Drinks That Help You Decrease Acid Reflux Chronic acid reflux, aka GERD or Gastroesophageal reflux disease has certain dietary and lifestyle choices that may exacerbate symptoms.Rhubarb And Acid Reflux
Institute of Dentistry, University of Turku, Lemminkäisenkatu 2, 20520 Turku, Finland
Sugar alcohols (polyols) are used in food manufacturing and in medical tests and examinations.Drinks That Help You Decrease Acid Reflux Heartburn Relief (☑ Instant Heartburn Relief) | Drinks That Help You Decrease Acid Reflux Besthow to Drinks That Help You Decrease Acid Reflux for d-Glucitol (sorbitol) and d-mannitol were previously the most common alditols used for these purposes. After the 1960s, xylitol became a common ingredient in noncariogenic confectioneries, oral hygiene products, and diabetic food. Erythritol, a polyol of the tetritol type, can be regarded as the sweetener of the “next generation.” The disaccharide polyols maltitol, lactitol, and isomalt have also been used in food manufacturing and in medical tests. Consumption of pentitol- and hexitol-type polyols and disaccharide polyols may cause gastrointestinal disturbances at least in unaccustomed subjects. The occurrence of disturbances depends on consumer properties and on the molecular size and configuration of the polyol molecule. Adaptation may take place as a result of enzyme induction in the intestinal flora. Some of the literature on xylitol has been difficult to access by health-care professionals and will be reviewed here. Research and clinical field experience have found no pathology in polyol-associated osmotic diarrhea—the intestinal mucosa having normal basic structure, except in extreme instances. Xylitol is better tolerated than hexitols or the disaccharide polyols. Erythritol, owing to its smaller molecular weight and configuration that differ from other alditols, normally avoids the gastrointestinal reactions encountered with other polyols. This review will also touch upon the FODMAPs diet concept.
Drinks That Help You Decrease Acid Reflux Foods To Avoid (🔥 Treatment) | Drinks That Help You Decrease Acid Reflux 12 Tipshow to Drinks That Help You Decrease Acid Reflux for The use of sugar alcohols (polyols) in the manufacturing of foods, medicines, and oral hygiene products has increased considerably during the past decades. Examples of more frequently used polyols include simple alditols such as erythritol, xylitol, d-glucitol (sorbitol), and d-mannitol and disaccharide sugar alcohols such as maltitol, lactitol, and isomalt. Sugar alcohols have been used in surprisingly numerous medical, cosmetic, techno-chemical, and similar applications. Xylitol-based infusion therapy currently comprises one of the largest single applications of this alditol . Xylitol-containing chewing gums have also been employed in various medical studies related to cognitive function, mastication, drug delivery, physiologic tests, and others .
Xylitol and d-glucitol are used in chewing gums and troches aimed at reducing the incidence of dental caries . Physiologically and physicochemically, these substances are normally absorbed slowly from the intestinal lumen and may cause so-called osmotic diarrhea in some individuals if the amounts consumed are too high . Such symptoms may occur especially in subjects unaccustomed to sugar alcohols, as has been found already since 1960s [3–9]. The occurrence of diarrhea, however, depends on a multitude of factors such as the person'' own judgments as to the origin of osmotic diarrhea following consumption of sugar alcohols are often confused by simultaneous consumption of fructose. The role of fructose and d-glucitol in the etiology of IBS has been somewhat controversial when these substances are ingested together . It nevertheless appears that the degree of symptom provocation is related to the amounts present in such a mixture but may not be related directly to the extent of colonic hydrogen production .
Sugar alcohols behave in the gut lumen in different ways, and their effects are not identical. Sugar alcohol molecules react in the gut lumen as physical and chemical entities based on their molecular mass, number of hydroxyl groups present in the molecule, the spatial orientation of those groups, and the overall symmetry of the molecule. All common dietary alditols are characterized by the presence of only two types of chemical groups, that is, CHOH and CH2OH. The number of OH groups present in these molecules is shown in Table for 1 last update 29 May 2020 1Table 1, which also reveals how the praxis of expressing concentrations differs significantly. These differences have also generated misunderstandings, since most clinical and nutritional reports customarily give the amount of sugar alcohols as percentages. The true chemical concentrations can be significantly different, however. The case of erythritol and sucrose serves as an example. The molarity of sucrose in a 10% (w/w) solution is only about one-third of the molarity of erythritol at the same 10% concentration. In physiological studies, it may be preferable to use chemical activities, that is, the chemical concentrations (molarities), to make the cases chemically comparable.
Relationship between the molarities and grams per 100 mL values in aqueous solutions of some dietary sugar alcohols and sucrose.
|Sweetener (number of OH groups in the molecule)||Molecular weight (g/mole)||Molarity of a 5% solution||Molarity of a 10% solution||Molarity of a 35% solution|
The intestinal absorption of xylitol is almost totally limited to the mechanism of permeation which applies to all strongly hydrophilic substances. The driving force behind free diffusion of xylitol is the direction of the concentration gradient between the intestinal lumen and the outside compartment [1, 3, 4, 8–14, 19]. These papers have concluded, among other things, that in case facilitated diffusion of xylitol is involved, the transport system must exert very low affinity to xylitol. In free diffusion, the uptake of the substance from the intestinal lumen takes place because of a simple physicochemical process through the hydrophobic pores in the membrane. In this process, molecular size is of particular significance. This parameter is to a certain extent indicated by the molecular weight of the substance. It is obvious that relatively extended molecules are in themselves ill-suited to the permeation process.
