For years, dentists have suggested xylitol as a swap for sugar that is easier on teeth, and our team has too. So when headlines in late August linked xylitol to heart attack and stroke, we went to the research behind them.
This post covers what the studies found, what they cannot tell us yet, and what we suggest while researchers work out the answer.
What is xylitol?
Xylitol is a sugar alcohol. Your body makes small amounts of it as it processes glucose, and some foods contain small amounts. Manufacturers add it, often at more than 1,000 times those natural levels, to sweeten foods, drinks, and oral care products. European Society of Cardiology: Press release
You will find it in sugar-free gum, mints, and candy, and in some toothpastes, mouthwashes, chewable vitamins, baked goods, nut butters, and sugar-free desserts. FDA: Xylitol and dogs
What the research found
In 2024, Cleveland Clinic researchers published a study in the European Heart Journal. They followed more than 3,000 adults who were having heart evaluations, most of whom already had heart disease. Those with the highest blood levels of xylitol had a higher three-year risk of heart attack, stroke, or death. European Heart Journal: Witkowski et al., 2024
In a small follow-up experiment, ten healthy volunteers drank a drink sweetened with 30 grams of xylitol. The researchers compared that amount to a pint of xylitol-sweetened ice cream, a xylitol-sweetened baked good, or several pieces of xylitol-sweetened candy. Afterward, the volunteers' platelets, the blood cells that help form clots, became easier to activate in lab tests. The experiment did not measure heart attacks or strokes. European Heart Journal: Witkowski et al., 2024
In August 2026, a team led by Dr. Marco Witkowski of Charité University Hospital in Berlin presented a larger analysis at the European Society of Cardiology's annual congress. It covered 17,710 adults in two long-running studies, one in Canada and one in England. ESC: Press release
- In the Canadian group, people in the top quarter of blood xylitol levels had a 57% higher risk of heart attack, stroke, or death over six years than people in the bottom quarter.
- In the English group, followed for 30 years, the same comparison showed an 18% higher risk.
- These are relative comparisons between the highest and lowest groups. They are not the chance that any one person will have a heart attack.
- The researchers accounted for age, sex, smoking, cholesterol, diabetes, high blood pressure, and body mass index.
What the research cannot tell us yet
These studies show a link, not proof that xylitol causes heart problems. The 2024 study measured xylitol in the blood, not how much xylitol people ate, and its participants had more heart risk than the general public. AJMC: Study summary The 2026 analysis also compared blood levels. ESC: Press release
Because the body makes its own xylitol, some scientists argue that high blood levels may reflect the body's own production, unrelated to diet. They also note that the platelet experiment involved ten people and no placebo drink. European Heart Journal: Commentary
The 2026 findings discussed here come from the European Society of Cardiology’s conference press release. A cardiologist commenting for the European Society of Cardiology said cause and effect is hard to establish from studies like these, and that more research is needed. ESC: Press release The researchers have also written that long-term safety studies of people eating xylitol over time had not yet been reported. European Heart Journal: Witkowski and Hazen
None of this proves the concern wrong, either. Studies in separate groups of people, in North America and Europe, found the same pattern: higher blood levels went with higher risk. The platelet experiment suggests one way that could happen. The research does not tell us a safe amount, or whether eating less xylitol lowers anyone's risk. Until it does, we think a cautious approach makes sense.
What about your teeth?
The evidence for xylitol’s added dental benefit is limited. A 2015 Cochrane review found low-quality evidence, from studies over about three years, that a fluoride toothpaste with 10% xylitol may reduce tooth decay in children's permanent teeth by about 13% compared with fluoride toothpaste alone. For other xylitol products, in children or adults, the evidence was too weak to say whether they prevent tooth decay. Cochrane: Xylitol-containing products for preventing dental caries
The American Dental Association's advice on gum does not depend on xylitol. It says chewing sugarless gum for 20 minutes after meals can help prevent tooth decay, and the gums carrying its Seal use several sweeteners, including aspartame, sorbitol, mannitol, and xylitol. ADA MouthHealthy: Chewing gum
In a lab study reported by the ADA, regular sugar caused a fast drop into the acid range that damages enamel, while sugar substitutes such as xylitol produced little acid. ADA News: Sugar substitutes and cavities Going back to sugar is not the answer.
What we suggest for now
- Keep using fluoride toothpaste. Brush twice a day with fluoride toothpaste, clean between your teeth once a day, and limit sweets and sugary drinks. NIDCR: Oral hygiene
- Sugar-free gum after meals is still a reasonable habit. Chewing sugarless gum for 20 minutes after meals can help prevent tooth decay; the ADA advises skipping gum if you have a TMJ disorder. ADA MouthHealthy: Chewing gum If you would rather avoid xylitol while the research continues, ADA Seal gums also come with other sweeteners. Check the label. The same researchers have raised similar questions about erythritol, another sugar alcohol. European Heart Journal: Witkowski and Hazen
- Go easy on foods and drinks with large amounts of xylitol, such as sugar-free desserts and baked goods. Those are the kinds of foods the researchers compared to the 30-gram drink. The senior researcher on the 2024 study said the findings do not mean you should throw out a toothpaste that contains xylitol, but cautioned about products with high amounts. AJMC: Study summary
- If you have heart disease, have had a stroke, or have been told you are at risk for blood clots, ask your physician about sweeteners. Your physician knows your heart history.
Keep xylitol away from your dog
Xylitol does not affect people the same way, but it is dangerous for dogs. It can cause a dog's blood sugar to drop, with signs such as vomiting, weakness, staggering, and seizures. If you think your dog has eaten something with xylitol, take your dog to a veterinarian or an emergency animal hospital right away. FDA: Xylitol and dogs
Store gum, mints, and toothpaste where your dog cannot reach them.
Bring your labels to your next visit
Bring the gum, mints, and toothpaste you use, or photos of their labels. Ask us to look at what you use and talk through your risk for cavities.
Call SiRa Dentistry at (732) 454-7472 to book your appointment. If your question is about your heart, your physician is the right person to ask.