New Study finds common Sugar Alcohols (Xylitol) linked to Heart Disease - is it true?
Summary
TLDRThe video script discusses recent studies linking sugar alcohols, specifically Xylitol and Erythritol, to cardiovascular disease. It explains the research methods, including metabolomic analysis and thrombosis assays, revealing a potential correlation between higher blood Xylitol levels and increased risk of cardiovascular events. However, the script also points out limitations in the studies, such as unaddressed confounding factors and the lack of long-term, randomized control trials. It concludes with a balanced view, suggesting that while there is cause for concern, more robust evidence is needed to establish a definitive causal relationship.
Takeaways
- đ The media frequently reports on new studies linking sugar alcohols like Xylitol and Erythritol to cardiovascular disease, causing public concern.
- đŹ Xylitol is a sugar substitute found in low-carb foods, processed foods, and dental products, and is also naturally produced by the body.
- 𧏠A study used an untargeted metabolomic approach to identify Xylitol metabolites associated with cardiovascular events and validated the findings with a targeted metabolomic technique.
- đ The validation cohort data showed a stepwise decrease in cardiovascular event-free survival with increased Xylitol levels in the blood.
- â ïž The study adjusted for potential confounding factors like age, sex, smoking, diabetes, blood pressure, and cholesterol, but some health differences among participants were not fully accounted for.
- đ Animal experiments indicated that Xylitol could have a potent effect on thrombosis, the aggregation of blood platelets into a clot.
- đ§Ș Human blood experiments showed that Xylitol increased the aggregation of platelets on a collagen chip, suggesting a potential impact on blood clotting.
- đ Short-term consumption of 30 grams of Xylitol led to a significant rise in blood Xylitol levels, but the long-term cardiovascular risk is still unclear.
- đ€ The study has limitations, including not fully adjusting for all health differences among participants and the lack of long-term, randomized control trials on Xylitol's cardiovascular risk.
- đ The study's findings should be considered cautiously, as other studies have indicated potential cardiovascular benefits of Xylitol, such as improved endothelial function.
- đ« The current evidence does not conclusively prove that Xylitol causes cardiovascular disease, and more robust studies are needed to establish a clear cause and effect.
Q & A
What is the main topic of discussion in the script?
-The main topic of discussion is whether sugar alcohols like Xylitol and Erythritol are linked to cardiovascular disease, as suggested by recent studies.
What is Xylitol and where is it commonly found?
-Xylitol is a sugar substitute found in many low-carb, processed foods, some dental items, and is also naturally produced by the human body.
What is an 'untargeted metabolomic' and how was it used in the study?
-An 'untargeted metabolomic' is a research technique that probes for many metabolites in the blood. In the study, it was used to associate these metabolites with cardiovascular events over a three-year follow-up period.
What is the purpose of the 'validation cohort' in the study?
-The validation cohort is a second group of participants used to validate the results of the initial study with a technique called targeted metabolomics, providing greater sensitivity to identify Xylitol specifically.
How did the researchers measure the cardiovascular event-free survival in the study?
-They measured the cardiovascular event-free survival by comparing the percentage of people who had not experienced any cardiovascular event over a three-year period, categorized by their blood Xylitol levels.
What does MACE stand for and what does it measure?
-MACE stands for Major Adverse Cardiovascular Events and it measures the risk of cardiovascular disease events such as heart attacks, strokes, etc.
What experiment was conducted on mice to understand the effects of Xylitol on blood clotting?
-A thrombosis assay was conducted on mice, where their blood vessels were injured to activate clotting and repair. The experiment compared the clotting times after injecting an inert substance or Xylitol.
What is the significance of the blood clotting experiment in the context of the study?
-The blood clotting experiment showed that Xylitol can have a potent effect on thrombosis, indicating that it may increase the risk of pathological clotting that can stop blood flow in finer veins and arteries.
How did the researchers determine if normal day-to-day amounts of Xylitol affect blood Xylitol levels?
-The researchers gave 30 grams of Xylitol to participants and measured their blood Xylitol levels over 24 hours to see if consuming this amount would significantly raise blood Xylitol levels.
What are some potential confounders in the study that the script mentions have not been fully addressed?
-Some potential confounders not fully addressed include the overall health status of participants, previous cardiovascular disease, kidney health, and the use of certain medications, which could all influence cardiovascular disease risk.
What is the conclusion of the script regarding the consumption of Xylitol and its potential health risks?
-The script concludes that while there are indications that Xylitol may increase cardiovascular disease risk, the evidence is not robust enough to warrant significant concern. It suggests that using Xylitol for dental purposes is likely not a major worry, and consuming it in normal quantities may not pose a significant risk based on the current studies.
