Xylitol, widely used in chewing gum, toothpaste, sugar-free drinks and diet snacks for its reputation as a cavity fighter, may carry cardiovascular risks. People with high blood levels of xylitol were 57% more likely to suffer a heart attack or stroke, or to die, within six years than those with low levels, according to new research.
High Blood Xylitol Tied to 57% Greater Cardiovascular Risk Within Six Years
A research team led by Dr. Marco Witkowski of Charité — Universitätsmedizin Berlin presented the findings at the annual congress of the European Society of Cardiology (ESC) in Germany, analyzing the link between blood xylitol concentrations and cardiovascular disease, according to the New York Post and other outlets.
The team examined data on 17,710 adults enrolled in the Canadian Longitudinal Study on Aging (CLSA) and the European Prospective Investigation into Cancer and Nutrition study in Britain (EPIC-Norfolk). Researchers classified heart attacks, strokes and deaths as major cardiovascular events and looked at whether the risk varied by blood xylitol concentration.
In the Canadian study, which tracked participants for six years, the group with the highest blood xylitol concentrations faced a 57% higher risk of a major cardiovascular event than the group with the lowest. The British study, which followed participants for 30 years, found an 18% higher risk in the high-concentration group.
The association held even after accounting for established cardiovascular risk factors including age, sex, body mass index, smoking, high blood pressure, diabetes and blood lipid levels.
Does Xylitol Promote Blood Clots? Earlier Experiment Found a Possible Link
Researchers are focusing on the finding because xylitol may increase platelet reactivity and promote the formation of blood clots.
In an earlier study published in 2024, the team had 10 healthy adults drink a beverage containing xylitol and then observed changes in their blood. Platelet reactivity rose along with blood xylitol concentrations.
Platelets clump together to stop bleeding when a wound occurs, but excessive activation can allow clots to form inside blood vessels. Such clots can block vessels and lead to a heart attack or stroke.
Xylitol is a sugar alcohol that delivers a sweetness similar to sugar with fewer calories. It is widely used in sugar-free gum, candy, beverages and diet foods, as well as in oral care products such as toothpaste. Small amounts are also produced during the body's glucose metabolism, and it occurs naturally in some foods.
Eating Xylitol Does Not Mean a Heart Attack, and More Research Is Needed
The researchers and other experts said the findings should not be read as evidence that consuming xylitol causes heart attacks or strokes. The study was observational and analyzed the association between cardiovascular events and blood concentrations of xylitol, not how much xylitol participants consumed.
Xylitol is not only ingested through food but also produced naturally in the body. A high blood concentration therefore does not establish that a participant consumed large amounts of xylitol-containing foods, and the study alone does not prove that xylitol directly caused cardiovascular disease.
Witkowski said much remains unknown about the cardiovascular safety of xylitol, adding that further research is needed as the amount of xylitol used in products increases.
Tracy Parker, a senior dietitian at the British Heart Foundation (BHF), also stressed that the findings do not mean people should return to consuming large amounts of sugar instead of xylitol. Rather than labeling either sugar or a sweetener as the healthy choice, she said, what matters is avoiding overconsumption of processed foods simply because they are sugar-free and reducing overall sugar intake.
