A common sweetener found in chewing gum, toothpaste, jam, yoghurt and ice cream has been linked to a higher risk of heart attacks, strokes and death, according to new research.

The sweetener xylitol is a type of sugar alcohol found naturally in some fruits and vegetables in very small amounts. It is also added to foods, drinks, and oral care products to provide sweetness with fewer calories than sugar.

Despite its growing popularity as a sugar alternative, researchers say relatively little is known about its long-term effects on cardiovascular health.

In the largest study of its kind, researchers examined blood levels of xylitol in 17,710 people and compared participants with the highest levels with those who had the lowest. Those in the highest group were 57% more likely to experience a major cardiovascular event, including a heart attack, stroke, or death, within six years compared with those in the lowest group.

Even after 30 years, people with the highest xylitol levels remained 18% more likely to have experienced one of these events. The findings were presented at the European Society of Cardiology's annual congress in Munich.

What Could Explain The Link?

Researchers found a dose-dependent relationship, meaning cardiovascular events became more common as blood xylitol levels increased. The association also remained after accounting for factors including age, sex, body mass index, high blood pressure, diabetes, and cholesterol levels.

Dr Marco Witkowski, from Charité University Hospital in Berlin and an author of the study, said the findings build on previous research into xylitol and blood clotting. 'In previous studies, we showed that xylitol can enhance the ability of platelets to form clots,' he said.

Platelets are blood components that help the body stop bleeding by forming clots. However, abnormal clot formation can contribute to blocked blood vessels, potentially triggering a heart attack or stroke.

The researchers previously found that people with high blood xylitol levels were more likely to experience cardiovascular events over three years, particularly among those already considered at high cardiovascular risk.

Does Xylitol Cause Heart Attacks?

Not necessarily. The distinction is important for anyone who regularly consumes products containing xylitol.

The latest research was observational, meaning it identified an association between people's blood xylitol levels and their subsequent health outcomes. It did not randomly assign people to consume xylitol and then monitor whether they developed cardiovascular disease.

Therefore, the findings cannot prove that xylitol directly causes heart attacks or strokes.

Prof Dan Atar, an expert member of the ESC communication committee who was not involved in the research, said causality was difficult to establish from observational research but agreed that the findings warranted further investigation.

Dell Stanford, a senior dietitian at the British Heart Foundation, also stressed that the study should not be interpreted as a reason to replace xylitol with sugar.

'It is important to note that this was an observational study, meaning it can only show an association between higher xylitol levels and cardiovascular events, rather than proving that xylitol directly caused them,' she said.

Should You Avoid Xylitol?

There is currently not enough evidence from this study alone to conclude that people should completely avoid xylitol.

Researchers are calling for further studies to establish whether xylitol itself contributes to cardiovascular disease and to better understand how it may affect blood clotting. For now, experts recommend focusing on established measures for protecting heart health, including eating a balanced diet, exercising regularly, and limiting highly processed foods.

The findings are nevertheless a reminder that replacing sugar with a low-calorie sweetener does not automatically make a product healthier. As researchers continue to investigate the long-term effects of sugar substitutes, consumers should avoid assuming that 'sugar-free' means risk-free.

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