Outlines
𧏠Controversy Over Xylitol and Cardiovascular Health
This paragraph delves into the recent media frenzy surrounding the potential link between sugar alcohols, specifically Xylitol and ariol, and cardiovascular diseases. The discussion is prompted by a study suggesting a correlation between xylitol consumption and an increased risk of heart attacks and strokes. Xylitol, a sugar substitute found in low-carb and processed foods, as well as in dental products, is scrutinized through an untargeted metabolomic analysis that identified its metabolites in the blood of individuals who suffered cardiovascular events. A validation cohort further confirmed these findings with a targeted metabolomics approach. The data presented shows a stepwise reduction in cardiovascular event-free survival with increased xylitol levels, indicating a potential risk that warrants further investigation.
đ Investigating Xylitol's Impact on Blood Clotting
The second paragraph expands on the initial findings by exploring xylitol's effects on blood clotting through both animal and human studies. In mice, xylitol was found to accelerate the clotting process, suggesting a potent effect on thrombosis. This was further supported by experiments using human blood, where xylitol exposure led to increased platelet aggregation on a collagen chip. The paragraph also discusses the potential implications of these findings, noting that while clotting is necessary for healing, pathological clotting can obstruct blood flow in veins and arteries. The speaker also humorously rates the physiological relevance of the findings, hinting at the complexity of interpreting these scientific results.
đ€ Weighing the Evidence on Xylitol and Cardiovascular Risks
The final paragraph critically examines the evidence linking xylitol to cardiovascular risks. It acknowledges the effort and methodology of the studies, including the use of reasonable doses to measure xylitol's impact on blood levels and the various aggregation assays. However, it also points out the limitations and potential confounders, such as the baseline health differences between study participants. The speaker emphasizes the need for more robust, long-term studies to establish a clear cause-and-effect relationship. They also mention a study using Mendelian randomization that found no association between xylitol and cardiovascular disease, adding another layer to the debate. The paragraph concludes by questioning the immediate need to abandon xylitol products, suggesting a balanced view on the current state of research.
Mindmap
Keywords
đĄSugar Alcohols
đĄXylitol
đĄCardiovascular Disease (CVD)
đĄMetabolomic
đĄValidation Cohort
đĄThrombosis Assay
đĄPlatelet Aggregation
đĄMandelian Randomization
đĄEndothelial Function
đĄMicromolar
đĄConfounding Factors
Highlights
Concerns raised about sugar alcohols like Xylitol and Erythritol potentially increasing cardiovascular disease risks.
Xylitol is a sugar substitute found in low carb foods, processed foods, and dental items, and is also naturally produced by the body.
A study links Xylitol to cardiovascular disease through an untargeted metabolomic analysis associating its metabolites with cardiovascular events.
A validation cohort was used to confirm the findings with a targeted metabolomics technique, identifying Xylitol specifically.
Data from the validation cohort shows a stepwise reduction in cardiovascular event-free survival with increased Xylitol levels.
Adjusted analysis still shows a significantly elevated risk in the group with the highest Xylitol levels, even after accounting for confounding factors.
Experiments in mice indicate that Xylitol can have a potent effect on thrombosis, the aggregation of blood into a clot.
Human blood experiments show increased platelet aggregation and clot formation when exposed to Xylitol.
Normal day-to-day consumption of Xylitol leads to a significant rise in blood Xylitol levels, which may be associated with increased cardiovascular risk.
A similar sugar alcohol, Erythritol, also shows effects on cardiovascular health in a separate study.
Despite the findings, there are concerns about the studies not adjusting for all potential confounders, such as overall health status.
The studies provide a patchwork of evidence, but do not conclusively prove a direct cause and effect relationship between Xylitol and cardiovascular disease.
A Mendelian randomization trial suggests no relationship between Xylitol and cardiovascular disease, offering a different perspective on the risk.
The long-term effects and safety of Xylitol consumption are still not fully understood due to a lack of prospective studies and long-term randomized control trials.
For dental use, the risk associated with Xylitol is likely minimal, but caution is advised for ingestion.
The study's findings should be considered alongside other research indicating potential benefits of Xylitol for cardiovascular function.
The presenter encourages viewers to remain open to future studies that may provide a clearer understanding of Xylitol's impact on health.
A call to action for viewers to consider their Xylitol consumption and whether they should continue using it based on the current evidence.
