View source for Xylitol

{{Short description|Natural sweetener}}
{{short_description|Synthetic sweetener}}
{{Use dmy dates|date=October 2025}}

{{chembox
| Verifiedfields = changed
| Watchedfields  = changed
| verifiedrevid  = 457481039
| Name           = Xylitol
| pronounce      = {{IPAc-en|ˈ|z|aɪ|l|ᵻ|t|ɒ|l}}
| Reference      = <ref>[[Safety data sheet]] for [http://ehsrms.uaa.alaska.edu/CMS/Laboratory/MSDS/MSDS%20by%20Vendor/Fisher/Xylitol.pdf xylitol] {{Webarchive|url=https://web.archive.org/web/20160303220707/http://ehsrms.uaa.alaska.edu/CMS/Laboratory/MSDS/MSDS%20by%20Vendor/Fisher/Xylitol.pdf |date=3 March 2016 }} from [[Fisher Scientific]]. {{Retrieved|access-date=2 November 2014}}</ref>
| ImageFile      = Xylitol Structural Formula V.1.svg
| ImageClass = skin-invert-image
| ImageSize      = 200 px
| ImageName      = Xylitol
| ImageFile1     = Xylitol crystals.jpg
| ImageSize1     = 250px
| ImageCaption1  = Xylitol crystals
| IUPACName      = ''meso''-Xylitol
| SystematicName = (2''R'',3''r'',4''S'')-Pentane-1,2,3,4,5-pentol
| OtherNames     = {{Unbulleted list|(2''R'',3''r'',4''S'')-Pentane-1,2,3,4,5-pentaol (not recommended)|(2''R'',3''r'',4''S'')-1,2,3,4,5-Pentahydroxypentane|Xylite}}
| Section1       = {{Chembox Identifiers
| CASNo_Ref = {{cascite|correct|CAS}}
| CASNo = 87-99-0
| ChEMBL_Ref = {{ebicite|correct|EBI}}
| UNII_Ref = {{fdacite|correct|FDA}}
| UNII = VCQ006KQ1E
| ChEMBL = 96783
| KEGG = C00379
| PubChem = 6912
| ChemSpiderID = 6646
| SMILES = OC[C@@H](O)[C@H](O)[C@@H](O)CO
| InChI_Ref = {{ebicite|correct|EBI}}
| InChI=1S/C5H12O5/c6-1-3(8)5(10)4(9)2-7/h3-10H,1-2H2/t3-,4+,5+
| InChIKey_Ref = {{ebicite|correct|EBI}}
| InChIKey = HEBKCHPVOIAQTA-SCDXWVJYSA-N
}}
| Section2       = {{Chembox Properties
  | C=5 | H=12 | O=5
  | Density = 1.52&nbsp;g/cm<sup>3</sup>
  | MeltingPtC = 92 to 96
  | MeltingPt_notes =
  | BoilingPtC = 345.39
  | BoilingPt_notes = predicted value using Adapted Stein & Brown method<ref>{{cite web |title=Xylitol |url=http://www.chemspider.com/Chemical-Structure.6646.html |access-date=13 May 2015 |website=Chemspider.com |series=Chemical Structure |archive-date=18 May 2015 |archive-url=https://web.archive.org/web/20150518093057/http://www.chemspider.com/Chemical-Structure.6646.html |url-status=live }}</ref>
  | Solubility = 168 g/100 g<ref name=Ullmann/>
  }}
| Section3       = {{Chembox Hazards
  | NFPA-H = 1
  | NFPA-F = 1
  | NFPA-R = 0
  }}
| Section4       = 
| Section5       = 
| Section6       = 
| Section8       = {{Chembox Related
  | OtherFunction_label = [[alkane]]s
  | OtherFunction = [[Pentane]]
  }}
}}
'''Xylitol''' is an [[organic compound]] with the formula {{chem2|HOCH(CH(OH)CH2OH)2}}.  Two other isomeric sugar alcohols exist. It is a colorless or white [[crystal]]line solid.  It is classified as a [[polyalcohol]]  and a [[sugar alcohol]], specifically an [[alditol]]. Of the common sugar alcohols, only [[sorbitol]] is more soluble in water.<ref name="Ullmann"/>

The name derives from {{langx|grc|ξύλον}}, ''xyl[on]'' 'wood', with the suffix ''-itol'' used to denote it being a sugar alcohol.

