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Are Sugar Alcohols Like Xylitol Safe Artificial Sweeteners?

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Posted Monday, Feb. 6th, 2012

Xylitol

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.

References

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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  • prad

    very interesting and informative reading. Glad someone passed me on to be part of the natural sherpa e mails. please try to get quality and at low cost due to budget restraints

  • jay

    I am very disappointed in this very opinionated article. Cooling sensation is put down as a side effect? This is what you put down as difficult?!! Laxative effects are stated as difficult when Nutra Sweet is listed as a neurotoxin…that is toxic…not an possible effect. This appears to be irresponsible journalism…frighten people about possible dangers without real basis.
    If you are being objective here, and there are few substitutes for sugar that are actually not dangerous (aspartame)..why try to discredit something that you find objectionable as it CAN have a laxative effect? I have chewed xylitol gum for years and have never experienced this side effect. Many others have chosen this gum with no side effects.

    If you are objective, then disclose ALL of your funding sources. Would Nutra Sweet be one of those? 
    This article is digging for problems without really offering helpful solutions.

  • Shirley Gekler

    Thanks to Natural Health Sherpa for these articles as they give us the facts, including the side effects which could occur from these various products.   I also do agree that two wrongs do not make a right.   I don’t think an occasional use of these products would be harmful, however, it is the consistent use of these products which could create an addictive reaction.  Also some people may have side effect from infrequent (accidential) use of these products.  If we have animals, it is my understanding that we must keep these products out of their reach.  I really appreciate the fact that Natural Health Sherpa does the physical research and give this information to us in a way that it can be clearly understood and trusted.

  • http://pulse.yahoo.com/_XQ4IS5G4MTU7VCGCXEDQ72YTHE JODIH

    Since I’m allergic to cane sugar, I try to use xylitol whenever possible.  As somebody who has had problems with constipation all my life, I like the fact that it helps me stay regular.

    I’ve tried Stevia and I  don’t like it.  It’s bitter, and if I don’t like something, I won’t use it.  Since I’ve been using xylitol, I haven’t had a cold and I used to have about 2 a year.  It’s been over 3 years now.

  • joan

    I am using Xylitol in a powdered nutritional supplement; I wish it were not in it.
     Also – please proofread  your articles because errors diminish the impact of your article.
    Thanks for the good work.

  • http://www.facebook.com/people/Sharon-Donohue/100000419920344 Sharon Donohue

    I find that different sources of Stevia are more or less bitter. The liquid one that I like best comes from Amazon Herb Co. If you decide to try it, I would enjoy your feedback.

  • Jeaniver38

    The only sugar substitute she recomended- very sparingly was Stevia-  not nutra sweet.  While I do not agree with her ban on all sugar alchols I will limit the amount I use.

  • Jeaniver38

    About 5 years ago I tried every form of Stevia on the market. Ugh, horible taste.  About 6 months ago I again tried stevia by Sweet Leaf and found it had no after taste.  Stevia is so sweet that you have to be carefull about the amount you use – too much and it can taste off

  • Jonathan

    Stevia tastes bitter if you taste it as is. Mixed properly it tastes good. And of all the sweeteners is the only one that is actually natural (leaf to you) and has a positive effect on blood glucose levels.  Nutra-sweet – are you kidding me?

  • Karen

        You omitted some important information about xylitol.  If xylitol is consumed in large amounts without gradually building up to that amount, temporary gastrointestinal distress can result.  However, this problem disappears
    quickly because the body not only produces it during normal metabolism
    but also produces the enzymes necessary to break it down.  Therefore,
    adaptation to the use of xylitol is very rapid.  Regular use reduces
    this small side effect, and most people can accept about 100 grams
    daily if individual servings are limited to 20 – 30 grams each to begin
    with.  Xylitol has far less intestinal side effects than maltitol,
    another polyol frequently used in candy, energy bars, and snack foods.

  • Primerica4

    Waaay too hard on xylitol. My whole family uses xylitol as a sweetener with NO side effects. I have frequent kidney infections and Candida symptoms which are aggravated by sugar. No issues w xylitol. Xylitol and stevia work synergistically and sweeten well while using less of each. We brush our teeth with xylitol mixed with baking soda and a few drops of mint extract…CLEAN teeth all day! We LOVE OUR XYLITOL

  • Jansmitty

    I appreciated the fact that you mentioned the fact that xylitol is toxic to dogs.  My dog found our packs and thought she had made a wonderful find.  Within 15 min. she had vomited 4 times, lost all control of her back legs and went into seizures.  We rushed her to the local animal hospital and the vet said she was minutes away from a coma.  It was 3 days and 700.00 dollors later that she got to come home.  If they put a warning on cigarettes why is no warning put on things containing xyitol?

  • Frantz

    I’m not in favor of their use, but describing sugar alcohols as the addition of sugar and alcohol makes it look like you have very little knowledge of chemistry.

  • http://twitter.com/SweetTish Tish Lanier

    Sweetleaf is the best Stevia but they are no longer affordable.  You could buy it in the bottle for about $9 now they want $15.  I leave it on the shelf.  I will try xylitol, I am tired of paying a lot extra for the same product.  So I need to try something new.

