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Understanding the cardiovascular risks of xylitol, a common sugar substitute


Recent research highlights potential health concerns associated with xylitol, a sugar alcohol commonly used as a sugar substitute. A study published in the European Heart Journal by Cleveland Clinic researchers indicates that higher levels of circulating xylitol may cause an increased risk of heart attacks, strokes, and other cardiovascular events.

What is xylitol?

  • Xylitol is a sugar alcohol added to various products, including sugar-free candy, gum, and toothpaste.
  • It is a lower-calorie alternative to sugar with a low glycemic index.
  • Naturally occurring in fibrous fruits and vegetables, xylitol is also produced by the human body.

Risks and research findings

The study’s findings are based on a large-scale patient analysis, clinical intervention, and pre-clinical research models. Notably, the research suggests that individuals with high levels of xylitol in their plasma are at a greater risk of experiencing cardiovascular events within three years. Pre-clinical tests also showed that xylitol could increase platelet clotting, potentially leading to thrombosis.

However, it’s important to recognize that the study has limitations, and clinical observation studies can only show associations, not causation. Further research is needed to understand the long-term cardiovascular safety of xylitol.

Expert opinions and advice

Medical experts advise caution when consuming large amounts of xylitol. Dr. Cheng-Han Chen, an interventional cardiologist, suggests avoiding substantial xylitol consumption until its effects are better understood. Dr. Rigved Tadwalkar, a consultative cardiologist, emphasizes that while the study is observational, it raises concerns that warrant further investigation.

Dr. Bradley Serwer, a cardiologist, points out the long history of concerns with sugar substitutes, advising patients to weigh their desire for sweets against their overall health. He suggests considering natural options like monk fruit extract but cautions that even products like Stevia, often mixed with erythritol, may pose risks.


This research on xylitol adds to the ongoing discussion about the safety of sugar substitutes and their impact on heart health. Consumers and healthcare professionals should stay informed about the latest findings and recommendations regarding the use of sugar alcohols and artificial sweeteners.