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{{chembox
| Verifiedfields = changed
| Watchedfields = changed
| verifiedrevid = 457481039
| Name = Xylitol
| Reference = <ref>[[Safety data sheet]] for [http://ehsrms.uaa.alaska.edu/CMS/Laboratory/MSDS/MSDS%20by%20Vendor/Fisher/Xylitol.pdf xylitol] from [[Fisher Scientific]]. {{Retrieved|accessdate=2014-11-02}}</ref>
| ImageFile = Xylitol-2D-structure.svg
| ImageSize =
| ImageName = Xylitol
| ImageFile1 = Xylitol crystals.jpg
| ImageSize1 = 250px
| ImageCaption1 = Xylitol crystals
| SystematicName = (2''R'',3''r'',4''S'')-Pentane-1,2,3,4,5-pentol
| OtherNames = (2''R'',3''r'',4''S'')-Pentane-1,2,3,4,5-pentaol (not recommended)<br />1,2,3,4,5-Pentahydroxypentane<br />Xylite
|Section1={{Chembox Identifiers
| CASNo_Ref = {{cascite|correct|CAS}}
| CASNo = 87-99-0
| ChEMBL_Ref = {{ebicite|changed|EBI}}
| UNII_Ref = {{fdacite|correct|FDA}}
| UNII = VCQ006KQ1E
| ChEMBL = 96783
| PubChem = 6912
| ChemSpiderID_Ref = {{chemspidercite|changed|chemspider}}
| ChemSpiderID = 6646
| SMILES = O[C@H](CO)[C@H](O)[C@@H](O)CO
| InChI = 1/C5H12O5/c6-1-3(8)5(10)4(9)2-7/h3-10H,1-2H2/t3-,4+,5+
| InChIKey = HEBKCHPVOIAQTA-SCDXWVJYBA
| StdInChI_Ref = {{stdinchicite|changed|chemspider}}
| StdInChI = 1S/C5H12O5/c6-1-3(8)5(10)4(9)2-7/h3-10H,1-2H2/t3-,4+,5+
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|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|website=Chemspider|accessdate=13 May 2015}}</ref>
| Solubility = ~ 0.1 g/mL
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|Section3={{Chembox Hazards
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|Section8={{Chembox Related
| OtherFunction_label = [[alkane]]s
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'''Xylitol''' {{IPAc-en|ˈ|z|aɪ|l|ᵻ|t|ɒ|l}} is a [[sugar alcohol]] used as a sweetener. The name derives from {{lang-el|ξύλον}}, ''xyl[on]'', "wood" + suffix -''itol'', used to denote [[sugar alcohols]]. Xylitol is categorized as a polyalcohol or sugar alcohol (alditol). It has the formula CH<sub>2</sub>OH(CHOH)<sub>3</sub>CH<sub>2</sub>OH and is an [[Chirality (chemistry)|achiral]]<ref>{{cite book|last=Wrolstad|first=Ronald E.|title=Food Carbohydrate Chemistry|year=2012|publisher=John Wiley & Sons|isbn=9780813826653|url=https://books.google.ca/books?id=gVB8l8ukYPYC&pg=PA176|accessdate=October 20, 2012|page=176|quote=Xylitol contains asymmetric carbon atoms, but it is not [[Chirality (chemistry)|chiral]] because the molecule as a whole is symmetrical.}}</ref> [[isomer]] of pentane-1,2,3,4,5-pentol. Unlike other natural or synthetic sweeteners, xylitol is actively beneficial for dental health by reducing [[dental caries|caries]] (cavities) to a third in regular use and helpful to remineralization.<ref>{{cite journal|last=Steinberg|first=LM|author2=Odusola, F|author3= Mandel, ID|title=Remineralizing potential, antiplaque and antigingivitis effects of xylitol and sorbitol sweetened chewing gum.|journal=Clinical preventive dentistry|date=Sep–Oct 1992|volume=14|issue=5|pages=31–4|pmid=1291185}}</ref> Multiple studies utilizing electron microscopy have indicated that xylitol is effective in inducing remineralization of deeper layers of demineralized [[Tooth enamel|enamel]].<ref>{{cite journal|title=Remineralization effects of xylitol on demineralized enamel. |vauthors=Miake Y, etal |pmid=14700079 | volume=52 |journal=J Electron Microsc (Tokyo) |pages=471–6 |doi=10.1093/jmicro/52.5.471}}</ref> Fair evidence was found that xylitol (as chewing gum, lozenges, nasal spray, etc.) reduced the incidence of acute [[otitis media|middle ear infection]] in healthy children.<ref name=":21">{{Cite journal
| last1 = Azarpazhooh | first1 = A.
| last2 = Limeback | first2 = H.
| last3 = Lawrence | first3 = H. P.
| last4 = Shah | first4 = P. S.
| editor1-last = Azarpazhooh
| editor1-first = Amir
| title = Xylitol for preventing acute otitis media in children up to 12 years of age
| doi = 10.1002/14651858.CD007095.pub2

| journal = The Cochrane Library
| issue = 11
| pages = CD007095
| year = 2011
| pmid = 22071833
| pmc =
}}</ref>