  • ben blumberg

    I have been using Stevia in the Raw to sweeten my coffee for several weeks now, and find that it gives adequate sweetness without laxative or other side effects. Perhaps more importantly, Stevia (as Truvia) used in baking seems to be everything that Splenda never was, as Stevia is stable when heated whereas the molecular form (sucralose?) of Splenda is unstable, thus rendering Splenda suitable only for sweetening cold drinks. As a sidelight, I think that we are at the very beginning of a Stevia revolution, in that Stevia will eventually replace high fructose corn syrup as the world’s sweetener of choice. The word has finally gotten out that high fructose corn syrup is the (unintended) cause of our obesity epidemic, and all the major manufacturers of HFCS are hurrying to make a Stevia-based product for use in e.g. diet sodas. The manufacturer of Stevia in the Raw is a small company that also makes Sugar in the Raw using the same techniques, and its stock (Ticker symbol STEV) might be a worthwhile investment on Wall Street.

  • http://pulse.yahoo.com/_XQ4IS5G4MTU7VCGCXEDQ72YTHE JODIH

     Chocolate is also toxic to dogs.

  • http://pulse.yahoo.com/_XQ4IS5G4MTU7VCGCXEDQ72YTHE JODIH

     Since I like xylitol, I probably won’t be trying Stevia.  I used it to sweeten coffee, and thought it was bitter.  Xylitol looks and tastes like regular sugar, and I’ve used it in recipes with good results.  We’ve also found things like jelly and ice cream at our local Sprouts that use xylitol.  The only downside is that it’s expensive.

  • Maltz1

    My husband and I have been using mouthwash and toothpaste with xylitol for over 2 months. We have both developed strange mouth and throat inflammations. Has anyone out there had any kind of problem similar to this? We are going xylitol free and see if it goes away.

  • http://www.facebook.com/people/George-Parigian-Jr/1033530163 George Parigian Jr.

    Some Xylitol is corn derived and if you are allergic to corn that “might” explain this problem.

  • vladmari, Australia

    I agree with people below who thinks it is way to opinionated… I have been using xylitol for a while now with NO side effects at all. Also agree that cooling sensation is way too mild to call it side effect… Anyway, I have found some good information in this article as well so thanks for that.

  • Jimpsy

    Referring to a “sugar alcohol” as a combination between sugar and alcohol is possibly the stupidest thing I’ve read in the past 6 months. It would be like calling table salt the combination of an explosive metal and a poisonous gas (sodium and chlorine)….

  • Paula

    has anyone developed severe leg pain from a small dose of xylitol?
    I had about 2 tablespoons total over a few days, and lost control of my legs, severe aching as if I had been beaten by a bat or such.

  • http://naturalhealthsherpa.com Natural Health Sherpa

    In point of fact, salt is exactly a combination of an explosive metal and a poisonous gas. The fascinating thing about organic chemistry is that in the right molecular proportions an explosive metal and a poisonous gas can become a critical mineral for human survival. I think it was from a similar perspective that the great Carl Sagan once said, “We are star stuff harvesting sunlight.” When I refer to sugar alcohol as a combination of sugar and alcohol I am not suggesting that this combination has the same effects as its constituent elements any more than one might think salt would explode and then poison you. According to Wikipedia (http://en.wikipedia.org/wiki/Sugar_alcohol): A sugar alcohol (also known as a polyol, polyhydric alcohol, polyalcohol, or glycitol) is a hydrogenated form of carbohydrate, whose carbonyl group (aldehyde or ketone, reducing sugar) has been reduced to a primary or secondary hydroxyl group (hence the alcohol). Okay, I grant you that it isn’t exactly a combination of sugar and alcohol–it’s not like dumping a bag of C&H into a bottle of whiskey. But the molecular structure is still basically sugar with some alcohol attached and to me that’s a pretty interesting fact.

  • Mia

    I have experienced all the horrible side effects of Xylitol from putting it in my tea for just one day. It destroyed my digestive system. Going on four days and the symptoms have not abated.

  • Anonymous

    I am also disappointed in this article. You seem extremely biased and perhaps even paid by a company that endorses sugar alcohols to write this. You miss the huge disadvantages of using sugar alcohols. For example, since some sugar alcohols are not absorbed there is no insulin spike like normal sugar. Since your body does not receive this insulin spike your body doesn’t think you have had any sugar which leads you to crave more sugar as well as foods in general. Using sugar alcohols will put you on your way to obesity in no time.

  • Tim

    Once again well written article. There is an aspect to xylitol that isn’t included here, and that is how it is produced. In that lies the key to understanding that the stuff is no longer very natural despite its roots.

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  • Rita

    Thanks for the Article but with more usage, we will see more problems. It made me very mentally foggy and emotional plus sleeplessness and intestinal issues. Have the same problems with artificial sweeters so I am afraid that it may be natural to start but during manufacturing something is happening to make this product dangerous to the public.

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