Xylitol : Is this the right sugar substitute for you?

xylitol gum

Last Updated December 20th, 2021

Xylitol: The wonder sugar

Xylitol is a polyol (sugar alcohol) that looks and tastes like sugar and can be used in the equal measurement.  Xylitol is a five-carbon sugar alcohol that naturally occurs in the fibers of certain fruits and vegetables such as raspberries, strawberries, yellow plums, lettuce, cauliflower, and corn.   Xylitol ’s chemical structure looks like a cross between a sugar and alcohol, but it is neither.  It is also extracted from birch wood and plant fiber called xylan to make medicine.  It is produced by hydrogenating xylose.

It was first discovered in 1891 by a German chemist and used as a sweetener in Finland due to sugar shortages during World War II.  In 1963 it was approved as a food additive by the U.S. Food and Drug Administration.  It was then marketed to Germany, Switzerland, the Soviet Union, Japan, and China.  It is now available in 35 countries.

xylitol teeth cleanThe xylose that is used to produce xylitol is most likely a natural product, extracted from plant biomass.

Xylose is a component of hemicellulose, an amorphous type of cellulose that contains both five-carbon and six-carbon sugars, of which xylose is the dominant five-carbon type.

Biomass will contain varying levels of hemicellulose depending on type and source, and it is extracted using biorefining methods.It is used as a sugar substitute and is used in sugar-free chewing gums, mints, and other candies.  It has a reduced caloric value, which can be helpful in weight control. One spoon of sugar contains 16 calories versus 10 calories from xylitol.

Xylitol tastes sweet but, unlike sugar, it is not converted in the mouth to acids that cause tooth decay.  It reduces levels of decay-causing bacteria in saliva and also acts against some bacteria that cause ear infections.

Understanding the versatility of xylitol


  • Xylitol is used to fight cavities.  Sugar consumption creates an acidic condition that promotes decay and demineralization of teeth whereas Xylitol is non-fermentable and does not feed acid-forming oral bacteria.
  • Regular use of Xylitol leads to capping the growth of cavity-forming bacteria commonly Streptococcus mutans, and this, in turn, decreases the level of acidic byproducts formed when bacteria ferment sugars.
  • Xylitol increases salivary flow, which helps to buffer these acids.  This leads to a more alkaline environment and consequently less tooth decay and plaque, and enhanced tooth re-mineralization. Untreated cavities can harden and become less sensitive from exposure to Xylitol.  Xylitol consumed in the form of granules in tea or coffee, chewing gums, and toothpaste can reduce tooth decay
  • Xylitol is used as a medicine to prevent middle ear infections (otitis media).  Otitis media is a common bacterial infection caused mainly by non-encapsulated Streptococcus pneumoniae and Haemophilus influenzae are the two main bacterias contributing to the cause of middle ear infections and sinusitis.  Xylitol prevents Streptococcus pneumoniae from sticking to tissues and form colonies of bacteria called biofilms, making the germ more vulnerable to treatment with the use of antibiotics such as amoxicillin. 
  • People suffering from penicillin allergy are prescribed antibacterial and topical analgesic ear drops.  It is also to be noted that a prophylactic administration of Xylitol to children attending daycare centers and school can reduce the occurrence of otitis media.
  • Xylitol is used in the treatment of diabetes and metabolic syndrome Since Xylitol is absorbed only 50% and is slowly emptied from the stomach, it has minimal effects on blood sugar and insulin secretion.  Xylitol has a considerably lower glycemic index of 13 when compared with sucrose 65 and glucose 100Xylitol intake helps diabetes patients have better glucose tolerance (more stable blood sugar levels), less weight gain and significantly lower food intake (suppressed appetite).  Xylitol is an ideal low-calorie sweetener for people with diabetes, metabolic syndrome, obesity, and other metabolic disorders.
  • xylitol stronger bonesXylitol is used in tube feedings for patients as a source for energy.  Xylitol is also used during nasal irrigation with patients having sinus problems.
  • Xylitol is used to prevent osteoporosis, as it helps in absorption of calcium and leads to increased bone volume and bone mineral content.
  • Xylitol is used in the treatment of constipation Xylitol feeds the friendly bacteria in our gut, which improves digestive health and helps move the bowels acting as a laxative.
  • Xylitol is also useful in treating gingivitis by reducing inflammatory cytokine expression.

Food and confectionary

Xylitol has about the same sweetness as sucrose, but more sweetness than similar artificial sweeteners like sorbitol and mannitol, and is about a third as sweet as sucrose.  Xylitol is also used in chewing gum.

Pharmaceutical Industry

Xylitol is used in the preparation of cough syrups, tonics, and vitamin preparations, which can neither ferment nor mold.


Xylitol – A list of health benefits

Xylitol increases the production of collagen, which is the most abundant protein in our body, found in large amounts in the skin and connective tissues.  Collagen may help counteract the effects of aging on the skin.

xylitol gumXylitol has only trace amounts of vitamins and minerals, but it helps in the absorption of calcium and vitamin B in our body.  Xylitol supplies liver glycogen, with about 10% of Xylitol metabolized in the kidneys and the remainder used up by blood cells, the adrenal cortex, lung, testes, brain, and other tissues.