The xylitol molecule is totally symmetrical and small compared with the d-glucitol molecule whose molar mass and dimensions are larger and which is also relatively asymmetrical (in the latter molecule, the hydroxyl groups on C4 and C5 are in the d-configuration). The molar mass and symmetry of d-mannitol also differ significantly from those of xylitol. Hence the consumption of d-glucitol and d-mannitol generates far more severe gastrointestinal disturbances than xylitol. A comparison between the molecular weights of xylitol (152.1) and glucose (180.2) suggests that xylitol absorption amounts to approximately 50% of the free diffusion of glucose. In this comparison, the intestinal uptake of d-glucitol (182.2) may be about 60% of the 1 last update 29 May 2020 the absorption of xylitol.The xylitol molecule is totally symmetrical and small compared with the d-glucitol molecule whose molar mass and dimensions are larger and which is also relatively asymmetrical (in the latter molecule, the hydroxyl groups on C4 and C5 are in the d-configuration). The molar mass and symmetry of d-mannitol also differ significantly from those of xylitol. Hence the consumption of d-glucitol and d-mannitol generates far more severe gastrointestinal disturbances than xylitol. A comparison between the molecular weights of xylitol (152.1) and glucose (180.2) suggests that xylitol absorption amounts to approximately 50% of the free diffusion of glucose. In this comparison, the intestinal uptake of d-glucitol (182.2) may be about 60% of the absorption of xylitol.
While glucose is virtually completely absorbed in the upper part of the small intestine, xylitol is normally only partly absorbed in the upper part and is present in considerable amounts in the lower region of the small intestine. However, this depends on the quantity of xylitol consumed. Experience from the Finnish Turku Sugar Studies [4, 20] also indicated that xylitol-associated diarrhea can be prevented by simultaneous administration of bulky food. However, bulky food does not considerably increase the absorbability of xylitol, since the preventive effect results primarily from delayed emptying of the stomach. The presence of plant fibers may bind water, mitigating xylitol-associated diarrhea. As soon as the causative agent (xylitol) is removed, the tendency of osmotic diarrhea passes. Also, no irritation is generally observed in mucous membranes, except in extreme instances. Total absorption of xylitol and lessened osmotic diarrhea are more likely to occur when smaller quantities are consumed as part of a regular diet.
When xylitol is administered in an isolated form in beverages, the xylitol molecules are no longer sufficiently absorbed in the small intestine and will reach the colon. This concerns other pentitols and all hexitols as well. Therefore, consumption of polyol-containing beverages—apart from those based on erythritol—is not generally recommended. In the colon, bacterial action converts d-glucitol to low-molecular decomposition products with much higher osmotic potential than in the case of xylitol.
A form of adaptation to xylitol was first discovered in animal feeding studies and subsequently also in humans. Most notably this phenomenon was discovered in the two-year xylitol feeding study in Turku [4, 20]. This adjustment has normally been linked to an enzyme induction; the activity levels of liver sorbitol dehydrogenase which catalyzes the initial oxidation of xylitol increase during habitual consumption of xylitol.
The largest single boluses of sugar alcohols that can elicit osmotic diarrhea in adult subjects differ based on experimental details. Typical for 1 last update 29 May 2020 results obtained in feeding studies are shown in Table 2. Such values must not be regarded as universally valid. The true effects depend on circumstances; evaluations conducted by different research teams may not be exactly congruent.The largest single boluses of sugar alcohols that can elicit osmotic diarrhea in adult subjects differ based on experimental details. Typical results obtained in feeding studies are shown in Table 2. Such values must not be regarded as universally valid. The true effects depend on circumstances; evaluations conducted by different research teams may not be exactly congruent.
Maximum bolus doses of some dietary sugar alcohols not causing catharsis. Based on de Cock .
|Sugar alcohol||Maximum sugar alcohol dose (g/kg body weight)|
∗Based on the 2-year Turku feeding study in adult subjects accustomed to xylitol .
Based on the interest focused on diets that reduce intake of poorly absorbed small-molecular-size carbohydrates, a particular FODMAP concept was developed [16, 17, 21–25]. FODMAPs are short-chain carbohydrates that are poorly absorbed in the small intestine. The term is an acronym derived from “Fermentable Oligo-, Di-, Mono-Saccharides, and Polyols.” The FODMAPs research and the low FODMAPs diet concept was developed at the Monash University in Melbourne. It is important to emphasize the role of polyols, such as xylitol, d-glucitol, and d-mannitol, in the FODMAP group of carbohydrates. Understanding the importance of dietary FODMAPs will be assisted by comprehensive food composition data . Although sugar alcohols can be used to alleviate chronic constipation, it is thus obvious that sugar alcohols—with the exception of erythritol—should generally be avoided as part of low FODMAPs diet. Dental health professionals are encouraged to get familiar with the FODMAPs concept.
