Erythritol vs. Xylitol for Preventing Cavities (Tooth Decay)

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Both erythritol and xylitol are not just neutral, but beneficial for dental health. Which one wins out?

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Purveyors of erythritol like to talk about how this low-calorie sweetener is a natural constituent of foods like melons and peaches. But it’s in such tiny amounts; the average person only gets like 25 milligrams, and now that it’s manufactured commercially, intake could easily be a thousand times that. I’ve done a few videos about it. What’s the update?

Well, here’s a paper with a twist: Erythritol, a Non-Nutritive Sugar Alcohol Sweetener and the Main Component of Truvia®, Is a Palatable Ingested Insecticide. Huh? Yeah, they found it killed fruit flies, and so researchers suggested we could start using erythritol as a safe, sustainable approach for pest control. It evidently induces in flies “lethal regurgitation.” It also kills the yellow fever mosquito, termites, and ants. So, why isn’t erythritol sprayed on crops? Because it hurts the crops, too! At the doses needed to kill insects, it has damaging effects on the plants. But hey, if it hurts plants, maybe we can use it as an herbicide too. Okay, but what about just as a human sweetener? 

We’ve long known that the bacteria that produce dental plaque on teeth aren’t fueled by erythritol, and they can’t seem to make acid out of it either to cause cavities. As long as plaque stays above a pH of 5.7, food is safe for teeth. Swish with some erythritol and nothing happens, whereas then swish with some table sugar, and pH dips down into the danger zone.

But xylitol, a sugar alcohol similar to erythritol, isn’t just dentally safe in terms of not causing cavities, but may actually have an active cavity-stopping benefit. See, dental cavities are reversible if detected and treated suciently early. Early on, we thought the cavity reduction found in xylitol studies, where people chewed on xylitol gum or sucked on xylitol candies, may have just been due to indirect effects, like getting your saliva going. Or hey, every xylitol candy may be one less sugar candy; so, maybe it was just a substitution effect. Can you imagine how you might design a study to test if there were direct xylitol effects? I’ll give you a moment to pause and try to come up with something.

How about secretly randomizing people to use xylitol-containing toothpaste? And indeed, boom!  There was a reduction in tooth decay, compared to the control toothpaste without the xylitol. So, xylitol really does seem to have cavity-reducing effects. What about erythritol, then? All studies strongly support the idea of erythritol as being cavity-reducing too––perhaps even more so than xylitol. For example, researchers saw more than twice the drop in the amount of plaque after six months sucking on erythritol candies versus xylitol, an effect that extends out at least three years. Yeah, but did that actually translate into fewer cavities? We have all these studies pointing in that direction. However, no long-term human cavity trials on erythritol had been completed, until now.

A double-blind randomized controlled trial involving hundreds of school children sucking on four erythritol, xylitol, or control candies three times per school day, and…erythritol won the day. A significantly lower number of cavity-ridden teeth and surfaces were found in the erythritol group. 

Another advantage to erythritol is safety to dogs. Doses of xylitol as little as a half teaspoon in a 30-pound dog can be life-threatening, whereas erythritol is so well-tolerated, with no adverse effects reported for upwards of more than a cup a day, suggesting it could even be used as an ingredient in chew toys or something.

Please consider volunteering to help out on the site.

Motion graphics by Avo Media

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Purveyors of erythritol like to talk about how this low-calorie sweetener is a natural constituent of foods like melons and peaches. But it’s in such tiny amounts; the average person only gets like 25 milligrams, and now that it’s manufactured commercially, intake could easily be a thousand times that. I’ve done a few videos about it. What’s the update?

Well, here’s a paper with a twist: Erythritol, a Non-Nutritive Sugar Alcohol Sweetener and the Main Component of Truvia®, Is a Palatable Ingested Insecticide. Huh? Yeah, they found it killed fruit flies, and so researchers suggested we could start using erythritol as a safe, sustainable approach for pest control. It evidently induces in flies “lethal regurgitation.” It also kills the yellow fever mosquito, termites, and ants. So, why isn’t erythritol sprayed on crops? Because it hurts the crops, too! At the doses needed to kill insects, it has damaging effects on the plants. But hey, if it hurts plants, maybe we can use it as an herbicide too. Okay, but what about just as a human sweetener? 

We’ve long known that the bacteria that produce dental plaque on teeth aren’t fueled by erythritol, and they can’t seem to make acid out of it either to cause cavities. As long as plaque stays above a pH of 5.7, food is safe for teeth. Swish with some erythritol and nothing happens, whereas then swish with some table sugar, and pH dips down into the danger zone.

But xylitol, a sugar alcohol similar to erythritol, isn’t just dentally safe in terms of not causing cavities, but may actually have an active cavity-stopping benefit. See, dental cavities are reversible if detected and treated suciently early. Early on, we thought the cavity reduction found in xylitol studies, where people chewed on xylitol gum or sucked on xylitol candies, may have just been due to indirect effects, like getting your saliva going. Or hey, every xylitol candy may be one less sugar candy; so, maybe it was just a substitution effect. Can you imagine how you might design a study to test if there were direct xylitol effects? I’ll give you a moment to pause and try to come up with something.

How about secretly randomizing people to use xylitol-containing toothpaste? And indeed, boom!  There was a reduction in tooth decay, compared to the control toothpaste without the xylitol. So, xylitol really does seem to have cavity-reducing effects. What about erythritol, then? All studies strongly support the idea of erythritol as being cavity-reducing too––perhaps even more so than xylitol. For example, researchers saw more than twice the drop in the amount of plaque after six months sucking on erythritol candies versus xylitol, an effect that extends out at least three years. Yeah, but did that actually translate into fewer cavities? We have all these studies pointing in that direction. However, no long-term human cavity trials on erythritol had been completed, until now.

A double-blind randomized controlled trial involving hundreds of school children sucking on four erythritol, xylitol, or control candies three times per school day, and…erythritol won the day. A significantly lower number of cavity-ridden teeth and surfaces were found in the erythritol group. 

Another advantage to erythritol is safety to dogs. Doses of xylitol as little as a half teaspoon in a 30-pound dog can be life-threatening, whereas erythritol is so well-tolerated, with no adverse effects reported for upwards of more than a cup a day, suggesting it could even be used as an ingredient in chew toys or something.

Please consider volunteering to help out on the site.

Motion graphics by Avo Media

Doctor's Note

I’ve seen xylitol toothpaste on the market, but not erythritol. Maybe someone will watch this video and come up with one!

Check out my other videos on dental health on the topic page

I also have a Preserving Your Teeth chapter in my upcoming book How Not to Age. (As always, all proceeds go to charity.) Stay tuned!

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