Are Xylitol, Sorbitol, and Other Sugar Alcohols Safe Replacements For Sugar?


In the last article of this series I discussed artificial sweeteners, and gave you my take on whether you should include them in your diet. This week, I want to talk about sugar alcohols, which are another popular low-calorie sugar substitute.

Xylitol is the most popular and most extensively researched, so I’ll focus my discussion on it, but the general takeaway of this article applies to other sugar alcohols as well, such as sorbitol and erythritol.

Xylitol and sorbitol are commonly used as sugar replacements, but are they safe? Here’s what you need to know!

What exactly are sugar alcohols?

Sugar alcohols are a type of ‘low-digestible carbohydrate,’ a category that also includes fiber and resistant starch. Sugar alcohols occur naturally in many fruits and are also known as ‘polyols,’ which you may recognize as a FODMAP. Unlike artificial sweeteners, sugar alcohols aren’t completely calorie-free, because we are able to digest and absorb them to some extent. The absorption rate varies among sugar alcohols, from about 50% for xylitol to almost 80% for sorbitol, depending on the individual. (1) Erythritol is almost completely absorbed, but is not digested, so it provides almost no calories. (2)

Compared with artificial sweeteners, sugar alcohols have very few safety and toxicity studies, and are generally accepted as safe. (3) In one long-term human study, 35 participants consumed xylitol as their primary dietary sweetener for two years, and no adverse effects other than GI distress were observed, and GI symptoms dissipated after the first couple months. (4) The amount of xylitol consumed during this trial regularly exceeded 100g per day, often going over 200g per day, depending on the participant.

Metabolic effects of sugar alcohols

Sugar alcohols are a popular choice for weight loss due to their reduced calorie content, and for diabetics due to their low glycemic index. There’s not nearly as much research on the metabolic effects of sugar alcohols as there is on artificial sweeteners, but the evidence we have suggests that sugar alcohols are at least harmless, and possibly beneficial.

For the most part, sugar alcohols cause no appreciable changes in blood glucose or insulin in humans, and sorbitol and xylitol have not been found to raise blood glucose following consumption. (5) In diabetic rats, 5 weeks of xylitol supplementation (as 10% of their drinking water) reduced body weight, blood glucose, and serum lipids, and increased glucose tolerance compared with controls. (6) Two other rat studies also found that xylitol-supplemented rats gained less weight and fat mass compared with control rats, and had improved glucose tolerance. (7, 8)

Because sweetness does not predict caloric value in sugar alcohols, one might expect that they would cause the same ‘metabolic confusion’ that is seen with noncaloric artificial sweeteners. Unfortunately there isn’t enough evidence to form a conclusion about this, but my feeling based on what I’ve read is that this isn’t a significant issue for sugar alcohols.

For one, sugar alcohols aren’t ‘intense sweeteners’ like artificial sweeteners, which are hundreds of times sweeter than sugar. In fact, many are less sweet than sugar. Also, sugar alcohols do provide some calories, so there’s not as much of a discrepancy between the caloric load your body expects and the caloric load it actually gets.

Does xylitol prevent tooth decay?

The most well-known health benefit of xylitol is easily its effect on dental health, and evidence for xylitol’s ability to prevent tooth decay is pretty robust. (9) A couple trials have found xylitol to be more effective at preventing cavities than fluoride, and benefits of xylitol consumption have even been observed in children whose mothers chewed xylitol-containing gum. (10) Unsurprisingly, the most drastic effects are observed when xylitol replaces sucrose in either the diet or in chewing gum, but significant reductions in cavities have been observed when xylitol is simply added on top of a normal diet as well. (11, 12)

Although some effects of xylitol are undoubtedly due to nonspecific factors such as increased saliva production or the replacement of sugar, it does appear to have specific properties that support dental health. Xylitol is not fermentable by common plaque-forming oral bacteria like sugar is, so it doesn’t provide a food source. (13) Additionally, xylitol actively inhibits the growth of these bacteria. It also forms complexes with calcium, which may aid in remineralization.

Sugar alcohols and digestive health

While sugar alcohols appear to be safe and potentially therapeutic, they are also notorious for causing digestive distress. Because sugar alcohols are FODMAPs and are largely indigestible, they can cause diarrhea by pulling excess water into the large intestine. The fermentation of sugar alcohols by gut bacteria can also cause gas and bloating, and sugar alcohols may decrease fat absorption from other foods. (14, 15) However, most evidence indicates that people can adapt to regular sugar alcohol consumption, and the adverse GI effects reported in studies tend to fade after the first month or two.

Erythritol is probably the best-tolerated sugar alcohol, and a few human trials have found that if the amount of erythritol is gradually increased and doses are spread throughout the day, many people can tolerate large amounts (up to1g/kg of body weight) of erythritol without GI distress. (16, 17) The average tolerance for xylitol and sorbitol is lower; most study subjects could tolerate about 30g per day without a problem, but significant adaptation was necessary to increase xylitol content in the diet. (18)

A few studies indicate that sugar alcohols may have a prebiotic effect. This isn’t too surprising, considering the prebiotic effects of other low-digestible carbohydrates such as fiber and resistant starch. Animal studies have found that xylitol causes a shift from gram-negative to gram-positive bacteria, with fewer Bacteroides and increased levels of Bifidobacteria. (19, 20) A similar shift has been observed in humans, even after a single dose of xylitol. (21) Additionally, the shifts observed allowed for more efficient use of the sugar alcohols by gut bacteria, which largely explains the reduction in GI symptoms after a few months of regular consumption.

In addition to the potential metabolic, dental, and prebiotic benefits already discussed, xylitol shows promise for preventing age-related decline in bone and skin health. One interesting study found that 10% xylitol supplementation over 20 months increased collagen synthesis in the skin of aged rats, resulting in thicker skin. (22) Preliminary rat studies have also shown that xylitol can increase bone volume and mineral content and protect against bone loss. (23, 24, 25)

Overall, sugar alcohols appear to be safer than artificial sweeteners with several potentially therapeutic effects. Although the metabolic and weight loss benefits of sugar alcohols haven’t been studied as extensively, I would recommend sugar alcohols over artificial sweeteners to anyone who needs a low-calorie sweetener, although I wouldn’t recommend that anyone consume huge amounts of them. I’ll also be interested to see additional research on their ability to alter the gut microbiome and disrupt biofilms, because this could make sugar alcohols a useful tool for certain patients.

