Xylitol is widely used as a sugar substitute in sugar-free foods, chewing gum, mints, and oral-care products. New research presented at the European Society of Cardiology’s ESC Congress 2026 is raising fresh questions about its cardiovascular safety.
New research found that higher blood xylitol levels were associated with a greater risk of major cardiovascular events, but the findings do not prove that consuming xylitol causes heart attacks or strokes.
Researchers examining 17,710 people across two large prospective cohorts found that those with the highest blood levels of xylitol had a greater risk of major cardiovascular events, including heart attack, stroke, and death, than people with the lowest levels.
In one cohort, the difference amounted to a 57% higher relative risk over six years after researchers adjusted for established cardiovascular risk factors. In the second cohort, followed for 30 years, the highest xylitol group had an 18% higher risk.
But there is an important distinction: the researchers measured xylitol circulating in the blood, not how much xylitol participants consumed.
Because the human body can produce xylitol naturally, the findings cannot establish that eating xylitol-containing foods or chewing xylitol gum causes heart attacks or strokes.
Key Takeaways
- The new research included 17,710 participants from two prospective population cohorts.
- Higher blood xylitol levels were associated with a greater risk of major cardiovascular events.
- In the Canadian cohort, people in the highest xylitol quartile had a 57% higher adjusted relative risk than those in the lowest quartile over six years.
- In the EPIC-Norfolk cohort, the corresponding increase was 18% over 30 years.
- The research is observational and does not prove xylitol caused the cardiovascular events.
- Blood xylitol is not the same as measured dietary xylitol consumption.
- Earlier peer-reviewed research found that xylitol can increase platelet responsiveness under experimental conditions.
- More research is needed before determining whether typical long-term xylitol consumption increases cardiovascular risk.
What Did the New Xylitol Study Find?
The new findings were presented by Dr. Marco Witkowski of Charité University Hospital in Berlin at ESC Congress 2026 on August 29. The analysis has not yet been published as a full peer-reviewed journal article, so the results should be considered conference findings rather than definitive evidence.
Researchers analyzed participants from two large prospective cohorts: the Canadian Longitudinal Study on Aging (CLSA) and the European Prospective Investigation into Cancer (EPIC)-Norfolk.
They divided participants according to their blood xylitol concentrations and compared cardiovascular outcomes among people with different levels.
Major adverse cardiovascular events were defined as death, myocardial infarction, or stroke.
In the CLSA cohort, participants with xylitol concentrations in the highest quartile had a 57% greater adjusted risk of a major cardiovascular event than those in the lowest quartile during six years of follow-up.
The analysis accounted for several established cardiovascular risk factors, including age, sex, smoking, lipid levels, diabetes, and hypertension.
In EPIC-Norfolk, people in the highest quartile had an 18% higher risk over 30 years than those in the lowest quartile.
The researchers also reported a dose-dependent pattern across the quartiles, with cardiovascular event rates generally increasing as blood xylitol concentrations increased.
Why a 57% Higher Risk Does Not Mean Xylitol Raises Your Risk by 57%
The 57% figure is likely to attract attention, but it needs context.
It represents a relative difference between groups defined by their blood xylitol concentrations. It does not mean that consuming xylitol increases an individual’s heart attack or stroke risk by 57%.
More importantly, the researchers did not randomly assign thousands of people to consume xylitol or avoid it. This was an observational analysis.
Even after statistical adjustment, people with higher xylitol concentrations could differ from people with lower concentrations in ways that contribute to cardiovascular risk.
The study therefore identifies an association that warrants investigation, not proof of cause and effect.
Blood Xylitol Is Not the Same as Eating Xylitol
This may be the most important limitation for consumers.
Xylitol is commonly described as a sweetener, but it is also a substance produced naturally in human metabolism. Small amounts are also present naturally in foods.
Commercial products can contain much larger amounts of added xylitol, but a person’s blood concentration does not necessarily reveal how much xylitol they consumed.
The ESC notes that xylitol occurs naturally in the body as a byproduct of glucose metabolism. This makes it difficult to determine from an observational blood measurement whether elevated xylitol is itself contributing to cardiovascular risk, reflects dietary exposure, or is associated with some other metabolic process.
That is why the new study should not be interpreted as showing that xylitol gum causes heart attacks.
Why Are Researchers Concerned About Xylitol?
The new findings are not the first evidence connecting xylitol with cardiovascular risk.
In 2024, Witkowski and colleagues published a study in the European Heart Journal examining circulating xylitol, cardiovascular events, and blood clotting.
The peer-reviewed study found that higher fasting plasma xylitol concentrations were associated with subsequent major cardiovascular events. The researchers also conducted laboratory, animal, and human experiments to investigate whether xylitol could influence clot formation.