Older literature is cited here on purpose in order to emphasize the existence of gradually growing clinical interest in this area of research. One of the earliest scientific reports on the very slow absorption rate of d-glucitol was published by Dahlqvist and Telenius . Intractable diarrhea associated with the use of d-glucitol has later been frequently reported in the clinical literature. This has most often resulted from the use of d-glucitol as a sweetener and bulking agent in dietetic candies and chewing gum, although use of the 1 last update 29 May 2020 d d-glucitol as a vehicle for suspending active drugs for oral preparations can also cause intractable diarrhea . Only about 35 years ago several researchers seemed surprised by the appearance of “dietetic food diarrhea” caused by excessive d-glucitol and d-mannitol consumption  and by the metabolism of d-glucitol by gut bacteria , even though already in the late 1950s some physicians had noted the very slow absorption of d-glucitol from the small intestine . The situation was partly a result of the limited information available in pediatric textbooks concerning diarrhea caused by poorly absorbed osmotically active substances. Pediatric gastroenterology texts contained only passing references to this form of diarrhea, caused by dietetic, d-glucitol-containing candies or chewing gum [31, 32]. A typical case report normally follows a series of events similar to the following example: A 3-year-old boy consumes six full packs of a d-glucitol chewing gum brand. The consumed amount of d-glucitol is about 40 g. About one hour after the gum ingestion the child complains of abdominal cramps and explosively passes about 500 mL of thin liquid stool.
Several case reports began to call attention to d-glucitol-containing “diet foods.” Special “pink” diarrhea was caused by d-glucitol-containing vitamin C supplements; the pink color was attributed to the cochineal dye added to the preparation . (“Cochineal” originally referred to the red dye manufactured from the dried bodies of female cochineal insects or wood lice; the dye can also be synthesized.) As late as 1984, physicians alerted public health experts to the diarrheal potential of d-glucitol , as the quantities of d-glucitol used in the candy and food industry increased significantly. The popular use of d-glucitol in cough mixtures, cough drops, and various pharmaceutical syrups also began to receive attention; all of them have been reported as potential causes of diarrhea especially in infants. Such products were, however, beneficial from a dental standpoint, provided that d-glucitol replaced all fermentable carbohydrates previously used in such products. This was clearly a positive property of the 1 last update 29 May 2020 d d-glucitol-containing items.
Drinks That Help You Decrease Acid Reflux Reflux Disease (🔥 Heartburn Remedies) | Drinks That Help You Decrease Acid Reflux Anti-Reflux Diethow to Drinks That Help You Decrease Acid Reflux for It is well known that d-glucitol and d-mannitol are present in a wide variety fruits and other plant material [16, 17]. The concentration of d-glucitol in dried fruit, such as prunes, may reach levels that can contribute to diarrhea. Anecdotal evidence suggests that, historically, pediatricians advised mothers to give prunes to children with constipation. Modern scientific research concerning the FODMAPs concept has, however, more quantitatively underlined the role of d-glucitol and d-mannitol in osmotic diarrhea and their occurrence in for 1 last update 29 May 2020 natural products [16, 17] (vide supra).It is well known that d-glucitol and d-mannitol are present in a wide variety fruits and other plant material [16, 17]. The concentration of d-glucitol in dried fruit, such as prunes, may reach levels that can contribute to diarrhea. Anecdotal evidence suggests that, historically, pediatricians advised mothers to give prunes to children with constipation. Modern scientific research concerning the FODMAPs concept has, however, more quantitatively underlined the role of d-glucitol and d-mannitol in osmotic diarrhea and their occurrence in natural products [16, 17] (vide supra).
As stated above, IBS was also reported to result from the ingestion of mixtures of fructose and d-glucitol . Yao et al.  concluded that increased and discordant absorption of d-mannitol andDrinks That Help You Decrease Acid Reflux To Eat (⭐️ 9 Natural Remedies) | Drinks That Help You Decrease Acid Reflux How To Naturally Treathow to Drinks That Help You Decrease Acid Reflux for d-glucitol occurs in patients with IBS compared to that in healthy controls. Both alditols induced gastrointestinal symptoms in patients with IBS independently of their absorptive pathway, indicating that dietary restriction of the alditols may be efficacious. Xiao et al.  emphasized the health-enhancing properties of so-called indigestible sugars which include a large assembly of simple and complex dietary carbohydrates including monosaccharides, oligosaccharides, and certain alditols and disaccharide polyols. d-Glucitol, erythritol, and xylitol were presented as health-enhancing substances. Similar comments have been made elsewhere [35, 36], with evidence that particularly fructose conditions the gut microflora. “Toxicity” of d-mannitol and d-glucitol was discussed as early as 1941 . Recent IBS papers included those of Shepherd et al. , Tuck et al. , Respondek et al. , Goebel-Stengel and Mönnikes , and El-Salhy .
