WHERE CAN WE FIND XYLITOL?

Natural Sources P
lums, strawberries, and raspberries are the rich sources of xylitol which has been demonstrated to
have benefits on  preventing tooth cavities, plaque formation and ear infection [1,2] and helping improve skin and bone
conditions in rats.

Xylitol Products Because of its unique properties, xylitol has been applied in many products. Examples of xylitol
products include xylitol sweetener, xylitol nasal sprays for moisturizing the nasal passages and sinuses, xylitol chewing
gum for reducing the risk of tooth decay, xylitol toothpaste, Ice Breakers, Trident, Xylitol Sours, Xylitol Lollipops, Xylitol
Jam, Xylitol Mints, Bulk Xylitol and more.

Xylitol Benefits

Xylitol benefits - on DENTAL CAVITIES AND PLAGUES
Studies have showed that xylitol gums, toothpastes and candies could help develop fewer dental cavities than those
receiving either placebo or no treatment [3-9,14-10]. Xylitol may prevent cavities by inhibiting the growth of the
Streptococcus mutans bacteria. [10] A double-blind placebo-controlled study of 1,677 children showed that xylitol-
enriched toothpaste user developed significantly fewer cavities than those used the floride-only toothpaste over a
three year period. [21] While, a double-blinded study showed that the effect of xylitol on developing fewer cavities was
in a dose-dependent fashion. [20]

Researchers from Thailand found xylitol chewing gums could effectively reduce the levels of mutans streptococci in
plaque and saliva in a study of 91 children, aged 10-12. [26] Researchers from Finland discovered that use of
erythritol and xylitol was associated with a statistically significant reduction in the plaque and saliva levels of mutans
streptococci from a study of 136 teenagers. [27]

Xylitol Benefits - on EAR INFECTION
Studies have shown that xylitol (in chewing gum) could be a preventive measure for middle ear infections [11-13, 24,
25].

Xylitol Benefits - on OSTEOPOROSIS / BONE HEALTH (RESORPTION)
Studies have shown that dietary xylitol supplementation diminishes bone resorption in rats, as well as protects against
ovariectomy-induced increase of bone resorption during experimental osteoporosis. 10% xylitol combined with 10%
ethanol seems to be more effective on diminishing bone resorption and to increase bone mineral density and content
in rats. [28]

Xylitol Benefits - SKIN HEALTH / ANTI-AGING
Dietary xylitol has been shown to increase the amounts of newly synthesized collagen, and to decrease fluorescence of
the collagenase-soluble fraction in the skin of both healthy and diabetic rats. As in diabetic rats, a decreased rate of
collagen synthesis and increased collagen fluorescence has also been detected in the skin of aged rats. [29]

Xylitol Benefits - ANTICARIOGENIC Activities
Sahni PS et al at Indiana University suggested that xylitol is both noncariogenic and anticariogenic.  They believe that
the ability of xylitol to act as an anticariogenic agent is related to its ability to be transported into caries-causing oral
bacteria and inhibiting fermentation. [30]

XYLITOL SIDE EFFECTS / XYLITOL DANGERS
Xylitol appears to be safe. Limited xylitol side effects have been reported. In general. Inhalation of aerosolized iso-
osmotic xylitol is well-tolerated by naive and atopic mice, and by healthy human volunteers. [31]

However, overdose of xylitol may cause serious side effects such as stomach discomfort, diarrhea, or even oral erosive
eczema. [32] Infusion of xylitol may cause renal failure and renal oxalosis. [33, 35]

Xylitol and Dogs
While xylitol is relatively safe for us, it can be dangerous for dogs. Oral consumption of a large quantity of xylitol-
containing gum was found to induce severe hypoglycemia, collapse and seizures in a 9-mo-old neutered male
Labrador Retriever. In
dogs, xylitol is a strong promoter of insulin release and can cause severe hypoglycemia with
ataxia, collapse and seizures.  [34]  Further, xylitol may also cause severe liver damage in dogs within 24 hours of
ingestion. [A1]
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COMMENTS FROM VISITOR:
On November 13, 2010, 2:11 PM, XXXXXXXXXXXXXXn@aol.com wrote:
In one of your research findings you listed the side effects of a xylitol “overdose.” What is considered an “overdose” of
xylitol?
My Response:
Xylitol has been approved by FDA as an inactive ingredient in chewing gum, and its max dose is 506.13MG. It is also
approved in some other products: In oral tablet, its max potency is 15.04MG. In oral extended release tablet, its max
potency is 72.00MG. In oral disintegrating tablet, its max potency is 42.30MG. Thanks.

RXXXXXXX@XXX.com Monday, January 31, 2011, 6:52 PM
Someone entered the question as to the safe amount and your answer was evasive.  Seldom do people chew just one
piece of gum per day. So, how many pieces of gum are safe per day?  Or what is the max total amount of xylitol from all
sources per day?  You only stated what is in one piece of gum, one tablet, etc.

