The recent study published in the British Medical Journal (BMJ) has raised significant concerns about the sweetener xylitol and its potential link to cardiovascular disease. This article aims to dissect the study’s findings, explore the biochemical nature of xylitol, and discuss the broader implications for public health.
Oh, and if you want a fast answer, because nowadays we barely have time for anything, here it is: no, xylitol does not cause heart disease, at least the study didn’t even measure properly xylitol intake. Nevertheless, let’s get to it.
Understanding Xylitol
Xylitol is a sugar alcohol commonly used as a low-calorie sweetener. It is approximately as sweet as glucose but with fewer calories, making it a popular ingredient in keto-friendly and low-carb products. Unlike some artificial sweeteners, xylitol has a relatively minimal impact on blood glucose levels, although it does contribute some calories and can slightly raise blood glucose.
Biochemical Nature of Xylitol
Xylitol is naturally produced by the human body as part of the metabolism of xylose, a sugar derived from dietary carbohydrates. This endogenous production means that even without external consumption, the body maintains baseline levels of xylitol in the blood.
The information for this article is largely based on the expertise from Dr Layne Norton and Thomas DeLauer.
Dr Layne Norton is a scientist, pro natural bodybuilder, raw elite powerlifter, and physique coach, among other things. He received his BS in Biochemistry, and his PhD in Nutritional Sciences. Besides being a coach, he also commands his YouTube channel in which he talks about science and fitness intertwined, sometimes breaking down scientific studies that come out so people can make better-informed decisions in their fitness journey.
Thomas DeLauer is a celebrity trainer and health author. His YouTube Channel has more than 3.5 million subscribers and he has been on the cover of numerous international magazines.
Does Xylitol Cause Heart Disease?
The Study in Focus
The study in question investigated the association between blood levels of xylitol and the incidence of major cardiovascular events (MACE). The researchers conducted a metabolomics panel, measuring various metabolites in the blood, including xylitol, and their correlation with cardiovascular disease events.
Study Population
It’s crucial to note that the cohort studied consisted of individuals with significant pre-existing health conditions:
- Average age of 64
- Over 20% had diabetes
- More than 70% had hypertension
- Over 75% had a history of cardiovascular disease
- Almost half had a history of a myocardial infarction (heart attack)
- Nearly 20% had a history of heart failure
- Over 70% were taking aspirin
- Half were on ACE inhibitors
This demographic already presents a high baseline risk for cardiovascular complications, which is an important factor when interpreting the results.
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Key Findings
The study initially reported an 80% increased risk of major cardiovascular events in individuals with higher blood levels of xylitol. However, when adjusted for factors like C-reactive protein (CRP) levels, an inflammation marker, and other traditional cardiovascular risk factors, the relative risk increase was reduced to 6% per standard deviation of xylitol.
Critical Analysis
The methodology and the study population raise several critical points:
- Endogenous Production vs. Dietary Intake: The study did not measure xylitol intake but rather blood levels. Given xylitol’s rapid metabolism and clearance from the body, elevated blood levels are more likely reflective of endogenous production, particularly in individuals with metabolic dysregulation.
- Reverse Causation: Higher xylitol levels in the blood may be a result of underlying health conditions rather than a cause. People with metabolic syndrome or other health issues often have disrupted carbohydrate metabolism, leading to higher levels of sugar alcohols like xylitol.
- Statistical Adjustments: The significant reduction in risk percentage after adjusting for CRP and other factors suggests that inflammation and other cardiovascular risk factors play a more critical role than xylitol levels per se.
Experimental Findings
In addition to the metabolomics panel, the study included an experiment where participants were given a 30g dose of xylitol, comparable to amounts found in some keto ice creams. Postprandial (after eating) blood levels of xylitol increased by a thousand-fold but returned to baseline within a few hours, indicating rapid metabolism and clearance.
Further experiments included investigating platelet aggregation and thrombosis in both mice and humans. In mice, xylitol was injected intraperitoneally (into the body cavity), leading to increased platelet aggregation and thrombosis.
However, mice do not absorb xylitol well orally, making these findings less applicable to humans. In humans, platelet-rich plasma (PRP) from individuals who had ingested xylitol showed increased platelet aggregation when treated with agonists that induce clotting.
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Practical Implications
Given these findings, it is premature to conclude that xylitol intake directly increases the risk of cardiovascular disease. The study highlights the need for further research focusing on actual dietary intake and long-term health outcomes. Meanwhile, consumers should consider the following:
- Moderation: Like any sweetener, xylitol should be consumed in moderation. It offers benefits for those managing blood glucose levels but is not devoid of calories.
- Health Status: Individuals with existing metabolic conditions should be particularly cautious and consult healthcare providers about their diet and sweetener use.
Conclusion
The study published in the British Medical Journal (BMJ) on xylitol and cardiovascular disease has sparked a necessary debate on the safety of artificial sweeteners. However, the evidence does not currently support a direct causal link between xylitol intake and increased cardiovascular risk. Consumers should maintain a balanced approach to sweeteners, focusing on overall dietary patterns and health status. Further research is needed to provide definitive answers and guide public health recommendations.
By thoroughly understanding the biochemical nature of xylitol, the study’s methodology, and the practical implications of these findings, individuals can make more informed decisions about their use of this common sweetener.
| Key Takeaways | Details |
| Xylitol Usage | Xylitol is a sugar alcohol used as a low-calorie sweetener, similar in sweetness to glucose, popular in keto and low-carb products. |
| Study Source | Recent study published in the British Medical Journal (BMJ) on xylitol’s potential link to cardiovascular disease. |
| Study Population | Study focused on individuals with significant pre-existing health conditions: average age 64, over 20% had diabetes, more than 70% had hypertension, over 75% had a history of cardiovascular disease. |
| Initial Findings | The study reported an 80% increased risk of major cardiovascular events in individuals with higher blood levels of xylitol. |
| Adjusted Findings | After adjusting for inflammation (CRP levels) and other cardiovascular risk factors, the relative risk increase was reduced to 6% per standard deviation of xylitol. |
| Endogenous Production | Elevated blood levels of xylitol are likely due to endogenous production, particularly in individuals with metabolic dysregulation, rather than dietary intake. |
| Reverse Causation | Higher xylitol levels in blood may result from underlying health conditions, not necessarily causing them. |
| Experimental Findings | Postprandial blood levels of xylitol increased thousand-fold after a 30g dose but returned to baseline within hours, indicating rapid metabolism. |
| Platelet Aggregation | Increased platelet aggregation observed in experiments with mice and humans, but human relevance is questionable due to methodological differences. |
| Practical Advice | Consumers should moderate xylitol intake and those with existing metabolic conditions should consult healthcare providers. |
| Conclusion | No direct causal link between xylitol intake and cardiovascular risk is currently supported; further research is needed for definitive answers. |
Bibliography
Xylitol is prothrombotic and associated with cardiovascular risk
