| Xylitol is a naturally occurring food substance. It is found in
many fruits and vegetables; a plum has about half of a gram. It is
about as sweet as table sugar (sucrose) with a third less calories.
It is classed as a "sugar alcohol," but properly it
is neither a sugar nor an alcohol. It looks like sugar; it tastes
like sugar. But it is O.K. for diabetics. A molecule of xylitol
(without all of the hydrogen atoms) looks like the model in the
picture at the top, but it is very flexible.
It is commonly used as a food supplement because of its natural
sweetness. The World Health Organization and the FDA (Sec. 172.395
(21 CFR 172.395)), have given it safe ratings as food supplements.
It is commonly available commercially without restriction and is
found in many health food stores.
It is made in the human body. An average sized person makes about
10 grams of xylitol every day.
Xylitol is slowly absorbed when eaten and if a person eats more
than a teaspoon or so at one time they are likely to have a few
loose stools, just like what happens with sorbitol, the most commonly
used of the sugar alcohols.
- People who use xylitol regularly learn to deal with it better
and it doesn't cause this problem.
- People in Turku, Finland ate about one-fourth cup daily in
a dental study and had no significant problems.
The xylitol that is absorbed is rapidly metabolized, but it has
very little effect on blood sugar levels. Asano and his associates
looked at this in the early 70’s when xylitol was being considered
for use in diabetics. He gave healthy people 5 grams of xylitol,
but could not detect any in their blood an hour later.
Xylitol costs about ten times as much as regular sugar. If there
is more demand I am sure that price will come down. I think this
is one reason it is not used more. With the current epidemic of
diabetes, due in large part to the combination of inactivity and
sugar heavy soft drinks, xylitol is a very attractive food supplement.
Xylitol is available in some countries in IV solutions. It is
used in diabetics and in some critical care situations such as
burns. In papers prepared for the FDA the usual IV dose is 0.25
grams per kilogram per hour and the safe dose is double that. For
a 154 pound person that is the equivalent of about 800 to 1600
plums a day.
Xylitol and Diabetes
This was the first medical use of xylitol. Xylitol is metabolized
into glycogen which can be stored in our cells until we need to make
it into glucose for energy. Glucose is the bodies preferred energy
sugar and is a problem for diabetics because it requires insulin
to get into the cells. The glycogen from the xylitol is already inside
the cells and does not need the insulin.
The glycemic index of xylitol is 7. The glycemic index is a measure
of how rapidly particular foods are turned into glucose after we
eat them and of how much insulin is required for the body to use
that food. It is useful information for diabetics and many can
control their diabetes just by not eating foods with a high glycemic
index. If you are interested in more information about the glycemic
index this link will take you to Rick Mendosa's web page which
has the best information I have found on the web.
Xylitol is interchangeable with sugar for most cooking applications.
Yeast cannot metabolize it so it won't work if you are baking bread
or anything else with yeast. (Doctors inclined toward natural treatments
have recommended the use of xylitol to prevent yeast infections
for this reason.)
Xylitol and Finland
The Finns began using xylitol because of the sugar shortages caused
by the Second World War. Originally it was made from the birch trees
that are plentiful in Finland.
About twenty years after the war they realized that the people
who used xylitol had less tooth decay. The Turku
done at the University of Turku, confirmed this observation:
For two years one hundred seventeen subjects ate specially prepared
diets sweetened with sucrose (table sugar), fructose, or xylitol.
The group eating xylitol ate an average of 57 grams a day, about
half the amount of sugar consumed by the average American. The study
looked at the change in decayed surfaces, fillings or missing teeth
over the two years. The bar graph above shows the results of that
study. Those eating the sucrose diet fared the worst. Those eating
fructose had less but still substantial decay, while those eating
the xylitol had none.
The results of this study were exciting to the Finns and they
increased their use of xylitol. They also did more studies. One
of the things they did that made both of these easier was making
gum with xylitol. Chewing the gum releases the xylitol over a short
period of time in the mouth where it is effective. Most of the
studies on tooth decay since that time have used gums as the delivery
because it is easy to dose and to measure how much is given (and
because they were funded by the company making the gum. The web
site at www.xylitol.net is maintained by the company manufacturing
the gum in Finland and has a lot of information about this and
other uses of xylitol.
