Xylitol - Is it Safe?

Laura

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Guardian sent me some links to articles about Xylitol so I'm going to post them here and ask that ya'll start checking out the data. For the record, we get xylitol made from Birch trees from Finland.

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Is Xylitol Safe or Effective?


According to a study conducted in 1977, consuming 1.4 ounces of Xylitol per day will cause diarrhea in many subjects. Xylitol, like most sugar alcohols, can have a laxative effect, because sugar alcohols are not fully broken down during digestion. The Xylitol.org web site sates, "In the amounts needed to prevent tooth decay (less than 15 grams per day), xylitol is safe for everyone." 15 grams of xylitol is about 0.5 ounces. What about doses over 15 grams?

Xylitol - What is it?

Xylitol is a five-carbon sugar alcohol that is used as a sugar substitute. Xylitol is a naturally occurring sweetener found in the fibers of many fruits and vegetables, including various berries, corn husks, oats, and mushrooms. It can be extracted from corn fibre, birch, raspberries, plums, and corn. Xylitol is roughly as sweet as sucrose but with only two-thirds the food energy.

Xylitol was first derived from Birch trees in Finland in the 19th century and was first popularized in Europe as a safe sweetener for diabetics that would not impact insulin levels. Today, using maize sources, most world supplies reportedly come from China. Xylitol is widely used in Finland, its "home country". Many Finnish confectioneries employ xylitol, or have a xylitol version available. Virtually all chewing gum sold in Finland, and in the rest of Europe, is sweetened with xylitol.

Properties

One teaspoon (5 mL) of xylitol contains 9.6 calories, as compared to one teaspoon of sugar, which has 15 calories. Xylitol contains zero net effective carbohydrates, whereas sugar contains 4 grams per 5 mL. Xylitol has virtually no aftertaste, and is advertised as "safe for diabetics and individuals with hyperglycemia". This is because sugar-alcohols have less impact on a person's blood sugar than regular sugars.

But before you jump to any conclusions - read on.

How is Xylitol Made?

A search of patents online explains one of the processes for making xylitol, You begin with some source material containing xylan. One commonly used source is corn imported from China. (Does this sound healthy to you ?)

1. First the xylan needs to be broken down by a process called acid hydrolyzing. This process leaves us with xylose and acetic acid. Then the process of hydrogenation is carried out at higher pressures and temperatures ranging from 158 degrees Fahrenheit and higher. Hydrogenation needs a catalyst, so a substance called Raney nickel can be used which is a powdered nickel-aluminium alloy.

2. The acetic acid needs to be removed as the material safety data sheet (MSDS) describes it as, "Very hazardous in case of skin contact (irritant), of eye contact (irritant), of ingestion, of inhalation. Hazardous in case of skin contact (corrosive, permeator), of eye contact (corrosive)."

3. Then the hydrolyzing acid and organic residues must be removed, this is done by heating the mixture and evaporating it.

4. The resulting syrup, hopefully now free of acetic acid, hydrolyzing acid, nick-aluminum and other residues.

5. The syrup is crystallized by stirring ethanol into it.

6. The crystalline xylitol is now separated in a centrifuge from the ethanol and from the sorbitol remaining in solution.

7. You now have xylitol.

Health Claims


It is obvious that xylitol, in addition to killing bacteria, will probably kill just about anything or anyone. This clearly explains why it is only recommended to be used in small doses. Yet if you go to a health food store, you will see larger sized bags of xylitol on the shelf, promoting its many health uses.

Health Concerns

In lab tests, xylitol will kill a rat 50% of the time in a dosage of 16.5 grams of xylitol for every 1000 grams of rat. Medium rats weigh 100-120 grams, or say .25 pounds. That means, to kill a 100 gram rat, you need only to get the rat to consume, 1.65 grams of xylitol.

A typical xylitol piece of gum contains .7 – 1 gram of xylitol. About half the amount needed to kill a rat. One study states that humans consumed up to 400 grams of xylitol per day without any ill health effects. It is hard to believe that such a study is accurate in comparison to the lab tests done as indicated on the material safety data sheets. If 1.65 grams can kill a rat, consuming 400 grams would be highly toxic to humans.

More concern is that there seems to be no long term safety data about the long term health effects of regularly consuming xylitol. The data sheets state the following:

"Epidemiology: No information found

Teratogenicity: No information found

Reproductive Effects: No information found

Mutagenicity: No information found

Neurotoxicity: No information found"

Critics will claim that lethal doses on material data sheets are not conclusive proof. But you must ask yourself this question, has xylitol been proven conclusively to be safe or effective?