Xylitol is used as a [[food additive]] and [[sugar substitute]].  Its [[E number|European Union code number]] is '''E967'''.<ref name=EAPP-Food-legtn>{{cite web |date=22 March 2017 |title=Food legislation |url=http://polyols-eu.org/legislation/food/ |access-date=7 February 2019 |website=polyols-eu.org |publisher=European Association of Polyol Producers |archive-date=6 February 2023 |archive-url=https://web.archive.org/web/20230206095907/https://polyols-eu.org/legislation/food/ |url-status=live }}</ref> Replacing [[sugar]] with xylitol in food products may promote better dental health, but evidence is lacking on whether xylitol itself prevents [[dental cavities]].<ref name=Riley-etal-2015>
{{cite journal |last1=Riley |first1=P. |last2=Moore |first2=D. |last3=Ahmed |first3=F. |last4=Sharif |first4=M.O. |last5=Worthington |first5=H.V. |date=26 March 2015 |title=Xylitol-containing products for preventing dental caries in children and adults |journal=The Cochrane Database of Systematic Reviews |volume=2015 |issue=3 |doi=10.1002/14651858.CD010743.pub2 |pmc=9345289 |pmid=25809586 |article-number=CD010743}}</ref><ref>{{cite journal |last1=Riley |first1=P. |last2=Moore |first2=D. |last3=Ahmed |first3=F. |last4=Sharif |first4=M. O. |last5=Worthington |first5=H. V. |year=2015 |title=Can xylitol – used in products like sweets, candy, chewing gum, and toothpaste – help prevent tooth decay in children and adults? |url=https://www.cochrane.org/CD010743/ORAL_can-xylitol-used-in-products-like-sweets-candy-chewing-gum-and-toothpaste-help-prevent-tooth-decay-in-children-and-adults |journal=The Cochrane Database of Systematic Reviews |series=Lay summary |volume=2015 |issue=3 |doi=10.1002/14651858.CD010743.pub2 |pmc=9345289 |pmid=25809586 |article-number=CD010743 |archive-date=29 September 2019 |access-date=28 October 2018 |archive-url=https://web.archive.org/web/20190929201125/https://www.cochrane.org/CD010743/ORAL_can-xylitol-used-in-products-like-sweets-candy-chewing-gum-and-toothpaste-help-prevent-tooth-decay-in-children-and-adults |url-status=live }} {{open access}}</ref> In the United States, xylitol is used as a common [[sugar substitute]], and is considered to be safe for humans.<ref name="fda">{{cite web |date=14 July 2023 |title=Aspartame and Other Sweeteners in Food |url=https://www.fda.gov/food/food-additives-petitions/aspartame-and-other-sweeteners-food |archive-url=https://web.archive.org/web/20230601065858/https://www.fda.gov/food/food-additives-petitions/aspartame-and-other-sweeteners-food |archive-date=1 June 2023 |access-date=12 September 2024 |publisher=US Food and Drug Administration}}</ref>

Xylitol can be toxic to [[dog]]s and [[ferrets]].<ref name="dogs-fda">{{cite web |date=7 July 2021 |title=Paws off xylitol; It's dangerous for dogs |url=https://www.fda.gov/consumers/consumer-updates/paws-xylitol-its-dangerous-dogs |access-date=9 September 2021 |publisher=US Food and Drug Administration |archive-date=14 July 2019 |archive-url=https://web.archive.org/web/20190714055817/https://www.fda.gov/consumers/consumer-updates/paws-xylitol-its-dangerous-dogs |url-status=live }}</ref>

==History==
[[Emil Fischer]], a German chemist, and his assistant Rudolf Stahel isolated a new compound from [[beech]] wood chips in September 1890 and named it {{lang|de|Xylit}}, after the Greek word for wood. The following year, the French chemist M.&nbsp;G.&nbsp;Bertrand isolated xylitol syrup by processing wheat and oat straw.<ref name="pmid10890712">{{cite journal |vauthors=Mäkinen KK |date=June 2000 |title=The rocky road of xylitol to its clinical application |url=https://journals.sagepub.com/doi/10.1177/00220345000790060101?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed |journal=Journal of Dental Research |volume=79 |issue=6 |pages=1352–5 |doi=10.1177/00220345000790060101 |pmid=10890712 |s2cid=31432699 |url-access=subscription}}</ref> Sugar rationing during [[World War II|World War&nbsp;II]] led to an interest in [[sugar substitutes]]. Interest in xylitol and other polyols became intense, leading to their [[Characterization (materials science)|characterization]] and manufacturing methods.<ref name=Ur-Rehman-etal-2015/><ref name=Hicks-2010>{{cite magazine |last=Hicks |first=Jesse |date=Spring 2010 |title=The pursuit of sweet |url=https://www.sciencehistory.org/distillations/magazine/the-pursuit-of-sweet |magazine=Science History |publisher=Science History Institute |lang=en |access-date=28 October 2018 |archive-date=5 November 2018 |archive-url=https://web.archive.org/web/20181105224816/https://www.sciencehistory.org/distillations/magazine/the-pursuit-of-sweet |url-status=live }}</ref>