Xylitol is naturally found in low concentrations in the [[fiber]]s of many [[fruit]]s and [[vegetable]]s, and can be extracted from various [[berry|berries]], [[oat]]s, and [[mushroom]]s, as well as fibrous material such as [[corn husk]]s and [[sugar cane]] [[bagasse]].<ref>{{cite book |last=Gare |first=Fran |title=The Sweet Miracle of Xylitol |url=https://books.google.com/?id=5tgZG6Sb2aAC |date=February 1, 2003 |publisher=Basic Health Publications, Inc. |isbn=1-59120-038-5 }}</ref><ref>{{cite journal |author1=Rao, R. Sreenivas |author2=Jyothi, Ch. Pavana |author3=Prakasham, RS |author4=Sharma, PN |author5=Rao, L. Venkateswar | year = 2006 | title = Xylitol production from corn fiber and sugarcane bagasse hydrolysates by Candida tropicalis|doi=10.1016/j.biortech.2005.08.015 | pmid=16242318 | volume=97 | journal=Bioresour. Technol. | pages=1974–8}}{{Verification needed|date=June 2015}}</ref><ref>{{cite journal | title=Xylitol production from corn fiber and sugarcane bagasse hydrolysates by Candida tropicalis |journal = Bioresource Technology | volume = 97 | issue = 15| pages = 1974–1978 | pmid = 16242318 | doi=10.1016/j.biortech.2005.08.015 | date=October 2006 | last1 = Rao | first1 = RS | last2 = Jyothi ChP | first2 = Prakasham RS | last3 = Sarma | first3 = PN | last4 = Rao | first4 = LV}}</ref> However, industrial production starts from [[xylan]] (a [[hemicellulose]]) extracted from hardwoods<ref>{{cite journal | url=http://www.dichep.unige.it/old_site/Italiano/ricerca/pub_biotec_av/1999/1999_12.pdf | title=Xylitol Production from Hardwood Hemicellulose Hydrosylates |author1=Converti, Atillio |author2=Parego, Patrizia |author3=Dominguez, Jose Manuel | journal=Applied Biochemistry and Biotechnology | year=1999 | volume=82 | pages=141–151 | doi=10.1385/abab:82:2:141}}</ref> or corncobs, which is hydrolyzed into [[xylose]] and catalytically hydrogenated into xylitol. A study in [[laboratory rat]]s that compared xylitol to other artificial sweeteners found that xylitol had fewer or no side effects, had fewer calories, and was less likely to cause cavities (that is, had lower [[cariogenicity]]) than sucrose (table sugar).<ref>{{Cite journal | last1 =
Islam| first1 =
Md. Shahidul| last2 =
Indrajit| first2 =
Mitesh| year =
2012| title =
Effects of Xylitol on Blood Glucose, Glucose Tolerance, Serum Insulin and Lipid Profile in a Type 2 Diabetes Model of Rats| journal =
Annals of Nutrition and Metabolism| volume =
61| issue =
1| pages =
57–64| publisher = | jstor = | doi = 10.1159/000338440 | pmid =
22832597| url = }}</ref>

==Production==
Xylitol is produced by [[hydrogenation]] of [[xylose]], which converts the sugar (an [[aldehyde]]) into a [[primary alcohol]].
Another method of producing xylitol is through microbial processes, including fermentative and biocatalytic processes in bacteria, fungi, and yeast cells, that take advantage of the xylose-intermediate fermentations to produce high yield of xylitol.<ref>{{cite journal|last=Nigam|first=Poonam|author2=Singh, D.|title=Processes for Fermentative Production of Xylitol--a Sugar Substitute|journal=Process Biochemistry|year=1995|volume=30|pages=117–124|doi=10.1016/0032-9592(95)80001-8}}</ref> Common yeast cells used in effectly fermenting and producing xylitol are ''[[Candida tropicalis]]'' and ''[[Candida guilliermondii]]''.<ref>{{cite journal|last=Barbosa,|first=M.F.S.|author2=de Medeiros, M.B.|author3= de Manchilha, I.M.|author4= Schneider, H.|author5= Lee, H.|title=Screening of yeasts for production of xylitol from D-xylose and some factors which affect xylitol yield in Candida guillermondii|journal=J. Indust. Microbiol.|year=1988|volume=3|pages=241–251|doi=10.1007/bf01569582}}</ref>

==Properties==
One gram of xylitol contains 2.43 [[calories|kilocalories]] (kcal),<ref>{{cite web|last=Walters|first=D. Eric|title=Xylitol|url=http://www.sweetenerbook.com/xylitol.html|work=All About Sweeteners |accessdate= March 14, 2012}}</ref> as compared to one gram of [[sugar]], which has 3.87&nbsp;kcal.<ref>{{cite web|title=Sugars, granulated (sucrose)|url=http://nutritiondata.self.com/facts/sweets/5592/2 |publisher= Self Nutrition Data|accessdate=March 14, 2012}} With a serving size of 100 grams, there are 387 calories.</ref> Xylitol has virtually no [[aftertaste]], and is advertised as "safe for [[diabetics]] and individuals with [[hyperglycemia]]." This tolerance is attributed to the lower effect of xylitol on a person's [[blood sugar]], compared to that of regular [[sugars]] as it has an extremely low [[glycemic index]] of 7 (glucose has a GI of 100).<ref>[http://www.ajcn.org/content/76/1/5/T1.expansion.html The American Journal of Clinical Nutrition, January 1, 2002: ''International table of glycemic index and glycemic load values''] Retrieved 2012-08-26</ref>

==Health benefits==

===Dental care===
Xylitol is a "[[tooth-friendly]]", [[fermentation|nonfermentable]] sugar alcohol.<ref>{{cite journal |last=Edwardsson|first=Stig|author2=Birkhed, Dowen|author3= Mejàre, Bertil|title=Acid production from Lycasin, maltitol, sorbitol and xylitol by oral streptococci and lactobacilli|journal=Acta Odontologica Scandinavica|year=1977|volume=35|issue=5|pages=257–263|pmid=21508|doi=10.3109/00016357709019801}}</ref><ref>{{cite journal|last=Drucker|first=D.B.|author2=Verran, J.|title=Comparative effects of the substance-sweeteners glucose, sorbitol, sucrose, xylitol and trichlorosucrose on lowering of pH by two oral Streptococcus mutans strains in vitro|journal=Archives of Oral Biology |year=1979 |volume=24 |issue=12 |pages=965–970|doi=10.1016/0003-9969(79)90224-3|pmid=44996}}</ref> It appears to have more dental health benefits than other [[polyol|polyalcohols]].<ref>{{cite journal | last = Maguire | first = A |author2=Rugg-Gunn, A J|title=Xylitol and caries prevention — is it a magic bullet? |journal=British Dental Journal |year=2003 |volume=194 |issue=8 |pages=429–436 |doi= 10.1038/sj.bdj.4810022 |url=http://www.nature.com/bdj/journal/v194/n8/abs/4810022a.html |accessdate= March 14, 2012|pmid=12778091}}</ref> The structure of xylitol contains a [[tridentate|tridentate ligand]], (H-C-OH)<sub>3</sub> that can rearrange with polyvalent cations like Ca<sup>2+</sup>. This interaction allows Ca<sup>2+</sup> to be transported through the gut wall barrier and through saliva which may allow enamel to remineralize before dental cavities form.<ref name=ReferenceA>{{cite book |title= Functional foods, ageing and degenerative disease|year=2004|publisher=Woodhead Publishing |location= Cambridge, England |isbn=978-1-85573-725-9|url=https://books.google.ca/books?id=E32UlBYUZhcC&lpg=PP1&pg=PA202#v=onepage&q&f=false|author=Reusens, B.|editor1=Remacle, Claude |editor2=Reusens, Brigitte |accessdate= March 14, 2012 |page=202}}</ref>