What About the Cavity Fighting Power?

Assume you don't mind your liver being poisoned or the diarrhea side effects that are possible from xylitol gum or mints, because you want to fight the cavities. You would assume that there is a huge body of evidence showing that xylitol prevents cavities, think again. An article published in the Journal of the American Dental Association in 2006 volume 137, states, "Some studies claimed that xylitol-sweetened gum had an anticariogenic effect, though these claims need further study." This article basically says that any evidence that xylitol sweetened gums stops cavities is not conclusive and requires further study.

Conclusions About Xylitol

Xylitol is a processed sugar. After being hydrogenated and having toxic chemicals added to xylan mostly from Chinese corn or other plant material, and then removed, you get xylitol. For anyone who wants to be healthy, the first thing that is pretty much unanimous about any diet or protocol to restore your health, is that you need to avoid processed sugars. While there are a variety of opinions on what foods to eat in replacement of processed sugar, it is blatantly clear that processed sugars, like xylitol, are extremely harmful to humans. Perhaps, xylitol has special uses in special cases; as a regular part of your diet, it is clearly a poor idea.There are much safer choices like Stevia or Raw, Organic Honey in small quantities. [WRONG]

Xylitol might inhibit bacteria growth, but so does white sugar. Xylitol's dirty little secret is that even in moderate doses of larger than 15 grams, (approximately 3 teaspoons), xylitol's own promotional material says it is not safe for everyone to use. Children being smaller and less developed than adults, will obviously be much more sensitive to xylitol's effects.

The way to prevent and control cavities is not with a processed sugar chewing gum or mint, but rather with a good diet. A good diet that is capable of preventing cavities is generally low in sugar, and high in absorbable vitamins and minerals, particularly fat-soluble vitamins in foods like avocado, coconut, wheat germ, and healthy sea foods.

If you want healthy teeth and gums, you need to avoid processed sugar's like xylitol. Avoiding other processed foods like processed sugar, white flour and other foods not made from freshly ground grains, cheap low quality vegetable oils, soft drinks and artificial flavors and preservatives, soy milk, pasteurized milk, and other non-organic, non-wholesome foods will help increase your immunity to cavities. Also bruch your teeth regularly and floss to remove plaque and food particles.

There is no short cut to good wholesome
whole and organic foods for health.

It is quite clear that xylitol is not safe or healthy.


AGAVE WORSE THAN HIGH FRUCTOSE CORN SYRUP ?

Many people interested in staying healthy have switched to agave as a safer "natural" sweetener. They want to avoid well documented dangerous sweeteners like HFCS (high fructose corn syrup) but are unaware that most agave is actually WORSE than HFCS.

A number of natural agave manufacturers and health conscious consumers still proclaim agave is a safe, all-natural sweetener that is good for everyone.

We recommend other options such as stevia products. You can also use xylitol in small amounts or glucose, which is sold commercially as dextrose, and can easily be purchased on Amazon for $1 per pound. we do not sell any of these products.

Our only purpose for sharing this information is to help people understand the truth about health. In case you haven't noticed, we have an epidemic of obesity in the US and it wasn't until recently that my eyes opened up to the primary cause -- fructose.

Yes, it is all about freedom of choice. It is hard to have freedom if you aren't given the entire story, and up until now that has been the case with agave.

Are Natural Agave Products Any Better?


The three products sent off to the lab were:

1. NOW Foods Organic Amber Agave Nectar

2. Madhava Agave Nectar

3. Wholesome Sweetener Organic Blue Agave

There was no particular reason these three brands, other than they are the products advertised and heard mentioned most often by agave syrup users.

And the Winner is: None of the Above!

The results support the point that they are ALL quite high in fructose, ranging from 59 to 67 grams of fructose per 100-gram sample.

It is important to note that high fructose corn syrup has 55 percent fructose. As you can see below, every one of these products far exceeded the fructose in high fructose corn syrup by considerable amounts.

The other variable that needs to be considered is whether or not the fructose is conjugated to glucose or another sugar molecule, as this would moderate the detrimental effects of fructose somewhat.

High fructose corn syrup fructose is 55 percent free floating fructose totally dissociated from glucose. This is also the case in nearly all the lower quality agave products as they are highly processed. Some of the higher quality agave products may be processed in a way that preserves the fructose bonding and thus somewhat limits its damage.

We did not test for fructose conjugation in our test, but even if it were, the Wholesome Sweetener Organic Blue Agave had 21 percent more fructose than high fructose corn syrup.