==Structure, production, commerce==
Xylitol is one of three 5-carbon sugar alcohols.  The others are [[arabitol]] and [[ribitol]].  These three compounds differ in the stereochemistry of the three secondary alcohol groups.
{{Gallery|title=5-carbon sugar alcohols|align=||height=80
|Arabitol.png
|Arabitol
|Ribitol structure.png
|Ribitol
| Xylitol Structural Formula V.1.svg
|Xylitol
|
}}

Xylitol occurs naturally in small amounts in plums, strawberries, cauliflower, and pumpkin; humans and many other animals make trace amounts during [[metabolism]] of [[carbohydrate]]s.<ref name=Ur-Rehman-etal-2015/> Unlike most sugar alcohols, xylitol is [[Chirality (chemistry)|achiral]].<ref name=Wrolstad-2012>
{{cite book |last=Wrolstad |first=Ronald E. |url=https://books.google.com/books?id=gVB8l8ukYPYC&pg=PA176 |title=Food Carbohydrate Chemistry |publisher=John Wiley & Sons |year=2012 |isbn=978-0-8138-2665-3 |page=176 |access-date=20 October 2012 |via=Google Books}}
</ref> Most other [[isomer]]s of pentane-1,2,3,4,5-pentol are chiral, but xylitol has a plane of symmetry.

Industrial production starts with [[lignocellulosic biomass]] from which [[xylan]] is extracted; raw biomass materials include [[hardwood]]s, [[softwoods]], and agricultural waste from processing maize, wheat, or rice. The mixture is hydrolyzed with acid to give [[xylose]].  The xylose is purified by [[chromatography]].  Purified [[xylose]] is catalytically [[hydrogenation|hydrogenated]] into xylitol using a [[Raney nickel]] catalyst.<ref name="Ullmann">{{cite book |last1=Schiweck |first1=Hubert |title=Ullmann's Encyclopedia of Industrial Chemistry |last2=Bär |first2=Albert |last3=Vogel |first3=Roland |last4=Schwarz |first4=Eugen |last5=Kunz |first5=Markwart |last6=Dusautois |first6=Cécile |last7=Clement |first7=Alexandre |last8=Lefranc |first8=Caterine |last9=Lüssem |first9=Bernd |year=2012 |isbn=978-3-527-30385-4 |chapter=Sugar Alcohols |doi=10.1002/14356007.a25_413.pub3 |last10=Moser |first10=Matthias |last11=Peters |first11=Siegfried}}</ref> The conversion changes the sugar (xylose, an [[aldehyde]]) into the [[primary alcohol]], xylitol.<ref name=Ur-Rehman-etal-2015/>

Xylitol can also be obtained by [[industrial fermentation]], but this methodology is not as economical as the acid hydrolysis/chromatography route described above. Fermentation is effected by bacteria, fungi, or yeast, especially ''[[Candida tropicalis]]''.<ref name=Ur-Rehman-etal-2015/><ref name=Jain-Mulay-2014>
{{cite journal |last1=Jain |first1=H. |last2=Mulay |first2=S. |date=March 2014 |title=A review on different modes and methods for yielding a pentose sugar: Xylitol |journal=International Journal of Food Sciences and Nutrition |volume=65 |issue=2 |pages=135–143 |doi=10.3109/09637486.2013.845651 |pmid=24160912 |s2cid=39929588}}
</ref> According to the US [[United States Department of Energy|Department of Energy]], xylitol production by [[fermentation]] from discarded [[biomass]] is one of the most valuable [[Renewable resource|renewable chemicals]] for commerce, forecast to be a US $1.41&nbsp;billion industry by 2025.<ref name=Felipe-H-P-etal-2019>
{{cite journal |last1=Felipe Hernández-Pérez |first1=Andrés |last2=de Arruda |first2=Priscila Vaz |last3=Sene |first3=Luciane |last4=da Silva |first4=Silvio Silvério |last5=Kumar Chandel |first5=Anuj |last6=de Almeida Felipe |first6=Maria das Graças |date=16 July 2019 |title=Xylitol bioproduction: State-of-the-art, industrial paradigm shift, and opportunities for integrated biorefineries |journal=Critical Reviews in Biotechnology |volume=39 |issue=7 |pages=924–943 |doi=10.1080/07388551.2019.1640658 |issn=0738-8551 |pmid=31311338 |s2cid=197421362}}</ref>

