Xylitol in gum linked to higher stroke and heart attack risk
A major new study links high blood levels of xylitol sweetener to a higher risk of heart attacks, strokes, and death. Researchers who compared 17,710 people found those with the highest xylitol levels were 57% more likely to suffer major cardiovascular events within six years, though the observational data cannot prove direct causation.
The findings were presented at the European Society of Cardiology annual congress in Munich—the world's largest heart conference—and have renewed scrutiny of a sweetener found in everyday products from chewing gum to jam.
Key Takeaways
- High blood xylitol levels were associated with a 57% higher risk of death, heart attack, or stroke within six years in the largest study of its kind.
- Xylitol appears in chewing gum, toothpaste, jam, yoghurts, and ice cream—often at levels far higher than found naturally in food.
- Researchers observed a dose-dependent pattern: the more xylitol in the blood, the higher the cardiovascular event rate.
- The study was observational, so it shows association—not proof that xylitol directly causes heart problems.
- Experts say further research is warranted as xylitol use in processed products continues to grow.
What is xylitol and where is it found?
Xylitol is a sugar alcohol present in tiny amounts in some natural foods. It is also added to artificially sweeten foods, beverages, and oral care products—sometimes at levels roughly 1,000 times higher than those found in nature.
Despite its growing popularity among people seeking lower-calorie alternatives to sugar, the long-term cardiovascular effects of xylitol had never been widely studied until now. The sweetener sits alongside broader debates about how artificial additives shape health over decades, a theme we track in our Future Tech & AI Wonders coverage.
What did the largest xylitol study find?
Researchers led by Dr Marco Witkowski of Charité university hospital in Berlin examined 17,710 people, comparing the top 25% with the highest blood xylitol levels against the bottom 25% with the lowest.
Those with the highest levels were 57% more likely to die or suffer a heart attack or stroke within six years than those with the least. Even after 30 years, they remained 18% more likely to have experienced one of these cardiac events.
Results from middle quartiles pointed to a dose-dependent relationship: higher xylitol blood levels correlated with higher cardiovascular event rates. The association held regardless of age, sex, body mass index, hypertension, diabetes, or lipid levels—factors that might otherwise explain why someone chooses low-calorie products.
Why can't researchers prove xylitol causes heart attacks?
Because this was an observational study, it can only show a link between elevated xylitol and cardiovascular events—not that the sweetener directly caused them. Prof Dan Atar, an expert on the ESC communication committee who was not involved in the research, noted that causalities are difficult to infer from such data.
Previous work by Witkowski's team found that xylitol can enhance platelets' ability to form clots, and that high blood levels were linked to adverse heart events in high-risk people over three years. That mechanistic evidence adds context, but regulators and scientists agree more targeted studies are still needed.
What should consumers do about xylitol sweetener?
Dell Stanford, a senior dietitian at the British Heart Foundation, said risks to heart health build over time and cautioned that people may consume more xylitol than they realise because they assume artificially sweetened products are healthier.
She stressed this study is not a green light to switch back to sugar—free sugar intake still needs to come down. Instead, the takeaway is to reduce processed foods and drinks high in sugar, salt, or sweeteners and focus on a balanced diet. Witkowski urged further investigation as xylitol concentrations in commercial products continue to rise. Full details are available in the Guardian's report on the ESC presentation.