At this point, there don’t seem to be any major problems with sugar alcohols, so if it’s something you’re interested in, I would experiment with your own tolerance and see how they affect you. However, people with gut issues should be cautious.

What’s your take on sugar alcohols? Share your thoughts in the comments below!

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Comments Join the Conversation

  1. Barbie says

    I have been very happy with erythritol mixed with stevia powder as my sweetener. I use it in my coffee and my baked paleo goodies. I experience no GI distress, and I have been using it for a year or so. Thanks for the great information!

  2. says

    Great info, thanks!

    We used Xylitol for all our recipes, but, same as described in your post, due to the known heavy side effects in most people we started experimenting with Erythritol.

    A bit more expensive exceeded all performance levels of Xylitol (baking behavior, calories zero, no side effects, especially no bloating).

    Since more than a year we converted all our recipes to Erythritol. Still a heavily processed ingredient, it is our favorite alcohol-sugar, if used in moderation.

    • Greg says

      I suspect that the sugar alcohols are metabolized just like fructose. I developed gout from xylitol. Perphaps the GI signs associated with this product related to

      • says

        I agree with Greg. I have developed gout recently. I am diabetic, and have the dry mouth syndrome. I constantly eat the sugar alcohol candies to moisten my mouth, and suspect that is causing my gout problems. I also have many cavities every three months when I get my dental check ups, I keep my teeth so clean that the hygienist finds little plaque when she cleans my teeth. I suspect the sugar alcohol is causing this too.

  3. says

    I can’t digest Sorbitol or Mannitol or most other sugar alcohols at all. They give me terrible GI distress. I don’t have that problem with Stevia. I do use pure stevia leaf but also use Truvia sometimes and have read lately that that might be a bad idea as it has fillers that make it much different from pure stevia extract.
    In the past I made the mistake of using a Lot of aspartame (I wondered where sudden ocular migraines kept coming from; I’d never had even a regular headache in my whole life before that wicked Equal came into my life) and still use sucralose some; it’s not good for me I know but at least I don’t get tummy upset from it it. And the form I use is pure sucralose from HerbStore that has no fillers (like the brands sold in stores). Pure sucralose has no maltodextrin or dextrose.
    Sugar alcohols are monsters :)

    • Dave Garrett says

      Malitol locks me up! I have almost checked into the emergency room over it. Terrible GI pain for over a day and at least a week to recover from it. I narrowed it down to Malitol the hard way. I won’t go near it. “Monster” it is. Most of the others I can tolerate but why take any at all, ever? I’m done with all forms of fake sugar. I also don’t eat regular sugar (as best I can). No cake, cookies, candy, ice cream, soda, etc. etc. I am much happier. I don’t need to be sweetened so bad I have to suffer for it.

  4. BK says

    Wow, you say Xylitol is better at preventing cavities than Fluoride???? First of all, Fluoride does not prevent cavities, so that’s not saying much is it? Can we just dispense with the processed BS food products? Processed food is bad for you! To even call it food is an insult to all our overloaded-with- processed-garbage metabolisms! Eat real food! forget about all this crap!

    • John says

      Bk, You are right on……People in general are seduced by all this BS mainly because they are ignorant and ill informed plus might I add…..lazy.

    • Lisa B says

      Xylitol, despite its’ chemical sounding name, is made from the birch tree. Yes, it’s processed, but so is maple syrup.
      Sure, we can dispense with sweeteners if we have a lot of will power, however there is a biological urge for a sweet taste and you probably already know the tongue is still wired to send a pleasure signal when we get it because it was rarer in nature in ancestral times. Since we didnt’ evolve past this despite great availability of sweet foods, the temptation can be overwhelming. We can at least use our intelligence to judge the scientific research and indulge in a something less taxing on the body, and perhaps even health promoting like in the case of xylitol.

  5. Jill says

    Tami, I too am using the Fast Tract digestion plan by Norm Robillard. Have you had any luck finding toothpaste, mouthwash, gum, etc without sugar alcohols?

  6. Quinn says

    Yacon syrup is natural and seem to have the same effect with diabetes. May be a better choice for sugar substitute? I’m personally experimenting with it, although it is expensive, maybe better than sugar alcohol. I’m not diabetic, but having a metabolic disease. Can someone please comment on this, if yacon syrup is a ok choice?

    • Lisa B says

      All I know of Yacon is it’s a FODMAP but it’s great choice for a low cal/ low diabetes sweetener. It’s also restrictively expensive. I don’t know if it’s any good for dental use.

  7. Hbear says

    What no one mentions is that stevia comes from the plant family that includes ragweed, chrysanthemums, marigolds & daisies – if you’re allergic to any parts of these plants, you’re probably allergic to stevia. I am & just a tiny amount is enough to set me off. Xylitol has been the ONLY low carb sugar substitute that I’ve been able to have. The secret: everything in moderation, including xylitol!

  8. mister worms says

    Xylitol has been an amazing adjunct to restoring my family’s dental health. We tolerate varying amounts but very little is needed for the oral health benefits so intolerance isn’t much of an issue.

    One question I’ve had in the back of my mind is if acid-producing microbes could actually adapt to using xylitol as a substrate after habitual use (years, decades). Or would that be impossible because of biochemical factors?

    • Quinn says

      How much of Xylitol is enough for oral rinsing? I’m looking for a effective product to with gum recession and dental decay. Thanks.

  9. Daren says

    One time, pre-Paleo, my wife had bought a big bag of sugarless gummy bears. Without thinking about it, I scarfed down about 20 of these things in a few minutes. If you want the definition of disaster pants, give this a try. In our house, we now refer to this as the “gummy bear cleanse”.

  10. Tami says

    Adding inulin, a prebiotic fiber, and increasing my intake of sugar alcohols to keep calories down (in chewing gum, protein bars and protein powders mostly) made my belly so distended I ended up in the ER.

    Currently I’m being treated for SIBO and being introduced to the FP (Fermentation Potential) of foods. Sugar alcohols definitely trigger a “fermentation bomb” making my complete digestive system becomes effervescent.

    Even just a tiny amount affects me. Does anybody know of any chewing gum, breath mints, toothpaste, or mouthwash that does not include sugar alcohols? Ditto on protein powders?

    • Amy says

      Sucrose is very bad for you. It’s basically the same as Aspertame. The FDA has been swamped with complaints of side effects (serious ones) of these sweetners.

