Xylitol sweetener benefit, side effects, use for dental health, tooth cavities by Ray Sahelian, M.D.
March 15 2016

Xylitol is a sugar substitute not only low in calories but may also help prevent dental caries. It is a natural sweetener found in various berries, corn, birch and other plant sources. Xylitol - a sugar alcohol - has minimal effects on blood sugar and insulin release. As a rule, it is a healthier sweetener than sucrose or fructose. There is some evidence that xylitol may reduce tooth decay. As for baking, stevia is preferable to xylitol.
   Researchers in Finland have been working with xylitol for the last three decades. In Russia it has been used as a sweetener for diabetics. Virtually unknown in Japan a few years ago, xylitol sales have soared to over 400 million dollars yearly. My favorite no calorie sweetener is stevia, the clear liquid form. You will also find other forms of stevia, such as powder.
   Young children given syrup containing the naturally occurring sweetener xylitol are less likely to develop decay in their baby teeth.

Xylitol gum and dental cavity prevention, jury is still out
Xylitol containing chewing gum has been claimed to reduce the growth of mutans streptococci and dental plaque which are associated with dental caries.
   Gummy bears containing the sugar substitute called xylitol is claimed to reduce cavity-causing bacteria on young children's teeth. Research has shown that the sugar substitute reduces levels of mutans streptococci bacteria, which are known to cause cavities. Xylitol differs from others sugars, like table sugar and glucose, which mutans streptococci bacteria use for energy. Mutans streptococci bacteria "take in" xylitol, but can not break it down to use for fuel.

However, others claim this evidence is of low quality and is insufficient to determine whether any other xylitol-containing products can prevent caries in infants, older children or adults.

Effect of xylitol on an in vitro model of oral biofilm.
Oral Health Prev Dent. 2008. UFR d'Odontologie, Université Victor Ségalen Bordeaux 2, Bordeaux cedex, France.
The aim of the present study was to examine whether xylitol, at different concentrations, inhibits the formation of an experimental model of oral biofilm. Biofilms of six bacterial species (Streptococcus mutans, Streptococcus sobrinus, Lactobacillus rhamnosus, Actinomyces viscosus, Porphyromonas gingivalis and Fusobacterium nucleatum) were prepared on hydroxyapatite discs. Xylitol was tested at two concentrations, 1% and 3%. Xylitol has a clear inhibitory effect on the formation of the experimental biofilms. This study shows that xylitol is not only efficient in inhibiting the acid production of cariogenic bacteria, but also in preventing the formation of a multispecies biofilm; it confirms the relevance of the use of this polyol for the prevention of oral diseases caused by dental plaque.

Virus infection
PLoS One. Jan 2 2014. Protective effect of dietary xylitol on influenza a virus infection. Xylitol has been used as a substitute for sugar to prevent cavity-causing bacteria, and most studies have focused on its benefits in dental care. Meanwhile, the constituents of red ginseng (RG) are known to be effective in ameliorating the symptoms of influenza virus infection when they are administered orally for 14 days. In this study, we investigated the effect of dietary xylitol on influenza A virus infection (H1N1). We designed regimens containing various fractions of RG (RGs: whole extract, water soluble fraction, saponin and polysaccharide) and xylitol, and combination of both. Mice received the various combinations orally for 5 days prior to lethal influenza A virus infection. Almost all the mice died post challenge when xylitol or RGs were administered separately. Survival was markedly enhanced when xylitol was administered along with RGs, pointing to a synergistic effect. The effect of xylitol plus RG fractions increased with increasing dose of xylitol. Moreover, dietary xylitol along with the RG water soluble fraction significantly reduced lung virus titers after infection. Therefore, we suggest that dietary xylitol is effective in ameliorating influenza-induced symptoms when it is administered with RG fractions, and this protective effect of xylitol should be considered in relation to other diseases.

Xylitol side effects - danger, caution, safety
No major side effects have been reported with reasonable amounts of xylitol sweetener use. Excess consumption may lead to mild diarrhea. It's best to use as little xylitol as one needs to sweeten food.