Drinks That Help You Decrease Acid Reflux Why (⭐️ How To Naturally Treat) | Drinks That Help You Decrease Acid Reflux Foods That Fight Hearbturnhow to Drinks That Help You Decrease Acid Reflux for Some researchers also interpreted other d-glucitol effects as positive: d-glucitol therapy reportedly improved psychomotor performance in cirrhotic patients . Patients with hepatic encephalopathy improved in all five mental function tests, whereas similar patients not receiving d-glucitol showed no improvement. d-Glucitol has naturally been exploited in medical practice as a cathartic preparation, another useful sugar alcohol application. A comparison between d-glucitol and lactulose showed that both were extensively fermented by the colonic flora . It was suggested the 1 last update 29 May 2020 that the much cheaper d-glucitol could be used in the treatment of postsystemic encephalopathy. The medical literature has, however, simultaneously been replete with case reports and clinical studies relating detrimental d-glucitol effects, that is, intolerance to this sugar alcohol, as evidenced by the literature references shown above. Based on field experience and clinical evaluations, most experts contend that d-glucitol may produce osmotic diarrhea if ingested in amounts of 20 g to 50 g. A debate on the possibility of glucose-stimulated influx of d-glucitol across the human jejunal mucosa has continued since the late 1990s .Some researchers also interpreted other d-glucitol effects as positive: d-glucitol therapy reportedly improved psychomotor performance in cirrhotic patients . Patients with hepatic encephalopathy improved in all five mental function tests, whereas similar patients not receiving d-glucitol showed no improvement. d-Glucitol has naturally been exploited in medical practice as a cathartic preparation, another useful sugar alcohol application. A comparison between d-glucitol and lactulose showed that both were extensively fermented by the colonic flora . It was suggested that the much cheaper d-glucitol could be used in the treatment of postsystemic encephalopathy. The medical literature has, however, simultaneously been replete with case reports and clinical studies relating detrimental d-glucitol effects, that is, intolerance to this sugar alcohol, as evidenced by the literature references shown above. Based on field experience and clinical evaluations, most experts contend that d-glucitol may produce osmotic diarrhea if ingested in amounts of 20 g to 50 g. A debate on the possibility of glucose-stimulated influx of d-glucitol across the human jejunal mucosa has continued since the late 1990s .
Maltitol (O-α-d-glucopyranosyl-1,4-d-glucitol; molar mass 344.31) is a disaccharide sugar alcohol derived from maltose by dehydrogenation. Owing to the hydrolytic cleavage of maltitol by intestinal enzymes, free glucose and free d-glucitol are formed. The liberated glucose molecules are absorbed virtually completely, whereas the liberated for 1 last update 29 May 2020 d d-glucitol is incompletely absorbed, contributes to osmotic diarrhea, and is eventually subject to microbial fermentation in the gut. Zunft et al.  showed already in 1983 that maltitol will be digested and utilized by man, rat, and rabbit. A daily application of 35 g maltitol to humans “did not influence the parameters of well-being, compatibility, and fecal state.”
A study carried out with maltitol indicated that 30 g maltitol in chocolate caused no significant symptoms in young adults, while 40 g caused mild borborygmus and flatus, but no laxation. An increased breath H2 response indicated primarily colonic maltitol fermentation . Another study reported that occasional or regular consumption of maltitol was not associated with severe digestive symptoms . In both patterns of maltitol consumption, osmotic diarrhea frequency was higher but appeared only for very high doses of maltitol (about 90 g); maltitol did not lead to intestinal flora adaptation after a 9-day period of consumption. In another experiment, a 45 g dose of maltitol caused transitory osmotic diarrhea in 29 of 34 subjects (85.3%) . The symptoms could be suppressed by simultaneous ingestion of partially hydrolyzed guar gum which consists of the ground endosperm of guar (a legume) seeds. The gum, which swells and disperses in water, contains a mannose- and galactose-based polysaccharide, guaran.
It may be of interest that maltitol has been shown to protect against dimethylhydrazine-induced tumours in rat caecum and proximal colon. This may result from butyric acid formation . Another possible benefit is the maltitol-associated promotion of calcium absorption and advantageous bone effects in rat models [48, 49], a reaction that has also been observed with xylitol . In the past, some countries, including Canada, Australia, New Zealand, Mexico, and Norway, have required manufacturers to include warning labels on packages of maltitol-containing comestibles, since “excessive consumption may have laxative effects.” The FDA has regarded maltitol as a GRAS substance (generally recognized as safe) with a warning about its cathartic potential when consumed at levels above 100 g per day (in adults).
d-Glucitol is also a hydrolysis product of isomalt (molar mass 344.31), which is an equimolar mixture of α-d-glycopyranosyl-1-6-d-glucitol and α-d-glucopyranosyl-1,6- the 1 last update 29 May 2020 dd-mannitol. The intact portion of isomalt and the unabsorbed d-glucitol and d-mannitol molecules eventually reach the lower parts of the gut where they serve as substrates for bacterial formation of volatile fatty acids. Isomalt may not be consumed by adults in quantities larger than about 50 g per day; flatulence and diarrhea may occur. For children, 25 g per day may represent a practical upper limit. Isomalt represents those disaccharide sugar alcohols that are treated by the human body as “dietary fiber” and not as a regular disaccharide. Consequently, isomalt can pass through the bowel partly undigested; part of it is hydrolyzed in the small intestine. Habitual consumption of isomalt may lead to partial adaptation, which suggests decreased occurrence of gastrointestinal changes. Isomalt could be used as an alternative to lactulose for colonic delivery system utilizing the principles of a unique colon-specific delivery technique called CODES . Since d-glucitol has been associated with greater colonic fermentation compared with isomalt , its formation from the latter should be considered.