      I receive migraines if I consume either of these. I went on a detox to be sure that was my problem, and it was definitely a trigger. Now I only drink Stevia Leaf Extract or actual sugar…not worth putting harmful chemicals in my body.

      Please be safe!

      • Scott R. says

        No, it’s not made from chlorine. It is made from sugar, it just has chlorine molecule attached to the sugar molecule. e.g. it is chlorinated sugar. Maybe you meant that sucralose is made with chlorine, not from.

  11. says

    Great article, thank you. Due to excess levels of candida I am unable to eat, fructose, honey, maple syrup, palm sugar, agave etc. so I have been using xylitol. In small quantities in baking. Having quit sugar including the more sugary fruits for the time being xylitol has been my savior. I don’t get sweet cravings generally as I no longer have a sugar addiction but when I do fancy something xylitol is my choice. My body responds well to it and the only time I get the laxative effect is if I eat way too much. I.e testing a whole batch of sugar free foods for a launch. I’ve found a lot of people nervous of xylitol as they have read the negative hype on it being from gm modified corn, major laxative etc, when in reality xylitol from birch bark is easily available in the uk, and having tested sugar free recipes on many of my friends, family and general public, the majority have no running to the toilet episodes post cake consumption. Thanks again! Alison

  12. Susan Weckter, CNHP says

    I have used xylitol for years. We are careful to order non-gmo from USA made from birch. I have read a book on xylitol and many internet based articles (here’s a good page:

    I am concerned about the processing as noted above. However, my family is extremely sensitive to sugar with blood sugar and insulin processing. I also use stevia and trehalose.

    In counseling clients for wellness I have noticed that certain people – they tend to be the ones who are overweight & have health issues (esp blood sugar processing issues) – will always crave and eat sweets. Studies show that some people detect smaller amounts (ppm) of sweet than others. I believe that for these people the benefits of avoiding other sweets and using xylitol (stevia, trehalose) outweigh the risks. I find that moderation or avoidance is nearly impossible with these people. There may be a genetic link or brain wired a certain way, I don’t know. I just know that they will not give up the sweets.

    • Lisa B says

      Please tell us what is trehalose?
      How is it made? What is it made from and what is the effect on the body? I thought I had heard of all the sweeteners…
      Do share!
      Thank you

  13. Carol Willis says

    For 2 months I used a liquid cal/mag product sweetened with xylitol. It was sickeningly sweet. Lots of intestinal gas almost as soon as I took the supplement. I later found out I’m very allergic to birch, and xylitol is often made from birch. SIBO and intestinal permeability are also issues but I didn’t think that those would come into play until at least 10-15 mins after ingestion. In my opinion, it’s better to just avoid the artificial sweeteners and to re-educate one’s taste to prefer less sweetness.

  14. mhikl says

    I forgot to add that after spraying my ears I plug my nose with my fingers and then blow hard to force the Xylitol into the ear tubes. I can then taste the sweet Xylitol in my mouth. I think this also helps in preventing colds and flues. (A doctor told me one could not damage the ears by forced blowing with the nose squeezed closed.)
    I misspelt three (there flues) in my first sentence above.

  15. mhikl says

    Xylitol has been a godsend for me. I worked in a windowless classroom that had foul air – acrid by the afternoon and had there flues that winter (maybe the same one three times running?) and five heavy colds. I came upon Xylitol in the spring and began using it (about six years now). Since then I have had the following improvements.
    1. Not a cold nor a flue in six years – used to get a flue once every seven or so years, a heavy cold every two years or so, a light cold once or twice a year. I did have a flutter of a sniffle with light head a year ago when I became lazy and languished in regular Xylitol use- but quickly resuming its use, nothing further developed from the flutter. Upon spraying the phlegm seems to become ‘unstuck’ and then after ‘snorting’ water or using a nasal neti pot (or my cupped hand) phlegm quickly is flushed out.
    2. I have suffered terrible sinusitis since about age nine (54 years ago). The Xylitol has banished the problem as long as I spray my nose once or twice a day. (However, cigarette smoking for a few weeks waiting for my electric cigarette solution from overseas to arrive inhibited the results very much.)
    3. Brushing my teeth with a mix of Xylitol and Borax (a mineral like chalk or magnesium) cleans and whitens my teeth better than toothpaste. These two are purported to strength bones and teeth.
    4. One spray to my itchy eyebrows completely stopped ‘itchy eyebrows’. Sprayed in the ears and let to rest a few minutes stops ear itch and then cleaning with a Q-Tip quickly cleans the ears tubes- works quicker and better than peroxide. It also clean ‘gunk’ from the eyes.
    5. I find it sweeter than sugar so I use about a quarter less Xylitol than I did sugar.
    6. I used it as a light foot spray and it helped eliminate foot odour- however, since going Primal (high fat, <50 gr protein and ultra low carbs, both foot and body odour have been eliminated).
    7. I spray cuts and abrasions with Xylitol. However, I haven’t noticed any affect on my eczema-strangely for that I use a heavy spray of hot chilli solution make from boiling four heaping Tablespoons of crushed dried chillies 2-3 times a day. I do add a Tablespoon of Xylitol for good measure.

  16. LaFrite says

    I mainly use xylitol and erythritol (I mix them when I need a substantial amount for baking). Xylitol I like best for taste and sweetness. But it is horribly expensive! And I believe its manufacturing is quite dirty. Erythritol is easier to manufacture and is half cheaper or even less. But you need more of it for the same sweetness. There is a combo erythritol – stevia extract (the stevia part is like < 1% of the total) to increase the sweetening power of the product. It is also OK re price. But xylitol has interesting health effects which makes it almost a staple at home.

  17. Ryan says

    My dog happily eats it’s own feces and drinks from the toilet and polar bears have no more icebergs to sunbathe on. None of this is relevant to Chris’s article but I wanted to post useless factoids like everyone else.

      • Ryan says

        Nope, the dog ran away and now I fill my day with reading these useless comments to a great article Chris wrote.

        I hope someone has recommendations for a pet that thrives on Xylitol. That’s what you all should do, find a pet that can eat Xylitol so you can both be fat dumb and happy.

        • Jenifer says

          A friend’s dog ate chocolate and was fine. I’m sure there would also be instances of dogs ingesting xylitol with no problem, although of course I’d err on the side of caution.