==Uses==
Xylitol is used as a sugar substitute in such manufactured products as [[drug]]s, [[dietary supplement]]s, [[Confectionery|confections]], [[toothpaste]], and [[chewing gum]], but is not a common household sweetener.<ref name=Riley-etal-2015/><ref name=fda/><ref name=Drugs-2018>{{cite web |year=2018 |title=Xylitol |url=https://www.drugs.com/npp/xylitol.html |access-date=12 October 2018 |website=Drugs.com |archive-date=18 March 2023 |archive-url=https://web.archive.org/web/20230318085610/https://www.drugs.com/npp/xylitol.html |url-status=live }}</ref> Xylitol has negligible effects on [[blood sugar]] because its assimilation and metabolism are independent of [[insulin]].<ref name=Drugs-2018/> It is approved as a food additive and sugar substitute in the United States.<ref name=fda/> 

Xylitol is also found as an additive to [[Saline (medicine)|saline]] solution for [[nasal irrigation]] and has been reported to be effective in improving symptoms of chronic [[sinusitis]].<ref name=Weissm-etal-2011>
{{cite journal |last1=Weissman |first1=Joshua D. |last2=Fernandez |first2=Francisca |last3=Hwang |first3=Peter H. |date=November 2011 |title=Xylitol nasal irrigation in the management of chronic rhinosinusitis: A pilot study |journal=The Laryngoscope |volume=121 |issue=11 |pages=2468–2472 |doi=10.1002/lary.22176 |issn=1531-4995 |pmid=21994147 |s2cid=36572019}}
</ref>

Xylitol can also be incorporated into fabrics to produce a cooling fabric. When moisture, such as sweat, comes into contact with the xylitol embedded in the fabric, it produces a cooling sensation.<ref>{{Cite journal |last1=Peng |first1=Yucan |last2=Cui |first2=Yi |date=15 April 2020 |title=Advanced Textiles for Personal Thermal Management and Energy |journal=Joule |language=en |volume=4 |issue=4 |pages=724–742 |bibcode=2020Joule...4..724P |doi=10.1016/j.joule.2020.02.011 |issn=2542-4351 |doi-access=free}}</ref>

==Food properties==

===Nutrition, taste, and cooking===
Humans absorb xylitol more slowly than sucrose, and xylitol supplies 40% fewer calories than an equal mass of sucrose.<ref name=Drugs-2018/>

Xylitol has about the same sweetness as [[sucrose]],<ref name=Drugs-2018/> but is sweeter than similar compounds like [[sorbitol]] and [[mannitol]].<ref name=Ur-Rehman-etal-2015>
{{cite journal |last1=Ur-Rehman |first1=S. |last2=Mushtaq |first2=Z. |last3=Zahoor |first3=T. |last4=Jamil |first4=A. |last5=Murtaza |first5=M.A. |date=2015 |title=Xylitol: A review on bio-production, application, health benefits, and related safety issues |journal=Critical Reviews in Food Science and Nutrition |volume=55 |issue=11 |pages=1514–1528 |doi=10.1080/10408398.2012.702288 |pmid=24915309 |s2cid=20359589}}
</ref>

Xylitol is stable enough to be used in baking,<ref name=UK-Diabetes-2018-10-28/> but, because xylitol and other polyols are more heat-stable, they do not [[Caramelization|caramelise]] as sugars do. Sugars and polyols lower the freezing point of foods such as ice-cream, but xylitol does so excessively, requiring thickeners to keep the ice-cream from being too soft.<ref name=leatherhead>{{cite web |last1=Burgos |first1=Karen |last2=Subramaniam |first2=Persis |last3=Arthur |first3=Jennifer |date=21 November 2016 |title=Reformulation guide for small to medium sized companies |url=https://www.fdf.org.uk/globalassets/resources/publications/reformulation-guide-sugars-aug2016.pdf|archive-url=https://web.archive.org/web/20200927023640/http://www.fdf.org.uk/corporate_pubs/Reformulation-Guide-Sugars-Aug2016.pdf |archive-date=27 September 2020 |access-date=28 October 2018 |publisher=Leatherhead Food Research |via=The Food and Drink Federation}}</ref>

