sweeteners are erythritol and xylitol. Erythritol and xylitol are both naturally occurring polyols, also called sugar alcohols, found in fruits and vegetables. They are potent artificial sweeteners with a higher sweetening intensity and lower calorie content than table sugar.This makes them attractive for the use as sugar substitutes or alternatives, particularly for patients with type 2 diabetes.

Up to now, there is no prospective data available about polyols with respect to their impact on event outcomes in cardiovascular patients, despite their extensive use in the food industry. Moreover, little is known about plasma levels and metabolic changes following food intake of artificial sweeteners, in particular polyols.

The investigators have previously measured fasting levels of various polyols in a large clinical cohort of cardiovascular patients and found that some candidate polyols are related to a higher risk of cardiovascular complications and death. In vitro data using human platelets revealed that the polyols xylitol and erythritol at the levels observed in fasting patients induce platelet aggregation potential. The investigator's data shows that erythritol and xylitol impact platelet function and may, therefore, contribute to cardiovascular mortality.

In preliminary studies the investigators found that when ingesting either erythritol or xylitol, the levels of these sweeteners in the plasma rise within the first hour after consumption. With this study the investigators wish to examine whether the postprandial levels are capable of altering platelet function in vitro. The investigators hypothesize that postprandial polyol concentrations following ingestion increase platelet aggregation in the blood.

Being tested
xylitol, 30g, erythritol, 30g, xylitol, 5g, glucose, 30g
Keywords
xylitol, erythritol

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • xylitol, 30gDietary supplement

    Intervention is a drink consisting of 300mL of water containing 30g of xylitol as a single oral dose.

  • erythritol, 30gDietary supplement

    Intervention is a drink consisting of 300mL of water containing 30g of erythritol as a single oral dose.

  • xylitol, 5gDietary supplement

    Intervention is a drink consisting of 300mL of water containing 5g of xylitol as a single oral dose.

  • glucose, 30gDietary supplement

    Also called dextrose, 30g

    Intervention is a drink consisting of 300mL of water containing 30g of glucose (dextrose) as a single oral dose.

Study groups in NCT04731363
Study groupRoleWhat they receive
Xylitol, 30gExperimentaloral xylitol, a potent artificial sweetener
Receives: Dietary Supplement: xylitol, 30g
Erythritol, 30gExperimentaloral erythritol, a potent artificial sweetener
Receives: Dietary Supplement: erythritol, 30g
Xylitol, 5gExperimentaloral xylitol, a potent artificial sweetener
Receives: Dietary Supplement: xylitol, 5g
Glucose, 30gActive comparatororal glucose, delivered as dextrose
Receives: Dietary Supplement: glucose, 30g

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Platelet Aggregation After Polyol Ingestion

    Measuring platelet function 30 minutes after polyol ingestion, using established in vitro platelet assays. Platelet aggregation responses, based on changes in light transmission after adding different concentrations of the agonists ADP and TRAP6 are reported. A higher percentage of light transmission indicates an increased aggregation response, with maximum amplitude (100%) indicating total aggregation.

    Measured: 30 minutes

  2. Change From Baseline in Platelet Aggregation at 30 Minutes Post Polyol Ingestion

    Measuring changes in platelet function before versus after xylitol or erythritol ingestion, using established in vitro platelet assays. Platelet aggregation responses, based on changes in light transmission after adding different concentrations of the agonists ADP and TRAP6 are reported. A higher percentage of light transmission indicates an increased aggregation response, with maximum amplitude (100%) indicating total aggregation.

    Measured: Baseline and 30 minutes post ingestion of polyol intervention

  3. Plasma Polyol Levels After Polyol Ingestion

    Measuring plasma levels (uM) of polyols (xylitol or erythritol) 30 minutes after xylitol or erythritol ingestion, using established techniques by mass spectrometry. Xylitol was measured, and is reported below, in the two xylitol intervention arms and erythritol was measured, and is reported below, in the erythritol and glucose intervention arms.