Lactitol [4-O-(β-d-galactopyranosyl)-d-glucose; molar mass 344.31] passes through the small intestine almost completely unabsorbed and is subject to microbial fermentation in the distal parts of the gut. Lactitol can cause flatulence and osmotic diarrhea in some individuals, since most subjects lack the necessary β-galactosidase enzyme in the upper gastrointestinal tract. After reaching the large intestine, the lactitol molecules can pull water into the gut lumen by simple osmosis. True loading tests with lactitol are limited. In a human study, consumption of 5 g of lactitol per day resulted in no gastrointestinal distress, while 10 g per day did cause some changes . Compare also with Natah et al. , whose study subjects reported no abdominal pain after ingesting lactitol.
In conclusion concerning disaccharide sugar alcohols, excessive consumption of maltitol and isomalt can cause significant osmotic diarrhea and flatulence. True gastrointestinal loading tests on lactitol should be repeated. The amount of disaccharide polyols present in chewing gum is too low to cause any gastrointestinal effects in most subjects.
The GOSs are not sugar alcohols but may occasion similar gastrointestinal disturbances as the latter. Historically, the GOS group of carbohydrates deserve attention in this context because of the presence of GOS in some polyol-containing manufactured foods. Indeed, field experience suggests that consumers frequently misjudge the causative food agent when simultaneously consuming raffinose-based food of a leguminous nature and sugar alcohol-containing confectionaries or medicines. Therefore, the role of GOS will be concisely discussed here. Legumes, rich in GOSs, normally contain only insignificant quantities of sugar alcohols.
Oligosaccharides began to receive more attention as a result of the growing interest in bringing new sources of protein into the food system, including soybeans, which contain these sugars. Oligosaccharides are not digested because the human alimentary canal does not produce the necessary enzyme, α-galactosidase. Nor are oligosaccharides resorbed by the intestinal wall, owing to their high molecular weight. Consequently, they come in contact with bacteria that inhabit the lower parts of the intestine. The bacteria are able to utilize the raffinose-family oligosaccharides with subsequent formation of flatus . These oligosaccharides may also promote the growth of bifidobacteria in the human intestine and cause diarrhea when consumed in excess of a particular quantity .
The molecular weight of oligosaccharides has an influence on flatus formation. These compounds include stachyose (molar mass 666.58), a tetraholoside, and verbascose (828.72, a pentaholoside). A holoside is a glycoside that yields only glycoses on hydrolysis. Both have marked effects as flatus formers. Raffinose (or melitose; 504.42), a triholoside, that is, O-α-d-galactopyranosyl-(1→6)-O-α-d-glucopyranosyl-(1→2)-β- for 1 last update 29 May 2020 dd-fructofuanoside, normally has a less significant effect. The objective of emphasizing the role of ordinary leguminous plants as a source of flatus (and diarrhea) is to underline the role of regular human food as another common source of gastrointestinal discomfort.
Flatulence is an old problem; the first scientific reports dealing with it were published early in the last century. Even a slight increase in pressure in rectal gas may lead to symptoms of discomfort. Researchers discovered about fifty years ago that some GOSs play a part in flatus formation. Flatus is often accompanied by a lowering of the pH. The lowered pH may in turn affect the metabolism of other substances [57, 58].
Microbial fermentations of GOS in the large intestine are responsible for flatus components such as hydrogen, methane, and carbon dioxide. Oxygen and nitrogen may also be present and originate from swallowed air. Significant, positive correlations were discovered between hydrogen production and the following chemical components that are present in various pea varieties: stachyose and raffinose and various glucans and pentosans. A study in patients with ileostomies showed that 88% of raffinose passed unabsorbed through the small intestine; in the same study, 74% of d-mannitol and 100% of lactulose passed unabsorbed [57–59].
Glucose and galactose which are common dietary carbohydrates can be concentrated against a tenfold gradient by an active transport mechanism that assures their early absorption in the intestinal tract [6, 13, 19, 20, 60, 61]. The question is of a facilitated transport mechanism. In the case of xylitol and d-glucitol, however, there is no evidence of such transport mechanisms [3, 60–66]. As mentioned above, their absorption takes place based on free diffusion, or, if an active transport system exists, it has only a low affinity. The driving force behind free diffusion is the concentration difference for the substance in question [65–67]. Another factor limiting diffusion is the pore size . The diameter of hydrophilic pores may range considerably from less than one nanometer to between 0.3 nm and 0.6 nm, but the structures may not assume the shape of pores but, rather, tunnel-like channels. Although the molecular weights of xylitol (152.1) and d-glucitol (182.2) differ by only about 20%, this difference is significant in the borderline range of free diffusion. The symmetrical configuration of the xylitol molecule may facilitate a single-file diffusion of the molecule through tunnels.