===Food risks===
Normal levels of consumption by humans have not been shown to pose serious health risks in most humans. The [[European Food Safety Authority]] has not set a limit on daily intake of xylitol. Due to the adverse [[laxative]] effect that all polyols have on the digestive system in high doses, xylitol is banned from soft drinks in the [[European Union]]. Similarly, due to a 1985 report by the E.U. [[Scientific Committee on Food]] which states that "ingesting 50&nbsp;g a day of xylitol can cause [[diarrhea]]", tabletop sweeteners (as well as other products containing xylitol) are required to display the warning "Excessive consumption may induce laxative effects".<ref name=UK-NHS-2016-04-13>{{cite web |date=13 April 2016 |title=Is xylitol good for your teeth? |url=https://www.nhs.uk/live-well/eat-well/is-xylitol-good-for-your-teeth/ |access-date=28 October 2018 |series=Live well: Eat well |publisher=U.K. [[National Health Service]] |archive-date=29 October 2018 |archive-url=https://web.archive.org/web/20181029030810/https://www.nhs.uk/live-well/eat-well/is-xylitol-good-for-your-teeth/ |url-status=live }}</ref>

===Metabolism===
Xylitol has 2.4 kilocalories of [[food energy]] per gram (10 kilojoules per gram) according to [[United States of America|U.S.]] and [[European Union|E.U.]] food-labeling regulations.<ref name=UN-FAO-y5022e04>{{cite report |title=Calculation of the Energy Content of Foods |publisher=The United Nations |access-date=30 March 2017 |chapter=Chapter 3: Energy Conversion Factors |department=Food and Agriculture Organization |chapter-url=http://www.fao.org/docrep/006/Y5022E/y5022e04.htm |archive-date=24 May 2010 |archive-url=https://web.archive.org/web/20100524003622/http://www.fao.org/DOCREP/006/Y5022E/y5022e04.htm |url-status=live }}</ref><ref name=EAPP-Food-legtn/> The real value can vary depending on metabolic factors.<ref name="Livesey-2003" />

The liver primarily metabolizes absorbed xylitol. The main metabolic route in humans occurs in the [[cytoplasm]] via nonspecific [[NAD+|NAD]]-dependent dehydrogenase (polyol dehydrogenase), which transforms xylitol to [[D-xylulose|{{sc|D}}-xylulose]]. Specific [[xylulokinase]] phosphorylates it to [[D-xylulose-5-phosphate|{{sc|D}}-xylulose-5-phosphate]], which then goes into the [[pentose phosphate pathway]] for further processing.<ref name=Livesey-2003/>

About 50% of ingested xylitol is absorbed via the intestines. In humans, 50–75% of the xylitol not absorbed in the gut is fermented by [[gut bacteria]] into short-chain organic acids and gases, potentially leading to [[flatulence]]. Any remnant unabsorbed xylitol that escapes fermentation is excreted unchanged, mostly in feces; less than 2&nbsp;g of xylitol out of every 100&nbsp;g ingested is excreted via urine.<ref name=Livesey-2003>
{{cite journal |last=Livesey |first=G. |year=2003 |title=Health potential of polyols as sugar replacers, with emphasis on low glycaemic properties |journal=Nutrition Research Reviews |volume=16 |issue=2 |pages=163–191 |doi=10.1079/NRR200371 |issn=1475-2700 |pmid=19087388 |doi-access=free}}
</ref>

Xylitol ingestion also increases [[motilin]] secretion, which may be related to the ability of xylitol to cause diarrhea.<ref name=Wölnerhn-etal-2019>
{{Cite journal |author1=Wölnerhanssen, B. K. |author2=Meyer-Gerspach, A. C. |author3=Beglinger, C. |author4=Islam, M. S. |date=June 2019 |title=Metabolic effects of the natural sweeteners xylitol and erythritol: A comprehensive review |journal=Critical Reviews in Food Science and Nutrition |volume=60 |issue=12 |pages=1986–1998 |doi=10.1080/10408398.2019.1623757 |pmid=31204494 |s2cid=189944738}}
</ref> The less-digestible but fermentable nature of xylitol also contributes to constipation-relieving effects.<ref name=Salli-etal-2019/>