Calciuria, oxaluria and phosphaturia after ingestion of glucose, xylitol and sorbitol in two population groups with different stone-risk profiles.
Urol Res. 2009. Rodgers A, Bungane N, Allie-Hamdulay S, Lewandowski S. Department of Chemistry, University of Cape Town, Rondebosch, Cape Town, South Africa.
The effects of glucose, sorbitol and xylitol ingestion on calciuria, oxaluria and phosphaturia in healthy black and white males on a standardized diet were investigated. After ingestion, they collected urine hourly for 3 h. Glucose decreased phosphaturia in blacks. Sorbitol decreased phosphaturia in both groups and increased oxaluria in whites. Xylitol increased oxaluria in blacks. Decreases in phosphaturia are attributed to penetration by phosphate into cells leading to decreases in phosphatemia and the renal filtered load. We suggest that this mechanism is more sensitive in blacks. We speculate that the increase in oxaluria after sorbitol ingestion occurs via its conversion to glyoxylate and that this pathway may be blocked in blacks. For the increase in oxaluria after xylitol ingestion, it is hypothesized that ketohexokinase and aldolase may be more active in blacks. Our results demonstrate, for the first time, a urinary effect due to sorbitol ingestion and an ethnic dependency of these and other effects.

Toxicity in dogs
Xylitol consumption is considered harmless to people but is known to cause life-threatening toxicoses in dogs. Dogs that ingest doses of >0.1 g/kg are at risk for developing hypoglycemia, while dogs that ingest >0.5 g/kg may develop acute liver failure. Compend Contin Educ Vet. 2010. Xylitol toxicity in dogs.

Xylitol product and recipes
Books are available that have dishes with a xylitol recipe.

What is xylitol?
Pure 100% pharmaceutical-grade xylitol is a white, crystalline carbohydrate that is classified as a sugar. It is found naturally in fibrous vegetables and fruits. It is produced by the human body during normal metabolism. It is a naturally occurring form of the 5-carbon sugar, xylose. The main sources of commercially produced xylitol are corncobs and wood scraps from the lumber industry.

Summary of Xylitol benefits
Xylitol is a sweet-tasting sugar substitute that has been approved for use in more than 40 countries. Consumption of xylitol is associated with a significant reduction in tooth decay, resulting in fewer cavities. This sugar has been shown in early studies to contribute to increased bone density, weight loss, stabilization of blood sugar and lowering of insulin levels.

Xylitol Research review
The effect of xylitol chewing gum on mutans streptococci in saliva and dental plaque.
Southeast Asian J Trop Med Public Health. 2004.
Dental caries are one of the most common infectious diseases occurred in Thai children. The chewing of xylitol, sorbitol, and even sugar gum has been suggested to reduce caries rates. The aim of the present investigation was to evaluate the effect of xylitol chewing gum on mutans streptococci (MS) in saliva and dental plaque. Ninety-one children, aged 10-12 years, with more than 1 x 10(5) MS per milliliter of saliva were included in this study. They were divided into three groups balanced according to their MS counts at baseline: one control group (no supervised gum use), and two xylitol groups (supervised 55% and 100% xylitol gum use). Whole saliva and pooled plaque samples were obtained after 90 school days. When comparing the MS counts between the groups, those chewing 100% and 55% xylitol gum showed significant reductions, but a dose response effect was not demonstrated. Chewing 100% xylitol gum caused significant reductions on salivary MS scores which was little different from the 55% xylitol group. The results suggest that the use of xylitol chewing gum can reduce the levels of mutans streptococci in plaque and saliva.

