A chewing gum after a meal, a breath lozenge, a “sugar-free” toothpaste: xylitol has discreetly become part of our daily lives. This sweetener, used to limit calories and prevent cavities, is now present in many food and oral hygiene products.
But a team from Charité University Hospital in Berlin now calls for questions about its long-term effects on cardiovascular health.
The higher the xylitol level, the greater the risk.
The researchers analyzed data from 17,710 adults from two large cohorts: the Canadian Longitudinal Study on Aging (CLSA) and EPIC-Norfolk.
Participants with the highest blood xylitol concentrations had a greater risk of major cardiovascular events — death, heart attack or stroke — than those with the lowest levels.
In the Canadian cohort, followed for six years, the risk was 57% higher after taking into account factors such as age, smoking, diabetes or hypertension. In the EPIC-Norfolk study, followed for thirty years, the increase reached 18%.
The results also suggest a dose-response relationship: the higher the blood level of xylitol, the greater the frequency of cardiovascular events. This association appeared independent of age, sex, or common risk factors.
“Artificial sweeteners are consumed by people who believe they are healthier than sugar, and they are generally considered safe by regulatory agencies. Our long-term results in the general population highlight how little we know about the cardiovascular safety of xylitol and indicate that additional studies are needed.” says Dr. Marco Witkowski of Charité University Hospital in Berlin.
A biological mechanism already observed
This study extends work published in 2024 by the same team. The researchers then showed that xylitol could promote the aggregation of platelets, cells involved in coagulation.
“In previous studies, we have shown that xylitol can enhance the ability of platelets to form clots.” Dr. Marco Witkowski.
This hypothesis could help explain the observed link with cardiovascular events, even if no mechanism has yet been formally demonstrated.
Should we stop using sugar-free chewing gum?
Not necessarily. The researchers point out that this is a
observational study : it highlights an association, but does not prove that xylitol is directly responsible for heart attacks or strokes.
Professor Dan Atar, member of the ESC communications committee, also calls for caution:
“In this observational study, it appears that xylitol has a long-term negative effect on cardiovascular events in the general population. As with all observational studies, it is difficult to infer causality, but this work shows that additional studies are needed on this topic of societal importance.”
The message is therefore not to give in to worry at the slightest chewing gum, but to remember that a product presented as an alternative to sugar is not necessarily devoid of scientific questions.
As sweeteners occupy an increasing place in our diet, understanding their long-term effects is becoming a major public health issue.