Peldyak was involved with some of the studies looking at xylitol
and tooth decay done through the University of Michigan Dental
School. He recently summarized the studies with this gum and the
prevention of tooth decay—regular frequent use is the key.
Chewing xylitol flavored gum once a day had little benefit. Twice
a day reduced cavities by 40%, three times a day by 60% and by
chewing this gum five times a day cavities were reduced by more
than 80%. The chart below is Dr. Peldyak's summary of eleven clinical
studies showing how well xylitol does at preventing tooth decay.
Tooth decay is caused by bacteria, Streptococcus Mutans (S. Mutans)
is the main one, that live in the mouth and on the teeth. These
bacteria actually build the plaque that is on the teeth; it is
their home. They take sugar (glucose) from the food we eat and
metabolize it. In the process they make an acid that eats through
the enamel surfaces of our teeth. This is the beginning of a cavity.
How xylitol prevents
Dental researchers looked at what happened when xylitol and the bacteria
were put together.
- The bacteria eat the xylitol, but can’t use it, so they
have to get rid of it. This takes energy and gives the bacteria
what we humans experience as indigestion.
- It also blocks the ability of these bacteria to hold on to
the surfaces in our bodies. They can hold onto the plaque, that
is their home, but they have a harder time holding on to the
host cells. This is an important concept and will be discussed further
in a page about how such sugar-like foods effect bacteria and
infection—it's part of a science called glycobiology. The
additional research on xylitol's effect on S. mutans will be
discussed there as well.
Xylitol and ear infections
After another 20 years of increased use the Finns also found
that xylitol decreased ear infections. Matti Uhari's group in
Oulu, Finland studied this and reported their findings in the British
Medical Journal in 1996; and in Pediatrics in
1998, where they used a syrup for those too young to chew gum.
- They showed that ear infections in children could be reduced
by up to 40% with 8-9 grams of oral xylitol every day.
- Both the prevention of tooth decay and the reduction of
the ear infections are by interactions of xylitol with the
bacteria—in the mouth where they cause tooth decay, and
in the nose where they cause ear, sinus, and bronchial
Uhari’s group looked at what happened
when the bacteria in the nose were exposed to xylitol.
The three main problem causing bacteria
that frequently colonize the nose are Streptococcus
Pneumoniae (S. Pneumo.), Haemophilus Influenzae (H.
Flu.), and Moraxella Catarrhalis (M. Cat.).
The nose is the only place they live without causing infection.
The back of the nose is called their reservoir.
S. Pneumo. got indigestion from the xylitol, and
so, to a lesser extent, did beta strep, the bacteria that cause strep
throat. This is not surprising because they already knew
that this was the effect on S. Mutans and these
bacteria belong to the family of streptococci and are
closely related. All of the studies done comparing the effect
of xylitol on S. Mutans and S. Pneumoniae show
Bacterial indigestion was the reason they
gave for the decrease in ear infections.
Remember that in these studies the xylitol was given
orally. That means that the xylitol had to get absorbed
into the blood and carried back to the nose where the bacteria
That's not very effective—One American doctor figured
that a child would have to chew close to a thousand pieces
of gum at a cost of about $100.00 to prevent one ear infection.
But it works much better than that when it is put in the nose,
where the bacteria live, and it works in other ways as well.
The Finnish doctors did another study that was reported in
between the two on ear infections. In this study, the group,
led by Tero Kontiokari,
looked at how xylitol effected the adherence of the major problem
bacteria to cells from the nose.
Bacteria must hang on to cells in the nose (or anywhere
else for that matter) in order to cause infection—if
they cannot hold on they are washed out and don't cause problems.
This study looked at that adherence.
They took cells from the nose and several strains of the
bacteria that cause most of the infections. Dividing each
into two groups they put a 5% solution of xylitol in one
group of the cells and the bacteria.
Then they put the different groups together, let them
sit for a while then spun them to get rid of unattached bacteria.