Early studies from Finland in the 1970s found, compared with chewing sucrose-sweetened gum, xylitol resulted in nearly two fewer cavities or missing teeth.<ref name=aapd>{{cite journal|title=Policy on the Use of Xylitol in Caries Prevention|journal=Reference Manual|year=2010 | volume = 33 | issue = 6 | pages = 42–44 | url = http://www.aapd.org/media/Policies_Guidelines/P_Xylitol.pdf|accessdate=March 14, 2012|publisher=American Academy of Pediatric Dentistry}}</ref> Cavity-causing [[bacteria]] prefer [[Hexose|six-carbon sugars]] or [[disaccharide]]s, while xylitol is non-[[fermentation|fermentable]] and cannot be used as an energy source - while still being taken up into the cell (due to similar shape) and interfering with bacterial growth and reproduction. The harmful micro-organisms are starved in the presence of xylitol, allowing the mouth to remineralize damaged teeth with less interruption. This same property renders it unsuitable for making [[bread]] as it interferes with the ability of [[yeast]] to digest sugars.<ref name=ReferenceA/> At least six&nbsp;grams of xylitol per day, in three to five chewing episodes, is thought to be needed for dental efficacy. A source of xylitol that releases it slowly, and a one- to three-minute initial pulse are thought to improve the dental effect.<ref name=ReferenceA/>

Xylitol also inhibits the growth of ''[[Streptococcus pneumoniae]]'', as well as the attachment of ''[[Haemophilus influenzae]]'' on the [[nasopharyngeal]] cells.<ref name="ReferenceA"/>

The perception of sweetness obtained from consuming xylitol causes the secretion of saliva which acts as a buffer against the acidic environment created by the microorganisms in dental plaque. Increase in salivation can raise the falling pH to a neutral range within few minutes of xylitol consumption.<ref>{{cite journal|last=Scheinin|first=Arje|title=Dental Caries, Sugars and Xylitol|journal=Ann Med|year=1993|volume=25|pages=519–521}}</ref>

However, despite these promising conjectures two systematic reviews of clinical trials could not find conclusive evidence that xylitol was indeed superior to other polyols such as [[sorbitol]]<ref>{{Cite journal | doi = 10.1111/j.1875-595X.2011.00113.x | title = Effect of xylitol versus sorbitol: A quantitative systematic review of clinical trials | year = 2012 | last1 = Mickenautsch | first1 = Steffen | last2 = Yengopal | first2 = Veerasamy | journal = International Dental Journal | volume = 62 | issue = 4 | pages = 175–88 | pmid = 23016999}}</ref> or equal to that of topical [[fluoride]] in its anti-caries effect.<ref>{{Cite journal | doi = 10.1111/j.1875-595X.2011.00086.x | title = Anticariogenic effect of xylitol versus fluoride - a quantitative systematic review of clinical trials | year = 2012 | last1 = Mickenautsch | first1 = Steffen | last2 = Yengopal | first2 = Veerasamy | journal = International Dental Journal | volume = 62 | pages = 6–20 | pmid = 22251032 | issue = 1}}</ref>

In the 33-month Xylitol for Adult Caries Trial, participants were given lozenges of either five grams of xylitol or a sucralose-sweetened placebo. While this study initially found no statistically significant reduction in 33-month caries increment among adults at an elevated risk of developing caries,<ref>{{cite journal|url=http://jada.ada.org/content/144/1/21.abstract |title=Results from the Xylitol for Adult Caries Trial (X-ACT) |author=Bader, James D. |journal=The Journal of the American Dental Association |date=Jan 2013 |volume=144 |issue=1 |pages=21–30 |doi=10.14219/jada.archive.2013.0010 |display-authors=etal |deadurl=yes }}</ref> a further examination of data from this study revealed a significant reduction in the incidence of root caries in the group that received xylitol.<ref>{{cite journal | title=Tooth-surface-specific Effects of Xylitol: Randomized Trial Results | author=Ritter, AV, Bader, JD, Leo, MC, Preisser, JS, Shugars, DA, Vollmer, WM, Amaechi, BT, Holland, JC | journal=Journal of Dental Research |date=June 2013 | volume=92 | issue=6 | pages=512–517 | doi=10.1177/0022034513487211}}</ref>

In March, 2015, Cochrane published a review<ref>{{cite web|url=http://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|title=Can xylitol used in products like sweets, candy, chewing gum and toothpaste help prevent tooth decay in children and adults?|publisher=Cochrane|date=26 March 2015}}</ref> of the entire body of evidence surrounding xylitol's effects on dental caries. Their conclusion was that, while low-quality evidence suggests that over 2.5 to 3 years of use, a fluoride toothpaste containing xylitol may reduce caries when compared to a fluoride-only toothpaste, the remaining body of evidence is of low to very low quality and is insufficient to determine whether any other xylitol-containing products can prevent caries in infants, older children, or adults.

Xylitol is categorized by the [[Food and Drug Administration|U.S. Food and Drug Administration]] as a food additive.<ref>{{cite web | url=http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?fr=172.395| title=CITE: 21CFR172.395 | publisher=United States Food and Drug Administration | work=Code of Federal Regulations Title 21 | date=2012-04-01}}</ref>
Like other sugar alcohol-sweetened products, xylitol-sweetened products are allowed to be labeled with the claim that they do not promote dental cavities.