    • Jet says

      Speaking of dogs, Xylitol is very toxic to dogs! Please read up on it as it has become a serious hazard for dogs that tend to get into their owners belongings! A very small amount can kill…..luckily we learned the lesson when our dog got into the garbage which contained “chewed gum”. Chewing removes most of the added ingredients so our dog was OK but it was a scary wake up call!!!

  18. Keren says

    Xylitol also possesses antifungal properties. This makes it a useful part of an anti candida diet. I have also found it helpful when added to purified water and a few drops of essential oils (such as thyme, oregano etc) as a sinus spray. Often resistant chronic sinusitis has an element of fungal infection and topical xylitol can be a valuable part of its treatment.

  19. Gabriela says

    I eat a very healthy diet and avoid allergenic foods since for a long while now, I’ve had reactions to them. I have tried all of these sugar alcohols and it’s the same reaction – I get terrible, strong headaches for the whole day. It’s the same with stevia both, the natural leaves and the drops. The headaches are so strong, that I need to rest. If it takes one to two months for your body to adapt to the GI issues and other issues, I wouldn’t put myself through that every single day. I agree, that it’s an individual thing and you have to see how your body responds to it, but for me, I definitely avoid it. Such a shame too, because I love to indulge in sweet foods now and again but, find it is hard on my body, so I avoid it. Natural sugars cause different reactions for me too.

  20. Rafael says

    I noticed the complete opposite when using alcohol sugars for guns. I wonder if anyone else has noticed tooth/gum sensitivity when using xylitol. Many years ago I was chewing gum made with these alcohol sugars and noticed that my gums would become sensitive, and/or bleed. Also I would get some tooth sensitivity. I stopped using any products with alcohol sugars it and the symptoms went away. a few months ago I purchased a how to floss that uses it all in it for the explicit purpose of being beneficial for the teeth and gums. I used it thinking the best and completely forgot about the issues I had with xylitol in the past. Overtime I was having problems with my gums again even though I diligently brushed and floss. There were no other changes in my diet. Just a few weeks ago, I ran out of the floss and started using the same brand floss without the xylitol. Interestingly, the problems I was having with my guns went away. So am I unique with this issue or is there anybody else that has noticed the same problem or maybe you just didn’t notice it was associated when you’re using products containing xylitol or other alcohol sugars?

  21. Corey says

    My concern with some of these sugar-alcohols is how the brain perceives them. The brain, I would expect, would be anticipating the normal rush of energy the body gets from consuming regular and other artificial sugars. So, when the taste is sweet, but the energy boost does not follow to the same degree as with real or artificial sugar, does this trigger the brain to want to consume more food to make up for the lack in expected
    energy production?

    • says

      I’ve heard that theory. I think we have to look at the long track record of xylitol, it’s been used since the 1930’s I think, and studied extensively. If that was the case, I think there would be evidence of it by now. I’ve been using it regularly for a couple of years and haven’t had any unusual food cravings after consuming.

  22. says

    This is a very timely article for me because I only just (literally TODAY) started supplementing with very small amounts of USA-made birch xylitol for dental health. I do have trouble with FODMAPs so I am starting with 2g/day (I weigh 120 lbs.) to see how I do. I appreciate all the info in this article so much.

  23. Jayme says

    I strongly disagree and find that sugar alcohols cause much stress on gi include bloating and other problems. I find stevia to be the best solution

    • Corey says

      The GI can be tricky like that. Sometimes it produces gas and bloating because what you consume is truly bad for you. Sometimes it produces gas and bloating because what you consumed is addressing all the crap that builds up in your intestines over the years, such as when people dare brockley after years of not eating any greens. Consequently, just because a person gets a little painful gas and bloating, that is not always proof that what they consumed is bad for them. In fact, it might be more beneficial for them than they begin to realize, but they might need to go through a little digestive distress to get to a better state of health through the use of such food choices. Healing and rebalancing the gut isn’t always a pleasant experience. People can take probiotics and get the same gas and bloating, and we know probiotics are good for us, because we would not have an immune system to speak of without those little critters getting in there and providing all their many health benefits.

      • says

        Good points Corey. Another example of a healthful food that often causes gastric issues initially: brewer’s yeast. The taste is also a problem for many. However, its health benefits are generally acknowledged.

        I was interested to see brewer’s yeast mentioned in the diary of Anne Frank! “Mood upstairs: bad.
        Mrs. van D. has a cold. Dussel caught with brewer’s yeast tablets, while we’ve got none.”

      • mhikl says

        Good stuff, Corey.
        I used to use probiotics but I can’t say they ever seemed to help until I turned to making my own.
        I brew my own non-pasturised sauerkraut. Remarkably, it seems to have fixed any digestion problems I had and made the final act of the digestion track stable, if you get my gist.
        It is cheap to make and delicious. I make four litres at a time using an old 4 Litre glass pickle jar and, Bob’s your uncle, I have a month+s supply to add to my two Paleo meals each day.
        It is the second best change I have made to my dietary programme, ever. Going Paleo, high fat, low protein, ultra low carb is my number one change. (Three years now).
        What you say about the gas is so true. It often takes the body a little while to adjust to changes made to one’s regimes. We are often too quick to toss the change that may actually be helping us.

  24. Sasha says

    Although Xylitol is much more preferable to sugar, since I have been doing the 30 day autoimmune reset and have eliminated it, I have felt much better. Of course, I have eliminated other things in this time too, but Xylitol was one of the last things that I eliminated, and I noticed a huge difference. I really appreciate all your information Chris.

  25. Laura, getting MPH says

    Chris, I respect your opinion on many issues, but I strongly disagree with you on this one. Xylitol is one of the most toxic substances your pet can ingest, and even very small amounts can be fatal. A recent study in PLOS revealed that erythritol apparently makes a very efficient insecticide; of all the sweeteners tested, it was the only one that killed the fruit flies. “The more you get them to consume erythritol, the faster they die.” No thank you.

      • Laura, getting MPH says

        Sarah – no, I wouldn’t. I have heard of garlic being used as an insect repellent, but never as insecticide. Thanks for sharing that information. :)

        However, garlic has been around since time immemorial. It has a proven track record of safety for humans thousands of years. (As does chocolate, which is toxic to pets.) Not so for xylitol and erythritol!

        • Richard says

          Laura, I’m so grateful to you for posting the links that you did. Hyrdogentated Sugar = Xylitol. Probably good in toothpaste, but as a sugar subsititute, dangerous. So glad you question, regardless of the guru advocate.

