Skip to main content Skip to main navigation menu Skip to site footer
Published: 17-02-2022

Positioning on the Use of Polyols as Table Sweeteners

Department of Medicine, Universidade Federal de São Carlos, São Carlos, SP, Brazil
Department of Medicine from FAMERP, SP, Brazil / Department of Nutrology of Fac. de Medicina Fundação Padre Albino - FAMECA, SP, Brazil / Department of Nutrology at HSPE/IAMSPE/SP, Brazil / Department of Nutrology, Endocrinology and Clinical Medicine by CFM/AMB, Brazil
polyols xylitol erythritol sweeteners benefits


Polyols are poorly digestible carbohydrates present in small amounts in some fruits and vegetables. Xylitol and erythritol are used as table sweeteners. These compounds are widely used in the food industry due to their low-calorie content. Erythritol is the only noncaloric polyol. Xylitol is the sweetest of the polyols, being the only one with sweetness equivalent to sucrose, but with one third of its calories. Clinical studies have shown reductions in the number of plaques, in counts of Streptococcus mutans, and in the number of dental cavities in individuals receiving erythritol and xylitol. Xylitol is also capable of reducing the growth and adherence to the oropharynx of bacteria that cause acute otitis media, such as Streptococcus pneumoniae, and several studies have shown that it reduces the risk of this bacterial infection in children. In addition to these effects, polyols can also have beneficial effects on metabolism. Both erythritol and xylitol have been approved by the European Union for use as sweeteners for several years, and replacing sugar with polyols decreases caloric intake, which can reduce body weight and blood glucose in individuals with obesity and type 2 diabetes mellitus. The safety of polyols is recognized by the Food and Drug Administration (FDA), who classifies them as compounds generally recognized as safe (GRAS). Thus, based on available scientific data, the daily consumption of both substances is associated with several benefits and does not represent any risk to human health.


Metrics Loading ...


