From diabetes and cavity prevention to cancer concerns, here’s the sweet and not-not-so-sweet side of xylitol. 

Relying on mainstream media for nutrition advice is like relying on the legacy media for unbiased political analysis. In other words, it’s futile, frustrating, and filled with biases and agendas. 

Consider the mainstream view on cholesterol. Up until recently, most so-called medical experts considered cholesterol in the diet a direct cause of heart disease. However, in 2015, the Dietary Guidelines Advisory Committee (DGAC) decided that cholesterol in food is not a nutrient of concern for overconsumption. This decision was based on evidence that dietary cholesterol has little effect on the amount of cholesterol in the bloodstream. Finally, my addiction to butter no longer seems like a lethal threat!

Last month, controversy surrounding xylitol played out in the mainstream media. With metabolic disorders increasingly prevalent due to excessive sugar consumption, natural, low-glycemic alternative sweeteners like xylitol can literally be a lifesaver. Or can they? A research study found that people who had higher levels of xylitol in their blood were more likely to have a heart attack or stroke within the next three years.

So which is it…is xylitol a godsend for those managing blood sugar disorders and obesity? Or is using this sugar alternative a harbinger of an early death? Before I weigh in as a Nurse Practitioner and functional medicine practitioner, let’s cover the basics.

What is Xylitol?

Xylitol is a sugar alcohol derived from plants like birch trees and from corn cobs. Chemically, it resembles sugar. However, it has fewer calories than table sugar (a combo of fructose and glucose). And importantly for those with type 2 diabetes, xylitol has a much lower glycemic index (approximately 10, compared to sugar’s 65). This means that xylitol provides a sweetness comparable to sucrose without causing the rapid spike in blood glucose levels associated with regular sugar.

What is a Sugar Alcohol?

Sugar alcohols are sweeteners that occur naturally in plants or are manufactured. Unlike artificial sweeteners, sugar alcohols are often used in food products due to their natural origins and their ability to provide sweetness with fewer calories. That’s why xylitol is prevalent in diet sodas, sugar-free chewing gum, toothpaste and mouthwash, desserts and baked goods.

Are Sugar Alcohols Safe? 

Not if you’ve been following the news lately. In addition to xylitol, the sugar alcohol erythritol has been demonized in the media. More on this later. But for now, the general consensus up until these recent reports was that sugar alcohols like xylitol are generally considered safe for most people when consumed in moderate amounts. 

Xylitol, like other sugar alcohols, is not completely absorbed in the small intestine. This produces a double-edged sword effect. On one hand, it leads to fewer calories absorbed than non-alcoholic sugars like table sugar. However, they can cause digestive issues such as bloating and diarrhea. But that’s more likely when consumed in large quantities.

What Are The Health Benefits of Xylitol?

While the world was rightfully concerned about another health problem in 2020, a study published in September of that year in Applied Microbiology and Biotechnology concluded the following about xylitol:

“Xylitol efficiently stimulates the immune system, digestion, lipid and bone metabolism; helps in glycemic and obesity control; reduces ear and respiratory infections; and treats diseases that cannot be cured through antibiotics or by surgery.” 

Wow! That’s quite a ringing endorsement. (If only the researchers tested it on that other health concern.) Because xylitol has been shown to have a minimal effect on blood glucose and insulin levels, it’s a great alternative for those managing these conditions and is an area of ongoing study.

What Are The Health Risks of Xyltiol?

But a 2024 study from the European Heart Journal, summarized in New Scientist has Xylitol in need of a reputation management specialist. The study suggested that the sugar alternative has been linked to a higher risk of heart attacks and strokes. In a study of 3306 adults in the US and Europe, the researchers analyzed a one-off blood sample from the participants to check their Xylitol levels after they fasted overnight. Over a three-year follow-up period, the team found that a third of those who had the highest levels of circulating xylitol were more likely to experience a cardiovascular event, such as a heart attack or stroke.

In a follow-up study on mice, the researchers found that Xyltitol could raise the risk of blood clots. The mice had significantly faster clot formation in their veins after receiving xylitol injections. Then, the research team — the same one that last year suggested an associated risk of cardiovascular problems with erythritol intake — tracked platelet activity in 10 people after giving them water that had been sweetened with the same amount of xylitol. Within 30 minutes, they showed a 1000-fold jump in levels of xylitol in their blood plasma.

So does that mean you should return to sweetening your food and drinks with good old-fashioned table sugar? Not so fast! Besides the obvious health risks of consuming added sugars in your diet, the study did not prove causation, merely an association. That being said, however, don’t drink several cans of xylitol-sweetened diet soda every day just to be on the safe side. 

Speaking of diet soda…

Chew On This: Xylitol Prevents Cavities

If there is a case to be made for chewing an occasional piece of gum sweetened with xylitol, it’s the potential of the sugar alternative to prevent dental caries (cavities). Again, moderation is likely key to preventing any potential cardiovascular problems. 

But here’s how Xyltiol is thought to work for oral health. For starters, it inhibits harmful bacteria that cause cavities and produce acid. Most notably, research shows it stops the growth of the Streptococcus mutans bacterium. That’s the main cavity-causing bacteria. Xylitol also helps maintain a neutral pH level and keeps the teeth’s outer layer intact. And by neutralizing acids produced by bacteria, it prevents mineral loss in the tooth enamel. Additionally, Xylitol increases saliva production, washing away food particles, and thereby preventing plaque formation. 

Is Xylitol Safe?

If I’m not sure about a specific ingredient’s safety, I’ll see what the regulatory agencies across the pond have to say. The EFSA (European Food Safety Authority) has approved xylitol as a food additive with no known carcinogenic effects, so that’s food for thought. 

Baking With Xylitol 

Integrating xylitol into daily life can be straightforward. It can be used as a substitute for sugar in cooking and baking, typically in a 1:1 ratio. Keep your consumption to 5 grams per day. At the end of the day, don’t believe the hype. I personally think Xylitol is a godsend for some of my patients. That being said, however, there’s no substitute for getting plenty of veggies and other natural foods in the diet.


  • Jenna Witt

    Jenna Witt has been a Nurse Practitioner since 2012. After working for five years in primary care at a Federal Qualified Health Center (FQHC), caring for the uninsured and underinsured, in 2016, Jenna began working in the local ER in Northeast Nebraska. Jenna has also earned a Master Certification in Health Coaching through the Dr. Sears Wellness Institute. She is also a certified Functional Medicine Practitioner, an integrative form of medicine that seeks to unveil the root causes of health concerns and disorders. In 2020, Jenna founded Fundamental Wellness. Her emphasis is helping those with emotional eating, blood sugar management disorders, chronic pain, and low energy. Through her skills as an integrative health expert, Jenna helps her clients optimize their nutrition and sleep, learn simple stress management techniques, and identify which movement/exercise program is best suited for them. Jenna is currently welcoming new clients, which she sees at the Diabetes & Wellness Clinic in Norfolk, NE.

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