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Home » Xylitol sugar substitute linked to higher risk of heart attack, stroke

Xylitol sugar substitute linked to higher risk of heart attack, stroke

I like to review new medical research that is often misused by those with unscientific agendas, and this time it’s about the sugar substitute, xylitol. A new study links xylitol to higher risks of heart attack and stroke, but some people are trying to make it seem like there is something wrong with all sugar substitutes, known as non-nutritive sweeteners.

Let’s review this new research to see what it says and what we should recommend about the use of xylitol.

colorful candy xylitol
Photo by Polina Tankilevitch on

What is xylitol?

Xylitol is a sugar alcohol that is used as a sugar substitute and food additive. Xylitol occurs naturally in small amounts in plums, strawberries, cauliflower, and pumpkin. Humans and many other animals make trace amounts during the metabolism of carbohydrates.

Humans absorb xylitol more slowly than sucrose, and it supplies 40% fewer calories than an equal mass of sucrose. It has negligible effects on blood sugar because its assimilation and metabolism are independent of insulin. It has about the same sweet taste as sucrose.

 Xylitol is approved as a food additive in the United States. In addition, the European Food Safety Administration also approved a marketing claim that foods or beverages containing xylitol or similar sugar alcohols cause lower blood glucose and insulin responses compared to sugar-containing foods or drinks. Xylitol is used in many sugar-free foods, gums, and toothpaste.

When taken in high doses, the sugar substitute’s only known adverse effects are gastrointestinal discomfort, including flatulence, diarrhea, and irritable bowel syndrome. Some people experience these adverse effects at lower doses.

However, xylitol is poisonous to dogs, so it’s important to keep any foods that have the sugar substitute away from your dogs.

Increased risk of heart attack and stroke from xylitol

In a paper published on 6 June 2024 in the European Heart Journal, Stanley Hazen, MD, Department of Cardiovascular and Metabolic Sciences, Cleveland Clinic Lerner Research Institute, and colleagues studied more than 3000 people in the US and Europe over 3 years. To show the early effects of xylitol, researchers studied platelet activity in volunteers who consumed a xylitol-sweetened drink and a glucose-sweetened drink.

The researchers found that people with the highest amount of xylitol in their plasma were more likely to have a problem with their heart or blood vessels. They found that circulating levels of xylitol were linked to major adverse cardiovascular event (MACE) risk, including heart attack and stroke.

The researchers concluded:

Xylitol is associated with incident MACE risk. Moreover, xylitol both enhanced platelet reactivity and thrombosis potential in vivo. Further studies examining the cardiovascular safety of xylitol are warranted.


    Although this study might seem scary, it is important that we carefully consider what the study entails. First, the study group seems to have a higher cardiovascular risk than the population at large. This could have added unintended bias to the results.

    Second, it is a relatively small study.

    I’d like to see more studies that examine potential links between xylitol and cardiovascular disease before coming to any conclusion about its safety.

    One last thing — this study was only about one sugar substitute, xylitol. It did not include any research about all other non-nutritive sweeteners out there. So, if you see someone quoting this article as if its a condemnation of all non-nutritive sweeteners (and I have), don’t buy into it.


    Michael Simpson
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