Diabetes, Osteoporosis, and Xylitol

Presenter: Drs. Kauko Makinen, Eva Soderling, and John Peldyak

The experts answer a variety of questions: Does xylitol encourage a “sweet tooth”? Are there negative effects associated with chewing xylitol gum? Is xylitol suitable as a sweetener for diabetes? Should one use xylitol before or after meals?

Video Transcription

Q&A Session, Day One:

Is Xylitol suitable as a sweetener for diabetes?

Soderling: I think it’s recommended by doctors because it’s very suitable. It doesn’t elevate the blood sugar levels, so it’s acceptable. The recommendations are about the same for anybody else. If you can get used to using high amounts of xylitol you can use it in cooking, that’s no problem. Also, it has a very low GI, so if you are one of those who want to be on a Montingnac diet, or something corresponding, xylitol is very suitable for that also.

Peldyak: Professor Mäkinen is aware of this research and there is a little bit about the effects of xylitol in this article about the anit-glycation effects of xylitol—that it helps keep our connective tissue younger. It helps prevent forming these complexes between the sugar and the protein that inactivates the structural proteins in our systems.

Mäkinen: Yes, that’s the so-called “protein sparing effective” that the Australians actually were first to discover. Before that, it was discovered in Germany, by physicians and biochemists, that xylitol consumption has this “protein-sparing effect.” By the way, although this is not directly in answer to the question, I just remembered that before we knew anything about it and the dental effects of xylitol, we did know about the diabetic effects, because in the former Soviet Union, xylitol had been used already in the 60s as a diabetic sweetener. Also in Japan—I have references showing that xylitol was used in Japan already in the 60s to resuscitate patients from diabetic comas. But again, our primary recommendation is to prevent caries, and caries-like infections. It’s not a panacea as I have said at least once, but there are indications of other uses of xylitol.

How about Osteoporosis?

Mäkinen: It has not only been suggested in animals studies, but it has been shown that xylitol can prevent osteoporosis, and also the detrimental consequences of diabetes. You can prevent them in experimental animals using xylitol. Also the strength of the bones, long bones, can be increased using xylitol in the diet, as we saw in the experimental animals. There were positive effects on the connective tissue.

Should one Use Xylitol Before or After Meals?

Soderling: When you use xylitol after the meal, you can stop the acid production directly, and then you also get xylitol into the plaque and affecting the bacteria. That is very good. If you use the xylitol gum before a meal, or actually with the meal, you will nullify the whole good effect of xylitol. So xylitol has to be taken after, not within the meal or something. It’s not an antibiotic which would remain in the mouth, so you have to really have it directly after the meal and do not eat anything after that.

Mäkinen: It doesn’t hurt you at all if you have xylitol before; it’s not detrimental to you. In fact, Dr. Soderling herself has shown in the Michigan study that it can be beneficial in some cases to modify dental plaque in advance chemically and microbiologically, to a certain extent, by having xylitol in there. But she’s a very modest person and doesn’t want to speak about her own research. I have often given this advice to Japanese dentists: that if you want to maximize the effects of xylitol, it doesn’t hurt if you use xylitol also before the sweet, before exposure to the sugar, but she is absolutely right that the most important thing is to have xylitol after the meal and after sugary snacks.

I thought that all babies are born germ-free…

Soderling: They are not born germ-free. If they are born the natural way, they are going to get the flora from the mother. So those babies that have been born the natural way, in this birth channel they are going to get some bacteria, which are going to colonize both the mouth and the intestine. Those children who are born with the Caesarean section, they are born in a certain way in a native state, and they don’t get this protective form of normal flora from their mother. They are born, in a certain way, germ-free, and then they get whatever; and they don’t get this. Actually the bacteria, you get by being born the natural way, it’s normal flora, it’s protecting the children. Then for example these mutans streptococci are not going to attack them so easily. There is a very nice study by Lee from 2005 showing that these babies who are born by caesarean section much more easily get this mutans infection from their parents and mothers than those who had been born and are acquiring the normal flora from their mother. That’s for the whole gastrointestinal tract.

Doesn’t the use of Xylitol in children encourage a “sweet tooth”?

Peldyak: You may see the preference for a sweet flavor; sweet taste is innate. There are some new studies on that also, and I believe the University of Washington has been involved in some of those, showing that, no, you’re not going to create a problem by introducing sweet products early on. The preference is already there.

Soderling: I have the same experience, because we did extensive work and consulted experts when we started this pacifier study because we are giving babies a small tablet of xylitol from when they are one month old already. We wanted to be sure that they are not going to be like any sugar addict when they are old. So we have done extensive work on this and it’s really innate as Dr. Peldyak said. There’s really no problem here.

It has been studied in physiological studies that when you give to babies, you give sour things, and you give acidic things, and then you give something sweet, and they at once feel that it is a good thing, so that is innate.

Are there any negative effects associated with the chewing of gum?

Soderling: There are actually studies showing that by chewing gum after dinner, if you have problems with the contents of your stomach coming up, so that it’s forming a foam—a saliva foam on the content, so it actually has been recommended in some cases. The only problem is if you have DNT problems, or if you have problems with periodontal diseases, so then you would choose tablets, and not chew gum. So you have to have alternative products. I have not seen any reports on recommended chewing, like three times, five minutes per day, that that could have any negative effects.

Mäkinen: Chewing gum may be a result of pop culture, and some people are arguing that it’s an environmental problem, because people tend to put the used gum everywhere. A Japanese company has launched a jar of chewing gum that has inside the jar a small pad of paper sheets, in which you can rip the used gum and dispose of it properly.

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Diabetes, Osteoporosis, and Xylitol
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