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Xylitol: Are Sugar Alcohols Like Xylitol Safe Artificial Sweeteners?


Posted Tuesday, May. 5th, 2015

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When you talk about addictions, many people think about drugs. Makes sense, right? Or maybe even alcohol. And, if they are really enlightened and understand nutrition, they know to add sugar into the mix of addictive substances.

So why do so many people believe that the combination of two known addictive substances like sugar and alcohol is somehow a safe, natural, and effective alternative to table sugar and dangerous sugar replacements like aspartame, saccharin, and Splenda?

Why do many nutrition and health advocates go so far as to not only tout the benefits of sugar alcohols like xylitol as an effective, diabetes-friendly alternative, but also as a health food with additional benefits in its own right?

Can this be true? Is it possible that two wrongs can make a right?

Unnatural Side Effects…

In our quest for sweet indulgences, we have tried every possible replacement under the sun. And the latest craze seems to be the so-called “natural” sugar alcohols.

Before I discuss the pros and cons of sugar alcohols, it’s important to understand what they are.

Sugar alcohols, as a rule, are fairly natural. Many are found in various fruits and vegetables, and some are even a by-product of normal metabolism. They are frequently used as a sugar replacement for three key reasons:

  • They visually look like sugar, in that they are white and granular.
  • They have, on average, half the calories per gram of table sugar.
  • They have anywhere from 50 to 100 percent the sweetness of table sugar.

Additionally, sugar alcohols have been shown to be safe, as they do not appear to cause cancer, liver damage, or other chronic health conditions. Plus, they do not cause the spikes in blood sugar or blood glucose like table sugar, due to the fact that they are incompletely absorbed into the blood from your small intestines.

But, like most things in nature, you have to take the good with the bad. And sugar alcohols are no different.

First, there’s the common “cooling” sensation that can occur with sugar alcohols. Some people have compared it to the menthol-like effect cough drops can have. While this is more of a sensation than a flavor issue, some people feel it negatively affects the overall taste of the food or beverage being consumed.

Next, and decidedly worse, is the laxative effect that can occur with overconsumption of sugar alcohols. Turns out, because they are not adequately digested, sugar alcohols can cause some fairly unpleasant side effects, namely bloating, cramping, flatulence, and diarrhea.

Yet, given these drawbacks, many people swear by sugar alcohols and even go so far as to claim that they have health benefits beyond simply replacing sugar.

A Sugar By Any Other Name…

While there are approximately 15 different sugar alcohols, the three most common include maltitol, erythritol, and xylitol. As you likely noticed, all three end with –tol. When reading labels, look for this suffix, as it denotes a sugar alcohol.

Maltitol is most commonly used sugar alcohol in commercially produced sugar-free products. It has 2.1 calories per gram and is 90 percent as sweet as table sugar.

Maltitol is also one of the least “natural” of the sugar alcohols, in that it is created by hydrogenising maltose, a sugar found in starch. Like most sugar alcohols, it does produce a cooling effect and definitely causes digestive upset when over-consumed, as well as with a single serving.

Next is erythritol, which occurs naturally in mushrooms, pears, melons, grapes, and fermented foods like wine, soy sauce, and some cheese. It has less than half a calorie per gram (0.2), and is 60 to 80 percent as sweet as table sugar.

While it too causes that cooling sensation, one thing that sets erythritol apart from other sugar alcohols is that it is fully absorbed in the small intestine. As such, it rarely causes the laxative or other digestive problems associated with sugar alcohols. Additionally, it does not spike blood glucose levels or insulin levels.

Given this fairly safe profile, it’s no surprise that erythritol is being used commercially with more and more frequency. In fact, it is one of the ingredients found in the stevia-based sweetener, Truvia.

But it is still overshadowed by it larger, bigger brother: xylitol

What is Xylitol…

Clearly the most recognizable sugar alcohol, xylitol has been around since 1891, and has been satiating our sweet tooth since the 1960s. Like erythritol, it is found in many fruits and vegetables, and is even produced in the body as a part of everyday metabolism.

Xylitol occurs naturally in many fruits and vegetables, including hardwood trees like birch. It is even produced by the human body during normal metabolism.

Racking up 2.4 calories per gram and 100 percent the sweetness of sugar, xylitol leads the sugar alcohol pack when it comes to widespread use. It is used in more than 35 countries and can be found in everything from gum and cough drops to toothpaste and mouthwash.

Like the rest of the sugar alcohols, there are some xylitol side effects, namely the laxative effect, as well as the less problematic cooling sensation. But what seems to make xylitol stand out is that there appear to be a few xylitol benefits as well.

While you’d think that most of the research for this sugar alcohol would center on the xylitol-diabetes connection, you’d be wrong. The bulk of the research is on dental health. Yes, dental health.

Xylitol Benefits For Your Teeth…

According to several gold-standard studies, there are some pretty impressive xylitol benefits for dental health.

One double-blind, randomized, placebo-controlled study of 94 children compared the effects of different dosages of xylitol-based topical syrup on tooth decay.1

Researchers divided the 9- to 15-month olds into three groups. All three groups were asked to give the children three doses of a syrup every day for about 10.5 months. In the first group, all three dosages contained 2.67 grams of xylitol. The second group took two dosages of the xylitol syrup (2.67 grams xylitol) and one dosage of a sorbitol syrup (a different sugar alcohol…note the –tol). The last group had one dose of the xylitol syrup (2.67 grams xylitol) and two doses of the sorbitol-based one.

