Is Your Sugar-Free Gum Bad for Your Heart? What a New Study on Xylitol Really Shows

What the study found

Dr. Marco Witkowski and his team at Charité University Hospital in Berlin presented the findings at the European Society of Cardiology Congress in Munich in August 2026. They drew on two long-running population studies: the Canadian Longitudinal Study on Aging and the UK's EPIC-Norfolk study. Combined, that's 17,710 people.

The researchers split each group into quarters based on blood xylitol levels, then compared the top quarter to the bottom. The results:

• In the Canadian group, tracked for six years, the highest-xylitol quarter had a 57% higher risk of a major cardiovascular event
• In the UK group, tracked for 30 years, the same comparison showed an 18% higher risk
• Risk rose with xylitol levels in a fairly clean dose-response pattern, and it held up across age groups, sexes, and people with and without diabetes or high blood pressure

There's a plausible reason for this. Witkowski's earlier lab work found that xylitol makes platelets stickier and more likely to clot. Stickier platelets, higher clot risk, higher stroke and heart attack risk. That's the chain the researchers think is at work here, though this study didn't test the mechanism directly. It just found the pattern at scale.

Where xylitol actually hides

Xylitol earned its popularity honestly. It tastes close to real sugar, doesn't spike blood sugar, and doesn't feed the bacteria that cause cavities. That's exactly why food and dental companies reach for it constantly:

• Sugar-free gum and mints. Trident and PUR both lean heavily on it
• Toothpaste and mouthwash, including some Tom's of Maine products
• "No sugar added" jams and preserves
• Low-sugar yogurt, ice cream, and baked goods
• Anything marketed as keto-friendly or "sweetened with sugar alcohols"

One detail worth sitting with: manufacturers typically add xylitol at roughly 1,000 times the concentration you'd find naturally in fruit. This isn't a trace amount you're getting. It's a formulated ingredient on an industrial scale.

The catch: this doesn't prove xylitol causes strokes

This was an observational study. Researchers measured xylitol in people's blood and tracked what happened to their hearts over time. They didn't run a trial where one group got xylitol and another didn't. That distinction matters, and the researchers know it.

Professor Dan Atar, an ESC committee member, put it plainly: "As with all observational studies, causalities are difficult to infer, but this work shows that further studies are mandated."

Witkowski was similarly direct about the limits of what they know: "Our long-term findings in the general population highlight how little we know about the cardiovascular safety of xylitol."

That's not a researcher walking back the finding. It's a researcher being honest that a strong correlation isn't the same as proof. Cleveland Clinic scientists found something similar with erythritol, a different sugar alcohol, in recent years. Two separate research teams landing on comparable red flags for two different sugar substitutes is the kind of pattern that's hard to wave off as coincidence, even without a clean causal mechanism nailed down yet.

What to actually do about it

Don't throw out your gum tonight. Do read the label next time you buy it.

"Sugar-free" tells you nothing about which sweetener you're getting. Flip the package over and check the ingredient list for xylitol, sorbitol, erythritol, or "sugar alcohols" generally.
If you already have heart disease, a history of stroke, diabetes, or a clotting disorder, this study is worth bringing to your next doctor's appointment, especially if you're someone who chews sugar-free gum through most of the day or uses xylitol mints as a steady habit rather than an occasional one.

Don't solve this by going back to regular sugar. Every expert quoted in this study, including the British Heart Foundation's Dell Stanford, made the same point: added sugar carries its own well-documented cardiovascular risk. Trading one problem for a bigger one isn't a fix. If you want an alternative, stevia and monk fruit haven't shown this signal so far, though the research on sugar substitutes broadly is still moving.

And keep the numbers in perspective. A 57% relative increase sounds enormous, but it's relative to your own baseline. If your baseline heart risk is low, that bump is still small in absolute terms. If your baseline risk is already elevated, it matters a lot more. That's a conversation for your doctor, not a decision to make alone at midnight after reading a headline.

Bottom line

This is a large, well-run study from a credible team, and it adds real weight to a pattern that's been building around sugar alcohols for a couple of years now. I wouldn't call it proof. I would call it a good enough reason to actually read the label on your gum, and a very good reason to mention it to your doctor if you're already managing heart risk. That's a reasonable, proportionate response. Panic isn't, and neither is ignoring it.

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