The greatest portion of absorbed xylitol is metabolized in the liver, although kidneys and other tissues are also sites of xylitol metabolism [19, 54]. Red blood cells metabolize xylitol readily. Most xylitol is metabolized by a pathway involving normal, physiologic enzyme-catalyzed steps of the pentose phosphate pathway. This pathway is a portion of the glucuronate-xylulose cycle, also called Touster''s most recent safety statements regarding xylitol and also for the scientific opinion of the Joint Expert Committee of the World Health Organization (WHO) and the Food and Agriculture Organisation (JECFA) resolutions concerning the safety of xylitol.
Relationship between the metabolism of xylitol and glycolysis in humans. The scheme describes the metabolism of dietary xylitol in broad outline only. The body receives energy from glycolysis (the thick horizontal arrow). The first intermediate of glycolysis is glucose 6-phosphate which forms an important link between glycolysis and another metabolic pathway, called the pentose phosphate shunt, or pentose phosphate cycle (curved arrow). The thinner black arrow represents the glucuronate-xylulose cycle of Touster. The differences in the thickness of the arrows reflect the relative portion of these three pathways in the overall metabolism. Although the significance of the Touster cycle is minor from the energetic point of view, it is nevertheless absolutely necessary for body functions. Pyruvic acid which may be regarded as the end product of glycolysis can be further metabolized in two ways: reduction to lactic acid under conditions of limited oxygen supply, or becoming a part of coenzyme A when the oxygen supply is sufficient. The scheme shows how xylitol can contribute to the overall energy metabolism of the body. The original scheme of Bässler  was modified and completed by the present author.
Drinks That Help You Decrease Acid Reflux GERD Diet (⭐️ Treatments) | Drinks That Help You Decrease Acid Reflux Acid Refluxhow to Drinks That Help You Decrease Acid Reflux for Few research papers have reported on gastrointestinal changes during xylitol consumption. This partly results from the nonexistence of such changes in clinical trials aimed at investigating oral biologic and dental effects of xylitol. In most stomatologic studies, xylitol consumption levels have been relatively small, and, consequently, the researchers did not need to focus on possible side effects of xylitol consumption. The scantiness of such reports is unfortunate, since the next generation of consumers, health-care authorities, and medical and dental practitioners has retroactively started to ask for hard data on the relationship between the consumption of xylitol and bowel movements, flatulence, meteorism, and other bowel reactions.
Observations on the occurrence of diarrhea in studies involving consumption of xylitol and other dietary alditols will be reviewed below, as reported by the authors of those studies. The individual studies are summarized instead of showing study details in the form of tables. This results from the publication of several early studies in difficult-to-locate journals, which have not provided abstracts of papers. Since these studies represent real-life situations, their review enables present readers to obtain direct information on the studies involved, with practical instructions regarding dosage levels of alditols for patient counselling purposes.
By the mid-1970s, various medical and dental benefits of xylitol were already known. Considerable experience had become available since the 1960s from the former Soviet Union, where the metabolism and uses of xylitol for nutritive and medical purposes had become a favored research topic. The Soviet researchers were not aware of the dental effects of xylitol until the publication of the Finnish Turku Sugar Studies in 1975 . This study prompted Galiullin  to undertake a two-year xylitol trial in the state of Kazan. His results were in line with those of the Turku study (vide infra). Some Russian-language medical articles have been difficult to access, but a valuable contribution to this xylitol literature was made by Dr. Nesterin from the Moscow Nutrition Institute. He wrote a comprehensive historic review of the Soviet investigations into the general medical effects of xylitol, including its toxicity, influence on bodily functions in diabetes mellitus, disorders of the hepatobiliary system, and other medical conditions. This Russian-language article was translated into English and appeared in 1980 in a German scientific journal . Although the article focused on diabetes and disturbances of the liver and gallbladder system, observations on gastrointestinal effects of xylitol were also made. Nesterin also described a large number of animal experiments. The direct quotes below are examples from the translation.
Nesterin'' feeling, and had a favorable effect on bile secretion and emptying of intestine” [sic]. Her patients also included diabetic subjects who had frequent pain in the right hypochondrium and suffered from constipation. Following the “xylite treatment (40 g daily), these symptoms disappeared.” She added, however, that the improvement in carbohydrate metabolism was not observed for 1 last update 29 May 2020 in all patients. It is also possible that the patients''s comprehensive physical check-ups revealed no differences between the xylitol and the control groups, apart from significantly lower caries incidence in the former. The groups also did not differ with regard to bowel movement recordings. Nesterin'' feeling, and had a favorable effect on bile secretion and emptying of intestine” [sic]. Her patients also included diabetic subjects who had frequent pain in the right hypochondrium and suffered from constipation. Following the “xylite treatment (40 g daily), these symptoms disappeared.” She added, however, that the improvement in carbohydrate metabolism was not observed in all patients. It is also possible that the patients''s comprehensive physical check-ups revealed no differences between the xylitol and the control groups, apart from significantly lower caries incidence in the former. The groups also did not differ with regard to bowel movement recordings.