===Diabetes===
Possessing approximately 33% fewer calories, xylitol is a lower-[[calorie]] alternative to table sugar. Absorbed more slowly than sugar, it does not contribute to high blood sugar levels or the resulting hyperglycemia caused by insufficient insulin response. This characteristic has also proven beneficial for people suffering from [[metabolic syndrome]], a common disorder that includes insulin resistance, hypertension, hypercholesterolemia, and an increased risk for blood clots.<ref>{{cite journal|last=Martí|first=N.|author2=Funes, L.L.|author3= Saura, D.|author4= Micol, V.|title=An update on alternative sweeteners|journal=International sugar journal |date=July 2008 |volume=110 |issue=1315 |pages=425–429 |issn=0020-8841}}</ref> Xylitol is used as a sweetener in medicines, [[chewing gum]] and [[pastille]]s.<ref>{{cite web|last=Savola|first=Päivikki|title=Xylitol combats cavities |url=http://virtual.finland.fi/netcomm/news/showarticle.asp?intNWSAID=43050#xyl|work=Advanced food development and functional foods from Finland|publisher=Finfood - Finnish Food Information |archiveurl= https://web.archive.org/web/20080411105055/http://virtual.finland.fi/netcomm/news/showarticle.asp?intNWSAID=43050#xyl |archivedate=April 11, 2008 }}</ref>

===Source of energy===

In the human gut xylitol is not absorbed as well as glucose or fructose; the unabsorbed xylitol acts as a dietary [[Dietary fiber|soluble fiber]] in helping to maintain certain aspects of gut function. Bacterial fermentation, mainly in the large gut, partly converts xylitol to [[short-chain fatty acid]]s that the gut can absorb as fuel for energy production in oxidative metabolic pathways. Xylitol also is useful in recovery after heavy exercise because the human body converts absorbed xylitol to [[glucose 6-phosphate]] and [[glycogen]]. The conversion is however slow, so that the xylitol amounts to a low-[[Glycemic index|GI]] source of energy.<ref>{{cite journal|last=Vasilescu|first=Razvan|author2=Ionescu, A.M.|author3= Mihai, A.|author4= Carniciu, S.|author5= Ionescu-Tirgoviste, C.|title=Sweeteners and metabolic diseases: Xylitol as a new player|journal=Proc. Rom. Acad.|year=2011|volume=2|series=B|pages=125–128}}</ref><ref>Xi Chen, Zi-Hua Jiang, Sanfeng Chen, and Wensheng Qin. Microbial and Bioconversion Production of D-xylitol and Its Detection and Application. Int J Biol Sci. 2010; 6(7): 834–844. Published online Dec 15, 2010. PMCID: PMC3005349
</ref>

===Ear infection===
Xylitol chewing gum appears to decrease rates of acute [[otitis media]] in children going to daycare by 25%.<ref>{{cite journal|last=Azarpazhooh|first=A|author2=Limeback, H |author3=Lawrence, HP |author4= Shah, PS |title=Xylitol for preventing acute otitis media in children up to 12 years of age.|journal=The Cochrane database of systematic reviews|date=Nov 9, 2011|issue=11|pages=CD007095|pmid=22071833|doi=10.1002/14651858.CD007095.pub2}}</ref>{{Update inline|reason=Updated version https://www.ncbi.nlm.nih.gov/pubmed/27486835|date=December 2016}}
Xylitol nasal sprays have also been shown to decrease incidence of acute otitis media as well as being a very effective way of both assisting and stimulating the body's own natural nasopharyngeal washing, and reducing both bacterial colonization and allergenic pollution, with their accompanying problems.<ref>{{cite journal|last=Jones|first=A|title=Intranasal Xylitol, Recurrent Otitis Media, and Asthma: Report of Three Cases.|journal=Clinical Practice of Alternative Medicine |date=Summer 2001|issue=2|pages=112–117}}</ref>

===Osteoporosis===
A feed containing Xylitol increased bone volume in rat studies conducted in 2001 and 2011, these results have generated interest in the sugar that would examine if it could be a human treatment for [[osteoporosis]].<ref>{{cite web|url=http://www.drugs.com/npp/xylitol.html|title=Xylitol|work=drugs.com|accessdate=12 July 2015}}</ref><ref>{{cite journal|title=Increased bone volume and bone mineral content in xylitol-fed aged rats. |vauthors=Mattila PT, etal |pmid=11721142 | volume=47 |journal=Gerontology |pages=300–5 |doi=10.1159/000052818}}</ref><ref>{{cite journal|title=The effects of oral xylitol administration on bone density in rat femur. |vauthors=Sato H, etal |pmid=21271323 | doi=10.1007/s10266-010-0143-2 |volume=99 |journal=Odontology |pages=28-33}}</ref>

==Toxicity==

===In humans===
Xylitol has no known [[toxic]]ity in humans, however, some report heart palpitations after consuming it. In one study, participants consumed a monthly average of 1.5&nbsp;kg of xylitol with a maximum daily intake of 430&nbsp;g with no apparent ill effects.<ref name="Mäkinen_1976">{{cite journal |author=Mäkinen, KK |title=Long-term tolerance of healthy human subjects to high amounts of xylitol and fructose: general and biochemical findings |journal=Internationale Zeitschrift für Vitamin und Ernahrungsforschung Beiheft |volume=15 |issue= |pages=92–104 |year=1976 |pmid=783060 |doi= 10.1002/14651858.CD010743 }}</ref> Like most sugar alcohols, xylitol has a [[laxative]] effect because sugar alcohols are not fully broken down during digestion; however, the effect varies from person to person. In one study of 13 children, four experienced [[diarrhea]] from xylitol's laxative effect when they ate more than 65&nbsp;grams per day.<ref name=Wang1981/> Studies have reported that adaptation occurs after several weeks of consumption.<ref name="Wang1981"/>

As with other sugar alcohols, with the exception of [[erythritol]], consumption of xylitol in excess of one's "laxation threshold" (the amount of sweetener that can be consumed before abdominal discomfort occurs) can result in temporary gastrointestinal side effects, such as [[bloating]], [[flatulence]], and [[diarrhea]]. Adaptation (that is, an increase of the laxation threshold) occurs with regular intake. Xylitol has a lower laxation threshold than some sugar alcohols, but is more easily tolerated than [[mannitol]] and [[sorbitol]].<ref name=Wang1981>{{cite journal |author1=Wang, Yeu-Ming |author2=van Eys, Jan |title=Nutritional significance of fructose and sugar alcohols |journal=Annual Review of Nutrition |volume=1 |pages=437–75 |year=1981 |pmid=6821187 |doi=10.1146/annurev.nu.01.070181.002253 |url=}}</ref><ref>{{cite web|title=Sugar Alcohols |url=http://www.dm2nb.ca/pdf/patient_resources/diabetes/sugar_alcohols_cda.pdf |publisher=Canadian Diabetes Association |accessdate=March 14, 2012 |date=May 2005 |deadurl=yes |archiveurl=https://web.archive.org/web/20120425092501/http://www.dm2nb.ca/pdf/patient_resources/diabetes/sugar_alcohols_cda.pdf |archivedate=April 25, 2012 }}</ref>