==Health effects==

===Dental care===
A 2015 [[Cochrane review]] of ten studies between 1991 and 2014 suggested a positive effect in reducing [[tooth decay]] of xylitol-containing [[fluoride]] toothpastes when compared to fluoride-only toothpaste, but there was insufficient evidence to determine whether other xylitol-containing products can prevent tooth decay in infants, children or adults.<ref name="pmid25809586">{{cite journal |vauthors=Riley P, Moore D, Ahmed F, Worthington HV |year=2015 |title=Xylitol-containing products for preventing dental caries in children and adults |journal=[[The Cochrane Database of Systematic Reviews]] |volume=2015 |issue=3 |doi=10.1002/14651858.CD010743.pub2 |pmc=9345289 |pmid=25809586 |article-number=CD010743}}</ref> Subsequent reviews support the belief that xylitol can suppress the growth of pathogenic [[Streptococcus]] in the mouth, thereby reducing dental cavities and [[gingivitis]], although there is concern that swallowed xylitol may cause [[Dysbiosis#Gut/intestinal dysbiosis|intestinal dysbiosis]].<ref name="pmid32638045">{{cite journal |vauthors=Benahmed AG, Gasmi A, Bjørklund G |year=2020 |title=Health benefits of xylitol |journal=[[Applied Microbiology and Biotechnology]] |volume=104 |issue=17 |pages=225–7237 |doi=10.1007/s00253-020-10708-7 |pmid=32638045}}</ref><ref name="pmid35462747">{{cite journal |vauthors=ALHumaid J, Bamashmous M |year=2022 |title=Meta-analysis on the Effectiveness of Xylitol in Caries Prevention |journal=Journal of International Society of Preventive & Community Dentistry |volume=12 |issue=2 |pages=133–138 |doi=10.4103/jispcd.JISPCD_164_21 |pmc=9022379 |pmid=35462747 |doi-access=free}}</ref><ref name="pmid31060040">{{cite journal |vauthors=Janket S, Benwait J, Meurman JH |year=2019 |title=Oral and Systemic Effects of Xylitol Consumption |journal=[[Caries Research]] |volume=53 |issue=5 |pages=491–501 |doi=10.1159/000499194 |hdl=10138/305074 |pmid=31060040 |hdl-access=free}}</ref> A 2022 review suggested that xylitol-containing [[chewing gum]] decreases plaque, but xylitol-containing candy does not.<ref>{{Cite journal |last1=Söderling |first1=Eva |last2=Pienihäkkinen |first2=Kaisu |date=2022 |title=Effects of xylitol chewing gum and candies on the accumulation of dental plaque: a systematic review |journal=Clinical Oral Investigations |volume=26 |issue=1 |pages=119–129 |doi=10.1007/s00784-021-04225-8 |issn=1432-6981 |pmc=8791908 |pmid=34677696}}</ref>

===Earache===
In 2011, [[EFSA]] "concluded that there was not enough evidence to support" the claim that xylitol-sweetened gum could prevent middle-ear infections ([[acute otitis media]]; AOM).<ref name=UK-NHS-2016-04-13/><ref>
{{cite journal |author=EFSA panel |date=June 2011 |title=Scientific opinion on the substantiation of health claims related to sugar-free chewing gum sweetened with xylitol and plaque acid neutralisation (ID 485), maintenance of tooth mineralisation (ID 486, 562, 1181), reduction of dental plaque (ID 485, 3085) |journal=EFSA Journal |volume=9 |issue=6 |page=2266 |doi=10.2903/j.efsa.2011.2266 |doi-access=free}}
</ref> A 2016 review indicated that xylitol in chewing gum or a syrup may have a moderate effect in preventing AOM in healthy children.<ref name=Azarpazh-etal-2016>
{{cite journal |last1=Azarpazhooh |first1=A. |last2=Lawrence |first2=H.P. |last3=Shah |first3=P.S. |date=3 August 2016 |title=Xylitol for preventing acute otitis media in children up to 12&nbsp;years of age |journal=The Cochrane Database of Systematic Reviews |volume=2016 |issue=8 |doi=10.1002/14651858.CD007095.pub3 |pmc=8485974 |pmid=27486835 |doi-access=free |article-number=CD007095}}
</ref> It may be an alternative to conventional therapies (such as [[antibiotic]]s) to lower risk of earache in healthy children&nbsp;– reducing risk of occurrence by 25%<ref name=Marom-etal-2016>
{{cite journal |last1=Marom |first1=Tal |last2=Marchisio |first2=Paola |last3=Tamir |first3=Sharon Ovnat |last4=Torretta |first4=Sara |last5=Gavriel |first5=Haim |last6=Esposito |first6=Susanna |date=12 February 2016 |title=Complementary and alternative medicine treatment options for otitis media |journal=Medicine |volume=95 |issue=6 |doi=10.1097/MD.0000000000002695 |issn=0025-7974 |pmc=4753897 |pmid=26871802 |article-number=e2695}}
</ref>&nbsp;– although there is no definitive proof that it could be used as a therapy for earache.<ref name=Azarpazh-etal-2016/>

