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Xylitol is associated with cardiovascular risk (oup.com)
54 points by geox 21 days ago | hide | past | favorite | 68 comments



It's also incredibly lethal to dogs so for that reason alone I keep it out of my house.

https://www.fda.gov/consumers/consumer-updates/paws-xylitol-...


I still don't understand how some brands could put it on peanut butter. A few tablespoons can kill a small dog.

It's commonly known that chocolate and onions are bad for dogs but this stuff is on another league.


> I still don't understand how some brands could put it on peanut butter. A few tablespoons can kill a small dog

My daughter is allergic to peanuts. A few tablespoons could kill her. Would it be reasonable for us to expect that no peanut butter is made? No. We simply don't buy it.

All that is needed is the regulatory requirement to list it in the ingredients.


Honestly, I simply don't understand any reason to add any ingredients to peanut butter than peanuts and salt (and the 2nd is optional).


I buy the stuff that's just peanuts and salt because it's tastier, but mixing it really is a chore. It's not hard to understand why the type with other ingredients exists.


Storing jars sideways risks oil leakage, but makes their contents easier to mix. Also refrigeration seems to slow oil separation.

I stir it when I first open the jar, then store it upside down in the fridge, which works great, I often just scrape what I need off of the lid, but I may try storing it sideways next, thanks.

How much Xylitol? We need resident researchers of HN to help us analyze the paper.

Or basically I’m hoping someone can tell me whether the paper is trustworthy or not so I can continue taking mints in peace.


Just read the paper. In the 2149 participants, detection in fasting plasma was associated with a hazard ratio of 1.57

It was also shown to enhance clotting at the levels detected in fasting plasma (in 10 people) which provides a potential mechanism to explain the effects observed in the larger group.

As for how legit it is... The number of people is significant. My only complaint is they didn't measure xylitol directly, rather they tested for polyol or something.


Thanks. That's a substantial ratio. Hazen's group is at the Cleveland clinic and has done a lot of good work so there is something there. Anything on how much Xylitol use is required to get to that risk level?


I believe they confirmed it was xylitol with LC-MS to validate it:

> Subsequent stable isotope dilution LC-MS/MS analyses (validation cohort) specific for xylitol (and not its structural isomers) confirmed its association with incident MACE


"xylitol-sweetened (30 g) water, an exposure comparable with a pint of numerous xylitol-sweetened ice creams, a xylitol-sweetened bakery good, or several pieces of xylitol-sweetened candy" (source: https://www.reddit.com/r/science/comments/1d9ql2u/comment/l7...)


Can anyone summarize how much risk? I don't see that in the abstract. And how much amount of xylitol where it becomes a risk? (We all know, everything can kill you in the right volumes, even water, but there are also healthy volumes.)

I go through a lot of chewing gum with xylitol.


I'm almost certain I'm mildly intolerant to xylitol, maltitol, and sorbitol - so I avoid them all. There must be others like me, but I hardly every see this discussed. And there's no medical test I know of that can prove it, but I really wish there was.


Sabine Hossenfelder, a physics Youtuber, recently departed from her usual content to discuss sorbitol giving her digestive problems: https://www.youtube.com/watch?v=K5v61YtDYo4


Do you get a laxative effect or other gastro symptoms? Sorbitol is the reason prune juice is an effective laxative.

Xylitol is usually such a small amount that it doesn't have that effect although some people are more sensitive.


These are FODMAPs, which many people with IBS find triggering. You might want to see a dietitian and find out which other FODMAPs you're sensitive to.


I've seen it discussed in reviews of sugar-free Haribo gummy bears: https://www.amazon.com/review/R2JGNJ5ZPJT4YC


I want to say one of those was originally made to induce diarrhea. I can't eat them either.


"Don't consume chemical sweeteners" is a pretty good rule of thumb. Almost all of them have been suspected of adverse effects of one sort or another.

Of course sugar has its own issues as well.

These days I use very little additional sweetening in any of my food. It's hard to avoid though, it's added to a lot of foods (check ingredients) and even fruit such as apples and oranges has been bred to be sweeter than it naturally was 100 years ago.

Biggest difference-maker for most people is probably sweetened drinks. Avoid soft drinks (diet or regular), sweetened tea or coffee, sports drinks, and most packaged juices.


> "Don't consume chemical sweeteners" is a pretty good rule of thumb.

I assume you mean non-caloric sweeteners, since all sweeteners are chemicals including table sugar (sucrose).

While suspected, few have any proven negative impacts. AceK and aspartame are probably the most well studied and the evidence is equivocal. It's probably in the end net neutral.

