Is your sugar-free habit hurting your heart?

Many people reach for sugar-free products to cut calories and support their health. But new research presented at the European Society of Cardiology (ESC) Congress 2026 is raising questions about one common sugar substitute: xylitol.

Xylitol is frequently used as a low-calorie sweetener in products such as sugar-free gum, mints, reduced-sugar beverages, protein bars, oral care products and some medications. While it has long been viewed as a healthier alternative to sugar, new evidence suggests researchers may need to better understand its long-term impact on cardiovascular health.

“This study is a reminder that ‘sugar-free’ does not automatically mean ‘risk-free,'” said Dr. Iva Minga, a cardiologist at Advocate Health Care. “No sweetener, whether it’s sugar or a sugar substitute, can replace the fundamentals of heart health. A healthy diet, regular physical activity, blood pressure control, cholesterol management and avoiding tobacco remain the most important steps people can take to reduce their cardiovascular risk.”

What the xylitol study found

Researchers analyzed data from more than 17,000 participants across two large observational studies and found that people with the highest blood levels of xylitol experienced more major adverse cardiovascular events, including heart attack and stroke, than those with the lowest levels.

In one of the studies analyzed, participants with the highest xylitol levels had a 57% greater risk of experiencing a major cardiovascular event over six years. In the second study, which followed participants for 30 years, those with the highest levels had an 18% greater risk. Researchers also observed a dose-response relationship, meaning cardiovascular risk increased as xylitol levels increased.

Previous research from the same investigators suggested xylitol may make platelets more likely to form blood clots, which could potentially contribute to cardiovascular events. However, researchers emphasized that these findings show an association, not proof that xylitol directly causes heart disease, heart attack or stroke.

“Xylitol has long been viewed as a healthier alternative to sugar, but this new research suggests we need to better understand its long-term effects on cardiovascular health,” says Dr. Minga. “The results do not prove that xylitol causes heart attacks or strokes, but they tell us that we need more research to better understand how artificial sweeteners may affect cardiovascular health over time.”

Should consumers stop using xylitol?

Not necessarily.

“People don’t need to panic or immediately throw out every product containing xylitol,” Dr. Minga says. “This study is a reminder that moderation and informed choices are important.”

While questions remain about the potential effects of xylitol and other artificial sweeteners, experts say the greatest threats to cardiovascular health remain well-known risk factors, including high blood pressure, high cholesterol, diabetes, obesity and tobacco use.

“We are continuing to learn about the health effects of many sweeteners,” Dr. Minga says. “The best approach is to limit highly processed foods overall and focus on a balanced diet rich in fruits, vegetables, whole grains, lean proteins and other minimally processed foods.”

Want to learn more about your risk for heart disease? Take a free online quiz.