(Chart here: _http://altmedsales.com/index.php?target=pages&page_id=xilitol)

Fructose is Fructose

We are fully convinced that if we can educate the public about how fructose is different from other sugars metabolically, we can actually reverse and eventually eliminate the obesity epidemic. We would encourage those of you who remain doubtful that fructose is any worse than any other sugar to look at the work done by Dr. Richard Johnson, chief of the kidney disease and hypertension department at the University of Colorado, and author of The Sugar Fix, one of the best books on the market on the health dangers of fructose—specifically, how fructose causes high blood pressure, heart disease, obesity, diabetes and kidney disease.

One of the surprising facts according to Dr. Johnson is how detrimental the impact of fructose is on your uric acid level.

For those of you who maintain that "a sugar is a sugar is a sugar," fructose -- and fructose ALONE -- drives up uric acid. The connection between fructose, uric acid, hypertension, insulin resistance/diabetes and kidney disease is so clear that your uric acid level can be used as a marker for toxicity from fructose.

According to Dr. Johnson:

"We've just finished a clinical trial where we gave a low fructose diet to overweight and obese adults from Mexico City.

"We tried two different low fructose diets, but first, before we go into that, we think that the effects of fructose are independent of its energy intake. So,table sugar (sucrose) -- which contains fructose and glucose -- although there is a caloric component, we think that the effects of fructose are not specifically related to the calories but rather to its mechanism, of which uric acid is a driving part.

"... [Uric acid levels] being too high seems to really increase the risk for diabetes and high blood pressure, kidney disease and obesity. And in fact, there are more and more papers coming out showing that connection."

If you doubt fructose is the leading contributor to obesity, then we urge you to watch an excellent video presentation by Dr. Robert H. Lustig, M.D. of the University of California San Francisco, Division of Endocrinology and Metabolism, which masterfully illustrates just exactly HOW the liver's breakdown of fructose leads to obesity and chronic disease.

Much of the fructose you eat is literally stored as fat. The carbohydrate fructose is converted into fatty acids (lipogenesis), which is then stored in your body's fat cells as fat.

It largely boils down to a quantity issue.

You need to keep your daily dose of ALL fructose down to below 25 grams per day. Additionally, you can use your blood uric acid level as a marker of sensitivity to fructose. If your uric acid level is above 4 mg/dl for men and 3.5 mg/dl for women, you are probably better off avoiding fructose in most forms.

We have nothing against the agave plant.

Like many plants, the agave undoubtedly has many different phytochemicals with health-supporting properties. The problem lies in the processing, which, like any food processing, destroys most of these nutrients. Obviously, branded products undergo different amounts and types of processing, under different temperatures, etc.

What you're left with, then, is a high-fructose syrup, similar metabolically to high fructose corn syrup in terms of metabolic impact. Regardless of the organic-ness, regardless of the care taken in processing, regardless of the overall quality -- agave syrup is mostly fructose. Plain and simple.

But even this is not a problem, IF your syrup is free of chemicals, and IF you are using it in very small quantities, and IF you have no issues such as obesity, metabolic syndrome, kidney or heart disease.

Unfortunately, most people cannot satisfy all those IFs.

If you are diabetic or insulin resistant, you'll want to avoid these concentrated sugars altogether, regardless of the product quality.

If you are among the fortunate few without any of those health problems, congratulations! You're definitely doing something right. Just keep your overall fructose usage below 25 grams per day, agave syrup included. One teaspoon of agave syrup has 4 grams of fructose.

Naturally, agave syrup brands are going to differ quite a bit in quality, as all products do. If you are going to use it, you'll have to judge for yourself what is true quality versus marketing hype.

Agave's Favorable Glycemic Index is Meaningless

The fact that agave has a favorable glycemic index (GI) is often mentioned in its defense. But GI does not tell the entire story.

Agave syrup and other high-fructose sweeteners have metabolic consequences that aren't measured by an immediate insulin spike. This is why I have never advocated using the GI to select your foods.

It is possible to have a low fasting glucose yet have significantly elevated insulin levels.

In fact, some people with particularly robust insulin responses actually have very normal blood glucose levels because their insulin suppresses blood glucose for some time. If this is going on, you are essentially pre-diabetic and should reduce or eliminate fructose altogether. But you would never know it by just spot-checking your blood sugar after consuming a dose of agave syrup!

On the topic of agave, Dr. Johnson made the following recommendation:
"We have not done any specific research with agave or with honey. But I do believe that those two compounds, because they're so high in fructose, probably will engage the same pathways that we see when we give fructose or sugar to animals. So we would not recommend those as sweeteners to use daily."