===Diabetes===
In 2011, EFSA approved a marketing claim that foods or beverages containing xylitol or similar sugar replacers cause lower blood glucose and lower [[insulin]] responses compared to sugar-containing foods or drinks.<ref name=UK-Diabetes-2018-10-28>{{cite web |title=Xylitol |url=https://www.diabetes.co.uk/sweeteners/xylitol.html |access-date=28 October 2018 |publisher=Diabetes.co.uk |archive-date=29 October 2018 |archive-url=https://web.archive.org/web/20181029031101/https://www.diabetes.co.uk/sweeteners/xylitol.html |url-status=live }}</ref><ref name=EFSA-2011>
{{cite journal |author=EFSA panel |date=April 2011 |title=Scientific opinion on the substantiation of health claims related to the sugar replacers xylitol, sorbitol, mannitol, maltitol, lactitol, isomalt, erythritol, D-tagatose, isomaltulose, sucralose and polydextrose and maintenance of tooth mineralisation by decreasing tooth demineralisation, and reduction of post-prandial glycaemic responses |journal=EFSA Journal |volume=9 |issue=4 |page=2076 |doi=10.2903/j.efsa.2011.2076 |doi-access=free}}
</ref> Xylitol products are used as [[sucrose]] substitutes for weight control,<ref name=UK-Diabetes-2018-10-28/><ref name=Salli-etal-2019>
{{Cite journal |last1=Salli |first1=Krista |last2=Lehtinen |first2=Markus J. |last3=Tiihonen |first3=Kirsti |last4=Ouwehand |first4=Arthur C. |date=6 August 2019 |title=Xylitol's health benefits beyond dental health: A comprehensive review |journal=Nutrients |volume=11 |issue=8 |page=1813 |doi=10.3390/nu11081813 |issn=2072-6643 |pmc=6723878 |pmid=31390800 |doi-access=free}}
</ref> as xylitol has 40% fewer calories than sucrose (2.4&nbsp;kcal/g compared to 4.0&nbsp;kcal/g for sucrose).<ref name=UK-Diabetes-2018-10-28/><ref name=Tiefenbkr-2017>
{{cite book |last=Tiefenbacher |first=Karl F. |title=Wafer and Waffle |publisher=Elsevier |year=2017 |isbn=978-0-12-809438-9 |pages=123–225 |chapter=Technology of Main Ingredients – Sweeteners and Lipids |doi=10.1016/b978-0-12-809438-9.00003-x}}
</ref> The [[glycemic index]] (GI) of xylitol is only 7% of the GI for [[glucose]].<ref name=Foster-Powell-etal-2002>
{{cite journal |last1=Foster-Powell |first1=K. |last2=Holt |first2=S.H. |last3=Brand-Miller |first3=J.C. |date=July 2002 |title=International table of glycemic index and glycemic load values: 2002 |journal=The American Journal of Clinical Nutrition |volume=76 |issue=1 |pages=5–56 |doi=10.1093/ajcn/76.1.5 |pmid=12081815 |doi-access=free}}
</ref>

==Adverse effects==

===Humans===
When ingested at high doses, xylitol and other polyols may cause [[gastrointestinal]] discomfort, including [[flatulence]], [[diarrhea]], and [[irritable bowel syndrome]] (see [[#Metabolism|Metabolism]] above); some people experience the adverse effects at lower doses.<ref name=UK-NHS-2016-04-13/><ref name=Mäkinen-2016>
{{cite journal |last=Mäkinen |first=Kauko |date=20 October 2016 |title=Gastrointestinal disturbances associated with the consumption of sugar alcohols with special consideration of xylitol: Scientific review and instructions for dentists and other health-care professionals |journal=International Journal of Dentistry |volume=2016 |doi=10.1155/2016/5967907 |pmc=5093271 |pmid=27840639 |doi-access=free |article-number=5967907}}
</ref> Xylitol has a lower [[laxation]] threshold than some [[sugar alcohols]] but is more easily tolerated than [[mannitol]] and [[sorbitol]].<ref name=Can-Diabetes-2005-05-01>
{{cite report |url=http://www.dm2nb.ca/pdf/patient_resources/diabetes/sugar_alcohols_cda.pdf |title=Sugar Alcohols |date=1 May 2005 |publisher=Canadian Diabetes Association |access-date=14 March 2012 |archive-url=https://web.archive.org/web/20120425092501/http://www.dm2nb.ca/pdf/patient_resources/diabetes/sugar_alcohols_cda.pdf |archive-date=25 April 2012}}
</ref>

Increased xylitol consumption can increase oxalate, calcium, and phosphate excretion to urine (termed ''[[oxaluria]]'', ''[[calciuria]]'', and ''[[phosphaturia]]'', respectively). These are known risk factors for [[kidney stone disease]], but despite that, xylitol has not been linked to kidney disease in humans.<ref name=Janket-etal-2019>
{{cite journal |last1=Janket |first1=S. |last2=Benwait |first2=J. |last3=Isaac |first3=P. |last4=Ackerson |first4=L.K. |last5=Meurman |first5=J.H. |date=2019 |title=Oral and systemic effects of xylitol consumption |journal=Caries Research |volume=53 |issue=5 |pages=491–501 |doi=10.1159/000499194 |hdl=10138/305074 |pmid=31060040 |s2cid=146811298 |hdl-access=free}}
</ref>