Some even have benefits, including most sugar alcohols being good for oral health. Erythritol has antioxidant effects in animal models as well.


This 5+ hour podcast on Aspartame is as fascinating as a podcast on the topic could be: https://www.strongerbyscience.com/podcast-episode-116/


For a very small but non-negligible amount of population aspartame is a severe migraine trigger.


last time I drank half a can of diet soda, about 2 months ago, I was in pain for a week because of aspartame. every single time I take it's like that. it's the same with most artificial sugars.


Sugar alcohols have other benefits like not dramatically raising blood sugar levels.

also:

> Xylitol is a sugar alcohol that is found in small amounts in fruit and vegetables, and the human body also produces it.


Everything you ingest is a chemical except light and heat.


Okay, sure, but there's colloquial definitions which in a culinary context mean "industrially-synthesized compound meant to mimic the culinary properties of a commonly consumed chemical", here trying to mimic sugar.

Xylitol may exist in nature and be produced by our bodies, but per this article foods with it added contain 1000x the amount we would ordinarily produce.

Perhaps a better rule of thumb would be "for a given chemical, keep your exposure/consumption within an order of magnitude of what would have been typical for a human pre-1850".


That sounds great if you think that humans had access to perfect diets in 1849.

I suggest to you that is not reasonable.

"For a given chemical, avoid doses known to have a high probability of harm" is, I think, what you actually want. Then we can talk about known vs suspected and what qualifies as high probability -- impact on years of life expectancy is probably a good initial measure.

There is no Golden Age in the past. There may be a Golden Age in the future, but it's not at all certain.


I think you misread me a bit there. I'm not saying that human diets in 1849 were perfect, by any means.

> "For a given chemical, avoid doses known to have a high probability of harm"

is exactly what I do not want. I don't want to assume everything is safe until it's shown otherwise, after I've eaten it for a decade.

I want to assume things are poison, unless they are shown to be safe. Things eaten in quantity in 1849 generally meet that criteria, minus a few things we now know to be more dangerous than thought back then.

When introducing some new compound meant to replace something in the diet like sugar, it seems much more reasonable to assume that its use may have side effects, until satisfactorily proven otherwise.


They didn't, but food was much less processed then. Of course, a lot of it was also spoiled/rotten, possibly contaminated, diseased, etc.

From the standpoint of the diet that human evolution is adapted to, you have to look back to hunter/gatherer diets. Meat, fruits and vegetables, and frequent periods of near-starvation. I've sometimes wondered what a diet of one or two big meals of meat per week, with the occasional handful of nuts and berries on other days would be like.


>I've sometimes wondered what a diet of one or two big meals of meat per week, with the occasional handful of nuts and berries on other days would be like.

Assuming your general health and all, if you were careful in your nutrient profile, there's no reason you couldn't try it for, say, a week and and see how you felt.


Xylitol gum stopped chronic ear pain for me. It'd be hard to give up, but I do like having a heart.


Apparently your ear pain is referred from an oral infection which xylitol helps with. You can consider xylitol mouthwash instead that is spit out. Pure table salt (without additives) also makes a decent antimicrobial mouthwash.


That sounds horrible. How much salt are we talking taking and for how long? If I only had iodized salt, is that going to make a difference?

Chemically, it makes sense, but I doubt my mouth loves being exposed to a salt bath either.


If it sounds horrible, it's because your interpretation of it is horrible, also horribly wrong. Iodine doesn't matter, but such salt is almost always coupled with numerous other additives that can be quite harmful to the teeth, e.g. starches, sugars, etc. It is best to get pure salt.

If not having an active infection, it needs to be done only at night before bed. It is not a big deal if you don't eat or drink anything after it. Do not swallow it while you rinse it. The moment you drink something after it, that's when it becomes horrible.

If having an infection, it is better to do it at least three times a day while you're waiting for professional treatment, e.g. antibiotics and/or a root canal.


I forgot to tell you yesterday that if antibiotics don't fix any recurring or underlying dental infection that you may have, you may then very much need x-rays and perhaps a root canal.

Besides the ear, it can also cause a headache, plus sharp pain in the back of the head, so it's good that you are keeping it in control.


My doctor checked for that with a CT scan and X-ray. I have a spot where my sinus narrows that is prone to infection but no abscesses or anything like that, but thank you I know this advice could be very important.

Millions upon millions of people chew xylitol gum every day. If you're actually observing direct benefits yourself, I'm sure those greatly outweigh any potential downsides.


