Business
New Study Links Xylitol Sweetener To Higher Heart Attack And Stroke Risk In 17,700 People, Cardiologist Warns
A large new study presented at a major European cardiology conference has found that higher blood levels of xylitol, a popular sugar substitute used in gum, candy, baked goods and dental products, are associated with an increased risk of heart attack, stroke and death, adding fresh evidence to a growing body of research questioning the sweetener’s long-term cardiovascular safety.
The findings were presented at the European Society of Cardiology Congress in Germany in late August. Researchers analyzed data from more than 17,700 participants across two large, long-running studies: the European Prospective Investigation into Cancer, or EPIC, Norfolk cohort in the United Kingdom, and the Canadian Longitudinal Study on Aging, or CLSA.
In the Canadian cohort, participants with the highest blood xylitol levels showed a 57% higher risk of experiencing a major adverse cardiovascular event, defined as death, heart attack or stroke, over a six-year follow-up period, compared with those who had the lowest xylitol levels. In the British cohort, followed over a considerably longer 30-year period, participants with the highest xylitol levels showed an 18% greater risk of a major cardiovascular event compared with those with the lowest levels.
Dr. Marco Witkowski of Charité University Hospital in Berlin, who presented the research, said the findings underscore how little is currently understood about the long-term cardiovascular effects of a sweetener widely regarded as a healthier alternative to sugar.
“Artificial sweeteners are consumed by people who think they are healthier than sugar and they are generally regarded as safe by regulatory agencies,” Witkowski said. “Our long-term findings in the general population highlight how little we know about the cardiovascular safety of xylitol and indicate that further studies are warranted, especially as the amount of xylitol in products continues to increase.”
According to the European Society of Cardiology, both study cohorts showed evidence of a dose-dependent relationship, meaning that as blood xylitol concentrations increased, so did the rate of cardiovascular events among participants. Researchers said the elevated risk persisted even after accounting for other factors that could independently influence cardiovascular health, including age, sex, body mass index, hypertension, diabetes and cholesterol levels.
The new findings build directly on earlier research led by Dr. Stanley Hazen, chair of cardiovascular and metabolic sciences at Cleveland Clinic’s Lerner Research Institute and co-section head of preventive cardiology in the hospital’s Heart, Vascular and Thoracic Institute. Hazen’s team published a study in 2024 in the European Heart Journal analyzing blood samples from more than 3,000 people already undergoing evaluation for heart disease. That research found that people with the highest xylitol levels in their blood had roughly double the risk of heart attack, stroke or death over a three-year period compared with those who had the lowest levels.
Hazen’s earlier study also included laboratory experiments examining how xylitol affects blood clotting. Researchers tracked platelet activity in people who drank a xylitol-sweetened beverage compared with those who consumed a glucose-sweetened drink, finding that every measure of clotting ability increased significantly and immediately following xylitol consumption, but not after glucose consumption. Separate experiments in mice and isolated human blood samples similarly found that xylitol enhanced the clot-forming activity of platelets, offering a possible biological mechanism to help explain the cardiovascular associations observed in the broader population studies.
Hazen said the newly presented findings reinforce the urgency of further investigating sugar alcohols and artificial sweeteners more broadly, particularly given how frequently they are recommended to patients managing conditions such as obesity or diabetes.
“This study again shows the immediate need for investigating sugar alcohols and artificial sweeteners, especially as they continue to be recommended in combatting conditions like obesity or diabetes,” Hazen said.
Following his 2024 research, Hazen also called for regulators to reconsider how sugar substitutes like xylitol are classified and labeled, given the mounting evidence of potential cardiovascular risk.
“I hope this serves as a calling for new regulatory guidelines to improve labeling mandates and remove sugar substitutes like xylitol from GRAS status,” Hazen told Healthline at the time, referring to the Food and Drug Administration’s “Generally Recognized as Safe” designation, which indicates a substance is considered harmless under its intended conditions of use.
Xylitol is a sugar alcohol commonly used as a low-calorie sweetener and sugar substitute, according to the National Institutes of Health. It is frequently used in higher concentrations to sweeten a range of everyday products, including chewing gum, candy, baked goods, peanut butter, and dental care products such as toothpaste and mouthwash, where it is also valued for its ability to help prevent tooth decay. In the European Union, xylitol is approved for use under the food additive designation E967.
Researchers involved in the newly presented study emphasized that their findings, like Hazen’s earlier work, remain observational in nature, meaning they demonstrate an association between xylitol levels and cardiovascular events rather than proving that xylitol directly causes heart attacks or strokes. The European Society of Cardiology noted in its release accompanying the study that further research would be needed to establish whether the relationship reflects a true causal effect or whether other unmeasured factors might help explain the pattern observed across both study cohorts.
