Over the past few years, research papers have suggested that sugar alcohols, specifically erythritol, may increase blood clotting and potentially lead to a major adverse coronary event or MACE for short. It gave me pause — to the extent that I stopped using sugar-free gum when I work out. The same research group recently presented a paper at a major heart disease conference suggesting that xylitol may do the same. I’m going to present some facts about what I’ve found, and you can make your own decision.

The Facts on Xylitol

Xylitol is a sugar alcohol. It is not an artificial sweetener. Some discussions have labeled it as such, but that’s wrong.

Our body makes xylitol along with other sugar alcohols. The amounts vary, but on average, the amount is 5 to 10 grams per day.

Pure xylitol powder contains 4 grams of xylitol. The highest processed food source is sugar-free dark chocolate at 1.2 grams of xylitol per ounce of chocolate. None of the studies collected data on sugar alcohol intake.

The research on xylitol and other sugar alcohols is limited to large observational studies. No randomized controlled trial exists. Therefore, while the relationship proposed between MACE and sugar alcohol intake is curious, it’s going to take specific randomized controlled trials to determine any cause and effect.

The problem with the current state of research is that it doesn’t preclude that some people may naturally produce more endogenous xylitol than others. That has to be separated out at some point in time.

One thing is true: xylitol can be lethal for dogs, even in small amounts like chewing gum! Make sure you keep any sugar alcohol products including gum away from all animals.

The Current Bottom Line on Sweeteners

I think that the research on sugar alcohols should continue but without the hyperbole. What’s often not stated is the impact sugar alcohols can have on gut bacteria. Even if sugar alcohol can have some role in MACE, the gas production can keep consumers from using it in excessive amounts. As for me, I still chew gum while I work out, but my gut works overtime producing gas if I eat foods with sugar alcohols in them. I’d rather pass on the sugar alcohols than pass gas, so it’s regular old gum for me.

A Note on the Memo

While I love writing the Memos and helping you live a healthier life, drchet.com is still a business, so I’m hoping to increase product sales. If I have a product in the store that relates to the Memo’s subject, I’ll be highlighting it in a P.S., starting today with an option if you decide xylitol isn’t for you.

What are you prepared to do today?

        Dr. Chet

References:
1. CVD Res 2025. (121)1319–1329 https://doi.org/10.1093/cvr/cvaf091
2. Eur Soc Cardiology 365. 2026. Poster: The association of Xylitol and incident cardiovascular events: the CLSA and EPIC-Norfolk cohort studies