(6) University of Texas Study. A study entitled “Oral Xylitol in Humans” was published by Wang et al. . The study was carried out at the University of Texas System Cancer Center in Houston. Seventeen adult subjects of both sexes received xylitol enterally so that the xylitol level was gradually increased from 3 × 10 g per day to 2 × 50 g per day over a 14-day period, with the final dose maintained for 3 days. The study investigated a total of 56 clinical-chemical parameters. Severe diarrhea was observed in one male subject when the xylitol dose was 3 × 20 g per day. Milder diarrhea and flatulence were reported in all subjects. Adaptation to xylitol was observed. The authors concluded that “the adult human can tolerate substantial amounts of daily xylitol.”
(7) Reexamination of the Turku Sugar Study Subjects. The general health of the participants in the above-mentioned Turku Sugar Studies [4, 20] was reexamined four years following the final xylitol feeding [71, 72]. These reexaminations included a special comparison of metabolic tolerance test of nine “xylitol chronics,” that is, human volunteers who had used xylitol regularly for 4.4–5.3 years (the first two years in the capacity of participants in the original two-year feeding trial). In this tolerance test, the subjects consumed, over 7 days, 70–100 g of sucrose per day with the basal diet (as in the case of the study of Förster et al.; vide infra), followed by the consumption of 70–100 g of xylitol per day in the basal diet for 14 days, and similar consumption of xylitol in normal diet for 7 days. This basal diet (formula diet) did not contain fiber and thus lacked the water-binding capacity of normal food. The subjects were investigated using versatile clinical, anthropometric, ophthalmological, and metabolic tests. The xylitol loading tests were not found to result in any abnormal metabolic reactions. As expected, the sudden increase in the level of xylitol consumption from those to which the subjects were accustomed resulted in osmotic diarrhea in some subjects. These symptoms disappeared in most cases in 3 to 4 days. No significant diarrhea was reported by subjects who consumed normal diet plus xylitol. Four instances of diarrhea (in two subjects) and six instances of flatus (in three subjects) were recorded during the basal sucrose diet and normal diet periods (without xylitol). Upon completing this review, all nine “xylitol chronics” are alive, the oldest ones being nearly eighty years old. Four of them have continued uninterrupted daily consumption of xylitol over 44 years.
(8) 55-Day Study in Children. Åkerblom et al.  studied the tolerance of increasing amounts of dietary xylitol in healthy children aged 7–16 years. Xylitol was incorporated into the diet in the form of chocolate, chewing gum, wafers, crystalline xylitol, meringue candies, yoghurt, and ice cream. The daily dose was increased from 10 to 25, 45, 65, and 80 g (in successive 10-day increments) and finally decreased to 65 g for 5 days. Gastrointestinal side effects were recorded daily during the 55-day xylitol consumption, as well as during xylitol-free periods before and after the trial. Flatulence was the most common side effect occurring infrequently in about half of the subjects during the 45 g/day intake of xylitol and in the majority of the children at higher doses. During the latter periods of high-level xylitol administration, an obvious adaptation to the substance was observed. Transient diarrhea (but no increase in the number of stools) occurred in four children at 65 g/day xylitol consumption and in one child at 80 g/day. The authors concluded that “a reasonable consumption of xylitol in the form of chewing gums and small candies or confections is harmless for children, and can be recommended when this would replace consumption of similar confections sweetened with sucrose or other cariogenic sweeteners.”
(9) German Study in Healthy Adults. Förster et al.  carried out a study on 12 healthy volunteers who consumed a standardized basal diet consecutively supplemented with either sucrose (6 days, 60–100 g/day) or xylitol (18 days, 40–100 g/day). With the exception of a few cases of diarrhea only at the start of the xylitol regimen, no other clinical signs indicated treatment-related side effects. This finding was considered remarkable, since the liquid nature of the formula diet consumed is devoid of fiber (and hence lacks water-binding capacity) and the subjects investigated had not been previously exposed to xylitol. (In the previous xylitol loading test of a similar nature [71, 72], subjects were partially adapted to xylitol.) The subjects were allowed to reduce somewhat the xylitol dosage until diarrhea subsided, although, in cases where diarrhea occurred or persisted, the achieved levels of xylitol nevertheless corresponded approximately to the targeted level of up to 100 g/day. “This provided further evidence that the gastrointestinal tolerance of the subjects was good” .
In an earlier paper, Förster  referred to older German experiments which indicated that xylitol was well tolerated by children and diabetic subjects. For example, in a study carried out by Mellinghoff already in 1960 (published in 1961), xylitol was used as a substitute for sugar with diabetics. Using low dosages (10 g per day), there were no symptoms of diarrhea. Only at higher dosages (60 g in tea), did cases of diarrhea occur. In another experiment of his own, Förster found that 100 g of xylitol was tolerated “without much difficulty” by six volunteers over a period of ten days . Förster found no adverse gastrointestinal effects during administration of 30 g of xylitol over a period of four weeks to diabetic children. Förster mentions in his paper also a study by Mertz et al., who observed no symptoms after their subjects had consumed 50 g xylitol, and a study with diabetic children who received 30 g xylitol per day over a period of four weeks. Only one child withdrew prematurely from the sequence of experiments on account of diarrhea .
