Alternative Medicine Cabinet—Sugar With Attitude

By Sara Altshul

It’s an ancient battle—humans versus disease-causing bacteria. Until the mid-1940s, the germs had the edge: Bacterial illnesses like pneumonia were frequently fatal. When researchers discovered how to mass-produce penicillin and other antibiotics after World War II, we smugly thought we’d won the war.

But you can’t turn your back on bacteria. Insidiously, the germs mutated to create defenses against antibiotics—80 percent of Staphylococcus aureus strains, which are responsible for toxic shock syndrome and other infections, became penicillin-resistant. Mycobacterium tuberculosis, the tuberculosis germ, now resists streptomycin, formerly a gold- standard TB treatment.

“The more antibiotics we use, the more problems we have with resistant bacteria,” says A.H. ‘Lon’ Jones, DO, retired clinical assistant professor of family medicine at Texas Tech University Medical School, Hale Center, Texas. “We need other options.”

Defeating dental caries

Enter xylitol. Rather than attacking germs, this natural sugar alcohol appears to interfere with germs’ ability to stick to tooth or cellular surfaces where they form colonies that cause disease. Xylitol’s ability to prevent tooth decay is very well established, and evidence mounts for its role in fighting ear and sinus infections. Given the way it works, xylitol presents an elegant solution to pathology. Instead of killing disease-promoting bacteria, xylitol may enable us to peacefully coexist with them, suggests Luc Trahan, PhD, a xylitol researcher at Université Laval in Québec, Canada.

Here’s how. Streptococccus mutans, a mouth-dwelling, cavity-promoting bacterium, metabolizes sucrose—common sugar—and excretes lactic acid. Through that process it creates an acidic environment that dissolves tooth enamel, opening the door to tooth decay. But dental plaque bacteria cannot digest xylitol. Instead, the xylitol accumulates within their cells as xylitol phosphate and prevents the bacteria from growing. Then, says Trahan, regular exposure to xylitol may actually select natural mutant colonies of harmless bacteria that “crowd out” the decay-causing bacteria.

Since 1970, more than 300 studies have proven xylitol’s ability to decrease cavities. When 10-year-old Estonian children were given xylitol gum or candy three times each schoolday (for a total of 5 grams per day), the number of cavities they developed dropped by 33 to 59 percent after three years. In a Finnish study, chewing xylitol gum between meals reduced cavities in teenagers by 30 to 60 percent. In Belize, where children eat lots of sugary treats and have sky-high cavity rates, not only did children who chewed 100 percent xylitol gum have 27 percent fewer pre-cavity lesions become cavities, the surfaces of their teeth actually hardened again. When the children’s permanent teeth came in, the rate of cavities plummeted by up to 90 percent.

And what’s more astonishing, the protection may even begin before birth. In Scandinavian studies, the babies of mothers who chewed xylitol gum during their pregnancies tended to have significantly fewer cavity-promoting
bacteria in their mouths.

Xylitol toothpaste, chewing gums, and mints are widely available—look for products that contain 100 percent xylitol as the sweetener. Studies have shown that using at least 6 grams of xylitol a day helps to reduce cavities, notes Peter Milgrom, DDS, a professor in the department of Dental Public Health Sciences at the University of Washington, Seattle, in the document he’s coauthoring for the California Dental Association.

But amid all this good news, Kiet A. Ly, MD, a researcher currently studying xylitol at Seattle’s Northwest/Alaska Center to Reduce Oral Health Disparities, offers this caution: “Although more and more products are being produced with xylitol . . . studies do not show that the small amounts of xylitol found in some of these products . . . are in high enough concentration to reduce cavities.” Ly explains that chewing one to two pieces of some xylitol-infused gums—currently the most popular way of delivering xylitol—three to five times a day can supply enough of the compound to be effective if the gum contains about 1 gram of xylitol per piece. That amount should put xylitol first on the ingredient list.

Preventing ear and sinus infections

If you’re a parent, no doubt you’ve dealt with kids’ ear infections. Known medically as acute otitis media, ear infections are the most common childhood illness in America for which antibiotics are prescribed. Despite frequent warnings that using too many antibiotics will produce resistant strains of bacteria, doctors still wrote 802 antibiotic prescriptions for every 1,000 children they treated for ear infections in 2000, according to a clinical practice guideline issued by the American Academy of Pediatrics.