        • mhikl says

          I am not sure of either onions or garlic. Google each them as ‘dangers of’.
          I gave them up years ago.
          To surely we accept without question things that may not do what they are purported to do so it is best to know both sides of the story so to make the better choice.

        • Anita says

          Gee xylitol has been around just as long as garlic, as a matter of fact, your body actually naturally produces small quantities of it. So you better not let your dog kiss you any more.

    • Ryan says

      Why on earth are so many people going on about this being toxic to their pets? Where did Chris promote this as a great idea for fido?

      Are any of these comments contributing anything of value to this article? Do everyone a favor, jot down what you want to say and then delete it.

      My comments are equally as unnecessary but I’m likely a narcissist like the rest of you.

      • Janknitz says

        Nobody said anything about feeding Xylitol to pets, but some people may have the type of dog that gets into human foods by climbing on the table, on the counters, or in the cabinets, or runs over to lick up spills before you can wipe them up, then having Xylitol may pose a danger. I have a very well-behaved dog right now, but growing up we had a dog with Pica who was constantly eating everything he could reach. We had to have his stomach pumped a few times.

        Likewise some people let their dogs do “pre-wash”–that is lick the plates before they are placed in the dishwasher (gross, I know, but some people do let their dogs do this)–they need to be aware of the danger if xylitol is used in the food preparation.

        So yes, an article favorable about Xylitol should have the warning about canine toxicity. If you don’t like it, skip those posts.

    • Jane says

      Why are people speculating about whether xylitol is toxic for dogs? It’s been known for years that ingesting it can kill a dog fairly easily. See info below. On the human side, I currently am recovering from acute gastritis and went looking fruitlessly for egg protein powder, thinking to live on smoothies for a few days. The only kind I could find was Jay Robb, and read the label when I got home..”xylitol.” Dammit. Why not use Stevia, Jay? Everything I read about sugar alcohols says they’re a “no” for IBS, gastritis, crohn’s etc..

      Two Deadly Effects of Xylitol:
      In the canine body, the pancreas confuses xylitol with real sugar and releases insulin to store the “sugar.” The problem is that xylitol does not offer the extra Calories of sugar and the rush of insulin only serves to remove the real sugar from the circulation. Blood sugar levels plummet resulting in weakness, disorientation, tremors, and potentially seizures.

      It does not take many sticks of gum to poison a dog, especially a small dog (see below for toxic doses). Symptoms typically begin within 30 minutes and can last for more than 12 hours. Vomiting and diarrhea may also occur.

      Hepatic Necrosis
      The other reaction associated with xylitol in the canine body is actual destruction of liver tissue. How this happens remains unknown but the doses of xylitol required to produce this effect are much higher than the hypoglycemic doses described above. Signs take longer to show up (typically 8-12 hours) and surprisingly not all dogs that experience hepatic necrosis, will have experienced hypoglycemia first. A lucky dog experiences only temporary illness but alternatively, a complete and acute liver failure can result with death following. Internal hemorrhage and inability of blood to clot is commonly involved.

      How Much Xylitol Is Dangerous?

      The hypoglycemic dose of xylitol for dogs is considered to be approximately 0.1 grams per kilogram of body weight (about 0.045 grams per pound). A typical stick of gum contains 0.3 to 0.4 grams of xylitol, which means that a 10 lb dog could be poisoned by as little as a stick and a half of gum.

      The dose to cause hepatic necrosis is 1 gram per kilogram of body weight, about ten times more than the above dose. In the example above, the 10 lb dog would have to find an unopened package of gum and eat it for liver destruction to occur.


      Ideally, the patient can be seen quickly (within 30 minutes) and can be made to vomit the gum or candy. Beyond this, a sugar IV drip is prudent for a good 24 hours. Liver enzyme and blood clotting tests are monitored for 2 to 3 days. Blood levels of potassium are ideally monitored as well. Elevated blood phosphorus levels often bode poorly.

    • Jet says

      Thank you for speaking to the issue of toxicity in dogs! Very few know about this and the info needs to be spread to prevent the death of our pets! Xylitol is very toxic to dogs and in very small amounts so if your pet likes to get into your purse or you leave your gum out, be prepared for a very large vet bill and/or
      maybe even the death of your beloved dog!

  26. finndian says

    Xylitol caused severe stomach distress that slowly built up. I only became aware of the cause when I was away for a week and had no xylitol with me. My watery stools disappeared immediately but it took months for the stomach distress to calm down.

    • Jane says

      thank you for this comment. I definitely am not going to be using the protein powder I got to help me recover from gastritis!!! (contains xylitol)

  27. Armelle says

    Thank you for this great article which put my mind at ease about sugar alcohol. I purchased Lakanto, which is an expensive “sugar” made of non-GMO Erythritol and Luo Han Guo (Monk Fruit Extract)… but been cautious and haven’t used it yet because I am nervous about using anything processed like that… Has anyone had any experience with Lakanto? Thx.

  28. Sarah says

    I hve used Erythritol for several months in making low carb mufffins and found it to be a great substitute for sugar or other artificial sweeteners. It is about half as sweet as sugar so only adds a hint of sweetness to a standard recipe. I choose Erythritol over the other sugar alcohols because I suffer from GI issues easily if I eat the wrong foods. Never had a problem, but then again, I probably consumer at most 1 tsp a day. For those of us who can’t quite break the “sweet tooth” habit, it has been a great substitute.

  29. Carie says

    Chris – I was chewing xylitol gum a couple of years ago. What I noticed is that I would experience my gut “squirting” at night, like digestive juices working overtime. I normally do not experience my body squirting its digestive juices, so I got really concerned. It took a while to figure out it was the xylitol gum. I stopped using it for a while, then tried it again. …the squirting started back up. I do not think I gave it more than two months, though. My question is – would you think this squirting was an extreme reaction, and indicative that it’s not safe for me? Or do you think it would be ok to try again? I like gum to clean teeth after a meal and to keep the saliva flowing and would love to get off of the “Extra” brand gum I now chew and go back to something that might actually be beneficial. I just was afraid I might be hurting myself after the intense and repeated “squirting” I was experiencing in my abdomen every night. Thanks!

    • Christine Parmigiani says

      Just wondered if you were chewing same brand as I have: Trident Xtra Care gum. I am not aware of any problem like you describe but maybe should pay closer attention next time I chew a piece! It, of course, has sorbitol as well as xylitol in it.

