Xylitol Side Effects: Safe or Dangerous?

December 5, 2017
Xylitol side effects - Dr. Axe

If reading food labels is part of your shopping experience, you’ve probably seen the ingredient “xylitol” coming up more and more the past couple years. Reported by most manufactures as being “all natural,” few suspect it’s anything but healthy. Unfortunately, natural doesn’t always mean “non-toxic.”

To make matter worse, the reports on the Internet have been anything but clear, and people ask me quite regularly about whether xylitol has been proven dangerous or beneficial to our health. So I have researched the xylitol side effects to find out whether this artificial sweetener is really safe or not.

In reality, there is no simple answer, and after careful research, I have come to the following conclusion: Using xylitol may be beneficial for oral health, although it’s not safe for consumption in large amounts. 

Why? The key lies in understanding what xylitol is.

What Is Xylitol?

Xylitol is a sugar alcohol, which is a low-digestible carbohydrate that resists starches and includes fiber. Recently gaining ground in many health circles because of the claim that sugar alcohols are “natural,” other varieties you’ve probably seen in the stores include:

  • Erythritol
  • Isomalt
  • Lactitol
  • Maltitol
  • Mannitol
  • Sorbitol

Considered a crystalline alcohol, xylitol is actually a derivative of xylose — a crystalline aldose sugar that is not digestible. Xylose, not xylitol, is naturally found in nature as it is mostly obtained from birch bark. Yet, just because something is “natural” doesn’t mean that it is good for you. I stress this because, ever since research conducted in the 1950s, it has been known that: (1)

  • Single-stomach animals are unable to properly metabolize xylose.
  • People who eat foods with xylose tend to experience digestive issues like gas, bloating and diarrhea.
  • Liver evaluation suggests that xylose gets stored in the body.

When foods that are eaten are normally digested, nutrients, like vitamins and minerals, are absorbed into the bloodstream in the small intestine. However, when chemical compounds like xylitol are consumed, the body cannot utilize them so they travel through your GI tract relatively unscathed.

Sometimes, these chemicals can react with the other foods that you eat, the enzymes that your pancreas produces or other “gastric juices” and cause complications. In the case of xylitol, this is generally experienced as gastrointestinal disturbances.

In spite of the research conducted since last century, I believe that this statement from a 1952 article published in the Journal of Nutrition still rings true: (2)

Pending more favorable experimental data at lower levels of intake, it is deemed inadvisable to risk the incorporation of xylose in foods at any level of intake for extended periods of time.

Are Xylitol Side Effects Dangerous?

Xylitol poisoning is relatively unheard of in humans, and the xylitol side effects associated with consuming it are generally minimal for most people. However, it has been reported that xylitol can raise blood glucose levels, which suggests that diabetics shouldn’t consume it. (3) This may seem odd to most people as many doctors recommend that people use it to replace sugar because it’s low on the glycemic index.

Another concern that I have with xylitol is the industrialization process that is used to manufacture it. Currently, most xylitol is produced by “hydrogenating” xylose, a chemical process that treats a compound with hydrogen usually with a catalyst, such as nickel. There are two major problems with this process.

First, the fact that xylitol is “hydrogenated” should raise some concerns because hydrogenated foods are known to cause:

  • Alzheimer’s disease
  • Behavioral irritability and aggression
  • Cancer
  • Diabetes
  • Obesity
  • Liver dysfunction
  • Major depressive disorder

Secondly, nickel is a known toxin has been linked to: (4, 5)

  • Asthma attacks
  • Cancer
  • Dermatitis (skin allergies)
  • Hand eczema (skin rash)
  • Indigestion
  • Kidney problems
  • Lung disorders

At this point, there is no research proving that chewing xylitol-sweetened gum or eating xylitol-sweetened cookies will cause these things, but I’d be careful before diving in and making xylitol part of your daily natural health regimen.


Xylitol side effects - Dr. Axe


A Special Warning to Pet Owners

On a very important side note, for all of my friends out there with pets, xylitol side effects are very toxic to pets. In fact, “xylitol is extremely toxic to dogs,” according to VCA Animal Hospitals. (6) For instance:

  • One animal poison control organization in Minneapolis received more than 1,500 calls for xylitol poisoning.
  • When non-primate species eat xylitol, it’s absorbed into the bloodstream quickly and releases a potent amount of insulin rom the pancreas.
  • “This rapid release of insulin results in a rapid and profound decrease in the level of blood sugar (hypoglycemia), an effect that occurs within 10–60 minutes of eating the xylitol. Untreated, this hypoglycemia can be life threatening.”