===In dogs===
Xylitol is often fatal to dogs. According to the [[ASPCA]] Animal Poison Control Center, the number of cases of xylitol toxicosis in dogs has significantly increased since the first reports in 2002. [[Dog]]s that have eaten foods containing xylitol (greater than 100&nbsp;milligrams of xylitol consumed per kilogram of bodyweight) have presented with low blood sugar ([[hypoglycemia]]), which can be life-threatening.<ref name=Dunayer_2006_acute>{{cite journal|last=Dunayer|first=Eric K.|author2=Gwaltney-Brant, Sharon M.|title=Acute hepatic failure and coagulopathy associated with xylitol ingestion in eight dogs|journal=[[Journal of the American Veterinary Medical Association]] |date=October 2006 |volume=229|issue=7|pages=1113–1117|doi=10.2460/javma.229.7.1113|pmid=17014359}}</ref> Low blood sugar can result in a loss of coordination, depression, collapse and seizures in as little as 30&nbsp;minutes.<ref name=Dunayer_2004>{{cite journal|last=Dunayer|first=Erik K.|title=Hypoglycemia following canine ingestion of xylitol-containing gum|journal=Veterinary and human toxicology |date=April 2004|volume=46|issue=2|pages=87–88|pmid=15080212}}</ref> Intake of doses of xylitol (greater than 500&nbsp;– 1000&nbsp;mg/kg bwt) has been implicated in liver failure in dogs, which can be fatal.<ref name=Dunayer_2006_new>{{cite journal|last=Dunayer |first=Erik K. |title=New findings on the effects of xylitol ingestion in dogs |journal=Veterinary Medicine |date=December 2006 |volume=101 |issue=12 |pages=791–797 |url=http://files.meetup.com/556343/xylitol%20in%20dogs.pdf |accessdate=March 14, 2012 |deadurl=yes |archiveurl=https://web.archive.org/web/20130617144130/http://files.meetup.com/556343/xylitol%20in%20dogs.pdf |archivedate=June 17, 2013 }}</ref> The possible cause of hypoglycemia experienced by dogs is that xylitol in chewing gum is released more slowly and absorbed over longer period than when it is consumed as a pure form.<ref>{{cite journal|last=Dunayer|first=Eric K|title=Hypoglycemia Following Canine Ingestion of Xylitol-Containing Gum|journal=Vet. Human Toxicol.|year=2004|volume=46|issue=2|pages=87–88}}</ref>{{non sequitur|date=July 2016}}

===In wild birds===
Thirty [[Cape sugarbird]]s died within 30 minutes of drinking a solution made with xylitol, from a feeder in a garden in [[Hermanus]], [[South Africa]]. It is suspected that it triggered a massive insulin release, causing an irreversible drop in blood sugar.<ref>{{cite web|url=http://beta.iol.co.za/scitech/science/environment/xylitol-could-kill-sugarbirds---and-pets-1847533|title=Xylitol could kill sugarbirds - and pets|work=Independent Online|accessdate=12 July 2015}}</ref>

==See also==
{{Portal|Food|Dentistry}}
* [[Aspartame]]
* [[L-xylulose reductase]]
* [[Sucralose]]
* [[Xylonic acid]]
* [[Birch sap]]

==References==
{{Reflist |colwidth = 30em}}

{{E number infobox 950-969}}
{{Sugar alcohols}}

{{Authority control}}

[[Category:Sugar substitutes]]
[[Category:Sugar alcohols]]
[[Category:Excipients]]

Revision as of 00:57, 13 February 2017

Xylitol[1]
Xylitol

Xylitol crystals
Names
Systematic IUPAC name
(2R,3r,4S)-Pentane-1,2,3,4,5-pentol
Other names
(2R,3r,4S)-Pentane-1,2,3,4,5-pentaol (not recommended)
1,2,3,4,5-Pentahydroxypentane
Xylite
Identifiers
3D model (JSmol)
ChEMBL
ChemSpider
ECHA InfoCard 100.001.626 Edit this at Wikidata
E number E967 (glazing agents, ...)
UNII
  • InChI=1S/C5H12O5/c6-1-3(8)5(10)4(9)2-7/h3-10H,1-2H2/t3-,4+,5+ ☒N
    Key: HEBKCHPVOIAQTA-SCDXWVJYSA-N ☒N
  • InChI=1/C5H12O5/c6-1-3(8)5(10)4(9)2-7/h3-10H,1-2H2/t3-,4+,5+
    Key: HEBKCHPVOIAQTA-SCDXWVJYBA
  • O[C@H](CO)[C@H](O)[C@@H](O)CO
Properties
C5H12O5
Molar mass 152.146 g·mol−1
Density 1.52 g/cm3
Melting point 92 to 96 °C (198 to 205 °F; 365 to 369 K)
Boiling point 345.39 °C (653.70 °F; 618.54 K) Predicted value using Adapted Stein & Brown method[2]
~ 0.1 g/mL
Hazards
NFPA 704 (fire diamond)
NFPA 704 four-colored diamondHealth 1: Exposure would cause irritation but only minor residual injury. E.g. turpentineFlammability 1: Must be pre-heated before ignition can occur. Flash point over 93 °C (200 °F). E.g. canola oilInstability 0: Normally stable, even under fire exposure conditions, and is not reactive with water. E.g. liquid nitrogenSpecial hazards (white): no code
1
1
0
Related compounds
Related alkanes
Pentane
Except where otherwise noted, data are given for materials in their standard state (at 25 °C [77 °F], 100 kPa).
☒N verify (what is checkY☒N ?)