Thank you.

My Response
You have raised a good question.

In a study, children were randomized to xylitol 15.6 g/day (X16, n = 53) or 11.7 g/day (X12, n = 49), or maltitol 44.7
g/day (M45, n = 52). [1] However, I am not sure if this 15.6 g/day really refers to the amount of xylitol or the amount of
the gummy bear. Each 5 g gummy bear piece contained1.3 g (26%) xylitol, 2.7 g (54%) polydextrose, water and
gelatin, and minuscule amounts (<1.5%) of citric and lactic acid, mineral oil, carnauba wax and sucralose. Let's say this
15.6 g/day refers to the gum bear, thus, the dose is 15.6*26% = 4 g.

In another study, a total of 176 children were randomised into equal groups. For 6 months the xylitol group chewed five
times during the day, 11.6 grams of a mixed gum containing 36.6% xylitol and other polyols (34.5%). [2] Thus, the daily
dose is 11.6 g X 36.6%=4.25 g.

FDA hasn't defined the maximum dose of xylitol (at least, I couldn't find the answer from the FDA website). I have no
idea what the maximum daily dose of xylitol is. However, from these two studies, it seems that the daily highest dose for
short-term use of xylitol is about 4 g. Well, more clinical studies are needed to confirm the safety of the high doses. If
possible, I wouldn't take more than 506.13MG daily.

Reference:
[1] Kiet A Ly et al, Xylitol gummy bear snacks: a school-based randomized clinical trial BMC Oral Health. 2008; 8: 20.
Published online 2008 July 25.
[2] Duane B Xylitol gum, plaque pH and mutans streptococci. Evid Based Dent. 2010;11(4):109-10.

XXX@XXXomuXXX.org, Wednesday, September 21, 2011 6:33 AM
Your article on xylitol (http://www.zhion.com/digestion/XYLITOL.html ) listed renal failure as a side effect (reference 33).
You failed to mention (or to notice?) that it was due to infusion, and not oral consumption.

My Response (Revised)
Good point; it is by infusion. Thanks for your comment.