Be sure to read your pet’s food labels, and never feed pets your table scraps if they have xylitol in them.

Xylitol Side Effects

The reason sugar alcohols like xylitol are not recommended for human consumption is because of the twofold metabolic xylitol side effects that burden the body and lead to weight gain:

  1. First, because the body cannot digest them properly, the non-metabolized portion ferments and creates a favorable environment for harmful bacteria to colonize. Exacerbating yeast problems, many people will also experience constipation, gas/bloating and diarrhea. (7)
  2. Second, as with all toxins, because the body cannot digest them sufficiently, precious metabolic resources are wasted in an attempt to clear it out of your digestive system and can thus cause unwanted weight gain.

According to one report, the key to the xylitol side effects is in its dosage. Xylitol side effects when exceeding 40–50 grams per day include: (8)

  • nausea
  • bloating
  • borborygmi (rumbling sounds of gas moving through the intestine)
  • colic
  • diarrhea
  • increased bowel movements

Next to minor GI complaints, weight gain is the most heavily researched side effect to consuming xylitol and other artificial sweeteners. In addition to the metabolic burden they place on the body, there is a psychosocial aspect that cannot be ignored. According to Harvard Medical School experts, “Research raises concern that they may do just the opposite and actually promote weight gain. How so? [Alternative] sweeteners are extremely sweet — hundreds to thousands of times sweeter than table sugar.” (9)

What happens is people who consume sweeteners habitually become desensitized to sweetness so much so that unsweetened, healthy foods become unappetizing. This can lead to a less healthy diet, avoiding foods that provide satiety and instead filling up on empty, unhealthy calories from sweetened products. The experts go on:

In addition, some research has identified sweetness receptors in fat tissue. We don’t know for sure, but that raises the possibility that [alternative] sweeteners could cause weight gain by directly stimulating the development of new fat cells.

There’s also some epidemiologic evidence of a correlation between [alternative] sweetener consumption and obesity, but it should be interpreted cautiously. People might consume [alternative] sweeteners because they’ve gained weight, not the other way around.

Xylitol Benefits

One of the beneficial xylitol side effects seems to be its ability to improve oral health. This appears to be widely held by most health care professionals. In fact, the dental community is one of its biggest supports because of xylitol’s reported ability to prevent cavities.

For example, according to a study published in the Journal of Dental Education, “The replacement of sucrose with sorbitol and xylitol may significantly decrease the incidence of dental caries.” (10)

A 2009 article published in the European Journal of Dentistry provides some details as to why: (11)

Xylitol has beneficial effects on the oral flora not shared by other polyols. The evidence so far supports specific xylitol-effects on oral bacteria, but not on saliva. Xylitol cannot be metabolized by plaque bacteria, contrary to sorbitol and other 6-carbon polyols, and may thus favor mineralization.

Interesting, there are conflicting reports, and we cannot jump to the conclusion that xylitol is completely effective at keeping cavities at bay. In the words of a frequently cited review in the journal Caries Research, “There is no evidence for a caries-therapeutic effect of xylitol,” which makes us wonder what side of the coin to believe. (12)

In my opinion, xylitol is relatively safe as a toothpaste or chewing gum sweetener, but it’s not recommended in large amounts for foods.

Xylitol vs. Stevia + Xylitol Alternatives

While the message is a little cloudy about the xylitol side effects, of the 345+ scientific papers referencing stevia, one message is clear: It is safe and effective. (13) As stated in the most recent critical evaluation, stevia “has a low glycemic index and, in the doses tested, is not cytotoxic nor has acute or chronic effect on blood sugar, which makes it a safe sweetener.” (14)

However, in spite of being a natural herb, not all stevia products on the shelves are created equal. In fact, in some of the more inferior brands, what they advertise as stevia isn’t even 100 percent stevia. It is cut with xylitol and disease-causing fillers like dextrose and sugar.

Most people do well with stevia, but listen to your body because stevia is an herb and everyone’s body may react differently to it. If you can’t get over its savory (almost tangy) flavor, however, some other natural sweeteners you may want to try are:

  1. Raw local honey (my personal favorite!)
  2. Dates
  3. Coconut nectar/sugar
  4. Grade B or C maple syrup


Xylitol alternatives - Dr. Axe


A good of thumb is that if it sounds too good to be true, then it probably is. If you want to satisfy your sweet tooth, include the herb stevia as a wonder alternative to sugar. It can easily be used in all of your deserts and drinks. It tastes great, has zero calories and is as natural as it gets.

