Xylitol, the sweetener found in chewing gum: ESC study links blood levels to risk of heart attack and stroke

Xylitol, a low-calorie sweetener used as a sugar alternative, has been associated with a higher risk of heart attack, stroke, and death, according to a study presented at the European Society of Cardiology (ESC) Congress 2026, held in Munich from 28 to 31 August 2026. The researchers note, however, that the findings show an association rather than proof that xylitol directly causes these problems.

The study analysed data from more than 17,700 participants from Canada and the United Kingdom, divided into two groups.

What the research found

The first group comprised participants in the Canadian Longitudinal Study on Aging (CLSA), a large-scale study examining the health of Canadian adults as they age. These participants were monitored for six years. Those with the highest blood xylitol levels had a 57% greater risk of death, heart attack, or stroke compared to those with low levels. The association held even after accounting for other known risk factors: age, sex, body mass index, hypertension, diabetes, and blood lipid levels.

The second group consisted of participants in the British European Prospective Investigation into Cancer (EPIC) study, followed for approximately 30 years. In this group, individuals with high blood xylitol levels had an 18% greater risk of major cardiovascular events.

The link to blood clot formation

These findings add to earlier research suggesting that xylitol may increase the ability of platelets to form blood clots.

Dr Marco Witkowski, from the Charité University Hospital in Berlin, who presented the study, explained: "Artificial sweeteners are consumed by people who believe they are healthier than sugar and are generally considered safe by regulatory authorities." According to the physician, the long-term results show that much remains unknown regarding the cardiovascular safety of xylitol, and that further research is needed, particularly given the growing use of this sweetener.

What is xylitol

Xylitol is a low-calorie sweetener used as a sugar alternative. It is found in certain foods and beverages, as well as in products such as chewing gum and some oral hygiene products. The substance does not come exclusively from diet — the human body can produce it naturally during glucose metabolism.

Cautions in interpreting the results

The researchers emphasise that the study is observational, meaning it demonstrates an association rather than a direct causal relationship between blood xylitol levels and cardiovascular risk. Furthermore, a high concentration of xylitol in the blood does not automatically indicate greater consumption of the sweetener, as the substance can also be produced naturally by the body.

The study's authors consider further research necessary to determine whether and to what extent xylitol consumption directly influences cardiovascular risk, as well as what the effects of its long-term use may be.