It’s also worth noting that artificial sweeteners, including xylitol, undergo rigorous safety testing before regulatory approval in markets including the United States and the European Union, and have long been recommended by health authorities as an alternative to added sugar for people managing weight, diabetes or other metabolic conditions. The new findings add to an evolving and still-developing body of evidence rather than settling the broader question of xylitol’s overall safety profile.
Researchers involved in both the newly presented study and Hazen’s earlier work have consistently recommended that individuals with questions about their own sugar substitute consumption speak directly with their doctor or a registered dietitian, particularly those managing existing cardiovascular risk factors or conditions such as diabetes, rather than making significant dietary changes based solely on observational research findings.
As scrutiny of xylitol and other sugar alcohols continues to build, researchers say additional large-scale, long-term studies will likely be necessary to more definitively characterize the sweetener’s cardiovascular safety profile, particularly given its increasingly widespread use across a broad range of everyday consumer products marketed to health-conscious buyers as a lower-calorie or diabetes-friendly alternative to traditional sugar.
The UK government is expected to approve the Jackdaw gas field off the coast of Aberdeen in mid-September, according to government and industry sources cited by the BBC. The decision would come just before Parliament breaks for party conference season.
The project was first approved by the Conservative government in 2022 but was halted by a legal ruling in Scotland after environmental groups argued that consent had been granted without fully considering the climate impact.
Jackdaw is operated by Adura, a joint venture between Shell and Norway’s Equinor, which also operates the Rosebank oil field off Shetland. Adura says Jackdaw will account for 6 per cent of UK gas output at peak production. Environmental groups say the field will supply only 2 per cent of UK use once imports are included.
Court ruling and consultation
Campaigners brought legal challenges after Jackdaw was approved in 2022 and after Rosebank was given the go-ahead in 2023. In January 2025 the Court of Session in Edinburgh ruled that both fields had been unlawfully approved because the government had not taken into account the emissions from burning the oil and gas extracted from them.
The judge ordered more detailed climate assessments to be published. Those updated estimates were put out for consultation in July, and the public consultation on Jackdaw and Rosebank closed in August.
Adura has estimated that Jackdaw could produce 35.8m tonnes of carbon over its 11-year lifetime, equivalent to 90 per cent of Scotland’s emissions for 2023. The company said a more likely estimate was about 23.6m tonnes, equivalent to 60 per cent of the 2023 figure.
The decision now rests with Energy Secretary Miatta Fahnbulleh. Speaking in the House of Commons on 3 September, Energy Minister Kate White said the energy secretary would take separate decisions on Jackdaw and Rosebank but gave no indication of timing.
“The process ended in August, and the Secretary of State will be taking those decisions in due course,” she told MPs.
Adura said that if approval comes in September the field could start delivering gas to UK homes by this winter, as construction is “99 per cent complete”. Advocates of the project told the BBC that Jackdaw’s output is critical to extending the life of other North Sea infrastructure, including the Shearwater production hub.
Energy security and prices
Prime Minister Andy Burnham has said there needs to be a “pragmatic approach” towards domestic oil and gas. “We won’t be able to stop using oil and gas for some time. That’s just a fact,” he said.
Unlike North Sea oil, most of which is exported and reimported in refined forms, almost all North Sea gas is used domestically. The UK imports more than 60 per cent of its gas, mainly from Norway and the United States, according to the BBC.
Wholesale gas prices, which rose this year as a result of the Iran war, are at a three-year high. Because prices are set internationally, approval for Jackdaw would not lower the cost of gas for domestic consumers.
Chris O’Shea, chief executive of British Gas owner Centrica, told the BBC’s Today programme that any additional domestic supply would reduce Britain’s reliance on imported fossil fuels, “so it’s got to be good”.
“It wouldn’t lower the cost materially, but basic economics would tell you that if you’ve got a fixed demand for a product and you increase the supply, the price should move,” he said.
Tessa Khan, executive director of Uplift, the environmental group that brought the legal challenge, said more North Sea drilling would not cut energy bills and would “make no meaningful difference” to UK energy supply.
“The science is clear that the world already has far more oil and gas than can ever be safely burned if we are to limit warming,” she said.
The Department for Energy Security and Net Zero said it does not comment on speculation. A spokesman said: “Any decision will take into account all relevant evidence, including environmental assessments and public representations received during the consultation process.”
Amy Ingham
Amy Ingham is a reporter at Business Matters, covering UK business news with a focus on breaking news, business policy, late payments and insolvency. She joined the magazine in 2026 after completing the NCTJ Diploma in Journalism at Harlow College’s journalism school. Her recent reporting includes British Steel’s nationalisation and its impact on SME suppliers, the decline in late payments by large firms, and Insolvency Service director disqualifications. Reach her at aingham@cbmeg.co.uk.
