Xylitol Sweetener Linked to Higher Heart Attack and Stroke Risk

A large study links high blood xylitol levels to a 57% higher risk of heart attack or stroke over six years.

High blood levels of xylitol — a sugar alcohol sweetener used in chewing gum, jam, toothpaste, yoghurts and ice-cream — were associated with an increased risk of major adverse cardiovascular events, including heart attack, stroke and cardiovascular death. In the largest study of its kind, researchers analysed data from 17,710 people in the Canadian Longitudinal Study on Aging and the European Prospective Investigation into Cancer-Norfolk, comparing the quarter with the highest blood xylitol levels against the quarter with the lowest. The findings were presented at the European Society of Cardiology annual congress in Munich.

Within a six-year follow-up, people in the highest xylitol quartile were 57% more likely to die or suffer a heart attack or stroke than those with the lowest levels. When the timeframe stretched to 30 years in the European cohort, the elevated risk was still 18%. The Guardian reports that data from the middle quartiles suggested a dose-dependent relationship: the higher the blood xylitol level, the higher the cardiovascular event rate. FOX 32 Chicago reports the six-year figure was reached after correcting for known risk factors such as age, sex, smoking status, diabetes and hypertension.

Xylitol occurs naturally in some foods in very low amounts, but is added to products — often in amounts 1,000 times higher — as a low-calorie sugar substitute, and regulatory agencies generally regard it as safe. Lead author Dr Marco Witkowski of Berlin's Charité university hospital said artificial sweeteners are consumed by people who think they are healthier than sugar, yet 'our long-term findings in the general population highlight how little we know about the cardiovascular safety of xylitol.' Geo News reports this is the first time researchers have studied the long-term health outcomes of these sweeteners, despite their ever-increasing use.

The association held consistently across subgroups such as age and sex, and was independent of underlying factors including body mass index, hypertension, diabetes and lipid levels — conditions that might otherwise predispose people to choose low-calorie products. According to The Guardian, Dr Witkowski said previous work showed xylitol can enhance the ability of platelets to form clots, and that high blood levels were already linked to adverse heart events in high-risk people over a three-year period. The new study extended that work to a much larger sample of the general population over far longer follow-up.

This was an observational study, so it can show only an association between higher xylitol levels and cardiovascular events, not prove xylitol directly caused them. Prof Dan Atar, an ESC communication committee member not involved in the research, said causality is difficult to infer in observational work but that further studies are mandated into this societally important topic. According to The Guardian, British Heart Foundation senior dietitian Dell Stanford warned that people may assume sweeteners are the healthier choice and consume more than they realise — while stressing it is 'not a green light' to switch to more sugar, since free sugar intake still needs to fall.

Researchers say further studies are warranted, especially as the amount of xylitol in products continues to increase. Dr Witkowski's team built this analysis on earlier findings in high-risk individuals, and the general-population results were presented at the ESC Congress 2026, the world's largest heart conference. The practical takeaway from the British Heart Foundation, per The Guardian, is a reminder to reduce intake of processed foods and drinks that are often high in sugar, salt or sweeteners and to focus on a balanced diet to help protect the heart, rather than simply swapping sugar for more sweetener.