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Sugar-Free Isn’t Always Heart-Friendly, New Study Suggests
Confirmed
In Short: A new study presented at the European Society of Cardiology Congress 2026 indicates that xylitol, a common sugar substitute, may be linked to higher risks of cardiovascular events.
A new study presented at the European Society of Cardiology Congress 2026 suggests that xylitol, a common sugar substitute, may be linked to higher risks of cardiovascular events, including heart attacks and strokes. The study, which included 17,710 people from two large population studies, found that those with the highest blood xylitol levels had an 18% higher risk of major adverse cardiovascular events compared to those with the lowest levels.
The researchers measured xylitol levels in the blood rather than directly assessing how much xylitol participants consumed. This approach, however, means that the study cannot establish causation. Dr. Punya Pratap Kujur, a consultant cardiologist at Gleneagles Hospital, Parel, Mumbai, advises caution, noting that high blood xylitol levels do not necessarily indicate higher consumption of the substance. Xylitol can also be produced naturally by the body, further complicating the interpretation of the findings.
The study, which followed participants for 30 years, found a dose-dependent relationship between xylitol and the risk of major adverse cardiovascular events. Dr. Marco Witkowski from Charité University Hospital in Berlin, Germany, who led the study, noted that high blood levels of xylitol were linked to cardiovascular events in high-risk individuals over a three-year period. However, the study was observational, and more research is needed to confirm these findings.
Dr. Dan Atar, a member of the European Society of Cardiology Communication Committee, commented that while artificial sweeteners are generally considered safe, this study suggests a potential negative long-term effect on cardiovascular health. He advised that artificial sweeteners can still play a practical role for people with diabetes, as they generally produce a smaller immediate increase in blood glucose than sugar. However, he noted that avoiding a short-term glucose spike does not necessarily mean that consuming large amounts of artificial sweeteners is beneficial for long-term health.
In conclusion, the study highlights the need for caution when choosing sugar-free products, as they may not always be the heart-friendly choice. Health practitioners advise consulting a doctor before starting any routine involving artificial sweeteners, especially for those at high risk of cardiovascular events.
What's confirmed
- In the UK cohort, people with the highest blood xylitol levels had an 18 per cent higher risk than those with the lowest levels.” As per the study, “Over a follow-up period of 30 years, the risk of major adverse cardiovascular events was 18% higher in those with the highest levels vs.
What's still developing
- Xylitol is commonly used in sugar-free products and is generally considered a better alternative to added sugar because it contains fewer calories and has a lower impact on blood glucose.
- And xylitol isn’t only obtained through food: the body naturally produces it as part of metabolism as well.
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- “Artificial sweeteners are widely embraced by modern society, and their safety ratings have been favorable and granted by regulatory authorities,” said Dan Atar, a member of the European Society of Cardiology Communication Committee, commenting on the study in the press release.
- Xylitol is a type of sugar alcohol : a carbohydrate that is a hybrid of sugar and alcohol molecules.
- Manufacturers often use it to add sweetness to food and oral care products without the calories or risk of tooth decay that sugar poses.
- The researchers wanted to examine a larger study population than in previous research and follow them over a longer period.