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I am a market enthusiast and part-time trader. I started writing for Seeking Alpha in 2011, and it has been a tremendous opportunity and learning experience. I have been interested in the markets since elementary school, and hope to pursue a career in the investment management industry. I have been active in the markets for several years, and am primarily focused on long/short equities. I hold a Bachelor of Science Degree from Lehigh University, where I double majored in Finance and Accounting, with a minor in History. My major track focused on Investments and Financial Analysis. While at Lehigh, I was the Head Portfolio Manager of the Investment Management Group, a student group that manages three portfolios, one long/short and two long only. I have had two internships, one a summer internship at a large bank, and another helping to manage the Lehigh University Endowment for nearly a year. Disclaimer: Bill reminds investors to always do their own due diligence on any investment, and to consult their own financial adviser or representative when necessary. Any material provided is intended as general information only, and should not be considered or relied upon as a formal investment recommendation.
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BSE, Groww, Angel One shares rally up to 8% after Sebi’s CAS circular. What did the regulator say?
The Securities and Exchange Board of India (Sebi) said on Thursday that it would review the methodology used to determine settlement prices for derivative contracts on expiry, following feedback from market participants after the rollout of the new Closing Auction Session (CAS) in the equity cash market.
Following the news, BSE shares rallied 5% to hit a day’s high of Rs 3,466, with Angel One shares jumping 8% to Rs 308. Motilal Oswal shares gained over 2% to Rs 1,038, and Groww climbed more than 3% to a day’s high of Rs 196 apiece.
“Having considered the experience of the initial period of CAS implementation and the feedback received from various stakeholders, Sebi may be proposing certain changes in the methodology for determination of settlement prices of derivative contracts for which a consultation paper will be issued in about a week,” Sebi said in a statement.
Among the issues raised, Sebi said, a significant area of feedback relates to the determination of settlement prices of derivative contracts on expiry based on the closing price determined through CAS.
CAS is a call auction mechanism used to determine the closing price of stocks in the cash segment on which derivative contracts are available.
Why this matters
The development gains significance as stock exchanges acknowledged that the newly introduced Closing Auction Session (CAS) had resulted in lower trading volumes.According to an ET report, equity derivatives turnover on the NSE and BSE fell to multi-month lows in August, with analysts attributing the decline to heightened volatility under the new CAS mechanism. The volatility prompted several market participants to scale back derivatives activity, particularly during the final half-hour of trading.
Last month, NSE’s total monthly equity derivative turnover stood at Rs 34.48 lakh crore, the lowest since November 2023. BSE’s August turnover stood at Rs 32.2 lakh crore, the lowest since June 2025.
Wall Street brokerage Jefferies, in a report earlier this week, said the key challenge with CAS has been the uncertainty on expiry day, forcing option writers to stay away from the market. This has reduced the profitability of proprietary traders. Jefferies said Sebi could address challenges with CAS through three measures: de-linking options expiry from the CAS window, improving the stock lending and borrowing mechanism, and deepening the auction pool.
Also read: Sebi to review derivatives settlement price methodology after CAS volatility
The review follows sharp expiry-day moves seen after the introduction of CAS. Traders have complained that sudden swings in the closing auction can lead to large changes in option prices in the final minutes of trade, especially when contracts are close to expiry.
The regulator did not specify what changes may be proposed. The consultation paper expected next week will be watched closely by brokers, proprietary desks, institutional investors and active derivatives traders.
Also read: Polycab, KEI Industries shares crash up to 9% after UltraTech Cement enters wires & cables business
Any change in methodology could be important for expiry-day risk management. If the settlement price is less directly linked to short-period CAS movements, it may reduce the chance of sudden option price spikes in the final minutes.
(Disclaimer: Recommendations, suggestions, views and opinions given by the experts are their own. These do not represent the views of The Economic Times)
VanEck is a global asset management firm offering ETFs, mutual funds, private funds, model portfolios, institutional strategies, separately managed accounts, as well as UCITS funds. Since our founding in 1955, putting our clients’ interests first, in all market environments, has been at the heart of the firm’s mission. VanEck has a long history of looking beyond financial markets to spot trends that create meaningful investment opportunities. We were one of the first U.S. asset managers to give investors access to international markets, which set the tone for identifying asset classes and themes such as gold investing in 1968, emerging markets in 1993, and exchange traded funds in 2006 that later helped shape the investment industry. The firm oversees $161.7 billion in assets as of September 30, 2025. Disclosures: http://ow.ly/SZ9450N5qTJ.
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