Xylitol Linked to Higher Heart Attack and Stroke Risk in New Study
New research involving more than 17,700 people has linked higher blood levels of xylitol with an increased risk of heart attack, stroke, or cardiovascular death. Here is what the findings mean.
A popular sugar substitute used in chewing gum, sweets, drinks, baked goods and oral care products is attracting renewed attention from cardiovascular researchers.
New research presented at the 2026 European Society of Cardiology Congress suggests that people with higher levels of xylitol in their blood may face a greater risk of major cardiovascular events, including heart attack, stroke and cardiovascular death.
The findings do not prove that eating or drinking xylitol directly causes heart attacks or strokes. However, researchers say the results add to earlier evidence suggesting that the sugar alcohol deserves closer examination, particularly as its use in low-sugar and reduced-calorie products continues to grow.
What is xylitol?
Xylitol is a type of sugar alcohol, sometimes called a polyol. It tastes sweet but generally provides fewer calories than conventional sugar, which has made it popular in products marketed as alternatives to ordinary sugar.
It can be found in sugar-free chewing gum, candies, certain baked products, beverages and some oral hygiene products.
Small amounts of xylitol can also occur naturally in foods, and the human body produces it as part of normal metabolism. The concern raised by researchers relates particularly to the much higher concentrations that can occur after consuming products containing added xylitol.
According to the National Institutes of Health, concentrations in artificially sweetened products can be more than 1,000 times higher than the amounts naturally present in foods.
New study involved more than 17,700 people
The latest research examined data from 17,710 participants enrolled in two large prospective observational studies, one based in Canada and the other in Britain.
Researchers compared participants with different concentrations of xylitol circulating in their blood.
In the Canadian cohort, people in the highest quarter for blood xylitol levels had a 57 percent higher risk of a major cardiovascular event over approximately six years compared with people in the lowest quarter.
The researchers also examined participants in the British cohort over a much longer period. During approximately 30 years of follow-up, those with the highest xylitol levels had an 18 percent higher risk of a major cardiovascular event compared with those with the lowest levels.
The cardiovascular outcomes included death, heart attack and stroke.
Researchers also reported a pattern in which cardiovascular event rates generally increased as blood xylitol concentrations increased. The European Society of Cardiology said the association remained after researchers accounted for several established cardiovascular risk factors.
Why might xylitol affect the cardiovascular system?
One possible explanation involves platelets, tiny blood components that play a central role in blood clotting.
When a blood vessel is damaged, platelets become activated and help form a clot. This is an essential protective process. However, excessive or inappropriate clot formation can contribute to serious conditions such as heart attacks and certain types of strokes.
Earlier research published in the European Heart Journal investigated whether xylitol could influence platelet activity.
In that 2024 study, researchers found that higher circulating xylitol levels were associated with an increased risk of major cardiovascular events among participants considered to have elevated cardiovascular risk. After statistical adjustment for conventional risk factors, people in the highest xylitol group had a significantly greater risk of cardiovascular events during three years of follow-up.
Laboratory experiments provided another piece of the puzzle. Researchers reported that exposure to xylitol increased platelet responsiveness to clotting signals and promoted clot formation in experimental models.
The research team also conducted a small human intervention study involving 10 healthy volunteers. After participants consumed a xylitol-containing drink, blood xylitol concentrations increased dramatically within about 30 minutes. Levels subsequently returned toward normal over several hours, while platelet responsiveness increased during the period when xylitol levels were elevated.
Does this mean xylitol causes heart attacks?
Not necessarily.
This distinction is particularly important when interpreting nutrition and health research.
The new population analysis found an association between higher blood xylitol concentrations and cardiovascular events. An association does not automatically establish a cause-and-effect relationship.
For example, people with certain underlying health conditions may be more likely to consume products containing sugar substitutes. Those underlying conditions could themselves influence cardiovascular risk.
