If you've ever reached for sugar-free gum, "natural" toothpaste, or low-calorie packaged snacks, chances are you've consumed xylitol. The sugar alcohol has been positioned for decades as a heart-friendlier, tooth-safe swap for sugar. New research presented at the European Society of Cardiology (ESC) Congress 2026 in Munich suggests that reputation may be completely unwarranted.
The study tracked more than 17,000 people across two continents over decades.
Researchers from Charité University Hospital in Berlin analyzed data from 17,710 participants drawn from two large prospective observational studies: the Canadian Longitudinal Study on Aging (CLSA), which followed participants for 6 years, and the European Prospective Investigation into Cancer (EPIC)-Norfolk, which tracked participants for 30 years. After adjusting for known cardiovascular risk factors, including age, sex, smoking status, lipid levels, diabetes, and high blood pressure, the team divided participants into four groups based on how much xylitol was circulating in their blood plasma.
People with the highest xylitol blood levels faced dramatically greater cardiovascular risk.
In the CLSA cohort, those in the highest quartile of blood xylitol had a 57% higher risk of major adverse cardiovascular events (MACE), defined as heart attack, stroke, or cardiovascular death, compared to those in the lowest quartile. In the longer EPIC-Norfolk cohort, the highest xylitol group had an 18% higher risk over 30 years. Critically, the association was dose-dependent: as blood levels of xylitol rose, so did the rate of cardiovascular events. The effect held regardless of baseline characteristics like age and sex, and was independent of factors such as body mass index, diabetes, and hypertension.
Xylitol makes blood more prone to dangerous clotting.
This is not the first time this sweetener has raised red flags. A 2024 study in the European Heart Journal (PMID: 38842092), also authored by Dr. Witkowski's team, showed that xylitol enhances platelet aggregation, the process by which blood cells clump together to form clots, and was associated with cardiovascular events in high-risk individuals over a three-year period. "In previous studies, we showed that xylitol can enhance the ability of platelets to form clots," said study author Dr. Marco Witkowski in the ESC press release. The new ESC Congress 2026 study extended that question to the general population, over far longer time horizons, and got the same answer.
Cardiologists say it's time to rethink the entire sugar alcohol category.
Dr. Stanley Hazen, Chair of the Department of Heart, Blood, and Kidney Research at the Cleveland Clinic and a leading researcher on sweeteners and cardiovascular risk, told Medical News Today he is now advising patients to avoid sugar alcohols like xylitol and erythritol altogether. "A growing body of research suggests sugar alcohols like xylitol and erythritol may not be a simple substitute for sugar to avoid calories," he said. "There is data showing they can enhance risk for clotting events like heart attack or stroke. I am recommending my patients avoid these non-nutritive sweeteners, especially those with cardiovascular disease or higher risk." Dr. Cheng-Han Chen, an interventional cardiologist at MemorialCare Saddleback Medical Center, echoed the concern, noting that "avoiding a short-term glucose spike does not necessarily mean that consuming large amounts of artificial sweeteners is beneficial for long-term health." Both experts agree that what the data keeps pointing back to is whole food: "When possible, I recommend choosing naturally sweet foods, such as whole fruit, which provide sweetness along with fiber and other beneficial nutrients," Chen said.