Xylitol /ˈzlɪtɒl/ is a sugar alcohol used as a sweetener. The name derives from Greek: ξύλον, xyl[on], "wood" + suffix -itol, used to denote sugar alcohols. Xylitol is categorized as a polyalcohol or sugar alcohol (alditol). It has the formula CH2OH(CHOH)3CH2OH and is an achiral[3] isomer of pentane-1,2,3,4,5-pentol. Unlike other natural or synthetic sweeteners, xylitol is actively beneficial for dental health by reducing caries (cavities) to a third in regular use and helpful to remineralization.[4] Multiple studies utilizing electron microscopy have indicated that xylitol is effective in inducing remineralization of deeper layers of demineralized enamel.[5] Fair evidence was found that xylitol (as chewing gum, lozenges, nasal spray, etc.) reduced the incidence of acute middle ear infection in healthy children.[6]

Xylitol is naturally found in low concentrations in the fibers of many fruits and vegetables, and can be extracted from various berries, oats, and mushrooms, as well as fibrous material such as corn husks and sugar cane bagasse.[7][8][9] However, industrial production starts from xylan (a hemicellulose) extracted from hardwoods[10] or corncobs, which is hydrolyzed into xylose and catalytically hydrogenated into xylitol. A study in laboratory rats that compared xylitol to other artificial sweeteners found that xylitol had fewer or no side effects, had fewer calories, and was less likely to cause cavities (that is, had lower cariogenicity) than sucrose (table sugar).[11]

Production

Xylitol is produced by hydrogenation of xylose, which converts the sugar (an aldehyde) into a primary alcohol. Another method of producing xylitol is through microbial processes, including fermentative and biocatalytic processes in bacteria, fungi, and yeast cells, that take advantage of the xylose-intermediate fermentations to produce high yield of xylitol.[12] Common yeast cells used in effectly fermenting and producing xylitol are Candida tropicalis and Candida guilliermondii.[13]

Properties

One gram of xylitol contains 2.43 kilocalories (kcal),[14] as compared to one gram of sugar, which has 3.87 kcal.[15] Xylitol has virtually no aftertaste, and is advertised as "safe for diabetics and individuals with hyperglycemia." This tolerance is attributed to the lower effect of xylitol on a person's blood sugar, compared to that of regular sugars as it has an extremely low glycemic index of 7 (glucose has a GI of 100).[16]

Health benefits

Dental care

Xylitol is a "tooth-friendly", nonfermentable sugar alcohol.[17][18] It appears to have more dental health benefits than other polyalcohols.[19] The structure of xylitol contains a tridentate ligand, (H-C-OH)3 that can rearrange with polyvalent cations like Ca2+. This interaction allows Ca2+ to be transported through the gut wall barrier and through saliva which may allow enamel to remineralize before dental cavities form.[20]

Early studies from Finland in the 1970s found, compared with chewing sucrose-sweetened gum, xylitol resulted in nearly two fewer cavities or missing teeth.[21] Cavity-causing bacteria prefer six-carbon sugars or disaccharides, while xylitol is non-fermentable and cannot be used as an energy source - while still being taken up into the cell (due to similar shape) and interfering with bacterial growth and reproduction. The harmful micro-organisms are starved in the presence of xylitol, allowing the mouth to remineralize damaged teeth with less interruption. This same property renders it unsuitable for making bread as it interferes with the ability of yeast to digest sugars.[20] At least six grams of xylitol per day, in three to five chewing episodes, is thought to be needed for dental efficacy. A source of xylitol that releases it slowly, and a one- to three-minute initial pulse are thought to improve the dental effect.[20]

Xylitol also inhibits the growth of Streptococcus pneumoniae, as well as the attachment of Haemophilus influenzae on the nasopharyngeal cells.[20]

The perception of sweetness obtained from consuming xylitol causes the secretion of saliva which acts as a buffer against the acidic environment created by the microorganisms in dental plaque. Increase in salivation can raise the falling pH to a neutral range within few minutes of xylitol consumption.[22]

However, despite these promising conjectures two systematic reviews of clinical trials could not find conclusive evidence that xylitol was indeed superior to other polyols such as sorbitol[23] or equal to that of topical fluoride in its anti-caries effect.[24]

In the 33-month Xylitol for Adult Caries Trial, participants were given lozenges of either five grams of xylitol or a sucralose-sweetened placebo. While this study initially found no statistically significant reduction in 33-month caries increment among adults at an elevated risk of developing caries,[25] a further examination of data from this study revealed a significant reduction in the incidence of root caries in the group that received xylitol.[26]

In March, 2015, Cochrane published a review[27] of the entire body of evidence surrounding xylitol's effects on dental caries. Their conclusion was that, while low-quality evidence suggests that over 2.5 to 3 years of use, a fluoride toothpaste containing xylitol may reduce caries when compared to a fluoride-only toothpaste, the remaining body of evidence is of low to very low quality and is insufficient to determine whether any other xylitol-containing products can prevent caries in infants, older children, or adults.

Xylitol is categorized by the U.S. Food and Drug Administration as a food additive.[28] Like other sugar alcohol-sweetened products, xylitol-sweetened products are allowed to be labeled with the claim that they do not promote dental cavities.

Diabetes

Possessing approximately 33% fewer calories, xylitol is a lower-calorie alternative to table sugar. Absorbed more slowly than sugar, it does not contribute to high blood sugar levels or the resulting hyperglycemia caused by insufficient insulin response. This characteristic has also proven beneficial for people suffering from metabolic syndrome, a common disorder that includes insulin resistance, hypertension, hypercholesterolemia, and an increased risk for blood clots.[29] Xylitol is used as a sweetener in medicines, chewing gum and pastilles.[30]

Source of energy

In the human gut xylitol is not absorbed as well as glucose or fructose; the unabsorbed xylitol acts as a dietary soluble fiber in helping to maintain certain aspects of gut function. Bacterial fermentation, mainly in the large gut, partly converts xylitol to short-chain fatty acids that the gut can absorb as fuel for energy production in oxidative metabolic pathways. Xylitol also is useful in recovery after heavy exercise because the human body converts absorbed xylitol to glucose 6-phosphate and glycogen. The conversion is however slow, so that the xylitol amounts to a low-GI source of energy.[31][32]

Ear infection

Xylitol chewing gum appears to decrease rates of acute otitis media in children going to daycare by 25%.[33][needs update] Xylitol nasal sprays have also been shown to decrease incidence of acute otitis media as well as being a very effective way of both assisting and stimulating the body's own natural nasopharyngeal washing, and reducing both bacterial colonization and allergenic pollution, with their accompanying problems.[34]

Osteoporosis

A feed containing Xylitol increased bone volume in rat studies conducted in 2001 and 2011, these results have generated interest in the sugar that would examine if it could be a human treatment for osteoporosis.[35][36][37]

Toxicity

In humans

Xylitol has no known toxicity in humans, however, some report heart palpitations after consuming it. In one study, participants consumed a monthly average of 1.5 kg of xylitol with a maximum daily intake of 430 g with no apparent ill effects.[38] Like most sugar alcohols, xylitol has a laxative effect because sugar alcohols are not fully broken down during digestion; however, the effect varies from person to person. In one study of 13 children, four experienced diarrhea from xylitol's laxative effect when they ate more than 65 grams per day.[39] Studies have reported that adaptation occurs after several weeks of consumption.[39]

