Is Your Sugar-Free Gum Putting Your Heart at Risk?

If you regularly reach for sugar-free gum, you may have seen xylitol hiding in the ingredient list.

This sugar substitute also turns up in candies, baked goods, beverages, and oral care products, and it's often marketed as a lower-calorie alternative to regular sugar. Yet, recent research presented at the European Society of Cardiology's 2026 Congress is raising questions about what higher levels of xylitol could mean for our hearts.

Researchers found that people with the highest levels of xylitol in their blood were more likely to experience a heart attack, stroke, or death than those with the lowest levels. That doesn't mean xylitol caused those events, but the association was strong enough to warrant further research.

But before we start emptying every pack of gum into the trash, there's quite a bit more we need to know.

What Is Xylitol?

Xylitol is a type of sugar alcohol that occurs naturally in our bodies and in very small amounts in certain foods. It's also manufactured for use as a sweetener.

The amounts added to artificially sweetened foods, drinks, and oral care products can be more than 1,000 times higher than the amounts naturally present in foods.

Unlike some intensely sweet artificial sweeteners, xylitol is about as sweet as regular sugar. That means manufacturers can use it in larger amounts as a substitute in everything from sugar-free candy and gum to baked goods.

Its use in oral care products also isn't an accident. Xylitol has long been used for its ability to help prevent cavities.

What Did the New Study Find?

Researchers looked at 17,710 people from two large observational studies in Canada and the United Kingdom. In the Canadian group, people in the top 25% for blood xylitol levels were 57% more likely to experience a major cardiovascular event over six years than those in the bottom 25%. Those events included heart attack, stroke, and death.

Researchers saw a similar pattern when they looked much further into the future. In the second group, people with the highest xylitol levels had an 18% greater risk of a major cardiovascular event over 30 years, compared to those who had the lowest levels.

Researchers also noticed a pattern: as xylitol levels rose, cardiovascular events became more common.

Why Are Researchers Looking at Xylitol and the Heart?

This isn't the first time scientists have spotted a possible xylitol heart risk. Research published in the European Heart Journal found a similar pattern. People with higher levels of xylitol in their bloodstream were more likely to experience cardiovascular events.

That study went a step further by investigating what might be happening inside the body.

In laboratory and animal studies, researchers found that xylitol made platelets more likely to react in ways that could lead to blood clots. They also gave a xylitol-sweetened drink to 10 healthy volunteers. 

After drinking it, their blood xylitol levels rose sharply, and their platelets became more reactive. That's particularly interesting because platelets help our blood clot. And when they're overly reactive, unwanted blood clots can potentially contribute to heart attacks and strokes.

Does Xylitol Cause Heart Attacks?

Here's where we need to put the brakes on the scary headlines. This new research found an association between higher blood xylitol levels and cardiovascular events. 

It didn’t prove that eating xylitol causes heart attacks or strokes. The researchers accounted for several known cardiovascular risk factors, including:

• Age

• Smoking

• Diabetes

• Hypertension

• Cholesterol Levels

Even after accounting for these factors, the association remained.

Still, observational research can't establish cause and effect. Scientists have also raised questions about the earlier research. Our bodies naturally produce some xylitol, so higher levels in the blood may not reflect how much someone consumed.

That's why researchers are calling for additional studies, rather than telling everyone to eliminate xylitol.

Should We Stop Using Xylitol?

For now, there's no need to panic over a stick of gum. The research does give scientists another reason to investigate the long-term cardiovascular safety of sugar substitutes, especially as they become more common in processed foods.

It also doesn't mean we need to toss out our toothpaste. When the research was published in the European Heart Journal, researchers specifically said that their findings weren't a recommendation to stop using xylitol-containing toothpaste.

Instead, researchers are looking at the higher amounts of xylitol in our foods and drinks.

Keeping Xylitol in Perspective

If you're concerned about xylitol side effects, check ingredient labels to see where it appears in your diet and talk with your doctor before making any dietary changes, particularly if you already have cardiovascular risk factors.

For now, xylitol isn't leaving the gum aisle. But scientists are giving us one more reason to take a closer look at what's sweetening our sugar-free foods.

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