A Cleveland Clinic study found that people with the highest xylitol blood levels faced triple the cardiovascular event risk. The sugar substitute, found in gum, mints, and keto products, makes blood stickier and more prone to dangerous clots. Millions choosing sugar-free products for health may want to reconsider what’s actually in them.
The Xylitol Heart Attack Connection
Cleveland Clinic researchers tracked over 3,000 participants across three years and found something unsettling: those with the highest blood levels of xylitol faced roughly triple the risk of a major cardiovascular event. But the research team went further.
Laboratory tests revealed that xylitol enhances platelet reactivity, making blood stickier and more prone to forming dangerous clots. Dr. Stanley Hazen, the study’s senior author, explained that xylitol stimulates the same pro-platelet pathways previously shown for glucose and drives enhanced platelet clotting.
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 matters. 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. The cardiovascular concerns add another layer to that dose conversation.
Xylitol hides in more places than most people expect: sugar-free gum and mints, toothpaste and mouthwash, keto-friendly baked goods and protein bars, cough drops and chewable vitamins, and some medications and nasal sprays. As Dr. Matthew Witkowski noted, caution is warranted until we learn more.