In laboratory experiments, xylitol increased several measures of platelet responsiveness. Researchers also observed enhanced thrombosis in an animal arterial-injury model.
A small human intervention experiment provided another clue. After volunteers consumed a xylitol-sweetened drink, researchers observed increased measures of platelet responsiveness. (Witkowski et al., 2024)
Platelets are blood cells that help form clots. Their activity is essential for stopping bleeding, but excessive platelet activation can contribute to the formation of clots involved in heart attacks and some strokes.
These experiments provide a biologically plausible mechanism connecting high xylitol exposure with thrombosis, but they still do not demonstrate that habitual xylitol consumption causes cardiovascular disease in the general population.
Does This Mean Xylitol Is Dangerous?
The current evidence does not justify such a broad conclusion.
The 2026 findings are observational, and they have so far been presented at a scientific meeting rather than published as a complete peer-reviewed paper.
The 2024 research provides experimental evidence that xylitol can affect platelet activity, but translating short-term experimental changes into the long-term risk associated with everyday consumption is difficult.
There has also been scientific debate about how the cardiovascular findings should be interpreted.
In a 2025 discussion in the European Heart Journal, researchers questioned aspects of the evidence linking xylitol to cardiovascular harm and pointed to its history of use, particularly in oral health. Witkowski and Hazen responded that long-term studies specifically examining major cardiovascular outcomes after dietary xylitol exposure remain lacking. (Witkowski & Hazen, 2025)
That distinction is important. Evidence that a substance has been used for years without obvious acute toxicity is not necessarily the same as evidence that long-term exposure has no cardiovascular effects.
Conversely, an association between elevated blood levels and cardiovascular events is not enough to establish that consuming the substance is harmful.
Should People Stop Using Xylitol?
The research does not establish that people need to eliminate xylitol from their diets.
What it does provide is a reason to investigate the question more rigorously.
A stronger test would require research that measures actual xylitol intake, tracks exposure over time, distinguishes internally produced xylitol from dietary xylitol, and determines whether greater consumption leads to more cardiovascular events.
Randomized studies could help establish effects on intermediate markers, but long-term randomized trials designed around heart attacks and strokes would be substantially more difficult.
For people using small amounts of xylitol in chewing gum or oral-care products, the current evidence does not tell us what cardiovascular risk, if any, those exposures carry.
Likewise, the findings should not be interpreted as evidence that replacing xylitol with large amounts of added sugar is healthier. Cardiovascular risk depends on the broader dietary pattern and established factors such as smoking, blood pressure, cholesterol, diabetes, physical activity, and body weight.
Who Funded the New Research?
According to the European Society of Cardiology, the 2026 work received support from the Canada First Research Excellence Fund, Fonds de recherche du Québec through the D2R Initiative at McGill University, the Corona Foundation, and the Advanced Clinician Scientist Program of the Berlin Institute of Health.
The ESC states that Witkowski reported no conflicts of interest for the new presentation.
For transparency, the earlier 2024 research included investigators with disclosed intellectual-property and commercial relationships related to cardiovascular diagnostics and therapeutics. These disclosures do not invalidate the findings, but they are relevant when evaluating the evidence alongside independent replication.
What Does the Evidence Actually Tell Us?
The new 2026 findings strengthen an emerging association between higher circulating xylitol levels and cardiovascular events.
The size and long follow-up of the two cohorts make the signal worth taking seriously. Earlier peer-reviewed research also provides a possible biological mechanism through increased platelet responsiveness and thrombosis.
But a crucial question remains unanswered: Does consuming more xylitol actually cause more heart attacks or strokes?
The new research cannot answer that because blood xylitol levels are not a direct measurement of dietary intake, and observational studies cannot completely eliminate alternative explanations.
For now, the evidence supports further investigation into xylitol’s long-term cardiovascular safety, not the conclusion that xylitol-containing gum, toothpaste, or foods have been proven to cause cardiovascular disease.
References
European Society of Cardiology. (2026, August 29). The association of xylitol and incident cardiovascular events: The CLSA and EPIC-Norfolk cohort studies. ESC Congress 2026.
https://esc365.escardio.org/presentation/330468
Witkowski, M., Nemet, I., Li, X. S., Wilcox, J., Ferrell, M., Alamri, H., Gupta, N., Wang, Z., Tang, W. H. W., & Hazen, S. L. (2024). Xylitol is prothrombotic and associated with cardiovascular risk. European Heart Journal, 45(27), 2439–2452.
https://doi.org/10.1093/eurheartj/ehae244
Witkowski, M., & Hazen, S. L. (2025). Xylitol and cardiovascular risks. European Heart Journal, 46(27), 2707–2708.
https://doi.org/10.1093/eurheartj/ehaf059