Transcripts
doesn't it seem like every few weeks
there's a new study that the media
landscape is up in arms about maybe my
ear is too close to the ground
considering well it's my field still it
seems constant we are here to discuss if
sugar alcohols like Xylitol and ariol
are going to stop your heart and send
you to an early life retirement and it's
all due to this study xylitol is a sugar
substitute that's found in many low carb
foods processed foods and even some
dental items however your body also
produces it as I mentioned Xylitol has
now been linked to cardiovascular
disease and we'll see if that's true or
not but I'd like to in Consulting speak
Loop in another study that shows the
same results but for ariol here so now
we have two studies indicating the same
scary situation should we run for the
hills last time I made that reference in
editing we accidentally added uh the
iron made song The Trooper instead of
Run to the Hills and got called out by
my fellow metalheads so allow me to
correct that here should we Run to the
Hills oh yeah I absolve myself of my
metal sins okay back to the study the
researchers of this study took data from
two different groups of people one group
called The Discovery cohort had blood
sampled and then the researchers
performed a research technique called an
untargeted metabolomic essentially they
probed for many metabolites in the blood
and then Associated that to a three-year
followup of these people to see who had
cardiovascular events like heart attacks
Strokes
Etc the idea being that if one
metabolite is much higher in people who
suffer from a CBD event that's
cardiovascular event then they can focus
on that metabolite they ended up
discovering that Xylitol like molecules
metabolites Associated well with CBD
events but because this was untargeted
they needed greater sensitivity to
separate out Xylitol specifically that's
where the validation cohort comes in the
second group to validate the results
with a technique called targeted
metabolis mix see how that works now
they had the sensitivity to identify
Xylitol specifically but don't take my
word for it I'm just a dude on the
interwebs let's look at the data here
I'm showing you the validation cohort
data on the left we see a graph with the
event free survival meaning that the
percentage of people who have not
experienced any cardiovascular event
remember that's heart attack stroke Etc
the higher the line the better the
outcomes so you don't want the lines to
go down the horizontal axis is the
number of years of followup that's a
three years total so we're comparing the
T1 with those with the lowest
concentration of blood Xylitol to T2
those with a moderate amount and T3
those with the greatest amount of
Xylitol You Now understand the worry
don't you it looks like a stepwise
reduced cardiovascular event survival
with increased in Xylitol levels this
was further Illustrated in the graph on
the right with the dotted line one being
the risk of the T1 group and the dots
and lines representing the elevated risk
relative to T1 if they move to the right
there's increased mace risk which is a
measure of cardiovascular disease events
the unique aspect here is that the red
dots and lines are an adjusted analysis
so the researchers are removing
potential confounding factors that might
explain the increased risk such as age
sex smoking diabetes uh blood pressure
cholesterol containing lipoproteins
triglycerides and an inflammation marker
C reactive protein as you can see the T3
condition still shows significantly
elevated risk are you slowly removing
that Xylitol filled gum from your mouth
yet well
that's not all the data another
experiment they did was in mice because
this experiment would be illegal to do
in humans they performed a thrombosis
assay which means that they injured the
blood vessels of mice to activate them
to clot and repair the injury however
they did this after injecting an inert
substance that's the vehicle seen here
or injected xylol if you want to look at
the micrographs the more white that
there is the more clotting happen
happened as you can see both conditions
clotted which is a good thing but look
at the times that it took to clot the
Xylitol exposed condition clotted much
faster this is also shown in the graph
on the right the red Xylitol condition
is lower indicating less time elaps to
clot now by itself that's not a bad
thing we need to clot but it's simply
shows that Xylitol can have a potent
effect on thrombosis the aggregation of
LS into a clot if it is pathological it
can completely stop blood flow in finer
veins and arteries I don't know about
you but I enjoy my blood flow although
it sometimes fails to reach the humor
side of my
brain I actually didn't think that was
too bad I think it fit pretty nicely
still physiological and still related so
I'll give that
one eight out of 10 got good blood flow
today next they repeated this experiment
in humans whole blood remember it would
be illegal to cause damage to someone's
arteries and watch it get clogged up
after injecting them with Xylitol so the
next best thing is to remove blood
expose it to a microchip with collagen
on it and then expose Xylitol and the
vehicle that's the inert substance
remember independently to the blood and
collagen then the more green that you
see means that there's more platelets
that bound to the collagen chip
indicating greater aggregation of
platelets we can see a quantification on
the right side over 3 minutes time I
probably don't need to spell it out for
you I'm assuming the XY all exposed
human blood aggregated onto the collagen
much more than the vehicle which is the
correct comparison they did many
experiments using different uh other
activating molecules but I'd like to
focus on the highlights the paper
reference is linked for you if you'd
like to Deep dive into it for yourself
now we know that people with more blood
Xylitol correlate with increased cvd
risk we know that Xylitol increases
aggregation of platelets and cloth
formation next we should probably find
out if consuming normal day-to-day
amounts of Xylitol will even budge our
