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

Abstract

Sugar alcohols (polyols) are used in food manufacturing and in medical tests and examinations. d-Glucitol (sorbitol) and d-mannitol were previously the most common alditols used for these purposes. After the 1960s, xylitol became a common ingredient in noncariogenic confectioneries, oral hygiene products, and diabetic food. Erythritol, a polyol of the tetritol type, can be regarded as the sweetener of the “next generation.” The disaccharide polyols maltitol, lactitol, and isomalt have also been used in food manufacturing and in medical tests. Consumption of pentitol- and hexitol-type polyols and disaccharide polyols may cause gastrointestinal disturbances at least in unaccustomed subjects. The occurrence of disturbances depends on consumer properties and on the molecular size and configuration of the polyol molecule. Adaptation may take place as a result of enzyme induction in the intestinal flora. Some of the literature on xylitol has been difficult to access by health-care professionals and will be reviewed here. Research and clinical field experience have found no pathology in polyol-associated osmotic diarrhea—the intestinal mucosa having normal basic structure, except in extreme instances. Xylitol is better tolerated than hexitols or the disaccharide polyols. Erythritol, owing to its smaller molecular weight and configuration that differ from other alditols, normally avoids the gastrointestinal reactions encountered with other polyols. This review will also touch upon the FODMAPs diet concept.

Exploring the microbiota and metabolites of traditional rice beer varieties of Assam and their functionalities

“…Other sugar alcohols detected in the rice beer samples were pentitol, xylitol, glucitol, fucitol, dulcitol and threitol. Among these, xylitol has been used as dietary supplement and as laxative (Mäkinen 2016). In addition, physovenine, quinoxaline-2-carboxamide, oxazolidin-2-one, acetyl tyrosine and thiocoumarine were detected in the rice beer samples.…”

Artificial and Natural Sweeteners: Chemical and Biological Properties, Production Processes and Potential Harmful Effects

“…No intestino grosso, o produto é rapidamente degradado em gases e ácidos graxos voláteis. 130 Efeitos nocivos do consumo de isomaltitol Após a ingestão de isomaltitol (10), os níveis de insulina e glicemia nos seres humanos aumentam ligeiramente. Isso, por sua vez, acaba provocando cárie dentária, pois o açúcar contido em 10 adere à superfície do dente, propiciando a formação da placa bacteriana.…”

Oral and Systemic Effects of Xylitol Consumption

“…Also, unabsorbed and subsequently fermented xylitol may contribute to the generation of butyric acid that helps in maintaining healthy colonic mucosa [Mäkeläinen et al, 2007]. However, the hydrogen gas can also cause flatulence [Sels et al, 1998;Mäkeläinen et al, 2007], and unabsorbed xylitol in the gut can also increase osmotic pressure and cause laxation and diarrhea [Mäkinen, 1984;Storey et al, 2007;Mäkinen, 2016;]. Additionally, the fecal microbiome was reported to shift from gram-negative to gram-positive bacteria with xylitol consumption [Salminen et al, 1985].…”

“…Only a low-calorie experimental diet given with sucralose resulted in significant low-glycemic effects [Reyna et al, 2003]; thus, diet and body weight are strong confounders in the glycemic responses from artificial sweeteners [Reyna et al, 2003;Janket et al, 2015] Xylitol and butyric acid • Helps in maintaining healthy colonic mucosa [Mäkeläinen et al, 2007] Negative effects Xylitol in the gut • Increase osmotic pressure and cause laxation and diarrhea [Mäkinen, 1984;Storey et al, 2007;Mäkinen, 2016] Xylitol and fecal microbiome • Reported to shift from gram-negative to gram-positive bacteria with xylitol consumption [Salminen et al, 1985] • Hence, utilization of xylitol for its low-glycemic/insulinemic benefits requires careful consideration [Livesey, 2001] Xylitol intake and gut dysbiosis Positive effects Role of xylitol in suppressing the growth of α-and β-hemolytic streptococci, as well as S. pneumoniae in vitro [Kontiokari et al, 1995] • Assuming the same is true in vivo, xylitol use in cold medications would be beneficial in this regard [Janket, 2012] Negative effects Xylitol and microbiome • Suppression of glucosyltransferase by xylitol inhibits the growth of predominantly glucose-fermenting microbiotas • Fecal microbiome shifted from gram-negative to gram-positive bacteria in humans and mice after xylitol consumption [Salminen et al, 1985] Xylitol and dysbiosis (animal studies) • Resulted in subsequently impaired glucose metabolism and weight gain [Suez et al, 2014;Burke and Small, 2015 [Narchi, 1998] • This relationship results in increased oxaluria, calciuria, and phosphaturia, which are risk factors for urolithiasis [Nguyen et al, 1993;Rodgers et al, 2009]…”