Xylitol Linked to Higher Heart Attack and Stroke Risk in New Study
New research involving more than 17,000 people has linked higher blood levels of xylitol with an increased risk of heart attack, stroke, and cardiovascular death. Here is what the findings mean.
For years, xylitol has been marketed as a convenient alternative to sugar. The sugar alcohol is found in many sugar-free chewing gums, candies, beverages, baked goods, and oral care products. Because it contains fewer calories than sugar and does not raise blood glucose in the same way, many consumers have viewed it as a healthier option.
Now, new research is raising questions about whether high levels of xylitol may have unintended effects on cardiovascular health.
Researchers studying more than 17,700 adults found that people with the highest concentrations of xylitol in their blood had a greater risk of experiencing serious cardiovascular events than those with the lowest concentrations. The findings add to earlier research that identified a possible connection between xylitol, blood clotting, heart attacks, and strokes.
Importantly, the findings do not prove that eating xylitol causes heart attacks or strokes. Researchers say additional studies are needed to determine whether xylitol itself contributes to cardiovascular disease or whether elevated blood levels are a marker of other factors associated with risk.
What Is Xylitol?
Xylitol is a type of sugar alcohol, also known as a polyol. It occurs naturally in very small amounts and is also produced by the human body during normal glucose metabolism.
Manufacturers add xylitol to products because it provides sweetness with fewer calories than ordinary table sugar. It is particularly common in sugar-free chewing gum and oral care products because it does not promote tooth decay in the same way as conventional sugar.
However, the amount consumed through some manufactured products can be substantially higher than the small amounts naturally present in food or produced by the body. The European Society of Cardiology notes that commercially added xylitol can occur at concentrations more than 1,000 times higher than naturally occurring levels.
That difference in exposure is one reason researchers are interested in understanding how the body responds when people consume larger quantities.
New Research Examines More Than 17,000 People
The latest analysis included 17,710 participants from two long-term population studies, one based in Canada and another in Britain.
Researchers examined blood concentrations of xylitol and then looked at cardiovascular outcomes over extended periods. In the Canadian group, participants whose xylitol levels were in the highest quarter had a 57 percent higher risk of a major cardiovascular event over approximately six years compared with people in the lowest quarter.
The British participants were followed for much longer, with cardiovascular outcomes examined over a period of up to 30 years. In that analysis, people with the highest xylitol concentrations had an 18 percent higher risk of death, heart attack, or stroke compared with those with the lowest concentrations.
Researchers also reported that cardiovascular event rates generally increased as blood xylitol concentrations increased.
The study was presented at the 2026 Congress of the European Society of Cardiology in Munich.
Why Might Xylitol Affect Blood Clotting?
One of the most important questions is how xylitol could potentially influence cardiovascular health.
Researchers behind the new work have previously investigated the relationship between xylitol and platelets. Platelets are tiny blood components that play an essential role in stopping bleeding. When a blood vessel is damaged, platelets become activated and help form a clot.
The problem occurs when excessive clotting takes place inside an artery. A blood clot can block blood flow to the heart or brain, potentially causing a heart attack or stroke.
A 2024 peer-reviewed study led by researchers including Marco Witkowski found that higher circulating xylitol levels were associated with an increased risk of major adverse cardiovascular events. The study involved a discovery cohort of 1,157 people and a separate validation cohort of 2,149 people.
Laboratory experiments provided another piece of the puzzle. Researchers found that xylitol increased several measures of platelet reactivity and increased the potential for thrombosis, or abnormal blood clot formation, in experimental models.
What Happened After People Consumed Xylitol?
The 2024 research also included a small intervention involving 10 healthy volunteers.
Participants consumed a xylitol-sweetened drink. Researchers found that blood levels of xylitol increased dramatically, reaching approximately 1,000 times their initial levels within about 30 minutes. The concentrations later returned toward normal within several hours.
During the period when xylitol levels were elevated, researchers observed increased platelet responsiveness.
