Is Erythritol Really All That?

erythritolYou hear a lot about xylitol and how it may help keep your teeth healthy, but lately, another sugar alcohol has been put forth as dentistry’s “new best friend”: erythritol.

It has nearly zero calories (0.2 calories per gram); does not raise plasma glucose, or insulin levels; is non-cariogenic; and is easy to digest. More than 90% of erythritol is absorbed in the small intestine, so minimal amounts reach the colon where some sugar alcohols can cause bloating, gas, or diarrhea. Erythritol is heat stable, so it can be used in food preparation.

And that’s not all. According to research published in Molecular Oral Microbiology, it seems to prevent the build-up of oral biofilm – the bacterial colonies that cause decay, more popularly known as plaque.

Another study looked at the effects of both xylitol and erythritol on caries prevention in children. For three years, nearly 500 children ate four xylitol, erythritol or sorbitol candies three times a day. Erythritol clearly outperformed the other two sweeteners in this double-blind, randomized study. Not only did the children consuming erythritol have significantly less decay, but the decay that did develop took considerably longer to form.

This confirmed the findings of a similar 2013 study in the Journal of Dentistry:

Three-year consumption of erythritol-containing candies by initially 7- to 8-year old children was associated with reduced plaque growth, lower levels of plaque acetic acid and propionic acid, and reduced oral counts of mutans streptococci compared with the consumption of xylitol or sorbitol candies.

However, a 2012 study found no effect on caries prevention, leading the authors to conclude that the lozenges would have no additional benefit “when compared with comprehensive prevention.”

Although erythritol does occur naturally in some plants and fermented foods, much more is added to food products. Industry produces 16,000 to 18,000 tons each year for use in chewing gum, pudding, condiments, cookies, and – especially – sodas (59% of all erythritol manufactured). It is also blended with stevia leaf extract and flavorings to make the consumer sugar substitute Truvia.

And, of course, when you consume such hyper-processed products, you’re usually getting a whole lot more than just erythritol. It’s unreal food, and beyond brushing and flossing, eating real food is the number one thing you can do to maintain a naturally healthy smile.

For 8 more things you can do, read on…

Previously

And the Current Verdict on Xylitol Is…

xylitol gum packetsOver the past few years, there’s been a lot of hype about xylitol – an artificial sweetener believed to prevent cavities. But as we’ve seen, research supporting that claim has been mixed at best. There’s seemed to be some benefit, but moderate and limited.

Now a new study in Cochrane Reviews has more clearly shown that, at present, there really isn’t much good evidence to justify the xylitol hype.

The authors analyzed results from 10 studies involving nearly 6000 subjects. The xylitol products ranged from lozenges to syrup to toothpaste and wipes. The only real positive evidence they found was for xylitol toothpaste, which was found to be more effective than a control product, with no adverse effects.

But overall, they found the evidence low quality and very limited.

One particularly glaring problem was that 7 of the 10 studies considered – including the toothpaste studies – were deemed “highly biased.” As for the rest?

The remaining evidence we found 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.

If there’s one thing this study makes clear, it’s that more and better research needs to be done.

That said, it’s also a fact that xylitol is hardly a necessity for your teeth. Like herbal and other specialized hygiene products, it may support good oral health. It doesn’t create it. That comes most from a healthful diet – with minimal added sugars and other hyper-processed carbs and starches – and optimal hygiene, including brushing, flossing.

Keep in mind, though: Some dental situations – such as bruxing and chronic dry mouth – can raise your risk of caries (tooth decay). In those cases, your dentist can help you successfully deal with those to keep your risk low.

Gummy Bears, Teeth & the Fine Print

Check out this list from an article on “6 Fortifying Foods to Boost Oral Health”:

  1. Cheese
  2. Black coffee
  3. Gummy bears
  4. Red wine
  5. Steak
  6. Green and/or black tea

How could gummy bears possibly make this list?

Well, the study cited in support of this food is legit. But it didn’t look at just any old gummy bears. It looked at gummy bears sweetened with xylitol – a sugar alcohol that has anti-cariogenic (cavity-causing) properties. Its authors found that such gummies reduced plaque and oral pathogens (bad bacteria) over a 6 week period.