Finally, they actually counted the bacteria attached to
each cell. The graph shows what they found.
The 68% decrease in the adherence of S. Pneumo shows it
to be the most sensitive to the presence of xylitol. This
is probably why they only saw a 30-40% reduction in ear infections. That
is about the percent caused by S. Pneumo. Giving xylitol
by mouth is not a very effective means of getting it to the
nose because it must be absorbed into the blood then carried
to the nose, but even the small amount getting there was
able to effect these bacteria.
There are several important things about this study:
These are significant bacteria—they kill people.
The Center for Disease Control (CDC) estimates that infections
with S. Pneumo cause the death of more than 40,000 people
every year in the U.S. with many of them being infants and
They cost our health care system billions of dollars every
year, to say nothing of the countless days of lost work due
to personal or family illness.
These are the bacteria that are the primary reason for
prescription antibiotics and those prompting concern about antibiotic
Xylitol, a food substance, reduces the adherence of these
bacteria – and without this adherence there is no infection.
It focuses on the inside of the nose. Because of Asano’s
study showing that xylitol is rapidly removed from the blood
stream we can tell that giving xylitol orally is not a very
good way to get reasonable amounts to the bacteria living
in the nose.
- Finally it shows that the indigestion model is not a sufficient
explanation for the reduced adherence. If the effect were
only on the bacteria the arm of this study where the cell,
but not the bacteria, was exposed to xylitol would not have
been as effective. But the reduction in adherence was
not significantly different. In fact adherence was less (21
vs. 25) when the cells were exposed to the xylitol. So its
most likely place of action is the interface between the
cells and the bacteria. This interface is the subject of
the page dealing with glycobiology.
At the end of this study Kontiokari states the following:
"These observations are consistent with the fact
that monosaccharides are able to inhibit adherence only at
high concentrations that are easily achieved in the oral
Notice two things here:
- High concentrations are needed. If high concentrations
are needed in the nose the best way to get them is
to put it there – just like the gum puts it in the
- He did not specify xylitol, but implied this was
a property of monosaccharides (sugars) in general.
What he is referring to is the fact that several other sugars
share this ability to interfere with bacterial
Again if bacteria cannot adhere, hold on to our cells, they
can't infect us. Is this a way to prevent infections?
YES! Read more in the section on glycobiology.
Return to HOME Continue
Xylitol absorption in healthy men.
Asano T, Levitt MD, Goetz FC
Metabolic response to lactitol and xylitol
in healthy men.
Natah SS, Hussien KR, Tuominen JA, Koivisto VA
Helsinki University Central Hospital, Department of Medicine,
Sugar alcohols are used in food
products, yet their metabolic
effects in humans are poorly known. We examined plasma glucose,
insulin, and C-peptide responses and changes in carbohydrate
and lipid oxidation after the ingestion of 25 g lactitol,
xylitol, or glucose. Eight healthy, nonobese men were studied
after an overnight fast. After the ingestion of lactitol
or xylitol, the rise in plasma glucose, insulin, and C-peptide
concentrations was less than after the ingestion of glucose
(P < 0.02), with no difference between the two polyols.
With the glycemic index of glucose as 100, the indexes of
xylitol and lactitol were 7 and -1, respectively. A reactive hypoglycemia
was observed 3 h after glucose ingestion, but not after the
ingestion of sugar alcohols. There were no significant changes
in the carbohydrate or lipid oxidation as determined by indirect
calorimetry after the ingestion of sugar alcohols. After
glucose ingestion, the rise in carbohydrate oxidation was
nearly significant (P = 0.07). In conclusion, lactitol and
xylitol cause smaller changes than does glucose in plasma
glucose and insulin concentrations and thermogenic response.
A small hormonal response and the lack of a thermogenic effect may
be beneficial when these sugar alcohols are used in food
products. The small glucose and
insulin responses also suggest
that lactitol and xylitol are
suitable components of the
diet for diabetic patients.
Randomized controlled trial
Turku sugar studies. V. Final report on
the effect of sucrose, fructose and xylitol diets on the
caries incidence in man.