Honey is better than agave for the simple reason that the benefits of raw, organic honey have been scientifically established. And the honey recommended is whole, raw and unprocessed. But use the same caution with honey as with agave syrup -- if you are fructose sensitive, you should be minimizing it or avoiding it altogether since it is also 70 percent fructose.

Isn't that kinda like talking out of both sides of the mouth at once? And above, they go on about xylitol, and then a little further down, recommend it. Now they are saying honey is okay even though it is higher in fructose that HFCS??? Plus they recommend whole grains which are deadly???


So, keep your dose below 25 grams of TOTAL fructose from all sources per day, and reduce this amount if you are sensitive to fructose.

How do you know if you are fructose sensitive?

Have your uric acid level checked. Your uric acid level should be about 4.0 mg/dl if you are a man or 3.5 mg/dl if you are a woman.

Busting Mythbusting Myths

Unfortunately, myths are being perpetuated -- not busted here such as seeking to confuse people that there is really a clinical difference between fructans and inulin, the form of starch that agave initially stores fructose in.

Simply speaking inulin is a fructose polymer in which the fructose molecules are interconnected. This is clearly better than free floating fructose that is present in HFCS or many lower quality agaves, but once you swallow the inulin your body will rapidly convert it to fructose, so ultimately, you will still receive a similar amount of fructose. You are not somehow 'magically" protected from the fructose because it is initially complexed as fructose polymer.

They also state that agave nectar does not contribute to liver inflammation, insulin resistance, cardiovascular disease, or obesity. Nothing could be further from the truth and it is shocking that the FTC doesn't come down on them like a ton of bricks for false advertising.

The evidence is BEYOND clear. There are loads of studies establishing that when you consume fructose in the high levels that are typically consumed by most Americans, your risk for all of these diseases dramatically increases.

Where are the studies that ANY of this is based on? The links to them??

What agave and HFCS manufacturers FAIL to tell you is that the AVERAGE American is consuming 70 grams per day.

While individuals may be able to tolerate larger doses of a complexed fructose polymer like inulin, ultimately it is broken down to fructose and they will need to metabolically address this sugar, which at doses typically consumed is a metabolic poison.

Most agave producers spout nearly identical garbage that the HFCS industry claims, They would have you believe that there really is no difference between glucose and fructose.

They claim that consuming large amounts of glucose or fructose is equally harmful. They simply have chosen to ignore the mountain of scientific evidence that proves fructose has clearly different metabolic pathways than glucose, and is much closer to alcohol with its chronic toxicity profile.

Some Fructose is OK

????????

Remember fructose is not a poison like aluminum or mercury that needs to be avoided at any dose. It is only a poison when you consume it at doses greater than 25 grams per day OR if you have elevated uric acid levels which appear to be a marker for fructose toxicity.

It is possible to safely consume agave or honey but you would have to be very strategic and careful about it. First you would have to eliminate ALL other sources of fructose in your diet, (fruits, fruit juices, sodas, most processed foods) and then restrict your dose to less than 40 grams of agave per day, which is less than three tablespoons. Anything more than that would put you over the 25 grams-per-day limit, at which fructose toxicity begins.

What the agave and HFCS industry seem to completely ignore is that we have two epidemics in the US that are directly related to fructose consumption: obesity and diabetes. The largest source of calories in the US is from fructose.

For most Americans, fructose can act like a poison. However, if you are healthy, normal weight, do not have diabetes, high blood pressure, or high cholesterol, then you certainly can enjoy fructose in moderation and it will cause you no harm or damage.

Here's the biggie!

Similar to Tobacco Industry Misinformation

This blatant misrepresentation of scientific truth reminds me of the same nonsense that the tobacco industry spouted. Up until the 90s they were vigorously denying that tobacco was addictive or increased the risk of cancer.

Of course, today nearly everyone realizes that this is utter nonsense.

This is an atrocious misrepresentation. Hopefully we won't have to follow the tobacco model and wait decades and engage in many class action law suits before we see change.

You can simply vote with your wallet and choose safer sweeteners like stevia or glucose (dextrose). This will avoid the need of any type of government intervention and will force industry to adjust their practices to meet the educated consumer demand.
 