Final Thoughts on Xylitol Side Effects

  • Xylitol is a sugar alcohol, which is a low-digestible carbohydrate that resists starches and includes fiber.
  • It has been reported that xylitol can raise blood glucose levels, which suggests that diabetics shouldn’t consume it.
  • Xylitol side effects also include constipation, gas, bloating, diarrhea, nausea, borborygmi, colic, increased bowel movements and weight gain.
  • Health care professionals do recommend xylitol for its oral health benefits, and research shows it does have the ability to prevent cavities.
  • In my opinion, xylitol is relatively safe as a toothpaste or chewing gum sweetener, but it’s not recommended in large amounts for foods.
  • Instead of xylitol, use natural sweeteners like stevia, raw honey, dates, coconut nectar, coconut sugar and maple syrup.

Read Next: Erythritol: The Good, the Bad & the Ugly with This Common Sweetener

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  1. Fernando A. on

    I have tried stevia in my coffee and smoothies but it tasted very bitter. I then switched to xylitol and it not only tasted much better than stevia but it resulted in me losing approx 8-9 lbs of excess weight around my midsection. Xylitol is also less expensive than stevia and is also made from plant fiber. I can’t say enough good things about xylitol. I agree than no sweetener should be consumed in large quantities but if you must use a sweetener then xylitol is the best bet for me.

  2. Sarah on

    Thank you, Dr. Axe for your research! This article is extremely helpful – everything is in one place. I’m not a fan of xylitol. :) I try to stay away from having the need for sweet all the time. My favorite sweeteners are stevia and raw honey. I enjoy low glycemic fruits sometimes. Thanks again for the article!

  3. Mary Earle on

    Thanks for the great information! I use Stevia in my one cup of coffee and a couple salad dressings that I make. I purchase 100% pure organic stevia from Trader Joes, but it is white, so it has to be processed in some way. My question, ok to use or should it be green, since it is a leaf! I am amazed at how they market it. Stevia in the raw, pure stevia, etc. but especially if it’s in a packet the first ingredient is never stevia. LOL I always tell people if the first and only ingredient isn’t stevia, well then it isn’t stevia! When my sweet tooth needs a little something, my go to is a frozen date, it is like eating a chewy candy!!

  4. Lisa on

    Thanks so much for that info because I have been on the Fast Metabolism diet that suggests using xylitol in place of real stevia. It isn’t that easy to find so I have just been using stevia. I never really even knew all of this about xylitol.

  5. Dina on

    Hi Dr. Axe,

    I’m a big fan of Swerve sweetener. It’s natural, non-GMO, made in the U.S.A, non-glycemic, measures cup for cup like sugar, and is derived from and occurs naturally in fruits and other foods. I wrote a blog post on all things sweet awhile back covering some of the same information. Check it out, I would love your feedback..
    I also use raw honey and coconut sugar from time to time because they’re easier to find and I’m a big fan of honey. I have weight to lose still, almost 100lbs down now and about 100 more to go. So I opt for low-glycemic more often than not. I love your site, posts, and tips!

  6. Val on

    I’m a muscle tester and zylitol tests well for the body as a whole, but if you zero in on the liver it does not test well. Stevia is a great choice but changes the receipe when you exchange it for sugar. It’s all about trial and error with cooking. The other natural sugars are great for most people unless they are fighting a disease process, and then a single blueberry can change the chemistry of the body. As a nutritional therapist practitioner, I give my clients supplements to change their bodies chemistry, but again a single blueberry can throw off the chemistry.

  7. Nora on

    I agree with your choice of more natural sweetners sych as coconut sugar etc. But I also know that sugar feeds cancer. Do you have a recommendation, a happy medium. Realistically there is no way to eliminate sugar 100 percent. I struggle with this so I am hoping you can make recommendation.