Obviously the condition demands attention. Children who get recurrent ear infections may experience learning problems and may need surgery—and it’s not just the kids who suffer. A course of antibiotics can be pricey—ranging from $10 to $100. And don’t forget the time you lose from work, not to mention the unsettling experience of waking in the middle of the night to hear your child cry out in pain.

The pathogens that cause children’s ear infections include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis—all of which are now antibiotic-resistant to some degree. As a result, many researchers are focusing on preventing infections in the first place—and that’s where xylitol
enters the picture.

The studies about xylitol’s ability to reduce cavities intrigued Lon Jones, now also retired from his small-town family medical practice. Linking ear infections, asthma, sinusitis, and allergies to “faulty hygiene” in the nasal passages, which allows bacteria to colonize and trigger infection, Jones reasoned that “washing” with a xylitol nasal spray could prevent the bacteria from gaining a foothold, just as xylitol prevents bacteria from adhering to teeth and gums.

To test his hypothesis, Jones created a xylitol nasal spray and began using it on his patients. After a story about a baby he’d successfully treated for ear infections appeared in the local paper, his office was soon full of ailing kids. Jones followed 10 of these children to see how well his nasal spray treatment worked. The parents reported that their kids had a total of 43 ear infections in the five months before seeing him. During Jones’ 11-month follow-up, the parents reported just seven infections—three of which occurred in one child, and three more in children who experienced an interruption in the use of the spray.

Clinical trials also support xylitol’s ability to quell ear infections. When children chew xylitol gum five times a day, they develop 36 to 42 percent fewer ear infections, note Benjamin Cable, MD, and Richard J. H. Smith, MD, authors of “Acute Otitis Media: New Approaches to a Common Problem,” for Virtual Children’s Hospital at the University of Iowa.

Finally, though more research is needed, xylitol looks like a promising treatment for sinusitis, too. “The evidence is fairly convincing that xylitol is effective for treating ear infections, so it seems likely that it could be a treatment for sinusitis,” says Betsy Blazek-O’Neill, MD, medical director of the Integrated Medicine Program at Allegheny General Hospital in Pittsburgh. In studies conducted on rabbits, xylitol “deactivated” bacteria in the sinuses, Blazek-O’Neill notes.

Is osteoporosis next?

If women’s bones react to xylitol the way rats’ bones do, then xylitol could become a useful strategy in preventing the condition, says Pauli Mattila, PhD, of the Institute of Dentistry at Oulu University in Oulu, Finland.

For more than 10 years, Mattila and his colleagues have studied the effects of xylitol on bone loss. They’ve learned that adding xylitol to rats’ diets increases the intestinal absorption of calcium. As a result, the levels of calcium and phosphorus in the rats’ bones increase as well—which protects bones from weakening, prevents the loss of bone minerals, and inhibits osteoporotic changes. “The results from the animal studies have been extremely promising, and I think it would be useful to further study the effects of xylitol in preventing osteoporosis,” says Mattila.

Xylitol’s promise almost sounds too good to be true. Can something this sweet actually be a boon to our health? The evidence continues to mount: Xylitol may actually be one sweet treat you—and your children—can indulge in without feeling guilty.

Xylitol 101

• A natural sugar alcohol, xylitol is neither a true sugar nor an alcohol. With a chemical structure that’s similar to both, it belongs to a family of low-calorie, carbohydrate-based sweeteners called polyols. Xylitol occurs naturally in fruits and vegetables like strawberries, raspberries, and yellow plums, and our bodies even produce small amounts of it.
• Similar to table sugar in appearance, sweetness, and bulk, xylitol has one-third the calories that sugar has. Because xylitol is digested and absorbed slowly, it raises blood glucose and insulin levels more slowly than sugar does, which makes it a good sweetener for diabetics.
• Xylitol is approved as an additive for foods, drugs, and oral health products in more than 35 countries, including the US. Its one known negative? It may cause a mild laxative effect at high doses until the body adjusts.
• Xylitol is available as a granulated sweetener that you can use in cooking; find as an additive in toothpaste, gum, and candy; and dilute for use in a nasal rinse or spray.
—Sara Altshul

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