Blood levels of xylitol were up to 1,000 times higher in people who consumed xylitol-sweetened products compared to those who didn’t [CBS News]. That staggering number comes from a Cleveland Clinic study published in June 2024, and it landed like a grenade in the wellness world. For years, xylitol enjoyed a reputation as one of the “good” sugar substitutes: natural, tooth-friendly, keto-approved. Now, researchers are connecting it to increased heart attack and stroke risk. Millions of people actively choosing sugar-free gum, mints, and baked goods as part of healthier routines may want to take a closer look at what’s actually in them.
The Xylitol Heart Attack Connection
Cleveland Clinic researchers tracked over 3,000 participants across a three-year observational study and found something unsettling: those with the highest blood levels of xylitol faced roughly triple the risk of a major cardiovascular event [CBS News].
Photo by That alone would raise eyebrows. But the research team went further.
Laboratory tests revealed that xylitol enhances platelet reactivity, making blood stickier and more prone to forming dangerous clots [CBS News]. Dr. Stanley Hazen, the study’s senior author, put it plainly:
“We discovered that xylitol is a nutrient that can stimulate the same pro-platelet pathways that we have shown previously for glucose and drive enhanced platelet clotting.” [CBS News]
This finding challenges decades of xylitol’s health halo. A substance many people chose specifically to protect their health may carry its own cardiovascular risks. It’s a pattern that repeats across nutrition science, where yesterday’s hero ingredient becomes today’s question mark.
What the Research Actually Shows
Before anyone clears out their medicine cabinet, some context is worth exploring.
Photo by This was an observational study, which means it identified a correlation, not a definitive cause-and-effect relationship. The cardiovascular effects appeared most pronounced in people already carrying elevated risk factors for heart disease or stroke.
Dosage also matters significantly. Many people encounter xylitol in small amounts: a stick of sugar-free gum here, a mint there. But regular users of sugar-free products can accumulate 10 to 30 grams daily without realizing it. At higher doses above 30g, xylitol is already known to cause digestive distress [Wellness]. The cardiovascular concerns add another layer to that dose conversation.
Xylitol hides in more places than most people expect [CBS News]:
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Sugar-free gum and mints
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Toothpaste and mouthwash
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Keto-friendly baked goods and protein bars
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Cough drops and chewable vitamins
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Some medications and nasal sprays
As Dr. Matthew Witkowski, the study’s first author, noted: “Caution is warranted until we learn more” [CBS News]. That gentle phrasing is deliberate. The researchers themselves aren’t calling for a ban. They’re flagging a signal that deserves attention.
Why Sugar-Free Became the Default
Xylitol’s rise didn’t happen in a vacuum.
Photo by Decades of anti-sugar messaging pushed consumers toward alternatives, and xylitol had a particularly compelling story. Derived from birch trees and corn, it felt natural in a way that aspartame or sucralose never quite managed. Dentists recommended it. Keto communities embraced it. The sugar substitute market, projected to reach $20 billion by 2027, gave xylitol a starring role.
Many people chose xylitol products precisely because they were trying to do the right thing for their bodies. That intention hasn’t changed. What’s shifted is the information available, and this study is a reminder that “natural” and “safe” aren’t always synonyms.
One additional note worth mentioning: xylitol is highly toxic to dogs, even in trace amounts [Medical Xpress]. For households with pets, this is a separate but important safety consideration that predates the cardiovascular findings.
Rethinking Sweetener Choices Gently
Rather than swapping one sweetener panic for another, many nutrition researchers suggest a more measured approach.
A few things that some people have found helpful:
- Check ingredient labels: xylitol also appears as E967 on European products
- Notice your total daily intake across all products, not just one
- Explore alternatives like stevia or monk fruit, which haven’t shown similar cardiovascular signals in current research
- Talk with a healthcare provider if you have existing heart disease risk factors
This isn’t about perfection or fear. Individual variation matters enormously. What concerns one person’s cardiologist may be irrelevant to someone else’s health profile. The study’s value lies in expanding the conversation, not shutting it down.
The Cleveland Clinic’s xylitol findings don’t demand that everyone abandon sugar-free products overnight. They do suggest that the assumption of universal safety deserves a second look, particularly for those with cardiovascular vulnerabilities. Reading labels, noticing how much xylitol accumulates across your daily routine, and having an honest conversation with a doctor if heart health is a concern all seem like gentle, reasonable next steps. Sometimes the most sustainable wellness practice is simply staying curious about what we consume.
