Health and Medicine
PUBLISHED
You might not instantly recognize the word “xylitol” – or, let’s face it, know how to pronounce it – but there’s a good chance you’ve consumed it.
It’s a sweetener that’s commonly added to products like sugar-free gum, mints, toothpaste, and sugar-free versions of foods like candy, ice cream, and baked goods.
If you’re a pet owner, you might be more aware of xylitol than most, because it’s toxic to dogs. For humans, however, it’s considered a safe food additive, and is also naturally found in trace amounts in some fruits and vegetables.
The most talked-about health risk for humans up to now has been stomach discomfort – check your gum packet for the warnings! – but many people can consume it in moderate amounts with no side effects at all.
However, a new study presented at a recent conference hints at more serious health impacts of xylitol, finding an association with higher xylitol consumption and an increased risk of stroke and heart attack.
“In previous studies, we showed that xylitol can enhance the ability of platelets to form clots,” said presenter Dr Marco Witkowski, from Charité University Hospital in Berlin, Germany, in a statement.
“We also found that high blood levels of xylitol were linked to cardiovascular events in high-risk individuals over a 3-year period. Here we studied if xylitol increases cardiovascular events in a larger sample of the general population over much longer follow-up.”
The study included 17,710 participants in two cohorts, one in Canada and one in the UK.
Those with the highest levels of xylitol consumption were found to be at the highest risk of a major adverse cardiac event, which is defined as death, myocardial infarction (heart attack), or stroke.
This trend persisted even when the team accounted for characteristics like age, sex, BMI, and conditions like diabetes and high blood pressure.
After six years, the risk of heart attack and stroke was observed to be 57 percent higher for those with xylitol consumption in the highest quartile versus the lowest quartile in the Canadian cohort.
In the UK cohort, after 30 years, it was 18 percent higher in those with the highest levels of consumption compared with the lowest.
Sweets for my sweet
Artificial sweeteners have certainly come under the microscope in the past. Previous studies have linked some of these products with an increased risk of cancer and faster brain aging, but other results have been conflicting.
Aspartame has come under more scrutiny than most. The US Food and Drug Administration (FDA) states that aspartame is “one of the most studied food additives in the human food supply,” and that it still considers it “generally safe”.
This is despite the fact that an assessment by various international bodies, including the World Health Organization and the International Agency for Research on Cancer, concluded in 2023 that aspartame is “possibly carcinogenic to humans”.
“It was classified as possibly carcinogenic (Group 2B) based on limited animal and limited human data. These are not strong opinions,” commented Cambridge University professor Andy Smith to the Science Media Centre at the time. “[The report] should not be a source of great concern.”
Professor Robin May, then chief scientific advisor to the UK Food Standards Agency, concurred with the FDA’s position that currently permitted levels of aspartame in food remained safe to consume.
That hasn’t stopped people being wary about sweetener consumption though, along with food additives in general – especially given the rise of widespread health fears associated with ultra-processed foods.
But there’s a reason why sweeteners were introduced into foods in the first place: as a replacement for sugar.
The American Heart Association, along with other charities, regulators, and health authorities around the world, recommends limiting the amount of added sugar in your diet, and sweeteners are one way of doing that.
A “societally important topic”
Witkowski said that the findings highlight gaps in our knowledge when it comes to xylitol and other sweeteners.
“Artificial sweeteners are consumed by people who think they are healthier than sugar and they are generally regarded as safe by regulatory agencies,” said Witkowski. “Our 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, especially as the amount of xylitol in products continues to increase.”
Professor Dan Atar, a cardiologist from the University of Oslo who sits on the European Society of Cardiology (ESC) Communication Committee, commented, “In this observational work [...] it appears that xylitol has a negative long-term effect on cardiovascular events in the general population.”
“As with all observational studies, causalities are difficult to infer, but this work shows that further studies are mandated into this societally important topic.”
The study was presented at the ESC Congress 2026 in Munich.
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