(10) Chronic Xylitol Users. Diarrhea-associated data of 11 subjects, who had habitually used xylitol for 3.2 to 4.5 years, was published in 1977 . Four of the subjects had also participated in the above-mentioned xylitol loading test . The group of 11 included three children who had used xylitol for most of their lives. Their ages at the commencement of the program were 1.4, 2.6, and 12.1 years. Six adult subjects in this group had also participated in the two-year Turku Sugar Studies (1972–1974) involving, on the average, 67 g intake of xylitol per day in the form of versatile xylitol products [4, 20, 71, 72]. Following the termination of the feeding study, that is, during the next 2.5 years, the six subjects consumed xylitol daily mostly in the form of chewing gum, troches, and chocolate, at consumption levels ranging from 1.4 kg per year to 11 kg per year. Two additional adults in the 11-subject group had used a total of 58 kg and 24.8 kg of xylitol, respectively, during 1972–1974, and 19.0 kg and 22 kg, respectively, over the next 2.5 years (the 2.5-year figures resulted mostly from the use of confectioneries). Detailed paper diary and questionnaire performances showed that none of the subjects reported diarrhea during the entire study period (the children''s group at the University of Washington used xylitol-containing foods in xylitol feeding studies in young children aged 3 to 6 years . The foods included popsicles, puddings, gum drops, gelatin dessert, cookies, and popcorn. This experiment was not a loading test but measured children''s disease . The feces were muddy in all animals with the uptake of erythritol alone, while muddy or very soft feces were not observed in animals fed a mixture of pectin and erythritol.
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Various gastrointestinal discomforts have been known to humans for thousands of years. Osmotic diarrhea, catharsis, meteorism, flatulence, and borborygmi (borborygmus) are terms that frequently appear in this context.
Osmotic diarrhea may result from the consumption of too-large doses of dietary sugar alcohols such as xylitol, d-glucitol, for 1 last update 29 May 2020 d d-mannitol, maltitol, lactitol, and isomalt. Also other related substances, such as the GOS and lactose, may cause similar effects. GOS-type substances are normal constituents in the seeds of leguminous plants, such as soya beans and peas.
Drinks That Help You Decrease Acid Reflux 23+ Home Remedies (🔥 6 Ways To Get Relief During) | Drinks That Help You Decrease Acid Reflux Herbshow to Drinks That Help You Decrease Acid Reflux for Sugar alcohols, along with some oligosaccharides, have also received attention in food and nutrition research owing to their prebiotic properties and other health benefits. IBS and functional constipation serve as examples of common gastrointestinal disorders whose treatment may benefit from the application of sugar alcohols and certain GOSs.
Osmotic diarrhea occasioned by excessive consumption of these substances is not a disease, but a simple osmotic response to the presence of slowly absorbed carbohydrates in the gut lumen. The presence of these solutes in the lumen will draw water from surrounding tissues.
The capacity of the common alditols to cause osmotic diarrhea depends on their molar mass, symmetry of the molecule, and, thus, the detailed configuration of the molecule.
Consumption of erythritol does not normally lead to any gastrointestinal changes, while that of hexitols (d-glucitol and d-mannitol) may cause changes in adults already at 10 to 20 g daily consumption levels. Xylitol is better tolerated, the largest safe doses ranging widely, normally from 20 g to 70 g per day. However, significant variation may occur. Consumption of disaccharide sugar alcohols maltitol, lactitol, and isomalt may also lead to similar gastrointestinal disturbances.
The quantity of xylitol currently recommended for caries limitation is about 10 g/day or more for adults and about half that for infants older than 3 to 4 years; younger infants have received smaller quantities under parental guidance.
European Union recommends that daily ingestion of 20 g ofDrinks That Help You Decrease Acid Reflux Home Remedies For (⭐️ 11 Foods That Cause) | Drinks That Help You Decrease Acid Reflux What Causes Heartburnhow to Drinks That Help You Decrease Acid Reflux for d-mannitol and 50 g of d-glucitol in the form of commercial food products should bear a warning statement about possible laxative effects.
Researchers have not always paid attention to study conditions, such as comparing administration of sugar alcohol in plain water versus as part of regular fiber-containing meals or snacks. For example, tolerance to xylitol present in beverages (such as lemonades, fizzes, and still drinks) normally causes diarrhea at lower xylitol levels than when present in solid food. Use of xylitol in a for 1 last update 29 May 2020 beverage (apart from as a sweetener in tea of coffee) cannot be recommended.Researchers have not always paid attention to study conditions, such as comparing administration of sugar alcohol in plain water versus as part of regular fiber-containing meals or snacks. For example, tolerance to xylitol present in beverages (such as lemonades, fizzes, and still drinks) normally causes diarrhea at lower xylitol levels than when present in solid food. Use of xylitol in a beverage (apart from as a sweetener in tea of coffee) cannot be recommended.
Adaptation to tolerate increasing quantities of xylitol has been observed in long-term feeding trials. The adaptive changes take place in the gut flora and possibly by enzyme induction in the liver.
Xylitol, other alditols, and disaccharide sugar alcohols possess undeniable utility value in dietary and medical applications. Therefore, health-care professionals should be aware of restrictions and recommendations regarding their safe and appropriate use.
The author declares no competing interests with respect to the authorship and/or publication of this article.
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