Xylitol, found in everything from chewing gum to frozen desserts, is also sold as tabletop sweetener.VadimZakirov/Getty Images
Xylitol, which belongs to the family of compounds known as sugar alcohols, is widely used as a sugar substitute. It’s often marketed as a sugar-free, keto-friendly, low-carb and natural sweetener.
Unlike sugar, xylitol doesn’t promote dental caries and has a relatively small effect on blood glucose levels.
It’s used to sweeten chewing gum, candies, mints, oral care products and a growing number of processed foods including keto- and low-carbohydrate muffins, cookies, cakes, baking mixes, jams and syrups, as well as frozen desserts. It’s also sold as tabletop sweetener.
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Despite the growing use of xylitol, its long-term impact on cardiovascular safety remains uncertain.
Now, a new study adds to emerging concerns that the common sweetener may harm cardiovascular health. Here’s what to know.
The latest research
While previous research has linked xylitol to cardiovascular harm in people already at high risk, the current study examined whether similar risks are seen in the broader population, among people with a wide range of health profiles.
The study, presented at the European Society of Cardiology’s Congress 2026 in Germany last month, examined the relationship between blood levels of xylitol and risk of major cardiovascular events, defined as a heart attack, stroke or cardiovascular death.
To do so, researchers from Canada, the United Kingdom and Germany analyzed data from 17,710 participants, with an average age of 61, who took part in two long-term observational studies: the Canadian Longitudinal Study on Aging (CLSA) and the European Prospective Investigation into Cancer (EPIC)-Norfolk.
During the follow-up period, which lasted six years in the CLSA and 30 years in EPIC-Norfolk, a total of 2,950 major cardiovascular events occurred in the CLSA and 5,670 events occurred in EPIC-Norfolk.
Higher blood levels of xylitol tied to greater risk of major cardiovascular event
In the CLSA, participants with the highest circulating levels of xylitol were 57 per cent more likely to experience a major cardiovascular event during the six-year follow up than those with the lowest levels.
In the EPIC-Norfolk study, participants with the highest xylitol levels had an 18 per cent greater risk of a major cardiovascular event than those with the lowest levels.
The results also suggested a dose-response relationship, meaning the higher the blood level of xylitol, the greater the risk of heart attack, stroke or cardiovascular death.
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To arrive at these conclusions, the researchers controlled for other factors that could influence the results including age, sex, body mass index, smoking status, blood cholesterol and the presence of hypertension or diabetes. In a separate analysis, they also accounted for participants’ diet quality and intake of artificial sweeteners, and the results remained the same.
Because this was an observational study, it can’t prove that higher xylitol blood levels directly caused a major cardiovascular event. Rather, it revealed an association between elevated xylitol levels and a greater risk of those events.
Even so, the new findings add to a growing body of evidence suggesting that sugar alcohols may not be as harmless as once thought.
What previous studies have found
A study published in June, 2024, in the European Heart Journal found that among 2,149 adults undergoing elective cardiac evaluation, those in the highest third of xylitol levels had a 57 per cent greater risk of a major cardiovascular event over three years compared to people in the lowest third.
This study also included laboratory experiments showing that xylitol accelerated platelet aggregation, the clumping together of platelets that helps form blood clots.
A blood clot that forms in an artery can block blood flow to the heart or brain, triggering a heart attack or stroke.
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As well, the researchers had 10 healthy volunteers drink water sweetened with a typical serving of xylitol. In every participant, platelet aggregation increased noticeably. The higher a volunteer’s blood xylitol level after consuming the drink, the greater the increase in platelet activity.
While this study didn’t prove that long-term xylitol consumption caused heart attacks and strokes, it identified a biologically plausible way in which the sweetener may harm cardiovascular health.
A 2023 study published in the journal Nature Medicine that investigated another sugar alcohol, erythritol, found that higher blood levels of erythritol were associated with a greater risk of heart attack and stroke.
Laboratory experiments in that study showed that erythritol, like xylitol, increased platelet aggregation and blood clot formation.
Erythritol is used to sweeten beverages, chewing gum, candies, bakery products, protein bars and other snack foods. It’s also blended with tabletop sweeteners such as stevia and monk fruit to add bulk and a sugarlike texture.
What to do?
Dr. Marco Witkowski, author of the xylitol study presented last month, said, “The new long-term findings in the general population highlight how little we know about the cardiovascular safety of xylitol and indicate that further studies are warranted.”
In the meantime, you may want to limit your intake of xylitol and other sugar alcohols by reading food labels. You’ll find them listed on the ingredient list and, in some cases, the Nutrition Facts table as “sugar alcohols” or “polyols.”
Reducing your intake of ultra-processed foods, many of which contain added sweeteners, can also help lower your consumption of sugar substitutes, not to mention added sugars.
Leslie Beck, a Toronto-based private practice dietitian, is director of food and nutrition at Medcan.