Understanding the Buzz about Xylitol

A new study linking low-calorie sweetener xylitol to heart attack and stroke is generating concerns about safety. Here’s what you should know.

New population research in adults at risk of heart attack or stroke shows that having the highest blood levels of xylitol is linked with a 57% increased risk of a major cardiovascular event compared with lower levels. Additionally, taking a single 30-gram dose of xylitol increases blood levels 1000-fold within 30 minutes – this increase can stimulate blood clotting, which is concerning for people with existing heart disease.

While this research only suggests a potential link, it is generating a lot of buzz in the news – fueling concerns about sugar substitutes in general. In the US, xylitol is an approved food additive. And products containing xylitol are permitted to state that it may reduce the risk of dental caries – it tastes sweet but doesn’t cause tooth decay and might slightly reduce the risk for cavities. While it’s been used in products like mouthwash and gummy vitamins for years, it’s increasingly being added to keto and low-calorie processed foods. Along with artificial sweeteners like erythritol, concerns about what other effects xylitol may have in the body are increasing.

For now, advise patients to be cautious – particularly those with cardiovascular risk factors. Using xylitol in the small amounts typically found in chewing gum, toothpastes, and mouth rinses seems to be safe. But using it in very high doses and long-term isn’t a good idea. Remind patients that their best bet is to focus on eating healthy, nutrient-dense, whole foods rather than choosing processed foods loaded with sugar alternatives.

Review our updated monograph for more details.