Xylitol is also used in the treatment of Xerostomia.  Xerostomia is a common side effect of irradiation to head and neck.  People suffering from head and neck carcinoma are exposed to high radiation therapy, and with higher doses to the glands, permanent xerostomia occurs.  In spite of Intensity Modulated Radiation Therapy with parotid sparing, salivary hypo-functioning has been observed.

Management of xerostomia is rarely effective, therefore prevention is important.  Xylitol improves salivary flow rates in patients receiving Intensity Modulated Radiation Therapy (IMRT) to head and neck cancers without significant side effects whereas long-term follow up is required for evaluating the final outcome of xylitol in the prevention of xerostomia.

Xylitol was also used to treat patients with myoadenylate deaminase deficiency, as it can be metabolically converted to D-ribose.

Xylitol is often given with amino acids and other carbohydrates as parenteral nutrition.  Metabolically administered Xylitol reduce gluconeogenesis and promote fatty acid oxidation, and moderate blood glucose and insulin levels.  Metabolic advantages over D-glucose include, Xylitol reduces insulin secretion and hepatic lipogenesis when compared with D-glucose.  The flow of amino acids from peripheral tissues to visceral organs remains unchanged.  Xylitol enters the pentose phosphate cycle directly, without insulin.

Substitution of Xylitol in food can reduce triglycerides and cholesterol levels.  A cholesterol-lowering effect may also stimulate the uptake of liver-lipoprotein cholesterol by up-regulation of low-density lipoprotein (LDL) receptor activity.

Xylitol is a prebiotic sweetener, which can modify the colonic microorganisms and enhance the growth of health-promoting bacteria particularly bifidobacteria and lactobacilli.

Side effects of xylitol

xylitol sweetenerXylitol can have some side effects when consumed in large quantities.  The most common side effect is bloating and diarrhea.  Sugar alcohols such as xylitol can cause a laxative effect, which is similar to consuming too much fructose, which is the natural sugar in fruit. This occurs when a person consumes large quantities like 40 grams per day.  Similarly, people suffering from irritable bowel syndrome have to avoid Xylitol due to its laxative effects, which in turn can aggravate the disease.  There is also a concern of developing tumors when Xylitol is consumed for more than 3 years in higher dosage.

Consuming high doses of sugar alcohols such as Xylitol can cause weight gain and affect blood-sugar levels.  Sugar alcohols are not free of calories, as they have 2.6 calories per gram.  People with type 1 diabetes see a surge in blood sugars as they consume sugar alcohols in uncontrolled amounts.

People may experience an allergic reaction to Xylitol.  Signs and symptoms of an allergic reaction include hives, skin rash, breathing difficulties, swelling of the mouth and hands, dizziness, vomiting, chest tightness, and general weakness.  In severe cases, an allergic reaction may lead to shock or death.

Xylitol: Is it safe for your pet?

Xylitol is safe for humans but extremely toxic for dogs.  Due to different metabolism, it can affect dogs fatally.  Unlike humans, Xylitol is quickly absorbed into the bloodstream, resulting in a potent release of insulin from the pancreas.  This rapid release of insulin causes a rapid and profound decrease in the level of blood sugar (hypoglycemia), an effect that occurs within 10-60 minutes of eating the xylitol. Untreated, this hypoglycemia can be life-threatening.

Symptoms of Xylitol poisoning in dogs include vomiting, weakness, lack of coordination or difficulty with walking or standing, depression or lethargy, tremor, seizures, and coma Since there is no antidote for Xylitol poisoning, it becomes very important to diagnose early and treat with IV fluids, sugar supplementation, and liver protective drugs.

Foods to be avoided for animals include Xylitol sweetened products such as cookies, gums, Xylitol powder, cupcakes, and muffins.  These products containing Xylitol sweeteners lead to hypoglycemia and liver failure.  There are also cases reported by the owners of the pet to not have any sign of hypoglycemia before the onset of liver failure.

The common signs of liver failure in dogs include loss of appetite, weight loss, vomiting and diarrhea, increased thirst, unstable walk, increased need to pee, confusion, yellowish eyes, tongue, and gums.

What is the normal dose for xylitol consumption?

Oral administration of Xylitol for reducing the risk of ear infections in children with total daily doses of 8.4 to 10 grams of xylitol in chewing gum, lozenges, or syrup given in five divided doses after meals.

Xylitol is administered for prevention of cavities in adults and children.  Typical doses are from 7 to 20 grams per day divided into three to five doses, usually given as candies or chewing gum.

Xylitol is considered to be safe in pregnancy and during breastfeeding. The use of xylitol gums in mothers reduced maternal oral bacterial load and reduced transmission of mutants streptococci to infants in pregnancy and during the postpartum period.

In conclusion

Xylitol can be utilized in food products such as confectionery, dairy and bakery products.  It can also be used in various medicines such as cough syrups and tonics, diabetes and gastrointestinal benefits.

Finally, it can be concluded that Xylitol is, in fact, a wonder sugar, which is a suitable alternative for sugar in the form of sweeteners, chewing gums, and toothpaste.  It is advisable to be consumed under the guidance of a medical professional to obtain adequate results.



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