Xylitol in chewing gums, toothpaste linked to higher heart risk

Research presented at ESC Congress 2026 linked higher blood xylitol levels with major cardiovascular events. The findings add to scrutiny of sugar substitutes, though the study did not prove causation.That sugar-free chewing gum you reach for after a meal, or the toothpaste marketed as a smarter choice for your teeth, may contain an ingredient that is now raising an unexpected cardiovascular question: xylitol.New research presented at the European Society of Cardiology (ESC) Congress 2026 has linked higher levels of xylitol in the blood with a greater risk of major cardiovascular events, including heart attacks, strokes and death.Based on the findings of the important observational analysis, Dan Atar, a senior ESC member remarked that “xylitol has a negative long-term effect on cardiovascular events in the general population” and that further studies should be mandated into this societally important topic, given that “artificial sweeteners are widely embraced by modern society.”WHY XYLITOL IS EVERYWHEREXylitol is a polyol, or sugar alcohol, that tastes broadly like sugar but contains fewer calories and does not cause the same rapid rise in blood glucose. Unlike high-intensity sweeteners such as aspartame or sucralose, it provides sweetness with a texture and bulk closer to sugar. That makes it particularly useful in products where sugar has to be replaced without losing taste or mouthfeel. It is widely used in sugar-free chewing gums, mints and other foods, and in oral-care products.Xylitol is especially popular in chewing gum because it does not promote tooth decay and has been associated with dental benefits. In India, xylitol is permitted as a food additive under the food safety and standards regulations. The Food Safety and Standards Authority of India (FSSAI)'s regulations list xylitol among permitted polyols, with specified uses and good manufacturing practice requirements.For decades, xylitol has therefore been viewed largely through the lens of its benefits: fewer calories than sugar, minimal impact on blood glucose and potential advantages for dental health. Regulatory agencies have generally regarded it as safe when used appropriately.THE LATEST ALARMThe latest research examined 17,710 people from two large prospective cohorts: the Canadian Longitudinal Study on Ageing and the European Prospective Investigation into Cancer-Norfolk study.Researchers found that people with the highest blood levels of xylitol had a higher risk of major adverse cardiovascular events – defined as cardiovascular death, heart attack or stroke – than those with the lowest levels.In the Canadian cohort, followed for six years, the highest xylitol group had a 57% higher risk after adjustment for established cardiovascular risk factors. In the European cohort, followed for 30 years, the increase was 18%.The researchers also observed a dose-dependent pattern: as xylitol levels rose, cardiovascular event rates tended to rise.This builds on a 2024 study published in the European Heart Journal, which found that higher circulating xylitol was associated with cardiovascular-event risk and suggested a possible biological mechanism.Laboratory and animal experiments indicated that xylitol could increase platelet reactivity and promote thrombosis. A small human experiment also found increased platelet responsiveness after consuming a xylitol-sweetened drink.But there is an important catch. The new long-term research is observational, meaning it can identify an association but cannot establish that xylitol itself caused the heart attacks or strokes. The ESC researchers themselves say further studies are needed.SUGAR ALTERNATIVES UNDER SCRUTINYThe xylitol findings arrive amid a broader scientific debate over sugar substitutes. Erythritol, another sugar alcohol, has also been investigated for possible links with cardiovascular risk, although regulators and researchers have stressed that existing evidence does not establish causation.In 2023, the World Health Organisation – International Agency for Research in Cancer classified aspartame, another artificial, low-calorie sweetener, as "possibly carcinogenic to humans" (Group 2B) even though it remains approved as safe by food safety regulators in most countries, including India, when consumed within established daily limits.Food scientists say that while the message is not to panic or immediately throw away every sugar-free product, the new alarm could be a further reminder that “sugar-free” does not automatically mean risk-free.“Also, as the use of alternative sweeteners grows, their long-term effects need to be studied as carefully as their short-term benefits,” said a food researcher associated with the Indian Council of Medical Research - National Institute of Nutrition (ICMR-NIN).- EndsPublished On: Sep 2, 2026 16:57 IST