  30. Gary Engstrom says

    Why do we think foods need supplemental sweeteners in the first place. I have quit sweetening things long ago and get along just fine. I do, on occasion, indulge in a sweet dessert, but besides that, no added sweeteners! I even make rhubarb juice and drink in unsweetened. I do dilute it ~4 to 1. It is tart, but refreshing and quite enjoyable.

  31. says

    Wow, I am extremely impressed with your article. I have been researching info on artificial sweeteners and sugar alcohols for a long-time now on the internet and have found your article to be one of the most informative and comprehensive on the subject. Thank you very much for your diligence in your research, analysis and commentary.

    I am definitely going to switch to sugar alcohols to see how they work for me. Hope you are having a wondrous day…:)

  32. Lin_momof5 says

    The studies referred to by the healthy home economist only apply to ONE method of extracting xylitol, and the source was corn from China. If you get organic birch xylitol, the data from that study is entirely irrelevant. Just doesn’t apply. So while that type of xylitol may indeed be hazardous in large quantities, I still like xylitol from birch, for all the reasons that Chris outlined. I think he did a really good job in this article.

      • John says

        Xylitol is produced chemically from wood sugar
        Glucose can be the base material for the production of xylitol. This develops in the process of starch saccharification of plant starch (corn syrup, glucose, fructose )
        • If glucose is from maize or maize starch it may definitely consist partly of genetically modified maize, this is especially true when the raw materials are imported from the China or Argentina. In the USA, genetically modified maize is grown nearly exclusively by GMO
        • GM-microorganisms are used to make enzymes …Amylases, glucose-isomerase, and pullulanase. These enzymes solubilise plant starch and metabolise it into compounds classified as ingredients and additives.
        • The USA uses a procedure that has been developed to produce xylitol by using a microorganism (Escherichia coli) Yes the same E coli. This bacteria also helps to solubilise cellulose and can produce Xylitol…Yes from birch trees
        • Do these companies need to label this? The short answer is NO because enzymes do not have to be declared on the list of ingredients.
        • An additive is not subject to labeling requirement even on the case that the microorganisms used in its production have obtained nutrients (substrates) derived from GM plants.
        Do Not be Deceived. This is not as sweet as you may believe. Eat real food!

      • John says

        Hi Jennifer, I did read the article on Karens healthy kitchen the truth about xylitol.
        There are a few miss leading statements, To make a blanket statement that GMO corn is a non-issue with xylitol is quite frankly deceptive. China both imports and export Corn and it is all GMO. To say the farmers in China have no interest in changing the way they have been farming for hundreds of years is absolutely ridiculous …The article goes on to say “This information was provided to us first hand by the owner of one of the largest xylitol importing companies who has personally made many trips to China to inspect their facilities and work with their government”..He surely isn’t going to say anything else is he! However he better visit China again I would say. I feel he has missed a few things.
        GM-microorganisms are used to make enzymes …Amylases, glucose-isomerase, and pullulanase. These enzymes solubilise plant starch and metabolise it into compounds classified as ingredients and additives used in the production of Xylitol These enzymes are used in Birch and maize or corn produced Xylitol.
        I would take Any Information coming from The USDA and the FDA with a grain of salt… IT is not well researched and biased to say the least. They are corporations representing corporations and their investors . They have NO interest in the health of the people in general, this is quite common knowledge.

    • Christine Parmigiani says

      I have a previous comment above concerning xylitol from Xyloburst made not only from birch but label says made in the US. I love the stuff and find nothing detrimental when taking it so far.

  33. says

    I found it best just to stay away from all sugar alcohols…..just natural ingredients…once away from all I don’t even crave it and when i do taste it they all taste too sweet for me….I used to be an addict to diet colas ..since giving up altogether do not even crave it…..xylitol extremely poisonous to pets…..

  34. says

    Excellent piece. I’ve been using xylitol, erythritol and although not addressed in this post, stevia, in my recipes for years. Interestingly, although I have a lot of Paleo followers, I’ve often been criticized for using these sweeteners. One of the things that I’ve found is when we make Paleo treats and swap out the flour for nut based flours and add in cups of honey, the end result is a treat that has more caloric density than its conventional counterpart.

  35. Katherine says

    Xylitol is part of the formula I use as a tooth powder. I can barely taste it in the toothpaste but I am confident that it is better for me than sugar and stuff like Splenda and other artificial sweeteners that may not be so good for you. I like that Xylitol helps prevent cavities and may aid in the remineralization of tooth enamel. I will continue to use Xylitol. Thank you for your insights into this Chris. I appreciate your posts!

  36. Lonnie says

    The page on Erythritol at has this warning: “May be fatal to pets including dogs & cats!” So I’d keep both Xylitol and Erythritol away from all pets.

    • Heather H says

      Interesting, I have read studies that show erythritol to be safe (but not xylitol!) except in extreme high doses. I wonder if that is what they are referencing? I also noticed their xylitol comes from China, um.. no thanks.

  37. says

    Hmmm. I am a bit stunned that you would promote this. Why something so unnatural when a healthy, NATURAL sweet like raw honey is available? Xylitol’s own promotional material says it is not safe for everyone to use.

    “While it is true that xylitol is a naturally occurring substance, manufactured xylitol is another matter entirely. Commercially available xylitol is produced by the industrialized process of sugar hydrogenation. In order to hydrogenate anything, a catalyst is needed, and in the case of xylitol, Raney nickel is used which is a powdered nickel-aluminum alloy. ”

    “Given the violent industrialized process that is required to produce a hydrogenated sugar like xylitol, it would seem wise to avoid it based on the very poor track record of hydrogenated foods in general!”

    “In a long term toxicology study on rats researchers found that xylitol caused a significant increase in the incidence of adrenal medullary hyperplasia in male and female rats in all dose levels tested (5%, 10% and 20%).5 That means it caused abnormal cell growth in the adrenal glands. In one higher-dose study in which mice consumed 20 percent of their diet as xylitol, there was a significant increase in the mortality of the males as compared to those consuming sucrose.6 A major study in dogs found an increase in liver weight associated with xylitol use.7″

    I prefer what some others say about this:

    • Katherine says

      I understand your concerns but why would anyone feed Xylitol to their pet? Sweets are a no no for pets to begin with. My cat seems to like bananas but I don’t just feed him sugar or any other sweetener. He would love to have some of the chocolate I consume but I don’t let him have it, either. I rarely use sweeteners, except for Xylitol in my toothpaste to make it a little more palatable.