Scheinin A, Makinen KK, Ylitalo K
The purpose was to study differences in the caries increment
rate as influenced by various sugars. The trial involved
almost complete substitution of sucrose (S) by fructose (F)
or xylitol (X) during a period of 2 years. There were no
significant initial differences as to caries status between
the prospective sugar groups; 35 subjects in the S-group,
38 in the F-group, and 52 in the X-group. During the entire
study 10 subjects discontinued or were excluded. The clinical
and radiographical observer error was reported and discussed.
After 2 years the mean increment of decayed, missed and filled
tooth surfaces was 7.2 in the S-group, 3.8 in the F-group,
and 0.0 in the X-group. The weakness of the DMFS-index in
not showing the development of new secondary caries and the
increase in size of the lesions was overcome by expressing
the caries activity in terms of indices showing the total
quantitative and qualitative development. The results showed
a massive reduction of the caries increment in relation to
xylitol consumption. Fructose was found to be less cariogenic
than sucrose. It was suggested that the non-
and anticariogenic properties
of xylitol principally depend
lack of suitability
for microbial metabolism and
physico-chemical effects in plaque
Randomized controlled trial
Agents Chemother 1995 Aug;39(8):1820-3
Effect of xylitol on growth of nasopharyngeal
bacteria in vitro.
Kontiokari T, Uhari M, Koskela M
Department of Pediatrics, University of Oulu, Finland.
Xylitol is known to reduce caries by inhibiting the growth
of Streptococcus mutans. We hypothesized that xylitol could
also affect the growth of other nasopharyngeal bacterial
flora, which could be important when considering respiratory
infections caused by these bacteria. We studied this in vitro
by adding xylitol to the medium and observed that 1 and 5%
xylitol reduced markedly the growth of alpha-hemolytic streptococci,
including S. pneumoniae. It reduced slightly the growth of
beta-hemolytic streptococci but not that of Haemophilus influenzae
or Moraxella catarrhalis. The inhibitory growth pattern was
similar to that previously seen with S. mutans, which may
indicate a similarity in the enzymatic processing of five-carbon
sugars such as xylitol. This sugar alcohol is a widely used
sweetener, and the concentrations used in our experiments
are easily achieved in the oral cavity. If xylitol reduces
the growth of S. pneumoniae in
the nasopharynx, it could also
reduce the carriage of this pathogen
and thus have clinical significance
in the prevention of pneumococcal
Xylitol chewing gum in prevention of acute
otitis media: double blind randomised trial.
Uhari M, Kontiokari T, Koskela M, Niemela M
Department of Paediatrics, University of Oulu, Finland.
OBJECTIVE: To examine whether xylitol, which reduces the
growth of Streptococcus pneumoniae,
might have clinical importance
in the prevention of acute otitis media. DESIGN: A double
blind randomised trial with xylitol administered in chewing
gum. SETTING: Eleven day care nurseries in the city of Oulu.
Most of the children had had problems with recurrent acute otitis
media. SUBJECTS: 306 day care children: 149 children in the
sucrose group (76 boys; mean (SD) age 4.9 (1.5) years) and
157 in the xylitol group (80 boys; 5.0 (1.4) years). INTERVENTION:
Either xylitol (8.4 g a day) or sucrose (control) chewing
gum for two months. MAIN OUTCOME MEASURES: The occurrence
of acute otitis media and antimicrobial treatment received
during the intervention and nasopharyngeal carriage of S
pneumoniae. RESULTS: During the two month monitoring period
at least one event of acute otitis media was experienced
by 31/149 (20.8%) children who received sucrose compared
with 19/157 (12.1%) of those receiving chewing gum containing
xylitol (difference 8.7%; 95% confidence interval 0.4% to
17.0%; P = 0.04). Significantly fewer antimicrobials were
prescribed among those receiving xylitol: 29/157 (18.5%) children
had at least one period of treatment versus 43/149 (28.9%)
(difference 10.4%; 0.9% to 19.9%; P = 0.032). The carriage
rate of S pneumoniae varied from 17.4% to 28.2% with no difference
between the groups. Two children in the xylitol group experienced
diarrhoea, but no other adverse
effects were noted among the
xylitol users. CONCLUSION: Xylitol
seems to have a preventive effect
acute otitis media.
