Sweetener used in chewing gum and jam linked to strokes and heart attacks
A large observational study has found that people with the highest blood levels of xylitol, a sweetener used in products including chewing gum, toothpaste and low-sugar foods, had a higher risk of heart attack, stroke or death. The findings raise questions about the long-term cardiovascular safety of a widely used ingredient often regarded as a healthier alternative to sugar, though they do not prove that xylitol itself causes these events.
Researchers analysed 17,710 people and found that the quarter with the highest xylitol levels were 57% more likely to experience a major cardiovascular event or die within six years than the quarter with the lowest levels; after 30 years, the difference was 18%. The association appeared dose-dependent and remained after accounting for factors including age, sex, body mass index, high blood pressure, diabetes and lipid levels, but experts stressed that further research is needed because the study was observational.
- High xylitol blood levels were associated with greater cardiovascular risk.
- The study cannot prove xylitol directly caused heart attacks or strokes.
- Researchers call for further safety research.
New here? Start with this
Xylitol is a sweet-tasting substance used in some chewing gum, toothpaste and foods with less sugar. It is a type of sugar alcohol, and is often chosen as a sugar substitute.
Researchers study whether substances in food are linked to changes in health by comparing people’s habits or biological measures over time. Such studies can find patterns, but on their own cannot show that one substance caused a health outcome.
Heart attacks and strokes happen when blood flow to the heart or brain is disrupted. Understanding possible risk factors matters because these conditions are major causes of serious illness and death.
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The case for
The findings justify closer scrutiny of xylitol’s cardiovascular safety: the study was large, found a dose-related association, and the link persisted after adjustment for several known risk factors. Since xylitol is widely used and often chosen as a healthier sugar substitute, consumers and regulators have a reasonable interest in whether long-term exposure carries risks that warrant further study or clearer guidance.
The case against
The study does not show that xylitol causes heart attacks, strokes or deaths, and blood levels may reflect other health, dietary or lifestyle factors that statistical adjustments cannot fully capture. It would be premature to change advice or avoid xylitol on this evidence alone; controlled research is needed to establish whether the association is causal and how it compares with the risks of alternatives such as sugar.