  8. Michelle on

    I could sure use your help! My 14yo has Tourette’s, allergic to many foods (beef corn dairy eggs gluten yeast wheat and 3 molds) an has candida do must stay away from all fermented foods and sugars (even honey & maple syrup) therefore I started using xylitol for baking so that he didn’t feel so deprived. I’m at a loss! I was using ACV for health benefits but he’s not supposed to vinegar, I was using honey as sweetner (knowing many benefits)…I’m in sucha state of confusion :/

  9. Irene Schallock on

    I’m very thankful that someone is researching this that knows where and how to get the information and share it with everyone else. I have been a gum chewer my whole life. With all of the artificial sweeteners and chemical additives that are in the gum available at the grocery store I have been ordering gum on line and the sweetener of choice is xylitol. Are there any other alternatives available that you would consider safe? Thanks again for all you do!

  10. Sharvani on

    I have been making my own toothpaste for a long time and xylitol is a main ingredient. I just want to be sure that the consensus is it is okay to use twice daily for oral health. I tried it once to sweeten my coffee and definitely didn’t do it again. Yuck!

  11. Linda Stoner on

    I’m so glad you are addressing this subject Dr. Axe. I prefer stevia, unadulterated, which I began using during a trip to Peru some years ago. The Peruvians also say that stevia as an herb has healthful properties as well as being a sweetener. I am distressed by companies who are putting “stevia” products on the market which are cut with other, undesirable chemicals, which proves we really do need to read labels and understand what we are reading. I am also a big fan of coconut sugar, which has a very nice flavor. I recently had a woman who is severely diabetic INSIST that agave syrup was a wonderful sweetener for people with her condition, and would you please comment on this? My impression is that agave syrup does raise the blood glucose level, but I would love to have your opinion on this. Thanks for all your work in keeping us healthy!

  12. Billie Sue on

    What stevia product, by name is recommended?? There’s so many out there & the one I picked up recently has such a bad aftertaste … Thank you :)

  13. dusty on

    One other area not covered in your research is xylitol’s use in the treatment of sinus infections. It is in many nasal sprays and neti pot remedies. It has been shown to shrink back the sinus membrane which is an effective treatment for cold and sinus infections. I don’t see any indication of harm from this use either. Your thoughts?

      • Kathryn Schultz on

        Thanks so much for addressing this aspect of xylitol’s benefits. I use both Xlear nasal spray and xylitol gum, but I don’t think I ingest enough xylitol to cause intestinal problems. I especially find the Xlear nasal spray helpful for relieving dry nasal membranes. I have read that xylitol reduces the ability of bacteria and viruses to adhere to nasal membranes. Do you have any research confirming or disproving this claim?

  14. Diana on

    Hi Dr. Axe,

    Thank you for this article. I’m currently using Grants Xylitol Natural Mouthwash (Alcohol Free). Xylitol is one of the ingredients along with Water, Glycerin (vegetable), Aloe Barbadensis Leaf Juice (Certified Organic), Polysorbate 20, Stevioside, Mentha Viridis (Spearmint) Leaf Oil, Menthol, Citric Acid, Cetylpyridinium Chloride, Natural Flavour (contains extracts of: Mint Oil, Eucalyptus Oil, Cardamom, Celery, Caraway, Coriander, Dill, Thyme, Rosemary, Sage). Should I avoid this as well? Thank you.

  15. Nancy on

    I use xylitol and really like it. My sweet tooth is slowly going away. I like that it can be used equally in place of sugar. Eating too much does cause gasiness. I have lost almost 40 pounds in the last year using it. My blood sugar levels are always right on as well

  16. Steph W on

    Thank you so much for the great research and info. I use xilitol in my daily coffee and “skinny” chocolate and I wonder if you could give a recommendation on what is a “safe” daily amount to ingest and what would be deemed “unsafe” in quantity on a daily basis? Thanks!

  17. Dian Pope on

    Eating health today is very challenging! Would you recommend the natural raw honey over say stevia or xylitol. I am fighting weight and raised insulin levels. I only use it in my 1-2 cups of coffee on weekends. So, not that much. I love honey in my coffee but switched because I thought xylitol was suppose to be better. Thoughts and thank you so very much. Dian

  18. Rachel Kelly-Hall on

    There was a study done on Stevia which was fed to mice in large doses. It affected the fertility in mice, so I rarely use it any more. Probably a good idea to stick to the unprocessed sweetners. We are way over marketed in this day and age. Back to basics.