===Dogs and other animals===
Xylitol is poisonous to [[dog]]s.<ref>{{cite web |date=7 July 2021 |title=Paws off xylitol; It's dangerous for dogs |url=https://www.fda.gov/consumers/consumer-updates/paws-xylitol-its-dangerous-dogs |archive-url=https://web.archive.org/web/20190714055817/https://www.fda.gov/consumers/consumer-updates/paws-xylitol-its-dangerous-dogs |archive-date=14 July 2019 |access-date=9 September 2021 |publisher=US Food and Drug Administration}}</ref> Ingesting 100&nbsp;milligrams of xylitol per kilogram of body weight (mg/kg&nbsp;bw) causes dogs to experience a dose-dependent [[insulin]] release; depending on the dose it can result in life-threatening [[hypoglycemia]]. Hypoglycemic symptoms of xylitol toxicity may arise as quickly as 30 to 60&nbsp;minutes after ingestion. Vomiting is a common first symptom, which can be followed by tiredness and [[ataxia]]. At doses above 500&nbsp;mg/kg&nbsp;bw, [[liver failure]] is likely and may result in [[Coagulopathy|coagulopathies]] like [[disseminated intravascular coagulation]].<ref name="Schmid-Hovda-2016">
{{cite journal |last1=Schmid |first1=R. D. |last2=Hovda |first2=L. R. |year=2016 |title=Acute hepatic failure in a dog after xylitol ingestion |journal=Journal of Medical Toxicology |volume=12 |issue=2 |pages=201–205 |doi=10.1007/s13181-015-0531-7 |pmc=4880608 |pmid=26691320}}
</ref> It is also poisonous to [[ferret]]s.<ref>{{cite web |date=15 April 2011 |title=FDA warns of xylitol dangers to dogs, ferrets |url=https://www.avma.org/javma-news/2011-04-15/fda-warns-xylitol-dangers-dogs-ferrets |website=[[American Veterinary Medical Association]] |access-date=3 June 2025 |archive-date=3 June 2025 |archive-url=https://web.archive.org/web/20250603142551/https://www.avma.org/javma-news/2011-04-15/fda-warns-xylitol-dangers-dogs-ferrets |url-status=live }}</ref>

Xylitol is safe for [[rhesus macaque]]s, [[horse]]s, and [[rat]]s.<ref name="Schmid-Hovda-2016" /> 

A 2018 study suggests that xylitol is safe for [[cat]]s in doses of up to 1000&nbsp;mg/kg; however, this study was performed on only 6 cats and should not be considered definitive.<ref name="Jerzsele-etal-2018">
{{cite journal |last1=Jerzsele |first1=Á. |last2=Karancsi |first2=Z. |last3=Pászti-Gere |first3=E. |last4=Sterczer |first4=Á. |last5=Bersényi |first5=A. |last6=Fodor |first6=K. |last7=Szabó |first7=D. |last8=Vajdovich |first8=P. |date=2018 |title=Effects of p.o. administered xylitol in cats |journal=Journal of Veterinary Pharmacology and Therapeutics |volume=41 |issue=3 |pages=409–414 |doi=10.1111/jvp.12479 |pmid=29430681 |doi-access=free}}
</ref> The American Society for the Prevention of Cruelty to Animals has never issued any warning about xylitol and cats. A 2022 article by the organisation explicitly lists xylitol as non-toxic.<ref name="Matt22">{{cite web |last=Bershadker |first=Matt |date=22 March 2022 |title=Matt's Blog: Be Prepared to Deal with Pet Poisons |url=https://www.aspca.org/blog/matts-blog-be-prepared-deal-pet-poisons |website=[[ASPCA]] |language=en |access-date=3 June 2025 |archive-date=3 June 2025 |archive-url=https://web.archive.org/web/20250603141631/https://www.aspca.org/blog/matts-blog-be-prepared-deal-pet-poisons |url-status=live }}</ref>

== See also ==
{{Portal|Food|Medicine}}

* {{anl|Aspartame}}
* {{anl|Birch sap}}
* {{anl|L-xylulose reductase}}
* {{anl|Xylonic acid}}

==References==
{{reflist}}

==External links==
* {{Commons category inline}}

{{Alcohols}}
{{E number infobox 950-969}}
{{Authority control}}

[[Category:Chewing gum]]
[[Category:E-number additives]]
[[Category:Excipients]]
[[Category:Sugar alcohols]]
[[Category:Sugar substitutes]]
[[Category:Veterinary toxicology]]