As with other sugar alcohols, with the exception of erythritol, consumption of xylitol in excess of one's "laxation threshold" (the amount of sweetener that can be consumed before abdominal discomfort occurs) can result in temporary gastrointestinal side effects, such as bloating, flatulence, and diarrhea. Adaptation (that is, an increase of the laxation threshold) occurs with regular intake. Xylitol has a lower laxation threshold than some sugar alcohols, but is more easily tolerated than mannitol and sorbitol.[39][40]

In dogs

Xylitol is often fatal to dogs. According to the ASPCA Animal Poison Control Center, the number of cases of xylitol toxicosis in dogs has significantly increased since the first reports in 2002. Dogs that have eaten foods containing xylitol (greater than 100 milligrams of xylitol consumed per kilogram of bodyweight) have presented with low blood sugar (hypoglycemia), which can be life-threatening.[41] Low blood sugar can result in a loss of coordination, depression, collapse and seizures in as little as 30 minutes.[42] Intake of doses of xylitol (greater than 500 – 1000 mg/kg bwt) has been implicated in liver failure in dogs, which can be fatal.[43] The possible cause of hypoglycemia experienced by dogs is that xylitol in chewing gum is released more slowly and absorbed over longer period than when it is consumed as a pure form.[44][non sequitur]

In wild birds

Thirty Cape sugarbirds died within 30 minutes of drinking a solution made with xylitol, from a feeder in a garden in Hermanus, South Africa. It is suspected that it triggered a massive insulin release, causing an irreversible drop in blood sugar.[45]

