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! #foodadditives #sugarreplacements #xilitol #sorbitol
What Exactly Are Sugar Alcohols?
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
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 demineralization.
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Sugar Alcohols and Digestive Health
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.
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.
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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.
What, your dog actually likes you? Yeah right, no wonder it eats it’s own…
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.
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.
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!!!
How do I un-notify myself from comments on this post? My inbox is overflowing!
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.
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.
You may not have been using pure xylitol. Dr. Ellie has some good info on xylitol and gut health. She advises us that the other sugar alcohols do cause gastric issues but that xylitol is different.
http://drecoaching.com/blog/2012/03/10/xylitol-for-gut-health
Sugar alcohol is a NO for diabetes
Based on personal experiance
Hmm. My a1c is way down using xylitol and other low carb high fat changes. I don’t use a lot of sweeteners, but do make ice cream and cookies with it. Every day in my coffee. I probably have a little something xylitol sweetened in addition to my morning Joe evey other day. Working for me!
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?
Thanks Chris for a great article, as usual!
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?
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.
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.
Thanks for this. The popularity of xylitol is driving me positively insane!
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
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.
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.”
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.
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.
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.
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0098949
http://www.cbsnews.com/news/truvia-sweetener-is-toxic-to-fruit-flies-study-finds/
Garlic makes a good insecticide too! Would you avoid that?
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!
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.
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.
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.
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.
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.
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..
from http://www.veterinarypartner.com –
Two Deadly Effects of Xylitol:
Hypoglycemia
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.
Treatment
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.
this is garbage information. insulin is released in response to elevated blood glucose levels. no raised levels from xylitol = no insulin.
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!
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.
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)
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.
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.
What is your take on Isomalt?
I get very bloated whenever I use xylitol….I stay away from sugar alcohols….
Yes, I would like to be notified of followup comments.
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!
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.