Just discovered that the above article about Xylitol is from one of our favorite disinfo sites: _http://www.naturalnews.com/022986_xylitol_health_sugar.html

Written by: Ramiel Nagel is the internationally published author of Cure Tooth Decay and Healing Our Children In "Cure Tooth Decay" Nagel, reveals how your teeth can heal naturally because they were never designed to decay in the first place! Now there is a natural way to take control of your dental health by changing the food that you eat. Receive 19 free lessons on how to stop cavities

"Healing Our Children" explains the true causes of disease conditions of pregnancy and childhood so that you can avoid and prevent them. It provides essential natural health programs so that mothers and their new babies can optimize their health during the times of preconception, pregnancy, lactation and early childhood. Receive a free chapter of Healing Our Children
Free health information is also available on the topics of:

A Program for preconception health based on indigenous wisdom.
The cause of disease and the end of suffering of humanity.

He's rather long on claims and short on references.

Here's his book sale site:
_http://www.curetoothdecay.com/

Here's a bit of discussion about what the book says:
_http://www.mothering.com/community/t/1331197/ramiel-nagel-whole-grains-cause-tooth-decay

Here he's talking about whole grains:
_http://www.healingourchildren.org/whole-grains-pregnancy/

Here's his bio:
_http://www.wishsummit.com/toothsummit/ramiel-nagel

Ramiel Nagel

Father knows best! So, when Ramiel's Nagel's little girl started developing cavities early in life, he got passionate about tooth-truth. Rather than subject his one year old daughter to anesthesia and fillings, Mr. Nagel researched the underlying cause of cavities and searched for methods of healing them. He turned this research into a groundbreaking book, Cure Tooth Decay: Heal and Prevent Cavities with Nutrition.

Ramiel is a dental health educator who imparts a treasure trove of wisdom about healing and preventing cavities with your everyday diet. His tooth decay research has been featured in many media outlets including Nexus Magazine and Fox Business News. He has two very informative websites: _www.curetoothdecay.com and _www.healingourchildren.org .

In the spirit of service to all, Mr. Nagel shares how we can cure tooth decay with nutrition.
 
PubMed article on the processing of xylitol:
http://www.ncbi.nlm.nih.gov/pubmed/10739093

Maybe someone with pubmed access can find more?
 
Notice that the guy writes: "A search of patents online explains one of the processes for making xylitol..."

and then goes on to describe it as if it was the ONLY method!

So, I had a look myself. Seems there are LOTS of methods and just because a patent is granted doesn't mean that everyone, or even anyone, is going to use that method.

See:

http://www.freepatentsonline.com/5081026.html

http://www.google.com/patents/US6846657

http://www.google.com/patents/US20060246563

http://www.google.com/patents/US6764706

http://www.google.com/patents/US20020164731

A book online:
http://books.google.fr/books?id=vreXeAyJe8cC&pg=PA301&lpg=PA301&dq=patents+xylitol+processing&source=bl&ots=bU6_JJRv5s&sig=Ip64qJbsN5vt8dilRQw1BthH8TQ&hl=en&sa=X&ei=GS6pUJy3Kcq90QWA84DQCA&redir_esc=y#v=onepage&q=patents%20xylitol%20processing&f=false

Looks like our guy got his description from here:
http://osdir.com/patents/Organic-compounds/Process-production-xylitol-06911565.html

Highly edited by him, too.
 
The specific alleged danger mentioned to me was that aluminum is used in the chemical processing of Xylitol.

I'm looking for a detailed description of the exact process used to extract Xylitol from Birch Trees in Finland, but so far, I haven't been able to find out how it's "rendered" from the chopped Birch?

Of course GMO's, corn, "made in China" etc. are out. My question is how much, if any, nickle-aluminum is used to extract Xylan from Birch trees? After it's all chopped up. what rendering process are they using, and who's using what?
 
I thought that all birch based Xylitol was done by freeze drying the juice and thus crystalizing. But then there is this:
How is Xylitol made?
The xylan molecule is extracted from hardwood trees through an all-natural process utilizing steam and ion exchange. Then, it’s crystallized and voila! – Emerald Forest all natural xylitol is ready for your coffee, tea, cereal, and all those delicious baked goods you wish you could eat but have been avoiding because of high calories
_http://www.xylitolcanada.com/faqs/
Not sure what that means for for the actual process?
 
Guardian said:
The specific alleged danger mentioned to me was that aluminum is used in the chemical processing of Xylitol.

I'm looking for a detailed description of the exact process used to extract Xylitol from Birch Trees in Finland, but so far, I haven't been able to find out how it's "rendered" from the chopped Birch?

Of course GMO's, corn, "made in China" etc. are out. My question is how much, if any, nickle-aluminum is used to extract Xylan from Birch trees? After it's all chopped up. what rendering process are they using, and who's using what?

We actually have a chemical assay on our xylitol and there is NO mercury. The alleged "nickel-aluminun" process is the "patented method" quoted by the author of that article and is NOT the method that is used by most producers of xylitol.