      • Jet says

        Pets tend to get into things and some gum, Mentos for example, has large amounts of Xylitol for which a small amount can be fatal. My dog go into the garbage and ate my already chewed gum which was lucky for us as the chewing removed most of the Xylitol! If they get a hold of your gum or any product with large amounts of Xylitol, you will end up with a large vet bill or a dead pet. We no longer buy gum or any product with Xylitol and are suspect of many others: Sorbitol, etc. Why take a change with your pets life!

    • Katherine Henry says

      I think this is a valuable discussion as some of us, T2 diabetics for example, cannot tolerate even the “natural sugars” such as honey. I find that erythritol and stevia, used in combination, can be very useful in baked goods. Consistency is different but since I am baking with nut flours , consistency IS DIFFERENT anyway. Another all natural sweetener that does not affect my BG levels is yacon syrup. It is expensive and is used in place of agave, honey, molasses or other liquid sweeteners. It may actually benefit T2D. Well worth a try when looking for a natural alternative. One thing I find difficult in baked goods is the cooling effect of sugar alcohols. Neither yacon or stevia cause this… For already cool things that need a bit of a sweet hit, erythritol is great!

    • Tim Sharpe says

      Jeanne, as in so many things, the dose makes the poison. A xylitol study dosed at 20% of body weight is not relevant. People add teaspoons of this stuff. Also, I wouldn’t say Chris is promoting xylitol. He is rendering an interpretation of the available data. That’s one of the main reasons people visit his blog.

      Also, I don’t intend offence, but the blogs you listed don’t do much to disprove this article. The homeeconomist link extensively references a blog – mostly NaturalNews (not peer reviewed research). The curetoothdecay link references some research, but much of it is neutral, and the negative studies are less real world relevant than what Chris posted.

      I can appreciate that you prefer foods that are less processed, and agree that in many cases raw honey may be a better choice. Here is a current article on raw honey in Type II diabetes:

      • Kai says

        Very well put Tim. “Processing” has acquired a bad rap. Yet even filtering, cooking or fermenting is processing. Processing isn’t good or bad, you have to look at what’s being changed and the evidence surrounding it.

        • says

          We humans all have such individual tolerances and needs that we need to be our own food advocate/detective. Highly processed foods worry me, too, but honey gives me gut distress, though Maple syrup does not. Xylitol does not. Nevertheless I don’t consume processed xylitol or maple syrup often. We just have to stay informed as best we can and Chris’s blog has helped me so much in that respect. And thanks to Kai and Tim for your rational approach to this topic.

    • a nelstone says

      I am VERY thankful someone addressed the TOXIC manner in which sugar alcohols are made…
      MSG is naturally occurring, however it is toxic to many in its manufactured form…
      Isn’t it part of the ethos of ‘healthy’ diet and living to eat what comes naturally to us through nature??? Is not the argument for why we are so ‘unhealthy’ these days due to the fact we have consumed all to many highly processed foods…
      Is not promoting yet another highly processed product a breach of this ‘healthy ethos’?

      • says

        Exactly a nelstone! I thought REAL FOOD was the key to health…certainly is for me and my family. xylitol is NOT real food.

        Type 2 diabetes is around because of eating processed foods. Why not just cure it and most of what ails one by eating REAL Food?

        I thought that was the key factor in “Ancestral Eating” !!

    • John says

      I agree with you Jeanne, Personally I do not want any food stuff that has been manufactured. These artificial sweeteners are a con. Organizations create the studies they want the public to read, mostly BS. Be on alert with anything made in China. 99% of Xylitol and Erythritol is made in china from GMO products and they are then repackaged here in the USA with a smiley face to say how good they are. They do not have to tell you where it comes from or if it has been irradiated. All non foods are irradiated. Xylitol is a non food as all grains and pulses. anything that has been irradiated is specifically dangerous to cats. Most labeling on packaged food is deceptive,so if its not clear or you don’t understand it don’t buy the crap.The consumer must take their power back. Just remember how many wonderful and well endorsed products have been recalled or are suspect carcinogens etc over the last 30 or 40 yrs. you can add these sweeteners to the list. be educated in this food deception people.

      • says

        I agree with you totally John! We are on the same wave length.

        Labeling is indeed, EXTREMELY deceptive, even in health food stores and organic.

        The best bet is to eat real food, grow it yourself if you can or make partnerships with sustainable farmers who let you inspect and prove their integrity.

  38. carole says

    I have tried using xylitol for several months and found it caused diarhea, excessive gas and abdominal pain which did not go after 1 or 2 months of use. After research I found that this is because it is from beets and the body digests it as fibre rather than as a sugar/carbohydrate so not everyone can tolerate it.

    • Christine Parmigiani says

      I use Xylitol Sweetener from XyloBurst in a 1 lb. bag and it is made from birch, it says on the lower left corner on package back. It’s working well for me; I’m not diabetic that I know of. Just overweight by about 25 lbs!

  39. Dr. Alvin Berger, MS, PhD, Prof, CSO says

    Regarding erythritol, it does not raise blood sugar in diabetics and can actually be beneficial for diabetics (improving endothelial functioning. It is a great polyol bulk sweetner to mix with high intensity sweetners (HIS) like stevia. I speak from personal experience with my son with T1D, and also these references:

    Effects of erythritol on endothelial function in patients with type 2 diabetes mellitus: a pilot study. Flint N, Hamburg NM, Holbrook M, G Dorsey P, LeLeiko RM, Berger A, de Cock P, Bosscher D, Vita JA. Acta Diabetol. 2014 Jun;51(3):513-6
    Multi-targeted mechanisms underlying the endothelial protective effects of the diabetic-safe sweetener erythritol.

    Multi-targeted mechanisms underlying the endothelial protective effects of the diabetic-safe sweetener erythritol. Boesten DM, Berger A, de Cock P, Dong H, Hammock BD, den Hartog GJ, Bast A. PLoS One. 2013 Jun 5;8(6):e65741

    • Sarah says

      I’m confused, I’ve read that sugar alcohols do raise BG and that they don’t. Has this been proven either way or is it totally individual….?

  40. Tracy says

    What about a product called “Just Like Sugar.” The ingredients list: Chicory root dietary fiber, calcium, vitamin c, natural flavors from the peel of the orange.

