Xylitol is a popular sugar substitute and a naturally occurring alcohol in the body and in some foods. And many people may think it’s healthy, because it has zero sugar, is low in calories, and it’s marketed as an alternative to more conventional artificial sweeteners that contain saccharin, aspartame, and sucralose, which may be linked to cancer (although the verdict remains inconclusive).
Because it has an extra-sweet taste and negligible effects on blood sugar levels and insulin, xylitol is now widely used in many sugar-free sodas and foods, baked goods, gums, toothpaste, and mouthwash.
However, despite its growing use, the long-term impact of xylitol on heart health and cardiovascular risk has not been widely studied. But a new study from the European Society of Cardiology (ESC) has found a potential link between the sweetener and cardiovascular disease.
Researchers in Germany conducted a long-term analysis of the effects of xylitol on the general population, looking at data from 17,710 participants in two prospective observational cohorts: the Canadian Longitudinal Study on Aging and the European Prospective Investigation Into Cancer in Norfolk, U.K.
The results: People with the highest levels of xylitol in their blood had significantly higher rates of adverse cardiovascular events (defined as myocardial infarction, stroke, or death) than those with lower levels. And over a follow-up period of six years, the risk was 57% higher in those with the highest levels versus the lowest levels, after correcting for risk factors such as age, sex, smoking status, lipid levels, diabetes, and hypertension.
“In previous studies, we showed that xylitol can enhance the ability of platelets to form clots,” lead author Dr. Marco Witkowski, a cardiologist at Charité University Hospital in Berlin, said in a news release. “We also found that high blood levels of xylitol were linked to cardiovascular events in high-risk individuals over a three-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 is being presented at the ESC Congress 2026, a major cardiology conference currently in session in Munich.