    Measured: 30 minutes

  4. Change From Baseline in Plasma Polyol Levels at 30 Minutes Post Polyol Ingestion

    Measuring changes in levels of plasma polyols before versus after xylitol or erythritol ingestion, using established techniques by mass spectrometry. Xylitol concentrations are reported in the two xylitol intervention arms. Erythritol concentrations are reported in the erythritol and glucose intervention arms.

    Measured: Baseline and 30 minutes post ingestion of polyol intervention

  5. Urinary Polyol Levels After Polyol Ingestion

    Measuring the urinary levels of polyols (xylitol or erythritol) 30 minutes after xylitol or erythritol ingestion, using established techniques by mass spectrometry. Xylitol was measured, and is reported below, in the two xylitol intervention arms and erythritol was measured, and is reported below, in the erythritol and glucose intervention arms.

    Measured: 30 minutes

  6. Change From Baseline in Urinary Polyol Levels at 30 Minutes Post Polyol Ingestion

    Measuring changes in levels of urinary polyols before versus after xylitol or erythritol ingestion, using established techniques by mass spectrometry. Xylitol was measured, and is reported below, in the two xylitol intervention arms and erythritol was measured, and is reported below, in the erythritol and glucose intervention arms.

    Measured: Baseline and 30 minutes post ingestion of polyol intervention

Secondary outcomes (1)
  1. Change From Baseline in Plasma Lipid Profile at 1 Day Post Polyol Ingestion

    Measuring changes in lipid levels as markers of changes in metabolism before versus after xylitol or erythritol ingestion.

    Measured: Baseline and 1 day post ingestion of polyol intervention

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted1 Feb 2021
  2. Study start10 Mar 2021
  3. Primary completion30 Aug 2023
  4. Study completion1 Apr 2026

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Non-randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
50 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04731363
Sponsor's protocol ID
21-005
Acronym
COSETTE
Status last verified
Jun 2026
First submitted
25 Jan 2021
Last updated
13 Jul 2026
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Makinen KK. Gastrointestinal Disturbances Associated with the Consumption of Sugar Alcohols with Special Consideration of Xylitol: Scientific Review and Instructions for Dentists and Other Health-Care Professionals. Int J Dent. 2016;2016:5967907. doi: 10.1155/2016/5967907. Epub 2016 Oct 20.

    PubMed 27840639
  • Oku T, Okazaki M. Laxative threshold of sugar alcohol erythritol in human subjects. Nutrition Research. 1996;16(4):577-89.

  • Witkowski M, Nemet I, Alamri H, Wilcox J, Gupta N, Nimer N, Haghikia A, Li XS, Wu Y, Saha PP, Demuth I, Konig M, Steinhagen-Thiessen E, Cajka T, Fiehn O, Landmesser U, Tang WHW, Hazen SL. The artificial sweetener erythritol and cardiovascular event risk. Nat Med. 2023 Mar;29(3):710-718. doi: 10.1038/s41591-023-02223-9. Epub 2023 Feb 27.

    PubMed 36849732
  • Witkowski M, Nemet I, Li XS, Wilcox J, Ferrell M, Alamri H, Gupta N, Wang Z, Tang WHW, Hazen SL. Xylitol is prothrombotic and associated with cardiovascular risk. Eur Heart J. 2024 Jul 12;45(27):2439-2452. doi: 10.1093/eurheartj/ehae244.

    PubMed 38842092
  • Witkowski M, Wilcox J, Province V, Wang Z, Nemet I, Tang WHW, Hazen SL. Ingestion of the Non-Nutritive Sweetener Erythritol, but Not Glucose, Enhances Platelet Reactivity and Thrombosis Potential in Healthy Volunteers-Brief Report. Arterioscler Thromb Vasc Biol. 2024 Sep;44(9):2136-2141. doi: 10.1161/ATVBAHA.124.321019. Epub 2024 Aug 8.

    PubMed 39114916

Questions about this trial

What is this clinical trial studying?

A study testing xylitol, 30g, erythritol, 30g and xylitol, 5g in people with Cardiovascular Risk Factor, run by The Cleveland Clinic at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 13 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 11 Jun 2025). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Platelet Aggregation After Polyol Ingestion (time frame: 30 minutes). The study lists 6 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04731363, which also lists 5 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Jul 2026.

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