    I do have to watch how much sugar replacements I use as they do upset my gut.

    I have been experimenting with half natural sugars and half sugar alcohols/Just like sugar. Also because the flavoring is better.

  41. Janknitz says

    Two important considerations:

    Consider the source. Xylitol can come from GMO corn or as a byproduct of hardwood which can be sustainably harvested. Look for the hardwood source.

    Xylitol is HIGHLY poisonous to dogs. If you have a beloved pet, use with caution or choose Erythritol instead.

    Xylitol and Erythritol do not have unpleasant aftertastes that stevia and artificial sweeteners do. They are stable in cooking. I was surprised to find I tolerate them well because the tiniest bit of sorbitol triggered instant heart burn and GI distress even before I swallowed it (eg, it’s used in many products used by dental hygienists and dentists, though I think they are shifting to more xylitol as my GI system is not being as disrupted during treatment now).

    • Wildrose says

      Yes indeed about dogs. I’m very careful with my Xylitol… I can’t use it much now because a pair of poodles keep coming over and they’re little munch hounds. Also I bake for my niece and nephew and I just can’t expect them to keep treats away from dogs. :) They’re only little kids…

    • Heather H says

      Because it is poisonous to dogs I won’t let xylitol in my house, and honestly why consume something that will kill another living being if they ingest even a tiny amount? I understand we are different species but still I think I’d rather not.

        • mhikl says

          True. A friend’s dog died after getting into the garbage and eating the raw onion discards.
          True also the problem to dogs. However, I am very careful with my sprays and digestion of Xylitol around my corgi. I do, however, spray her ears and eyes with it and then wash the fur afterwards. It has eliminated gunky eyes and itchy ears. I might do it once a week.
          According to research this teensy amount of Xylitol is safe. It is the ingestion that plagues their liver.

      • Kai says

        The only reason it’s bad for dogs is it causes an insulin release as if it were real sugar. This puts them into a hypoglycemic coma/death. Humans simply don’t have this insulin release. What’s more is you are currently getting 5-15g of xylitol a day in your body, so I really don’t think a few more grams would hurt :)

        • Tom says

          Insulin release is not the only reason. “Once thought to cause only hypoglycemia in dogs, this sugar substitute has recently been discovered to also produce acute, possibly life-threatening liver disease and coagulopathy.” See “New findings on the effects of xylitol ingestion in dogs,” Eric K. Dunayer, Veterinary Medicine, Dec 2006.

      • Corey says

        The reality is that there are a lot of foods in the normal human diet that could either cause severe medical conditions or even deth in dogs. So, jumping to conclusions about how your body will react to a food or substance choice, based on another species reaction, may not be such a great guide to use, seeing that chocolate, garlic, onions, grapes, macadamia nuts, and a host of other items humans consume every day can impair or even kill dogs. To complicate matters further, the fact that some people can eat peanuts and drop dead on the spot from a dangerous peanut allergy does not make peanuts deadly to everyone who eats them either.

      • Wildrose says

        Dark chocolate can be fatal to dogs too. That’s not a good reason to avoid xylitol. Because your dogs will eat anything that hits the floor, that’s a good reason. :)

    • says

      Interesting topic. My body functions best when I avoid sugar alcohols. They cause digestive disturbances and bloating in my body. Diarrhea is another bothersome side effect.

      The worst of all is Truvia brand of stevia. The first time I ingested it, I had severe distress for over two weeks. Burning sensation in the mouth was the initial reaction, followed by muscle spasms and severe stomach ache and bloating. I had been eating a careful, limited diet of only unprocessed foods for a month when a friend served strawberries dipped in Stevia. The first taste was bitter, followed by sweet, then the burning in mouth. Even my teeth hurt. I stopped eating, immediately spit out the food and rinsed my mouth.

      Eventually I looked up Truvia, read manufacturers website and discovered despite claims of all natural, it is a highly processed product that creates a potent sugar alcohol. I then researched on line, side effects from Truvia. There were multiple websites containing reports of side effects ranging from mild to severe. A number of people reported identical side effects to the ones I experienced. One woman, a tennis pro had been unable to play tennis for months due to debilitating muscle spasms. Only after she discontinued Truvia as a sweetener did she recover. This stuff is dangerous!

      • Susan says

        The majority of xylitol is now made from GMO corn according to my nutritionist as well as articles I’ve read. Xylitol certified to be made from birch trees may be available on the internet.

        I eat few sweets except fruit any more. For my family, I do want to get an organic stevia plant from whole foods and a dehydrator for the leaves. I’ve heard the crushed leaves are good and a small amount goes a long way.

        My friend and her daughter who definitely eat less sugar and flour foods than the average person still had to go through withdrawal symptoms from a sugar detox. They really liked the recipes and info in the 21 Day Sugar Detox by Diane Sanfilippo (which is similar to paleo with a few important differences posted by Amazon reviewers for anyone interested who doesn’t want to buy another book).

      • laura m. says

        Best to get liquid stevia with no additives. I get mine at I do use the powered packets with dextrose which seems ok. The brand is Stevia in the raw.

    • says

      This I’d a great article. We didn’t use stevia in our products because of the after taste. I can’t stand the aftertaste! But fresh stevia leaf is quite nice. xylitol also bakes well as a replacement for sugar 1:1 ratio and it improves the texture of baked muffins and cakes. See Ugg for recipes.

  42. Matt says

    Great article.
    I wonder if this will become another rage like resistant starch.
    Biofilm disruption? Intriguing.

  43. Petrell says

    I like Xylitol for brushing my teeth, but I instantly get heartburn even after swallowing tiniest amounts of it.

    • Leah says

      Hey Petrell,
      I did too, then started separating sweets from proteins by an hour for sweets, and several hours for proteins….addressing GERD issues helps.

  44. says

    Thanks for putting together the facts about xylitol, Chris.
    Since it benefits so many crucial aspects of health, it seems to me that many would do well to incorporate it in their diets, although I agree that large amounts aren’t desirable or necessary.

    I understand that some say it raises their blood sugar. However, a study at PubMed reported significant decreases in blood glucose.

  45. Wenchypoo says

    There’s a device that will tell you which sugar alcohol is safe for you–it’s called a BG meter. If the sugar alcohol doesn’t make your blood sugar rise much in 2 hours, then it’s safe for you. For Hubby, it’s stevia glycerite–made him rise 1 point in 2 hours.

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