blood Xylitol levels it's estimated that
Xylitol consumers eat or drink on
average around 30 gram of Xylitol so so
the researchers gave 30 G of Xylitol to
people and measured their blood values
over 24 hours each line represents a
single person the vertical axis is the
amount of blood Xylitol and the
horizontal axis is the 24 hours of
measurement you can see the blood
Xylitol levels start below one
micromolar and the peak is around I
don't know what like 7 800 micromolar
something like that now for reference
the amount found to be associated with
increased cvd events was a measly 30
micromolar and even less than that the
researchers have drawn a dotted line for
the 30 micromolar cut off so these
people had above believe dangerous
levels for about 30 to 60 Minutes
however keep in mind that the risk was
also seen at values as low as a few
micromolar meaning these people were in
the at risk concentration for at least 6
hours and probably longer after 13 G
consumption of Xylitol you also notice
that three people had their lines go up
and they didn't have the lines go
further into measurement that's because
they suffered massive coronary heart
attacks and died I'm kidding it was just
measurement error and inability for them
to be remeasured so they removed their
data
points could you imagine okay I won't go
through all the data again but there is
an ariol study a similar sugar alcohol
to Xylitol that also shows these same
effects just as a quick glance does this
look familiar the Q4 is the highest
blood ryol
levels okay enough doomsday by now
you've spit out your sugar-free gum and
thrown the whole pack in the trash well
you may want to pull it back out or not
we'll
see obviously these studies took a lot
of work and I do like aspects of them
like the fact that they used a
reasonable dose to indicate the overall
burden of Xylitol on blood at Xylitol
levels or some of these aggregation
assays many of which I didn't show you
for time sake I also like the fact that
they didn't adjust at analysis on the
association because it strengthens the
argument that all said there are some
undercover problems that haven't been
addressed for example if we pop open the
validation cohort data again the T3
condition there is yes high in Xylitol
and yes it's adjusted for many factors
but if you open the Baseline data on
these participants in both the Xylitol
study and the ariol study they also have
higher rates of previous cardiovascular
disease they take more drugs for their
health and they have worse Kidney Health
among other differences so while the
researchers adjusted for some factors
they didn't adjust for all of them plus
even if they had it seems clear to me
that the T3 and even the t2 group were
in worse overall health which is not
something that you can just adjust for
statistically for example if you remove
all the diabetic individuals that still
doesn't account for the people that have
had previous heart problems and may be
pre-diabetic the overall background of
these people their overall health is
different which is a huge contributor to
their risk of cardiovascular disease
it's an entirely different story when
you have two groups of people that are
the same Health at the beginning except
they differ in one factor because then
you can adjust for that factor that
isn't the case here additionally we're
looking at Xylitol blood levels but
we're not talking about consuming
Xylitol yes there were some short-term
experiments but all these data culminate
in a patchwork of evidence that on
assumptions that they tie into one
another for example I understand it's
worrisome to see data indicating Xylitol
increases clotting when activated to
clot and that's important it doesn't
just cause clotting on its own but other
Studies have also indicated that Xylitol
improves other mechanisms of
cardiovascular function like endothelial
function as a matter of fact that study
that I just referenced is a mandelian
randomization trial which means that it
looks at Xylitol related genes and tries
to find associations between these genes
and disease risk it's a honestly it's a
pretty lackluster explanation but time
is money and money is time or I don't
know something like that the point is
it's another way of assessing xylol risk
and they concluded there was no
relationship between Xylitol and
cardiovascular disease I have some small
issues with this study too though so
it's not perfect and I don't think that
it absolves Xylitol
entirely
unfortunately we don't have any
prospective studies on Xylitol or
long-term randomized control trials
looking at its cardiovascular risk and
just because I brought up some
confounders to this analysis does not
mean that xylol couldn't be the culprit
however since we only have a handful
studies it's impossible to get a clear
idea that said using it for dental and
not ingesting it is probably not a big
worry and I understand that consumption
is also a common use and it's true that
30 G did lead to a significant rise but
again the long-term data was in blood
levels not consuming xylol additionally
all the aggregation assets indicating
Xylitol increases blood clotting were
done at a concentration of 30 micr Moler
but let me clue you in on one more piece
of data here this is another aggregation
assay with the higher levels on the
vertical axis indicating greater
thrombosis but I want you to pay
attention to the horizontal axis notice
that the effect is only statistically
significant at 30 100 and 300 and notice
the effect size at
300 which is 10 times what people are
exposed to in blood for 60 minutes only
increased aggregation by 2.46 fold and
consider that generally your Xylitol
levels will be well below 10 micromolar
which according to this assay shows no
effect so am I worried based on this and
the orthol study alone no I'm not
however I am open to Future studies that
actually show a more robust cause and
effect so my question for you is did you
take your Xylitol gum out of the trash
or not anyway allow me to freak you out
in this next video right here I'll speak
with you over there
[Music]
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