Researchers attempted to account for several potential confounding factors, including age, sex, smoking, diabetes, blood pressure and cholesterol-related measures. Nevertheless, observational research cannot completely eliminate the possibility of other explanations.
The earlier 2024 research adds biological evidence because experiments suggested that xylitol can influence platelet activity. However, laboratory and animal findings also cannot establish that everyday consumption of xylitol causes heart attacks or strokes in humans.
That is why researchers are calling for additional studies.
What did earlier research find?
The 2024 study involved more than 3,000 people across its discovery and validation groups. Researchers found that participants with higher blood xylitol concentrations had a greater likelihood of experiencing a major cardiovascular event during follow-up.
The researchers then investigated potential mechanisms.
Their experiments suggested that xylitol could increase platelet reactivity and the potential for thrombosis, meaning the formation of blood clots inside blood vessels. The study was published in the European Heart Journal and is indexed by PubMed.
The National Institutes of Health described the findings as evidence that warranted additional research into the long-term cardiovascular effects of sugar alcohols and other low-calorie sweeteners.
Should consumers stop using xylitol?
The current evidence does not justify telling everyone to completely avoid xylitol.
Xylitol is present in a wide range of consumer products, including some toothpaste and oral care products. The NIH has previously emphasized that the findings do not mean people should automatically stop using products such as toothpaste simply because they contain xylitol.
Instead, the research highlights an unresolved question about the cardiovascular effects of consuming larger amounts of the sweetener.
People who regularly consume large quantities of sugar-free sweets, chewing gum, beverages or other products containing xylitol may want to discuss their overall dietary pattern with a healthcare professional, particularly if they already have cardiovascular risk factors.
It is also important to remember that replacing sugar with a sweetener is not automatically equivalent to following a heart-healthy diet. Overall dietary quality, physical activity, blood pressure, cholesterol, smoking status, sleep and other lifestyle factors all influence cardiovascular health.
The bigger question about sugar substitutes
Xylitol is not the only sugar substitute receiving scientific attention.
Researchers have increasingly been examining whether some low-calorie sweeteners and sugar alcohols may have biological effects that were previously underestimated.
That does not mean all sugar substitutes are harmful, nor does it mean that consuming ordinary sugar is necessarily safer. Excessive consumption of added sugar is itself associated with several health concerns.
Rather, the emerging research suggests that the long-term effects of frequently consuming concentrated sweeteners deserve careful study.
As products containing sugar substitutes become increasingly common, researchers need larger clinical studies to determine whether the associations observed in observational research represent genuine causal effects.
What should consumers take away?
The latest findings provide a reason for caution and further investigation, not panic.
Higher blood xylitol concentrations were associated with increased cardiovascular risk in two large population cohorts. Earlier laboratory and human experiments also suggested that xylitol may increase platelet responsiveness and promote conditions associated with blood clot formation.
However, the available evidence does not establish that consuming xylitol directly causes heart attacks or strokes.
For now, the most reasonable approach is to pay attention to how much of the sweetener is being consumed and to consider the broader nutritional quality of the diet.
The research community will need longer and more rigorous studies to determine whether reducing xylitol consumption actually lowers cardiovascular risk.
Sources
- European Society of Cardiology: Research update on xylitol and cardiovascular events.
- National Institutes of Health: Overview of research examining xylitol and cardiovascular health.
- PubMed: Xylitol is prothrombotic and associated with cardiovascular risk, published in the European Heart Journal.
- National Heart, Lung, and Blood Institute: Background on research into potential cardiovascular risks associated with xylitol.
Disclaimer
This article is provided for general informational and educational purposes only. It is not medical advice, a diagnosis, or a substitute for consultation with a qualified healthcare professional. The research discussed here shows associations and possible biological mechanisms, but it does not establish that xylitol consumption directly causes heart attacks or strokes. Anyone concerned about their cardiovascular health, diet, medications or use of sugar substitutes should speak with a doctor or other qualified healthcare professional before making significant dietary changes.