This experiment was very small, so it cannot establish that xylitol consumption causes cardiovascular disease. However, it provided researchers with a possible biological mechanism that may help explain the associations observed in larger studies.
Does This Mean You Should Stop Using Xylitol?
Not necessarily.
The latest findings should be interpreted carefully. An association between higher blood xylitol levels and cardiovascular events does not automatically mean that consuming xylitol causes those events.
Observational studies can identify patterns, but they cannot by themselves establish cause and effect. People with higher xylitol levels may differ from people with lower levels in other ways that influence cardiovascular risk.
The researchers themselves have emphasized the need for additional studies into the long-term cardiovascular safety of xylitol and other sugar substitutes.
The National Heart, Lung, and Blood Institute has similarly noted that the earlier evidence does not mean consumers should completely avoid products such as toothpaste containing xylitol. Instead, the findings highlight an area where more research is needed.
A Bigger Question About Sugar Substitutes
The discussion surrounding xylitol is part of a broader scientific debate about sugar substitutes.
Many people turn to low-calorie sweeteners because they want to reduce their intake of added sugar. For individuals trying to manage calorie intake or blood glucose, replacing large amounts of added sugar may seem like an obvious strategy.
But scientists are increasingly interested in what happens after these substances enter the body.
Xylitol is especially interesting because the body naturally produces it, yet consumption through certain processed products can expose people to much higher levels. Researchers are now asking whether repeated exposure to these higher concentrations could have effects that were not previously recognized.
That does not mean sugar is suddenly a better choice. Excessive added sugar is associated with a range of established health concerns, including obesity and metabolic disease. Instead, the emerging research suggests that replacing sugar with another ingredient does not automatically make a food healthy.
What Consumers Can Do Now
For most people, the most practical approach is to avoid focusing on a single ingredient and instead look at the overall quality of the diet.
Eating more whole foods, including vegetables, fruits, legumes, whole grains, nuts, and other minimally processed foods, can reduce reliance on highly processed products that often contain added sweeteners.
Consumers who regularly use xylitol can also check ingredient labels and become familiar with how frequently it appears in their favorite sugar-free products.
People with cardiovascular disease or significant cardiovascular risk factors may want to discuss their individual diet and sweetener use with a qualified health professional rather than making major dietary changes based on a single study.
The Bottom Line
New research has added to growing questions about the long-term cardiovascular effects of xylitol.
In a large analysis involving more than 17,000 people, higher blood concentrations of xylitol were associated with increased risks of major cardiovascular events. The findings build on a 2024 study in which researchers observed an association between higher xylitol levels and cardiovascular events, along with laboratory evidence suggesting that xylitol can increase platelet activity and clotting potential.
However, it is too early to conclude that xylitol directly causes heart attacks or strokes.
For now, the research is best viewed as a warning signal rather than a final verdict. As sugar substitutes become increasingly common in foods, drinks, and oral care products, understanding their long-term effects will be important.
Consumers should not panic, but they should also remember that "sugar-free" does not necessarily mean "risk-free." A balanced diet based largely on minimally processed foods remains a sensible foundation for cardiovascular health.
Sources
- European Society of Cardiology, "Xylitol may increase the risk of cardiovascular events," Aug. 26, 2026.
- Witkowski M, et al., "Xylitol is prothrombotic and associated with cardiovascular risk," European Heart Journal, 2024.
- National Institutes of Health, "Xylitol may affect cardiovascular health," June 25, 2024.
- National Heart, Lung, and Blood Institute, "Common sweetener linked to potential cardiovascular risks."
Disclaimer
This article is for informational and educational purposes only and does not constitute medical advice. The research discussed here does not establish that xylitol causes heart attacks, strokes, or other cardiovascular events. Individual health risks vary. Readers should consult a qualified doctor or other healthcare professional before making significant changes to their diet, especially if they have heart disease, diabetes, or other medical conditions.