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A low-calorie sweetener called xylitol used in many reduced-sugar foods and consumer products such as gum and toothpaste may be linked to nearly twice the risk of heart attacks, stroke and death in people who consume the highest levels of the sweetener, a new study found.
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“We gave healthy volunteers a typical drink with xylitol to see how high the levels would get and they went up 1,000-fold,” said senior study author Dr. Stanley Hazen, director of the Center for Cardiovascular Diagnostics and Prevention at the Cleveland Clinic Lerner Research Institute.
“When you eat sugar, your glucose level may go up 10% or 20% but it doesn’t go up a 1,000-fold,” said Hazen, who also directs the Cleveland Clinic’s Center for Microbiome and Human Health.

“Humankind has not experienced levels of xylitol this high except within the last couple of decades when we began ingesting completely contrived and sugar-substituted processed foods,” he added.

Worrisome blood clots occur
In 2023, the same researchers found similar results for another low-calorie sweetener called erythritol, which is used as a bulking sugar in stevia, monkfruit and keto reduced-sugar products.

Additional lab and animal research presented in both papers revealed erythritol and xylitol may cause blood platelets to clot more readily. Clots can break off and travel to the heart, triggering a heart attack, or to the brain, triggering a stroke.

In the new study on xylitol, “differences in platelet behavior were seen even after a person consumed a modest quantity of xylitol in a drink typical of a portion consumed in real life,” said Dr. Matthew Tomey, a cardiologist at Mount Sinai Fuster Heart Hospital in New York City, who was not involved in the study.

“These experiments are interesting but alone do not prove that platelet abnormalities are to account for a linkage between xylitol and clinical events,” said Tomey, who is also an assistant professor of medicine at the Icahn School of Medicine at Mount Sinai.