A novel use of xylitol sugar in preventing
acute otitis media.
Uhari M, Kontiokari T, Niemela M
Department of Pediatrics, University of Oulu, Oulu, Finland.
BACKGROUND: Xylitol, a commonly used sweetener, is effective
in preventing dental caries.
As it inhibits the growth of
pneumococci, we evaluated whether xylitol could be effective
in preventing acute otitis media (AOM). DESIGN: Altogether,
857 healthy children recruited from day care centers were
randomized to one of five treatment groups to receive control
syrup (n = 165), xylitol syrup (n = 159), control chewing
gum (n = 178), xylitol gum (n = 179), or xylitol lozenge
(n = 176). The daily dose of xylitol varied from 8.4 g (chewing
gum) to 10 g (syrup). The design was a 3-month randomized,
controlled trial, blinded within the chewing gum and syrup
groups. The occurrence of AOM each time the child showed
any symptoms of respiratory infection was the main outcome.
RESULTS: Although at least one event of AOM was experienced
by 68 (41%) of the 165 children who received control syrup,
only 46 (29%) of the 159 children receiving xylitol syrup
were affected, for a 30% decrease (95% confidence interval [CI]:
4.6%-55.4%). Likewise, the occurrence of otitis decreased
by 40% compared with control subjects in the children who
received xylitol chewing gum (CI: 10.0%-71.1%) and by 20%
in the lozenge group (CI: -12.9%-51.4%). Thus, the occurrence
of AOM during the follow-up period was significantly lower
in those who received xylitol syrup or gum, and these children required
antimicrobials less often than did controls. Xylitol was
well tolerated. CONCLUSIONS: Xylitol sugar,
when given in a syrup or chewing
gum, was effective in preventing
AOM and decreasing
the need for antimicrobials.
Antiadhesive effects of xylitol on otopathogenic
Kontiokari T, Uhari M, Koskela M
Department of Paediatrics, University of Oulu, Finland.
The exposure of either epithelial cells or pneumococci
or both to 5% xylitol reduced the adherence of pneumococci.
Exposure of epithelial cells or bacteria alone to xylitol did
not reduce the adherence of Haemophilus influenzae, although
the exposure of both cells and
bacteria to xylitol reduced the
adherence significantly. The
adherence of Moraxella catarrhalis
remained low irrespective of
Xylitol for caries prevention.
Peldyak J, Makinen KK.
Institute of Dentistry, University of Turku, Turku, Finland.
Xyitol is a naturally occurring sweetener which is essentially
not fermentable by the caries-inducive oral microflora. When
tested as a sucrose replacer, or even as a small dietary addition, systematic
xylitol use leads to impressive reductions in caries incidence.
Xylitol is compatible and complementary with all current
oral hygiene recommendations. The appealing sensory and functional
properties of xylitol facilitate a wide array of applications
that promote oral health.
The spray described in these pages
is not a drug. This means that the people manufacturing this spray
cannot advertise what the spray does to prevent disease and illness.
The spray only helps to clean your nose. The benefits come from
a clean nose. The only way people will learn about this practical
and sensible way to help the immune system wash pollutants from
the back of the nose is by interested people, like you, sharing
If you have family or friends with any of these problems, they
may benefit greatly from your sharing this information with them.
Links in the other sections, referring to a person or study, will
take you to a Medline summary, from the National Library of Medicine,
of the article in question.
This spray is protected by United States and international patents.
While careful reading of these pages will tell you how to mix this
spray yourself we request that you do not sell such spray on the
open market. Such sales would be prohibited by the above mentioned
Disclaimer: All material provided in this web site is provided
for educational purposes in the hope of improving our general health.
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specific medical advice with respect to a specific patient and/or
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Dr. Jones specifically disclaims any liability, loss or risk, personal
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A. H. 'Lon' Jones D.O.
812 West 8th St. Suite 2A
Plainview, Texas 79072
Phone (806) 291-0700
Fax (806) 293-8229