Xylitol is found in sugar-free gum, candy, oral care products, and many sweetened foods. Now it is back under the lens of cardiologists: higher levels in the blood were associated with a greater risk of heart attack, stroke and death in a study conducted on 17,710 people and presented at the ESC Congress 2026 in Munich.
Researchers at the Charité in Berlin analyzed two large populations followed over time, one Canadian and one British. In both, those with the highest xylitol concentrations had more major cardiovascular events than those in the lowest range. And the signal was not small: in the Canadian cohort the relative risk was 57% higher.
The more xylitol in the blood, the more cardiovascular events
The analysis used data from Canadian Longitudinal Study on Aging and of theEuropean Prospective Investigation into Cancer – Norfolk. Overall we are talking about 17,710 participants.
In the Canadian sample, followed for six years, people in the quartile with the highest xylitol levels had a 57% greater risk of death, heart attack or stroke than those in the lowest quartile. The result took into account factors such as age, sex, smoking, diabetes, hypertension and lipid levels.
In the British EPIC-Norfolk cohort, where the observation period extended to 30 years, the relative increase in risk was 18%. Also looking at the intermediate groups, the researchers also observed a progressive trend: as the levels of xylitol in the blood increased, the cardiovascular events recorded also increased.
The association, reports the European Society of Cardiology, remained visible even considering baseline characteristics such as age, sex, body mass index, hypertension, diabetes and lipid levels.
The study is observational and therefore does not prove on its own that xylitol causes heart attacks or strokes. However, there is a detail that makes the result more interesting than a simple statistical correlation: the same research group had already found experimental clues of a possible effect on coagulation.
By 2024, researchers had already observed an effect on platelets
In 2024 Marco Witkowski and colleagues had published onEuropean Heart Journal a study that combined analyzes on patients, experiments on human blood, animal models and a small test conducted on volunteers.
The result had attracted attention especially for the behavior of platelets, the cells involved in the formation of clots. In the laboratory, xylitol increased various indicators of their reactivity and in experimental models it favored the formation of thrombi.
The researchers then asked ten healthy volunteers to drink a drink containing 30 grams of xylitol, a quantity compatible with that present in some heavily sweetened products. After intake, both xylitol levels in plasma and various parameters linked to platelet activation increased rapidly.
The new work of 2026 therefore shifts the focus to a much larger population and, above all, to the long duration, as Witkowski explained when presenting the data:
Our findings highlight how little we know about the cardiovascular safety of xylitol.
From sugar-free gum to “low carb” products
Xylitol is a polyol, that is, a sugar alcohol. It exists naturally in the body as a product of glucose metabolism and is also found in very small quantities in some foods. In industrial products, however, it is added in much higher concentrations to replace sugar.
It has a similar sweetness to sucrose and is used in chewing gum, candies, drinks, reduced-sugar products and oral hygiene items. It has also become particularly popular in the product market low carb And keto.
And it is precisely the growth in its use that has sparked the interest of researchers. For years, the focus on sugar substitutes has been primarily on calories, blood sugar and teeth. The cardiovascular system, evidently, still has something to add to the conversation.
The new study does not yet deliver a ruling on xylitol, but it adds two large cohorts and up to thirty years of observation to a signal that had already appeared in previous studies. For an ingredient that has found its way into gum, candy and “sugar-free” products with great ease, it’s enough to deserve some extra attention.
