Is xylitol harmful to human health?

Is xylitol harmful to human health?
Xylitol's safety profile is well established for food use, with JECFA setting no daily intake limit. However, its caloric contribution is often overstated: while sweetness is 1.2x sucrose, gut absorption is only about 20%, so effective calories per equal sweetness are roughly 11% of sugar. The main acute risk is osmotic diarrhea at intakes above 50g/day, caused by unabsorbed xylitol drawing water into the gut, not by toxicity. A 2024 European Heart Journal study linked high plasma xylitol levels to increased cardiovascular event risk and prothrombotic effects, though this correlation requires further mechanistic validation. For diabetics, xylitol does not require insulin for metabolism but still slowly converts to glycogen, so it is not a treatment for diabetes.