Send your story / comment to:
zhion@zhion.com

References
1. Hildebrandt GH, Sparks BS. Maintaining mutans streptococci suppression with xylitol chewing gum. J Am Dent Assoc. 2000;131:909–
916. 2. Uhari M, Kontiokari T, Niemela. A novel use of xylitol sugar in preventing acute otitis media. Pediatrics. 1998;102:879–884.3.
Gales MA, Nguyen T-M. Sorbitol compared with xylitol in prevention of dental caries. Ann Pharmacother. 2000;34:98–100.4. Makinen KK,
Bennett CA, Hujoel PP, et al. Xylitol chewing gums and caries rates: a 40-month cohort study. J Dent Res. 1995;74:1904–1913.5.
Makinen KK, Hujoel PP, Bennett CA, et al. Polyol chewing gums and caries rates in primary dentition: a 24-month cohort study. Caries
Res. 1996;30:408–417.6. Makinen KK, Pemberton D, Makinen P-L, et al. Polyol-combinant saliva stimulants and oral health in Veterans
Affairs patients—an exploratory study. Spec Care Dent. 1996;16:104–115.7. Isokangas P, Alanen P, Tiekso J, et al. Xylitol chewing gum
in caries prevention: a field study in children. J Am Dent Assoc. 1988;117:315–320.8. Scully C, Greenman J, Porter S, et al. Anti-caries
efficacy of xylitol and sodium fluoride in dentifrices [abstract]. Int Dent J. 1995;45:325.9. Sintes JL, Escalante C, Stewart B, et al. Enhanced
anticaries efficacy of a 0.243% sodium fluoride/10% xylitol/silica dentrifrice: 3-year clinical results. Am J Dent. 1995;8:231–235. 10. Uhari
M, Kontiokari T, Niemela. A novel use of xylitol sugar in preventing acute otitis media. Pediatrics. 1998;102:879–884.11. Kontiokari T,
Uhari M, Koskela M. Antiadhesive effects of xylitol on otopathogenic bacteria. J AntimicrobChemother. 1998;41:563–565.12. Uhari M,
Kontiokari T, Koskela M, et al. Xylitol chewing gum in prevention of acute otitis media: double blind randomised trial. BMJ. 1996;313:
1180–1184. 13. Uhari M, Kontiokari T, Niemela. A novel use of xylitol sugar in preventing acute otitis media. Pediatrics. 1998;102:879–
884.14. Gales MA, Nguyen T-M. Sorbitol compared with xylitol in prevention of dental caries. Ann Pharmacother. 2000;34:98–100. 15.
Makinen KK, Bennett CA, Hujoel PP, et al. Xylitol chewing gums and caries rates: a 40-month cohort study. J Dent Res. 1995;74:1904–
1913. 16. Makinen KK, Hujoel PP, Bennett CA, et al. Polyol chewing gums and caries rates in primary dentition: a 24-month cohort study.
Caries Res. 1996;30:408–417.17. Makinen KK, Pemberton D, Makinen P-L, et al. Polyol-combinant saliva stimulants and oral health in
Veterans Affairs patients—an exploratory study. Spec Care Dent. 1996;16:104–115. 18. Isokangas P, Alanen P, Tiekso J, et al. Xylitol
chewing gum in caries prevention: a field study in children. J Am Dent Assoc. 1988;117:315–320. 19. Sintes JL, Escalante C, Stewart B,
et al. Enhanced anticaries efficacy of a 0.243% sodium fluoride/10% xylitol/silica dentrifrice: 3-year clinical results. Am J Dent. 1995;8:
231–235. 20. Makinen KK, Bennett CA, Hujoel PP, et al. Xylitol chewing gums and caries rates: a 40-month cohort study. J Dent Res.
1995;74:1904–1913. 21. Sintes JL, Escalante C, Stewart B, et al. Enhanced anticaries efficacy of a 0.243% sodium fluoride/10%
xylitol/silica dentrifrice: 3-year clinical results. Am J Dent. 1995;8:231–235. 22. Makinen KK, Pemberton D, Makinen P-L, et al. Polyol-
combinant saliva stimulants and oral health in Veterans Affairs patients—an exploratory study. Spec Care Dent. 1996;16:104–115. 23.
Alanen P, Isokangas P, Gutmann K. Xylitol candies in caries prevention: results of a field study in Estonian children. Community Dent Oral
Epidemiol. 2000;28:218–224. 24. Uhari M, Kontiokari T, Niemela. A novel use of xylitol sugar in preventing acute otitis media. Pediatrics.
1998;102:879–884. 25. Uhari M, Kontiokari T, Koskela M, et al. Xylitol chewing gum in prevention of acute otitis media: double blind
randomised trial. BMJ. 1996;313:1180–1184. 26. Thaweboon S et al, The effect of xylitol chewing gum on mutans streptococci in saliva
and dental plaque. Southeast Asian J Trop Med Public Health. 2004 Dec;35(4):1024-7. 27. Makinen KK et al, Similarity of the effects of
erythritol and xylitol on some risk factors of dental caries. Caries Res. 2005 May-Jun;39(3):207-15. 28.Mattila PT, The effect of a
simultaneous dietary administration of xylitol and ethanol on bone resorption. Metabolism. 2005 Apr;54(4):548-51.] 29. Mattila PT et al.
Effects of a long-term dietary xylitol supplementation on collagen content and fluorescence of the skin in aged rats. Gerontology. 2005 May-
Jun;51(3):166-9.] 30. Sahni PS et al. In vitro testing of xylitol as an anticariogenic agent. Gen Dent. 2002 Jul-Aug;50(4):340-3. 31. Durairaj L
Safety assessment of inhaled xylitol in mice and healthy volunteers. Respir Res. 2004 Sep 16;5(1):13. 32. Hanakawa Y, Hanakawa Y,
Tohyama M, Yamasaki K, Hashimoto K. Xylitol as a causative agent of oral erosive eczema. Br J Dermatol. 2005 Apr;152(4):821-2.
33.
Meier M, et al J. Ethylene glycol intoxication and xylitol infusion--metabolic steps of oxalate-induced acute renal failure. Clin Nephrol. 2005
Mar;63(3):225-8. 34. Dunayer EK Hypoglycemia following canine ingestion of xylitol-containing gum. Vet Hum Toxicol. 2004 Apr;46(2):87-8.
35. Renal oxalosis with renal failure after infusion of xylitol Dtsch Med Wochenschr. 2001 Nov 30;126(48):1357-60. 35. Nyyssola A et al,
Production of xylitol from d-xylose by recombinant Lactococcus lactis J Biotechnol. 2005 May 22. A1 Pouillart P, et al. Regioselective
synthesis and biological profiling of butyric and phenylalkylcarboxylic esters derivated from D-mannose and xylitol: influence of alkyl chain
length on acute toxicity. Eur J Pharm Sci. 1999 Jan;7(2):93-106. [A1] Wood, Deborah Sweetener Suspected in Dogs Liver Damage, The
Oregonian, 10 October 2006
XYLITOL side effects, XYLITOL BENEFITS
xylitol gum, xylitol danger, xylitol and dogs, xylitol products  zhion@zhion.com
NOTICE: Consumption of xylitol decreases levels of Strptococcus mutans in saliva and plaque and
inferentially lowers the risk of caries. Previously, xylitol has been mistakenly stated as a potential
anti-cancer agent in this article. In fact, There are no studies showing that Xylitol is an "anti-cancer agent"
though, an in vitro study suggested that xylitol  butyric derivatives may have anti-cancer activities. [A1]
This website discusses the benefits and side effects of various supplements, herbs and drug products.
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www.fda.gov., or report the adverse side effects to the
manufacturer, you should be able to find the contact information on the label.

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