Plus, we have a number of dental studies showing the effectiveness of xylitol in reducing or eliminating dental problems, so his claim:

An article published in the Journal of the American Dental Association in 2006 volume 137, states, "Some studies claimed that xylitol-sweetened gum had an anticariogenic effect, though these claims need further study." This article basically says that any evidence that xylitol sweetened gums stops cavities is not conclusive and requires further study.

Turns out to be a half-truth. Indeed, the American Dental Association published the above statement, but there are many other dental journals that show quite otherwise.
 
Here is a study comparing Manuka honey, chlorhexidine and xylitol
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3220139/

Problem is, they don't say anything about diet at all and, as I've learned, it is the diet, above all, that makes the difference. Their results?

The mean plaque scores for Groups I, II and III were 1.37, 1.35 and 1.57, respectively. The ANOVA revealed that between-group comparison was significant, with an F-value of 5.99 and a probability value of 0.004. The T-test was carried out to evaluate the inter-group significance, which revealed that the plaque inhibition by Manuka honey was similar to that of chlorhexidine mouthwash. Both Manuka honey and chlorhexidine mouthwash reduced plaque formation significantly, better than the xylitol chewing gum.

I'm not sure that "significantly better" applies to those numbers especially since the test only lasted 72 hours!!! And notice that the chlorhexidine group was the "best". Yeah.

The studies we've got are multi-year studies.
 
Seems that most of the significant research is being done in other countries:

http://jdr.sagepub.com/content/79/11/1885.abstract

Occurrence of Dental Decay in Children after Maternal Consumption of Xylitol Chewing Gum, a Follow-up from 0 to 5 Years of Age

P. Isokangas
Ylivieska Health Care Center

E. Soderling
Institute of Dentistry, University of Turku, FIN-20520 Turku, Finland

K. Pienihakkinen
Institute of Dentistry, University of Turku, FIN-20520 Turku, Finland

P. Alanen
Institute of Dentistry, University of Turku, FIN-20520 Turku, Finland

Abstract

Studies have shown that prevention of mutans streptococci (MS) colonization in early childhood can lead to prevention of dental decay. In the microbiological part of the present study in Ylivieska, Finland, with 195 mothers with high salivary MS levels, regular maternal use of xylitol chewing gum resulted in a statistically significant reduction in MS colonization in their children's teeth at the age of 2 years compared with teeth in children whose mothers received fluoride or chlorhexidine varnish treatment. The children did not chew gum or receive varnish treatments. For the present study, the children were examined annually for caries occurrence by experienced clinicians who did not know whether the children were colonized with MS. Regardless of the maternal prevention group, the presence of MS colonization in children at the age of 2 years was significantly related to each child's age at the first caries attack in the primary dentition. In children at the age of 5 years, the dentinal caries (dmf) in the xylitol group was reduced by about 70% as compared with that in the fluoride or chlorhexidine group. We conclude that maternal use of xylitol chewing gum can prevent dental caries in their children by prohibiting the transmission of MS from mother to child.
 
http://www.ncbi.nlm.nih.gov/pubmed/16521385?ordinalpos=7&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

J Am Dent Assoc. 2006 Feb;137(2):190-6.
The use of sorbitol- and xylitol-sweetened chewing gum in caries control.
Burt BA.
Source

Department of Epidemiology, School of Public Health, University of Michigan, 109 Observatory St., Ann Arbor, Mich. 48109-2029, USA. bburt@umich.edu
Erratum in

J Am Dent Assoc. 2006 Apr;137(4):447.

Abstract
BACKGROUND:

The author compared the caries-inhibitory action of sorbitol- and xylitol-sweetened chewing gum and assessed the role of these products in caries prevention.
TYPES OF STUDIES REVIEWED:

The author reviewed studies including randomized field trials with substantial numbers of participants and observational studies. He did not review case studies. He found studies through a MEDLINE search and by hand searching.
RESULTS:

When compared with sugar-sweetened gum, sorbitol-sweetened gum had low cariogenicity [corrected] when it was chewed no more than three times per day. Xylitol-sweetened gum was noncariogenic in all of the protocols tested. Some studies claimed that xylitol-sweetened gum had an anticariogenic effect, though these claims need further study. There also is good evidence that when mothers of infants and young children chew xylitol-sweetened gum, it will block transmission of mutans streptococci from mother to child.
CLINICAL IMPLICATIONS:

The evidence is strong enough to support the regular use of xylitol-sweetened gum as a way to prevent caries, and it can be promoted as a public-health preventive measure. Chewing xylitol-sweetened gum, especially for patients who like chewing gum, can be fitted readily into a regimen that includes frequent fluoride exposure, good oral hygiene and regular dental appointments.
 
http://www.ncbi.nlm.nih.gov/pubmed/10096456?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
J Dent Res. 1999 Mar;78(3):797-803.
The optimum time to initiate habitual xylitol gum-chewing for obtaining long-term caries prevention.
Hujoel PP, Mäkinen KK, Bennett CA, Isotupa KP, Isokangas PJ, Allen P, Mäkinen PL.
Source

Department of Dental Public Health Sciences, School of Dentistry, University of Washington, Seattle 98195, USA.
Abstract

Habitual xylitol gum-chewing may have a long-term preventive effect by reducing the caries risk for several years after the habitual chewing has ended. The goal of this report was (1) to determine if sorbitol and sorbitol/xylitol mixtures provide a long-term benefit, and (2) to determine which teeth benefit most from two-year habitual gum-chewing - those erupting before, during, or after habitual gum-chewing. Children, on average 6 years old, chewed gums sweetened with xylitol, sorbitol, or xylitol/sorbitol mixtures. There was a "no-gum" control group. Five years after the two-year program of habitual gum-chewing ended, 288 children were re-examined. Compared with the no-gum group, sorbitol gums had no significant long-term effect (relative risk [RR], 0.65; 95% confidence interval [c.i.], 0.39 to 1.07; p < 0.18). Xylitol gum and, to a lesser extent, xylitol/sorbitol gum had a long-term preventive effect. During the 5 years after habitual gum-chewing ended, xylitol gums reduced the caries risk 59% (RR, 0.41; 95% c.i., 0.23 to 0.75; p < 0.0034). Xylitol-sorbitol gums reduced the caries risk 44% (RR, 0.56; 95% c.i., 0.36 to 0.89; p < 0.02). The long-term caries risk reduction associated with xylitol strongly depended on when teeth erupted (p < 0.02). Teeth that erupted after 1 year of gum-chewing or after the two-year habitual gum use ended had long-term caries risk reductions of 93% (p < 0.0054) and 88% (p < 0.0004), respectively. Teeth that erupted before the gum-chewing started had no significant long-term prevention (p < 0.30). We concluded that for long-term caries-preventive effects to be maximized, habitual xylitol gum-chewing should be started at least one year before permanent teeth erupt.
 
http://www.ncbi.nlm.nih.gov/pubmed/7733059?ordinalpos=11&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Am J Orthod Dentofacial Orthop. 1995 May;107(5):497-504.
Effect of polyol gums on dental plaque in orthodontic patients.
Isotupa KP, Gunn S, Chen CY, Lopatin D, Mäkinen KK.
Source

Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, USA.
Abstract

Sixty 11- to 15-year-old children wearing fixed orthodontic appliances were given chewing gums containing polyol for daily use after meals and snacks, to study whether the chewing of gums that contained slowly fermentable polyols (xylitol and sorbitol) affects the amount of dental plaque and the number of mutans streptococci present in plaque and saliva. The 60 subjects were randomly divided into four groups, each of which was provided with a supply of 1.35 gm pellet-shaped gums for a period of 1 month, as follows: (1) xylitol; (2) sorbitol; (3) xylitol-sorbitol mixture I (3:2); and (4) xylitol-sorbitol mixture II (4:1). In each group, two pellets with a total initial gum mass of 2.7 gm (maximum polyol dose per day: 10.5 gm), were used six times a day. The fresh and dry weight of dental plaque, collected at baseline and 28 days later from incisors, canines, and premolars from the area between gingival margin and the bracket, reduced in all groups, but most significantly (by 43% to 47%) in children receiving xylitol gum. The plaque and saliva levels of mutans streptococci did not change in the sorbitol group, but was significantly (in most cases) reduced by 13% to 33% in groups that received gum containing xylitol. Provided that the quantity of dental plaque and the plaque and salivary levels of mutans streptococci can be regarded as risk factors in dental caries, these results suggest that regular use of polyol gum--and especially gum that contains xylitol as the predominant sweetener--can reduce the caries risk in young patients wearing fixed orthodontic appliances
 
http://www.ncbi.nlm.nih.gov/pubmed/11961328?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
Caries Res. 2002 Jan-Feb;36(1):36-9.
Effect of a triclosan-containing toothpaste supplemented with 10% xylitol on mutans streptococci in saliva and dental plaque. A 6-month clinical study.
Jannesson L, Renvert S, Kjellsdotter P, Gaffar A, Nabi N, Birkhed D.
Source

