An ingredient found in everything from sugar-free foods to oral care products has been linked to higher risk of having a stroke or heart attack. A study due to be presented at the European Society of Cardiology (ESC) Congress 2026 found that people with higher blood levels of xylitol, a commonly used artificial sweetener, were more likely to experience major cardiovascular events over the long term than those with lower levels. The sugar alcohol is often used as a substitute for sugar in foods, drinks and dental products.
While it occurs naturally in the body and in some foods at very low levels, it is frequently added to products in much larger amounts. "Artificial sweeteners are consumed by people who think they are healthier than sugar and they are generally regarded as safe by regulatory agencies," said presenter Dr. Marco Witkowski from Charité University Hospital in Berlin, Germany, in a statement.
The research team analyzed data from 17,710 participants across two large observational studies: the Canadian Longitudinal Study on Aging (CLSA) and the European Prospective Investigation into Cancer (EPIC)-Norfolk study. Participants with xylitol levels in the highest quarter of the population were found to have a substantially greater risk of major adverse cardiovascular events, including death, heart attack and stroke, compared with those in the lowest quarter. In the CLSA cohort, which followed participants for six years, those with the highest xylitol levels had a 57 percent greater risk of a major cardiovascular event after researchers accounted for known risk factors such as age, sex, smoking status, cholesterol levels, diabetes and high blood pressure.
Meanwhile, in the EPIC-Norfolk study, which followed participants for 30 years, people with the highest levels had an 18 percent higher risk of major adverse cardiovascular events than those with the lowest levels. Researchers said the findings also pointed to a dose-dependent relationship, meaning cardiovascular risk appeared to rise alongside blood levels of xylitol. The association remained consistent regardless of factors such as age or sex and was independent of characteristics including body mass index, high blood pressure, diabetes and lipid levels.
Kirsty Thomas, a registered nutritionist who offers a nutrition-focused perspective on dietary choices and health, and who was not involved in the study, told Newsweek: "The findings provide an interesting insight into the potential relationship between dietary habits and health outcomes. "From a nutrition perspective, I would recommend interpreting these results within the broader body of scientific evidence rather than drawing conclusions from a single study." Thomas noted that people's responses may differ based on factors such as their overall diet, lifestyle, health status and any existing medical conditions. The study adds to a growing body of research examining artificial sweeteners and their possible effects beyond calorie reduction.
"Our long-term findings in the general population highlight how little we know about the cardiovascular safety of xylitol and indicate that further studies are warranted, especially as the amount of xylitol in products continues to increase," Witkowski said. Thomas, who works for Prowise Healthcare, a supplement brand, said people with diabetes or trying to reduce their sugar consumption shouldn't suddenly change their diet based on this study alone. She said: "The results are noteworthy, however, especially for individuals at risk for cardiovascular disease.
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