This is one study, if you are seeing a benefit I would continue to use it but remain alert to new research.


How much risk? How much Xylitol? Disappointed those numbers aren't mentioned in the results section. Without seeing more, leaving that out leads me to suspect that the risk is low and the level of Xylitol is quite high. The links to get access to the article weren't working for me. Anyone have another link?



Here's the correct principle to live by:

If it didn't occur in nature where evolution honed both its existence and human's tolerance to it, then don't consume/use it.

After so many years, I simply can't count how many times "science" has brought us some new food, ingredient, or chemical, which passed all security measures, only to find later it causes or contributes noticeably to some horrible outcome. And I'm perfectly fine not attributing malice. My experience tells me we're quite good at doing the wrong thing while thinking we're doing the right thing. Although, given the current economic climate, malice is probably just as valid.


"Xylitol is found naturally in fruits and vegetables like strawberries, raspberries, mushrooms and cauliflower"

https://foodinsight.org/what-is-xylitol/#:~:text=Xylitol%20i....


"The human body also produces 5–15 g xylitol per day during normal carbohydrate metabolism in the liver"

Page 347 in: http://www.chemistry-chemists.com/chemister/Pishevye/sweeten...


https://en.wikipedia.org/wiki/Xylitol

> Xylitol occurs naturally in small amounts in plums, strawberries, cauliflower, and pumpkin; humans and many other animals make trace amounts during metabolism of carbohydrates.


> Xylitol is a sugar alcohol that is found in small amounts in fruit and vegetables, and the human body also produces it.


This principle is fine, but its application is the issue.

This ingredient occurs in nature frequently. Why shouldnt it be used?


It appears in very small quantities in nature (raspberries apparently being the highest). What was the amount in the study (I don't have access)? I credit xylitol for much improved mouth health, but I maybe take 5g a day.


Agree strongly. Another good example is industrial seed oils: canola/rapeseed oil, and even things thar sound innocuous like sunflower seed oil. Avoid, avoid, stick to olive oil which has been field tested for millenia.

It reminded me a couple of days ago of that scene from the Princess Bride: https://x.com/jqgatsby/status/1798395071353717183?t=0CZzGU7_...


Do you extend that rule to toothpaste?


Xylitol exists in nature.


As usual the dose makes the poison


Natural sources often contains "antidote" which could be as simple as shell, fiber or cellulose, something to limit your consumption. For example sugar cane is a wooden stick. You would have to chew it with your measly human teeth for hour to get the sugar out of it. But if it's processed into sugar powder, you don't need to chew. By processing you lost the "antidote" that would otherwise moderate your consumption. Xylitol is found in birch tree. Good luck eating birch tree.


Interestingly, the NeilMed sinus rinse I use has a "xylitol added" version. But you can also buy the regular saline-bicarb powder on Amazon, thank God.

Xylitol! Who TF wants that up their nose?


Xylitol kills strep bacteria and breaks down biofilms. It's a useful addition to toothpaste and sinus rinse to help breakdown plaque and prevent ear infections or throat infections by strep bacteria. It's also used in wound care formulations as a paste applied to a wound to help inhibit biofilm formation that slows healing.


Well, that might be. However, the Precautionary Principle applies here for me: saline and bicarb just mimic the chemistry inside your nose. Xylitol isn't necessary, so why introduce it? Who knows what side effects it might have?

YMMV.


Reasonable men may differ.


Xylitol in nasal spray helps pull liquid into the nasal passages which helps if you have dry nasal passages and reduces your risk of contracting airborne infections. The amount of Xylitol is also tiny compared to what you get from even natural sources (which, granted, is different than inhaling it).


I wonder how much this generalizes to other sugar alcohols, I've got some erythritol in the cupboard...


Erythritol consumption was already related to increased rate of cardiovascular events: https://www.nih.gov/news-events/nih-research-matters/erythri...


Same researchers


Damn near the same study conclusion. Uncanningly similar.


Damn! I consume it regularly. Not so much in one day, of course, because it does have a laxative effect. But every cake I've made has been baked with it.


I started reading the different sections of the paper and —- wait, no, this is still the Abstract!


"widely used sugar substitutes in processed foods" - what could go wrong, right


As opposed to throwing corn syrup into everything possible. Any non raw food you acquire is probably loaded with some junk or another.


It kills a lot of animals very quickly with a low dose... I stay away from the stuff


Hopefully this means all of the sugar alcohols will get taken off the market. Nothing makes for a worse long road trip than accidentally buying a drink that contains that garbage at the beginning.




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