Erythritol & Xylitol: What the Research Really Says
Sugar-free candy has become increasingly popular among people who want to enjoy a sweet treat while reducing their intake of added sugar. Two ingredients you may see in sugar-free products are erythritol and xylitol, which are both sugar alcohols, also known as polyols.
You may also have seen recent headlines raising questions about these ingredients and cardiovascular health.
So, what does the research actually say?
The science is still evolving. Some studies have identified associations between higher blood levels of erythritol or xylitol and cardiovascular events, while other research has raised questions about how those findings should be interpreted.
Importantly, the existing research does not establish that consuming a particular food containing erythritol or xylitol causes heart attacks or strokes.
At Zolli, we believe consumers deserve straightforward information about the ingredients in the products they choose. That's why we've put together this overview of the current research.
What Are Erythritol and Xylitol?
Erythritol and xylitol are sugar alcohols used as alternatives to traditional sugar.
Despite their name, sugar alcohols are not the type of alcohol found in alcoholic beverages. They are carbohydrates that have different properties from table sugar and are commonly used in sugar-free foods and beverages.
The U.S. Food and Drug Administration (FDA) permits the use of sugar alcohols, including erythritol and xylitol, as sugar substitutes. The FDA notes that sugar alcohols are used in products such as sugar-free candies, cookies and chewing gum.
Because sugar alcohols have different effects on the body than traditional sugar, they are commonly used in products designed to reduce or eliminate added sugar.
What Does the Research Say About Erythritol?
In 2023, researchers published a study in *Nature Medicine* reporting an association between higher circulating erythritol levels and an increased risk of major cardiovascular events.
The study attracted considerable attention because laboratory and experimental research also suggested that erythritol could affect platelet activity and blood clotting.
However, an important distinction is necessary:
Blood erythritol levels are not necessarily the same as dietary erythritol intake.
The human body naturally produces erythritol as part of normal metabolism. Therefore, measuring the amount of erythritol in a person's blood does not necessarily tell researchers how much erythritol that person consumed from food.
The 2023 study was also observational. It identified an association between higher circulating erythritol levels and cardiovascular events, but an observational association does not by itself establish that consuming erythritol caused those events.
Research is continuing.
Additional studies published since 2023 have continued to investigate the relationship between erythritol and cardiovascular health.
For example, a 2025 genetic analysis reported associations between genetically predicted erythritol levels and certain cardiovascular outcomes. Other research has continued to examine circulating erythritol as a potential marker of cardiometabolic health.
A 2025 review of the available evidence concluded that erythritol and other sugar alcohols remain an area of active research and that a direct causal relationship between consuming these ingredients and cardiovascular disease has not been established.
The takeaway: Research has raised legitimate questions about erythritol, but the current evidence does not establish that eating erythritol causes heart attacks or strokes.
What Does the Research Say About Xylitol?
Xylitol has also been the subject of cardiovascular research.
A 2024 study published in the *European Heart Journal* reported that higher circulating xylitol levels were associated with major cardiovascular events and found evidence that xylitol could increase platelet reactivity and thrombosis potential in experimental models. The researchers concluded that additional studies examining the cardiovascular safety of xylitol were warranted.
New research in 2026
In August 2026, researchers presented additional findings at the European Society of Cardiology Congress involving more than 17,000 participants.
The researchers reported that participants with the highest blood xylitol levels experienced more major cardiovascular events than participants with the lowest levels.
These findings received significant attention because they add to the growing body of research examining a potential relationship between xylitol and cardiovascular health.
However, there are important limitations.
The 2026 findings were observational and, as presented, do not establish that consuming xylitol causes heart attacks or strokes. Blood xylitol levels can also reflect xylitol produced naturally by the body, rather than dietary intake alone.
The researchers have called for additional research to determine whether the observed association represents a causal relationship.
The takeaway: Emerging research has raised questions about xylitol and cardiovascular health, but more research is needed before a cause-and-effect relationship can be established.
What Does This Mean for Zolli?
Zolli uses different sweeteners across its product line, depending on the product and formulation.
Some Zolli products contain erythritol, while select products contain xylitol.
The amount and combination of ingredients in a finished food product are important considerations. Research examining circulating blood levels of an ingredient cannot automatically be interpreted as evidence that consuming a specific food product causes the same effects.
For example, our current formulation information indicates that the amount of erythritol in the Zolli products where it is used is less than 1/30th of 1%.
We believe consumers should be able to make informed decisions based on the actual ingredients and amounts in the foods they choose.
For the most accurate information about a specific Zolli product, always refer to that product's current Ingredient List and Nutrition Facts panel.
What Does This Mean for People with Diabetes?
Sugar-free products can be an option for people who want to reduce their intake of added sugar, including people with diabetes.
The American Diabetes Association's Standards of Care in Diabetes—2026 provides evidence-based recommendations for diabetes management and nutrition. The ADA recognizes that nonnutritive sweeteners may be used as an alternative to sugar-sweetened products in appropriate circumstances.
People with diabetes have individual nutritional needs and blood-glucose goals. When choosing a sugar-free product, consider the serving size, total carbohydrate and other information provided on the Nutrition Facts panel.
If you have questions about whether a particular food fits your individual diabetes management plan, consult your physician or registered dietitian.
Read more about how Zolli Candy fits in with choices for diabetics.
Our Approach to Ingredient Research
At Zolli, we're committed to making delicious candy without traditional added sugar while keeping transparency at the center of what we do.
We also believe responsible health communication means acknowledging when scientific research is evolving.
We don't believe consumers benefit from either extreme:
"This ingredient has been proven dangerous."
or
"There is absolutely nothing to be concerned about."
The current research doesn't support either conclusion.
Instead, we will continue to monitor research involving erythritol, xylitol and other sweeteners and update our information as the scientific evidence develops.
Our goal is simple: give you the information you need to make choices that are right for you and your family.
For product-specific information, please refer to the current ingredient list and Nutrition Facts panel on each product page.
Sources & Further Reading
U.S. Food & Drug Administration (FDA)
Aspartame and Other Sweeteners in Food
The FDA's current information on sugar alcohols, including erythritol and xylitol.
American Diabetes Association (ADA)
Standards of Care in Diabetes—2026
Current evidence-based clinical guidance for diabetes care and nutrition.
Witkowski et al., 2023 — Nature Medicine
The artificial sweetener erythritol and cardiovascular event risk
Research examining circulating erythritol levels, cardiovascular events and experimental measures of thrombosis.
Witkowski et al., 2024 — European Heart Journal
Xylitol is prothrombotic and associated with cardiovascular risk
Research examining circulating xylitol levels, cardiovascular events and experimental platelet activity.
Wölnerhanssen et al., 2025 — Cardiovascular Research
Erythritol, xylitol and cardiovascular risk—friend or foe?
Review of the evidence surrounding sugar alcohols and cardiovascular health.
Fan et al., 2025
Associations between artificial sweeteners and cardiovascular outcomes: a Mendelian randomization analysis
Genetic analysis examining potential relationships between erythritol and cardiovascular outcomes.
European Society of Cardiology, 2026
New research presented at the 2026 ESC Congress examining circulating xylitol levels and cardiovascular events.
Last reviewed: September 2026