Effects of a long-term dietary xylitol supplementation on collagen content and fluorescence of the skin in aged rats.
Gerontology. 2005.
Dietary xylitol has been shown to increase the amounts of newly synthesized collagen, and to decrease fluorescence of the collagenase-soluble fraction in the skin of both healthy and diabetic rats. As in diabetic rats, a decreased rate of collagen synthesis and increased collagen fluorescence has also been detected in the skin of aged rats. We hypothesize that dietary xylitol supplementation may protect against these changes during aging. OBJECTIVE: The purpose of the present study was to investigate whether a long-term dietary supplementation can protect against the decrease in the amounts of newly synthesized collagen, and against the increase in fluorescence in the collagenase-soluble fraction in the skin of aged rats. Twenty-four male Sprague-Dawley rats were used in the study. After weaning, the rats were divided into 2 groups of 12 animals. The rats in the control group were fed a basal RM1 diet, while the rats in the experimental group were fed the same diet supplemented with 10% xylitol. After 20 months, the rats were killed and pieces of skin from their dorsal areas were excised. The thickness of the samples was measured with a micrometer screw gauge. The collagen contents of rat skin were measured as hydroxyproline, and glycosylation as fluorescent intensity of collagen. Statistical significances of the differences between the groups were determined using the unpaired t test. No general side effects were detected in the rats during the experimental period. The skin of the xylitol-fed rats was a little thicker than that of the control rats. The hydroxyproline content of the acid-soluble fraction was significantly greater in the xylitol group as compared to the controls. However, there were no significant differences in the hydroxyproline content of the collagenase-soluble fraction between the groups. The fluorescence of the collagenase-soluble fraction was significantly smaller in the xylitol-fed aged rats than in the aged rats fed the basal diet. The results of this study indicate that xylitol caused an increase in the amount of newly synthesized collagen and a decrease in collagen fluorescence in the skin of aged rats.

Use of xylitol chewing gum in daycare centers: a follow-up study in Savonlinna, Finland.
Acta Odontol Scand. 2003.
The use of toothbrushes in daycare centers has been questioned because of the possibility of infections spreading through unsupervised brushing. Several field studies have demonstrated a caries-preventive effect of xylitol chewing gum--a measure that could be a practical way of taking care of oral hygiene during daycare hours without brushing. A community trial was conducted in Savonlinna, Finland to test the caries-preventive effect of xylitol chewing gum at these centers. A total of 921 children were recruited. The daycare centers were randomly distributed to xylitol chewing gum or brushing groups. An additional 270 children who had not been in daycare centers were later organized into an external reference group in order to check whether the children in the daycare centers were representative of all children in Savonlinna. The results revealed a statistically significant but clinically small difference between the xylitol and brushing groups in favor of the xylitol group. Many families used the daycare services irregularly. Changes in workplace, periods of unemployment, the birth of other children in the family, etc., affect the likelihood of families keeping their children in a daycare center for many years. Despite the fact that conditions were not optimal, oral health status in the xylitol group was a little bit better than in the control group. The use of xylitol can therefore be recommended, especially if the personnel do not have the possibility to supervise the brushing.

Q. Under alcohol sugars on your site you mention the possibility of diabetics having issues with these sugars. Is this just with Sorbitol, because the information I've gathered on Xylitol seems to show that it may be helpful for diabetics. Perhaps you could go into a little more detail about Xylitol. It's up there with stevia for me.
   A. Xylitol appears to be a good sugar and hopefully its popularity will increase.

Love your site and have recommended your products and info to a number of counselling clients. I have one query however, that has me stumped. Xylitol, the natural sugar alternative. I have done a lot of research and it has been used for over 40 years in Europe without any unwanted side effects. I have been using it for a couple of years, without a problem. However, a friend has refused to use it recently as she said that ants invaded her kitchen and refused to eat it. I cannot find out why they don't like it. She thinks that if ants won't eat it, it must be bad for you. I know that ants love Splenda and eat it by the bowl full and then go off to die, so it's a conundrum. Can you give me any clues as to why ants won't eat it or opinions on the use of Xylitol.
    There is no direct relationship between what insects and animals eat and what is appropriate for humans. Some insects may consume substances that work well for them but could be toxic to humans and vice versa. Cats don't like cucumbers but that does not mean cucumbers are not healthy. Some animals chew leaves of certain plants that are toxic to human yet they do fine. Therefore, one should not make a direct correlation between what is appropriate for an insect or animal and relate that to humans.

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