Department of Health Sciences, University of Kristianstad, Sweden. Lillemor.Jannesson@staff.hkr.se
Abstract

The aim of the present investigation was to evaluate the effect of the combination of triclosan and xylitol in toothpaste on mutans streptococci (MS) in saliva and dental plaque. 155 individuals with >10(5) MS/ml saliva were included in a 6-month double-blind clinical study. They were divided into three groups (n = 51-52) balanced according to their MS counts at baseline. Each group used one of the following types of dentifrice: (1) Colgate Total with the addition of 10% xylitol (Total-Xylitol), (2) Colgate Total and (3) Colgate Total without triclosan and without xylitol. Whole saliva and pooled plaque samples were obtained after 2, 4 and 6 months. When comparing the MS counts within the groups for saliva and plaque samples, Total-Xylitol showed significant reduction at all three sampling occasions (p < 0.001). Mean reduction at the 6-month sample for saliva was 0.81/ml and for plaque 0.89 per sample (log values). ANOVA revealed significant differences between Total-Xylitol and the two other products at 6 months for MS in saliva and dental plaque. The conclusion from this 6- month study is that the addition of 10% xylitol to a triclosan-containing dentifrice reduces the number of MS in saliva and dental plaque.
 
http://www.ncbi.nlm.nih.gov/pubmed/8860027?ordinalpos=18&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Caries Res. 1996;30(3):180-8.
Properties of whole saliva and dental plaque in relation to 40-month consumption of chewing gums containing xylitol, sorbitol of sucrose.
Mäkinen KK, Chen CY, Mäkinen PL, Bennett CA, Isokangas PJ, Isotupa KP, Pape HR Jr.
Source

Department of Biologic and Materials Sciences, The University of Michigan, Ann Arbor, Michigan, USA.
Abstract

Samples of whole saliva and dental plaque were collected from initially 10-year old subjects who participated in a 40-month cohort study investigating the effect of chewing gum usage on caries rates. The subjects represented nine cohorts of which one did not receive gum, while in eight cohorts the subjects received gum containing either xylitol, sorbitol, their mixtures, or sucrose as bulk sweeteners, the maximum sweetener consumption in the form of gums being up to 10.7 g/day, used in 3-5 daily chewing episodes. Gum usage had no significant effect on the levels of salivary protein, IgA, alpha-amylase, peroxidase, lysozyme, SCN and buffer capacity. At the endpoint, the group that received 100% xylitol pellet-shaped gum five times/day, had significantly lower levels of sucrase (p <0.05) and free sialic acid (p < 0.001) in whole saliva than at baseline. This group showed significantly (p <0.05) smaller plaque index scores at two cross-sectional measurements, and exhibited the lowest log(10) counts of salivary lactobacilli at endpoint than most other groups. The salivary levels of peptidase(s) (oligopeptidase B-like enzymes) hydrolyzing N-alpha-benzoyl-DL-arginyl-p-nitroaniline were significantly (p<0.05) or almost significantly lower in groups which received 100% xylitol pellet gums. All groups exhibited obviously an aging-related increase of salivary mutans streptococcus scores, except the above xylitol group in which the mean scores did not change.
 
http://www.ncbi.nlm.nih.gov/pubmed/783060?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Int Z Vitam Ernahrungsforsch Beih. 1976;15:92-104.
Long-term tolerance of healthy human subjects to high amounts of xylitol and fructose: general and biochemical findings.
Mäkinen KK.
Abstract

Three groups of volunteers, totalling 125, lived for two years on strict diets so that comparisons might be made with regard to the sweeteners: fructose (F), sucrose (S), and xylitol (X). The sizes of the test groups were: S, 35; F, 38; X, 52. The average monthly amounts of the sugars consumed in a varied assortment of foods were: S, 2.2 kg; F, 2.1 kg; X, 1.5 kg. The highest daily doses of fructose and xylitol were 200 - 400 g (maximum 430 g xylitol). Serum samples were analyzed for several chemical parameters. The dietary regimens did not result in clinically significant changes between the sugar groups. The ability of X to produce osmotic diarrhoea and flatulence was found to depend on the individual physiological responses of each volunteer. In many cases no symptoms were found although high amounts (200 - 400 g) of X were consumed. All pregnancies and deliveries in the F and X groups were normal. Practically all the volunteers accepted the F and X foods (almost 100 varities) and adhered to the dietary regimen for two years. This was due in the main to the fact that most F and X products were comparable to those containing sucrose.
 
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