See also

References

  1. ^ Safety data sheet for xylitol from Fisher Scientific. Retrieved 2014-11-02.
  2. ^ "Xylitol". Chemspider. Retrieved 13 May 2015.
  3. ^ Wrolstad, Ronald E. (2012). Food Carbohydrate Chemistry. John Wiley & Sons. p. 176. ISBN 9780813826653. Retrieved October 20, 2012. Xylitol contains asymmetric carbon atoms, but it is not chiral because the molecule as a whole is symmetrical.
  4. ^ Steinberg, LM; Odusola, F; Mandel, ID (Sep–Oct 1992). "Remineralizing potential, antiplaque and antigingivitis effects of xylitol and sorbitol sweetened chewing gum". Clinical preventive dentistry. 14 (5): 31–4. PMID 1291185.
  5. ^ Miake Y, et al. "Remineralization effects of xylitol on demineralized enamel". J Electron Microsc (Tokyo). 52: 471–6. doi:10.1093/jmicro/52.5.471. PMID 14700079.
  6. ^ Azarpazhooh, A.; Limeback, H.; Lawrence, H. P.; Shah, P. S. (2011). Azarpazhooh, Amir (ed.). "Xylitol for preventing acute otitis media in children up to 12 years of age". The Cochrane Library (11): CD007095. doi:10.1002/14651858.CD007095.pub2. PMID 22071833.
  7. ^ Gare, Fran (February 1, 2003). The Sweet Miracle of Xylitol. Basic Health Publications, Inc. ISBN 1-59120-038-5.
  8. ^ Rao, R. Sreenivas; Jyothi, Ch. Pavana; Prakasham, RS; Sharma, PN; Rao, L. Venkateswar (2006). "Xylitol production from corn fiber and sugarcane bagasse hydrolysates by Candida tropicalis". Bioresour. Technol. 97: 1974–8. doi:10.1016/j.biortech.2005.08.015. PMID 16242318.[verification needed]
  9. ^ Rao, RS; Jyothi ChP, Prakasham RS; Sarma, PN; Rao, LV (October 2006). "Xylitol production from corn fiber and sugarcane bagasse hydrolysates by Candida tropicalis". Bioresource Technology. 97 (15): 1974–1978. doi:10.1016/j.biortech.2005.08.015. PMID 16242318.
  10. ^ Converti, Atillio; Parego, Patrizia; Dominguez, Jose Manuel (1999). "Xylitol Production from Hardwood Hemicellulose Hydrosylates" (PDF). Applied Biochemistry and Biotechnology. 82: 141–151. doi:10.1385/abab:82:2:141.
  11. ^ Islam, Md. Shahidul; Indrajit, Mitesh (2012). "Effects of Xylitol on Blood Glucose, Glucose Tolerance, Serum Insulin and Lipid Profile in a Type 2 Diabetes Model of Rats". Annals of Nutrition and Metabolism. 61 (1): 57–64. doi:10.1159/000338440. PMID 22832597.
  12. ^ Nigam, Poonam; Singh, D. (1995). "Processes for Fermentative Production of Xylitol--a Sugar Substitute". Process Biochemistry. 30: 117–124. doi:10.1016/0032-9592(95)80001-8.
  13. ^ Barbosa,, M.F.S.; de Medeiros, M.B.; de Manchilha, I.M.; Schneider, H.; Lee, H. (1988). "Screening of yeasts for production of xylitol from D-xylose and some factors which affect xylitol yield in Candida guillermondii". J. Indust. Microbiol. 3: 241–251. doi:10.1007/bf01569582.{{cite journal}}: CS1 maint: extra punctuation (link)
  14. ^ Walters, D. Eric. "Xylitol". All About Sweeteners. Retrieved March 14, 2012.
  15. ^ "Sugars, granulated (sucrose)". Self Nutrition Data. Retrieved March 14, 2012. With a serving size of 100 grams, there are 387 calories.
  16. ^ The American Journal of Clinical Nutrition, January 1, 2002: International table of glycemic index and glycemic load values Retrieved 2012-08-26
  17. ^ Edwardsson, Stig; Birkhed, Dowen; Mejàre, Bertil (1977). "Acid production from Lycasin, maltitol, sorbitol and xylitol by oral streptococci and lactobacilli". Acta Odontologica Scandinavica. 35 (5): 257–263. doi:10.3109/00016357709019801. PMID 21508.
  18. ^ Drucker, D.B.; Verran, J. (1979). "Comparative effects of the substance-sweeteners glucose, sorbitol, sucrose, xylitol and trichlorosucrose on lowering of pH by two oral Streptococcus mutans strains in vitro". Archives of Oral Biology. 24 (12): 965–970. doi:10.1016/0003-9969(79)90224-3. PMID 44996.
  19. ^ Maguire, A; Rugg-Gunn, A J (2003). "Xylitol and caries prevention — is it a magic bullet?". British Dental Journal. 194 (8): 429–436. doi:10.1038/sj.bdj.4810022. PMID 12778091. Retrieved March 14, 2012.
  20. ^ a b c d Reusens, B. (2004). Remacle, Claude; Reusens, Brigitte (eds.). Functional foods, ageing and degenerative disease. Cambridge, England: Woodhead Publishing. p. 202. ISBN 978-1-85573-725-9. Retrieved March 14, 2012.
  21. ^ "Policy on the Use of Xylitol in Caries Prevention" (PDF). Reference Manual. 33 (6). American Academy of Pediatric Dentistry: 42–44. 2010. Retrieved March 14, 2012.
  22. ^ Scheinin, Arje (1993). "Dental Caries, Sugars and Xylitol". Ann Med. 25: 519–521.
  23. ^ Mickenautsch, Steffen; Yengopal, Veerasamy (2012). "Effect of xylitol versus sorbitol: A quantitative systematic review of clinical trials". International Dental Journal. 62 (4): 175–88. doi:10.1111/j.1875-595X.2011.00113.x. PMID 23016999.
  24. ^ Mickenautsch, Steffen; Yengopal, Veerasamy (2012). "Anticariogenic effect of xylitol versus fluoride - a quantitative systematic review of clinical trials". International Dental Journal. 62 (1): 6–20. doi:10.1111/j.1875-595X.2011.00086.x. PMID 22251032.
  25. ^ Bader, James D.; et al. (Jan 2013). "Results from the Xylitol for Adult Caries Trial (X-ACT)". The Journal of the American Dental Association. 144 (1): 21–30. doi:10.14219/jada.archive.2013.0010. {{cite journal}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  26. ^ Ritter, AV, Bader, JD, Leo, MC, Preisser, JS, Shugars, DA, Vollmer, WM, Amaechi, BT, Holland, JC (June 2013). "Tooth-surface-specific Effects of Xylitol: Randomized Trial Results". Journal of Dental Research. 92 (6): 512–517. doi:10.1177/0022034513487211.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  27. ^ "Can xylitol used in products like sweets, candy, chewing gum and toothpaste help prevent tooth decay in children and adults?". Cochrane. 26 March 2015.
  28. ^ "CITE: 21CFR172.395". Code of Federal Regulations Title 21. United States Food and Drug Administration. 2012-04-01.
  29. ^ Martí, N.; Funes, L.L.; Saura, D.; Micol, V. (July 2008). "An update on alternative sweeteners". International sugar journal. 110 (1315): 425–429. ISSN 0020-8841.
  30. ^ Savola, Päivikki. "Xylitol combats cavities". Advanced food development and functional foods from Finland. Finfood - Finnish Food Information. Archived from the original on April 11, 2008.
  31. ^ Vasilescu, Razvan; Ionescu, A.M.; Mihai, A.; Carniciu, S.; Ionescu-Tirgoviste, C. (2011). "Sweeteners and metabolic diseases: Xylitol as a new player". Proc. Rom. Acad. B. 2: 125–128.
  32. ^ Xi Chen, Zi-Hua Jiang, Sanfeng Chen, and Wensheng Qin. Microbial and Bioconversion Production of D-xylitol and Its Detection and Application. Int J Biol Sci. 2010; 6(7): 834–844. Published online Dec 15, 2010. PMCID: PMC3005349
  33. ^ Azarpazhooh, A; Limeback, H; Lawrence, HP; Shah, PS (Nov 9, 2011). "Xylitol for preventing acute otitis media in children up to 12 years of age". The Cochrane database of systematic reviews (11): CD007095. doi:10.1002/14651858.CD007095.pub2. PMID 22071833.
  34. ^ Jones, A (Summer 2001). "Intranasal Xylitol, Recurrent Otitis Media, and Asthma: Report of Three Cases". Clinical Practice of Alternative Medicine (2): 112–117.
  35. ^ "Xylitol". drugs.com. Retrieved 12 July 2015.
  36. ^ Mattila PT, et al. "Increased bone volume and bone mineral content in xylitol-fed aged rats". Gerontology. 47: 300–5. doi:10.1159/000052818. PMID 11721142.
  37. ^ Sato H, et al. "The effects of oral xylitol administration on bone density in rat femur". Odontology. 99: 28–33. doi:10.1007/s10266-010-0143-2. PMID 21271323.
  38. ^ Mäkinen, KK (1976). "Long-term tolerance of healthy human subjects to high amounts of xylitol and fructose: general and biochemical findings". Internationale Zeitschrift für Vitamin und Ernahrungsforschung Beiheft. 15: 92–104. doi:10.1002/14651858.CD010743. PMID 783060.
  39. ^ a b c Wang, Yeu-Ming; van Eys, Jan (1981). "Nutritional significance of fructose and sugar alcohols". Annual Review of Nutrition. 1: 437–75. doi:10.1146/annurev.nu.01.070181.002253. PMID 6821187.
  40. ^ "Sugar Alcohols" (PDF). Canadian Diabetes Association. May 2005. Archived from the original (PDF) on April 25, 2012. Retrieved March 14, 2012. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  41. ^ Dunayer, Eric K.; Gwaltney-Brant, Sharon M. (October 2006). "Acute hepatic failure and coagulopathy associated with xylitol ingestion in eight dogs". Journal of the American Veterinary Medical Association. 229 (7): 1113–1117. doi:10.2460/javma.229.7.1113. PMID 17014359.
  42. ^ Dunayer, Erik K. (April 2004). "Hypoglycemia following canine ingestion of xylitol-containing gum". Veterinary and human toxicology. 46 (2): 87–88. PMID 15080212.
  43. ^ Dunayer, Erik K. (December 2006). "New findings on the effects of xylitol ingestion in dogs" (PDF). Veterinary Medicine. 101 (12): 791–797. Archived from the original (PDF) on June 17, 2013. Retrieved March 14, 2012. {{cite journal}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  44. ^ Dunayer, Eric K (2004). "Hypoglycemia Following Canine Ingestion of Xylitol-Containing Gum". Vet. Human Toxicol. 46 (2): 87–88.
  45. ^ "Xylitol could kill sugarbirds - and pets". Independent Online. Retrieved 12 July 2015.