But despite the list-maker’s claim, xylitol is not “one of the main ingredients in the pre-packaged snacks.” For instance, take a look at the ingredients list for Haribo Gold-Bears, the original Gummi Bear:

Corn Syrup, Sugar, Gelatin, Dextrose, Citric Acid, Corn Starch, Artificial and Natural Flavors, Fractionated Coconut Oil, Carnauba Wax, Beeswax Coating, Artificial Colors Yellow 5, Red 40, Blue 1

gummy bearsThree of the four most prevalent ingredients are sugars. Not a bit of xylitol to be seen. The case is similar for other major brands, such as Black Forest, in which corn syrup and sugar again play the starting roles. (And while it’s true that they’re “made with real fruit juice,” just as it says on the front of the package, this is actually just another form of sugar.)

Suffice it to say, these sweets aren’t so hot for your teeth. Not only are they mostly sugar, but they easily get stuck between teeth, giving oral pathogens more time to feed on those sugars and do their damage.

As for the sugarless variety of gummy bears made by Haribo, even they are not sweetened with xylitol but a substance called lycasin – a hydrogenated syrup that’s mostly maltiol, a different sugar alcohol. As Olga Khazan wrote earlier this year at the Atlantic,

Maltitol is great because it doesn’t cause cavities, but not so great because our bodies can’t fully digest it, so it can ferment in the gut. The known side effects of the excessive consumption of lycasin are bloating, flatulence, loose stools, and borborygmi, the scientific term for tummy-rumbling.

Though the substance is considered safe to eat, in clinical studies, adults who consumed 40 grams of lycasin saw an increased frequency of bowel movements and “watery feces.” The gummy bears in question come in bags of 5 pounds, otherwise known as 2,267 grams, otherwise known as a world of hurt.

Keep in mind the Snackwell effect – how people will offset any benefit of “diet” foods by eating lots more of them than they otherwise would – and you can see the potential for disaster.

Image by peddhapati

When It Comes to Preventing Cavities, Is Xylitol Really All That?

xylitolXylitol – a sugar alcohol that may actually help fight tooth decay – isn’t quite the silver bullet some have touted it to be.

Though a recent study found some positive results in using xylitol lozenges, there’s not too much to write home about. Following up on earlier research, this study aimed to see if xylitol had different effects on different tooth surfaces (e.g., the biting surface, roots and so on).

Participants in the xylitol arm developed 40% fewer root caries lesions…[but] there was no statistically significant difference between xylitol and control participants in the incidence of smooth-surface caries, occlusal-surface caries, or proximal-surface caries. (emphasis added)

cariesCommon in older adults, root caries (“caries” is the clinical term for cavities) involves decay on exposed root, where gum tissue has receded due to brushing too hard or too much, chronic bruxing (clenching and grinding) or other factors. That sucking xylitol lozenges helps prevent them is a good thing: 40% is significant, and it certainly wouldn’t hurt to use them as an adjunct to regular brushing and flossing.

Then again, we might ask: Is it really the xylitol? Studies of xylitol-sweetened gum have suggested that saliva may actually make the difference. As a paper published in Community Dentistry and Oral Epidemiology put it, “The results indicate that the caries preventive effect of chewing sugar-free gum is related to the chewing process itself.”

Why saliva? It has several roles in preventing caries:

buffering capability; the ability. . .to wash the tooth surface, to clear bacteria, and to control demineralization and mineralization; saliva’s antibacterial activities; and perhaps other mechanisms all contribute to its essential role in the health of teeth.

Clearly, promoting saliva is beneficial to your oral health, and both chewing and sucking increase its flow.

There’s also an inherent danger in exalting any one substance as beneficial. We may misread the claims and see that product as a quick fix or a viable alternative to the tools we know will help us stay healthy. We can’t fall victim to the “health halo” effect and assume all things xylitol will be good for our teeth.

Also keep in mind that xylitol is a sugar alternative, so may sustain our natural preference for sweets. Feeding it may only beget eating more sugar and sweeteners of all kinds. Sugar, in turn, may encourage us to eat more food beyond overall because, in the words of one research paper, “chronic consumption of sugar blunts activity of pathways that mediate satiety.”

Xylitol lozenges or gum alone are just not enough to prevent caries. Even pro-xylitol dentists believe you need to practice good oral hygiene to maintain good oral health. Instead of looking for a panacea, just hang on to that toothbrush, toothpaste, and floss – and use them! Regularly!

Xylitol image by HeatherMG, via Flickr;
caries illustration by Nerdture, via Wikimedia Commons