Many people choose xylitol instead of sugar because it has fewer calories and has little effect on blood sugar. It is commonly found in sugar-free gum, candies, toothpaste, mouthwash, baked goods, and other low-sugar products. However, new research suggests there may be more to learn about how this popular sweetener affects heart health. While the findings do not prove that xylitol causes heart attacks or strokes, they raise important questions that researchers say deserve further study.
What Is Xylitol?
Xylitol is a type of sweetener known as a sugar alcohol. It tastes similar to sugar but contains fewer calories and has a much smaller effect on blood sugar levels.
It is commonly found in:
- Sugar-free gum
- Sugar-free candies
- Toothpaste and mouthwash
- Protein bars
- Baked goods
- Some low-sugar foods and drinks
Small amounts of xylitol occur naturally in some fruits and vegetables, and the body also produces tiny amounts during normal metabolism. However, processed foods often contain much larger amounts.
What Did the Research Find?
Researchers analyzed health information from 17,710 adults in two large long-term population studies conducted in North America and Europe.
They found that:
- People with the highest blood levels of xylitol had a greater risk of heart attack, stroke, or death from cardiovascular disease than those with the lowest levels.
- In one study, participants with the highest xylitol levels had a 57% higher risk of a major cardiovascular event over six years.
- In another study, the risk remained 18% higher over 30 years.
- The higher the blood level of xylitol, the greater the cardiovascular risk appeared to be.
- The association remained even after accounting for age, sex, smoking, diabetes, high blood pressure, cholesterol levels, and body weight.
Why Might Xylitol Increase Cardiovascular Risk?
The new findings build on earlier research that explored how xylitol affects the body.
Researchers found that xylitol can make platelets more active. Platelets are small blood cells that help stop bleeding by forming clots. While clotting is essential after an injury, platelets that become too active may increase the risk of harmful clots that can lead to a heart attack or stroke.
In a study of healthy volunteers, drinking a beverage sweetened with xylitol caused blood xylitol levels to rise rapidly. Shortly afterward, platelets became more likely to stick together and form clots. Laboratory and animal studies showed similar effects, providing a possible explanation for the increased cardiovascular risk seen in the larger population studies.
What Does This Mean for People Who Use Xylitol?
These findings are important, but they should be interpreted carefully.
This research shows an association, not proof that xylitol directly causes cardiovascular disease. More studies are needed before health experts can determine whether xylitol itself is responsible for the increased risk.
For now:
- There is no recommendation for everyone to completely avoid xylitol.
- More long-term research is needed to confirm these findings.
- People with heart disease or several cardiovascular risk factors may want to discuss their use of sugar substitutes with their healthcare provider.
- Choosing a diet based mainly on whole, minimally processed foods remains one of the best ways to support heart health.
What This Means for You
Xylitol has long been viewed as a healthier alternative to sugar, especially for people trying to reduce calories or manage blood sugar. These new studies suggest that scientists still have more to learn about its long-term effects on the heart.
Until more evidence is available, there is no need to panic or immediately eliminate every product containing xylitol. Instead, focus on proven ways to protect your heart, including eating a balanced diet, staying physically active, managing blood pressure and cholesterol, avoiding smoking, and following your healthcare provider’s advice. Future research will help determine whether recommendations for xylitol should change.
Source
- Zheng TM, Nemet I, Koeth RA, et al. The association of Xylitol and incident cardiovascular events: the CLSA and EPIC-Norfolk cohort studies. Presented at ESC Congress 2026. Accessed by: https://www.escardio.org/news/press/press-releases/xylitol-may-increase-the-risk-of-cardiovascular-events/.
- Witkowski M, Nemet I, Li XS, et al. Xylitol is prothrombotic and associated with cardiovascular risk. Eur Heart J. 2024;45:2439-2452. Accessed by: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11295463/.