  19. Karen on

    I absolutely cannot stand the taste or aftertaste of stevia! I know that you recommend honey as a natural sweetener. But I have diabetes (which I do not treat with insulin), so raw honey might endanger my blood sugar levels. I also suffer from Candida, which would be presumably exacerbated by honey. I have been using Erythritol as a sweetener, mostly in a cup of tea or mixing with my daily dose of goat yogurt. In my case, do you think switching from Erythritol to honey is a wise choice?

  20. Stephenie on

    Thank you for this article. I use xylitol in my morning coffee as well as my chocolate recipe. So I’m wondering if you could give some quantities that you believe would define the “safe or unsafe” amount for a daily intake. Thanks!

  21. sherry on

    Hi, and thank you for your informative article on xylitol. I have been using xylitol for 2 or 3 months now and have gained weight (I use no other sweeteners, eat chicken or fish daily, enjoy a serving of nuts, eat raw vegies and consume almost no fruits). Now, I know why I have gained weight. I will STOP consuming xylitol and see what happens. I think your right, it is not as safe as it is concocted up to be! I am thankful I found your helpful and knowledgeable information on this subject. You opened up my eyes.
    Thank you, Sherry
    Wichita Falls, TX

  22. Kristen on

    I see Xyllitol as an ingredient in a nasal spray that I am using. What is the purpose of this and is it effective?

  23. Charlotte on

    Ok, so I have your cookbook and some recipies call for Xylitol…what gives? Why publish recipes with it if it’s bad for you?

    • Dr. Josh Axe on

      It effects everyone differently, but is not good for those with digestive issues. The book was written 4 years ago, I would simply take out the xylitol and replace it with raw honey instead.

  24. Shar on

    I am using the Trim Healthy Mama brand of Stevia extract, but was considering the “Sweet Blend” which contains Stevia & Erythritol, to use in baked goods. What do you think of that product?

  25. LuSinda on

    Several years ago I started using Xylitol and was shocked to learn it was made from corn husks. I phoned the company and got an uncertain reply from them which lead me to believe they were using GMO corn.
    I tried to get it made from hardwood trees which was not possible in Canada and could not import it from the US.

    Now Xyla is made from Canadian hardwood trees.
    My experience with this product was that it helped immensely with dry mouth. I use it is very small quantities and it seems to be useful.

    I had rather high blood sugar (borderline Diabetic) and switched to coconut sugar. My blood sugar is in the ideal range. For me I feel palm sugar (coconut sugar) is the safest for me.

    MY latest bout of high blood sugar (and high blood pressure) came from eating home made gluten-free bread. My pH level shot down to pH 4.5 worse than vinegar and slightly better than the tap water in Toronto, Ontario, Canada.
    I am now researching recipes that are healthy and gluten-free for breads, crackers and waffles.

  26. Ginny McPhail on

    Do you ship Dr. Axe products (i.e. Whey protein products) to CANADA?
    THANK YOU! I receive Dr. Axe newsletter daily as a result of watching Dr. Oz.

  27. Christine on

    Thank you for this information. My kids and I chew Spry just about every day. I have been using it to deter cavities after school, until they can brush. Is this likely too much consumption? What do you chew, Dr. Axe?

  28. Lon Jones on

    Your take on xylitol is out of date. You ignore its ability to inhibit bacterial adherence. Researchers in Brazil (Ferreira, da Silva et al, PMID 25483720) argue that xylitol may be a partial solution to our problem of antibiotic resistance.
    While it does cause GI problems if too much is used that issue is indeed universal; everything is toxic in excess. It works in the GI tract exactly like sorbitol, which is the most common remedy prescribed by hospice care workers for constipation. The only problem is that one does learn to metabolize xylitol so you need increasing doses that make it harder to play with.
    Xylose you also misunderstand. It is plant sugar; what glucose is to the animal kingdom xylose is to plants. It is also one of the sugars involved in our immune complexes–those sugars and sugar complexes tied on to the proteins on our cell surfaces that are used to signal the proper interactions and or adherence. It is not foreign and is not toxic in moderation.
    You are fearful that the enzymatic reaction using nickel gets into the xylitol? The definition of an enzyme is something that promotes a reaction WITHOUT changing itself or becoming a part of the reaction. There is no nickel in xylitol.
    Please don’t ignore the decades of research showing how, why and when best used xylitol prevents tooth decay. While it doesn’t heal a cavity it does prevent them and you need to emphasize that rather than rely on the judgment of someone writing before any of the dental research even began. And if you do really like the old wisdom why not accept the GRAS (generally recognized as safe) label that comes from the same time?

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