At the end of the study period, researchers found that nearly 52 percent of the children in the single xylitol group (2.67 grams xylitol/day) had tooth decay. Forty percent of the kids in the three-serving group (8.01 grams daily) had tooth decay, while just 24 percent of the kids in the two-serving group (8 grams daily) had decay.

Interestingly, researchers stated that “no statistical difference was noted between the two xylitol treatment groups.” What? No statistical difference between 40 percent and 24 percent? While it is clear that 8 grams of xylitol a day helped prevent tooth decay in these young children, it would have been nice to have the researchers explain what we see as a very significant difference between the two groups receiving the same daily dosage.

Another study sought to discover why xylitol benefits oral health.2 In this small, randomized, double-blind, cross-over study, researchers divided 12 participants with Streptococcus mutans (bacteria that causes gum disease and tooth decay) into two groups.

The first group chewed gum containing 65 percent xylitol (about six grams xylitol) a day for four weeks. The second group chewed gum containing 63 percent sorbitol and 2 percent maltitol for four weeks. The two groups then switched gum (not literally of course, but types of gum) for another four weeks.

At the end of the eight total study weeks, researchers found that when participants chewed the xylitol gum, they had significant decrease in Streptococcus mutans found on the teeth as well as in the plaque itself. Interestingly, the xylitol did not seem to affect other bacteria in the mouth, including beneficial bacteria like Lactobacillus acidophilus.

Xylitol Benefits Ear Infections Too…

In addition to oral health, there is something to be said for xylitol’s effect on ear infections. One randomized, placebo-controlled, double-blind study recruited 857 children and divided them into five groups:

  • Control syrup (no xylitol),
  • Xylitol-based syrup (10 grams xylitol),
  • Control gum (no xylitol),
  • Xylitol-based gum (8.4 grams xylitol), or
  • Xylitol-based lozenge (about 8.4 grams xylitol).3

After three months of daily use, researchers noted the incidence and/or reduction or increase of middle ear infections in the children. They found that 41 percent of the children taking the control syrup had at least one middle ear infection, compared with just 29 percent of those taking the xylitol-based syrup, which was a 30 percent reduction in infections in the xylitol group compared to the control

Similarly, there was a 40 percent reduction in middle ear infections in the xylitol gum group as compared to the control gum, as well as a 20 percent reduction in the xylitol lozenge group.

Researchers concluded that xylitol was effective in preventing middle ear infections, though they qualified it by saying that only the gum and syrup were effective, as compared to the lozenges. However, they did not state why the gum worked better than the lozenge, though both appeared to contain similar amounts of xylitol.

Is Xylitol Safe?

While xylitol does appear to have medical benefits, you do have to consider any possible xylitol dangers. Like other sugar alcohols, xylitol is relatively safe from a disease-causing standpoint. However, safe and well-tolerated are not the same thing.

As I discussed earlier, there are those nasty xylitol side effects to consider. Like diarrhea. And flatulence.

Also, since excessive consumption can cause excessive diarrhea, you can assume that chronic use can have the same types of negative consequences that long-term laxative use would cause, namely nutrient deficiency (due to poor absorption), electrolyte imbalance, even constipation, as your bowel slowly loses its ability to contract properly.

Additionally, there is significant xylitol danger for your pets. Specifically, xylitol toxicity in dogs can be acute.4

To Use or Not To Use…

So here’s where I stand: Sugar alcohols (namely maltitol, erythritol, and xylitol) appear to have a fairly safe profile with rather disgusting side effects. And, when it comes to dental health and middle ear infections (especially in children), a case can be made for the use of xylitol-based syrup and chewing gum.

But what about the real question? Are these sugar alcohols a good option for people trying to manage their waistlines or even lose weight? Are they good options for people with diabetes?

That depends on what you are willing to put up with and how often you plan to use them. As I’ve noted, chronic use can result in chronic diarrhea, which carries with it a whole host of negative consequences.

Given this, I say no to sugar alcohols as a sugar replacement, with the possible exception of erythritol for occasional use (no more than once a week), as it does not appear to cause the same level of digestive distress.

Instead, try to wean off your dependence on sugar and sweet treats by trying stevia as a bridge sweetener. This herb is available in granulated as well as liquid forms and can be found in most grocery and health food stores. And, as I’ve indicated before, stevia has been shown to improve insulin sensitivity rather than decrease it.5

Best of all, you won’t have to worry about embarrassing yourself after eating it!

Remember, keep an open mind to new ideas, but ALWAYS do your own homework … and combine that with common sense to figure out what’s best for YOU.


1Milgrom, P et al. Xylitol pediatric topical oral syrup to prevent dental caries: a double-blind randomized clinical trial of efficacy. Arch Pediatr Adolesc Med. 2009 Jul;163(7):601-7.

2Soderling, E et al. The effect of xylitol on the composition of the oral flora: a pilot study. Eur J Dent. 2011 Jan;5(1):2-31.

3Uhari, M et al. A novel use of xylitol sugar in preventing acute otitis media. Pediatrics. 1998 Oct;102(4 Pt 1):879-84.

4Campbell, A and Bates, N. Xylitol toxicity in dogs. Vet Rec. 2010 Jul 17;167(3): 108.

5Lailerd, N et al. Effects of stevioside on glucose transport activity in insulin-sensitive and insulin-resistant rat skeletal muscle. Metab Clin Exp. 2004 Jan;53(1):101-7.

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Natural Health Sherpa, Internet Selling Services, Wilmington, NC