Xylitol linked to 57% higher heart attack risk, study finds

A widely used sugar substitute found in chewing gum, toothpaste, and low-calorie snacks may carry hidden cardiovascular risks, according to new research presented at the European Society of Cardiology Congress 2026 in Munich. The study found that people with the highest blood levels of xylitol faced a 57% greater risk of heart attack, stroke, or cardiovascular death over six years compared to those with the lowest levels.medicalnewstoday+1

The findings, from a team led by Dr. Marco Witkowski of Charité University Hospital in Berlin, analyzed data from 17,710 participants across two large observational studies: the Canadian Longitudinal Study on Aging and the European Prospective Investigation into Cancer-Norfolk cohort.medscape+1

A Dose-Response Pattern Across Two Cohorts

In the Canadian cohort, tracked over six years, participants in the highest quartile of blood xylitol had a 57% higher risk of a major adverse cardiovascular event. The EPIC-Norfolk cohort, followed for 30 years, showed an 18% higher risk among those with the highest xylitol levels. Both cohorts suggested a dose-response relationship: as xylitol levels rose, so did the rate of cardiovascular events, even after adjusting for age, sex, smoking, diabetes, hypertension, and cholesterol.sedaily+2

The results build on earlier work by Witkowski's team. A 2024 study found that in a small trial of 10 healthy volunteers, consuming a xylitol-sweetened drink increased platelet reactivity, a possible mechanism by which xylitol could promote blood clots that lead to heart attacks or strokes.yahoo+1

Caution, Not Panic

Experts stressed that the observational design means the study cannot prove xylitol causes cardiovascular events. Elevated blood xylitol may reflect metabolic processes rather than dietary intake alone, since the body produces small amounts of xylitol naturally. The research has also not yet been peer-reviewed.health+1

Stanley Hazen, chair of the Department of Heart, Blood & Kidney Research at the Cleveland Clinic, who was not involved in the study, told Medical News Today he is now recommending patients avoid sugar alcohols like xylitol and erythritol, "especially those with cardiovascular disease or higher risk".medicalnewstoday

Dan Atar, a member of the ESC Communications Committee, said in a press release that while "causal inferences cannot be made," the findings "clearly support the need for further study in an area of major public health importance".medscape

The Bigger Picture on Sweeteners

Tracy Parker, a senior dietitian at the British Heart Foundation, cautioned against swinging back toward heavy sugar consumption, emphasizing that the priority should be reducing overall intake of processed foods. Boris Hansel, an endocrinologist at Bichat Hospital in Paris, echoed that sentiment: "Between sugar and sweeteners, which is worse? We must not give the public the impression that sugar is no more harmful than sweeteners".sedaily+1

As Witkowski concluded, "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".medscape+1