  1. Taruno A, Nomura K, Kusakizako T, Ma Z, Nureki O, Foskett JK. Taste transduction and channel synapses in taste buds. Pflugers Arch 2021; 473 (01) 3-13
  2. Chéron J-B, Marchal A, Fiorucci S. Natural Sweeteners. Reference Module in Food Science. 2018
  3. Philippe RN, De Mey M, Anderson J, Ajikumar PK. Biotechnological production of natural zero-calorie sweeteners. Curr Opin Biotechnol 2014; 26: 155-161
  4. Jain T, Grover K. Sweeteners in human nutrition. Int J Health Sci Res 2015; 5 (05) 439-451 [4]
  5. Saraiva A, Carrascosa C, Raheem D, Ramos F, Raposo A. Natural Sweeteners: The Relevance of Food Naturalness for Consumers, Food Security Aspects, Sustainability and Health Impacts. Int J Environ Res Public Health 2020; 17 (17) E6285
  6. Grembecka M. Sugar alcohols—their role in the modern world of sweeteners: a review. Eur Food Res Technol 2015; 241: 1-14
  7. Sugar Alcohols (Polyols) and Polydextrose Used as Sweeteners in Foods - Food Safety - Health Canada, H. Canada, Editor. 2005
  8. O'Donnell K, Kearsley MW. Sweeteners and Sugar Alternatives in Food Technology. 2nd Edition ed.. 2012. UK: Wiley-Blackwell;
  9. Mäkinen KK, Saag M, Isotupa KP. et al. Similarity of the effects of erythritol and xylitol on some risk factors of dental caries. Caries Res 2005; 39 (03) 207-215
  10. Usha C. R S. Dental caries - A complete changeover (Part I). J Conserv Dent 2009; 12 (02) 46-54
  11. Rathee, M. and A. Sapra. Dental Cavities. 2020
  12. Shaw JH. Causes and control of dental caries. N Engl J Med 1987; 317 (16) 996-1004
  13. Touger-Decker R, van Loveren C. Sugars and dental caries. Am J Clin Nutr 2003; 78 (04) 881S-892S
  14. Kawanabe J, Hirasawa M, Takeuchi T, Oda T, Ikeda T. Noncariogenicity of erythritol as a substrate. Caries Res 1992; 26 (05) 358-362
  15. Mäkinen KK, Bennett CA, Hujoel PP. et al. Xylitol chewing gums and caries rates: a 40-month cohort study. J Dent Res 1995; 74 (12) 1904-1913
  16. Deshpande A, Jadad AR. The impact of polyol-containing chewing gums on dental caries: a systematic review of original randomized controlled trials and observational studies. J Am Dent Assoc 2008; 139 (12) 1602-1614
  17. Newton JT, Awojobi O, Nasseripour M. et al. A Systematic Review and Meta-Analysis of the Role of Sugar-Free Chewing Gum in Dental Caries. JDR Clin Trans Res 2020; 5 (03) 214-223
  18. Riley P, Moore D, Ahmed F, Sharif MO, Worthington HV. Xylitol-containing products for preventing dental caries in children and adults. Cochrane Database Syst Rev 2015; (03) CD010743
  19. Honkala S, Runnel R, Saag M. et al. Effect of erythritol and xylitol on dental caries prevention in children. Caries Res 2014; 48 (05) 482-490
  20. Falony G, Honkala S, Runnel R. et al. Long-Term Effect of Erythritol on Dental Caries Development during Childhood: A Posttreatment Survival Analysis. Caries Res 2016; 50 (06) 579-588
  21. Van Loveren C. Sugar alcohols: what is the evidence for caries-preventive and caries-therapeutic effects?. Caries Res 2004; 38 (03) 286-293
  22. Steinberg LM, Odusola F, Mandel ID. Remineralizing potential, antiplaque and antigingivitis effects of xylitol and sorbitol sweetened chewing gum. Clin Prev Dent 1992; 14 (05) 31-34
  23. Gupta M. Sugar Substitutes: Mechanism, Availability, Current Use and Safety Concerns-An Update. Open Access Maced J Med Sci 2018; 6 (10) 1888-1894
  24. Burt BA. The use of sorbitol- and xylitol-sweetened chewing gum in caries control. J Am Dent Assoc 2006; 137 (02) 190-196
  25. Nakai Y, Shinga-Ishihara C, Kaji M, Moriya K, Murakami-Yamanaka K, Takimura M. Xylitol gum and maternal transmission of mutans streptococci. J Dent Res 2010; 89 (01) 56-60
  26. O'Connell AC. Use of xylitol chewing gum in mothers may delay transmission of mutans streptococci to their infants. J Evid Based Dent Pract 2011; 11 (01) 62-64
  27. Monasta L, Ronfani L, Marchetti F. et al. Burden of disease caused by otitis media: systematic review and global estimates. PLoS One 2012; 7 (04) e36226
  28. Murphy TF. Otitis media, bacterial colonization, and the smoking parent. Clin Infect Dis 2006; 42 (07) 904-906
  29. Kontiokari T, Uhari M, Koskela M. Effect of xylitol on growth of nasopharyngeal bacteria in vitro. Antimicrob Agents Chemother 1995; 39 (08) 1820-1823
  30. Kontiokari T, Uhari M, Koskela M. Antiadhesive effects of xylitol on otopathogenic bacteria. J Antimicrob Chemother 1998; 41 (05) 563-565
  31. Danhauer JL, Johnson CE, Corbin NE, Bruccheri KG. Xylitol as a prophylaxis for acute otitis media: systematic review. Int J Audiol 2010; 49 (10) 754-761
  32. Azarpazhooh A, Lawrence HP, Shah PS. Xylitol for preventing acute otitis media in children up to 12 years of age. Cochrane Database Syst Rev 2016; (08) CD007095
  33. Evert AB, Dennison M, Gardner CD. et al. Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report. Diabetes Care 2019; 42 (05) 731-754
  34. Amo K, Arai H, Uebanso T. et al. Effects of xylitol on metabolic parameters and visceral fat accumulation. J Clin Biochem Nutr 2011; 49 (01) 1-7
  35. Rahman MA, Islam MS. Xylitol improves pancreatic islets morphology to ameliorate type 2 diabetes in rats: a dose response study. J Food Sci 2014; 79 (07) H1436-H1442
  36. Wölnerhanssen BK, Cajacob L, Keller N. et al. Gut hormone secretion, gastric emptying, and glycemic responses to erythritol and xylitol in lean and obese subjects. Am J Physiol Endocrinol Metab 2016; 310 (11) E1053-E1061
  37. Overduin J, Collet TH, Medic N. et al. Failure of sucrose replacement with the non-nutritive sweetener erythritol to alter GLP-1 or PYY release or test meal size in lean or obese people. Appetite 2016; 107: 596-603
  38. den Hartog GJ, Boots AW, Adam-Perrot A. et al. Erythritol is a sweet antioxidant. Nutrition 2010; 26 (04) 449-458
  39. Tabit CE, Chung WB, Hamburg NM, Vita JA. Endothelial dysfunction in diabetes mellitus: molecular mechanisms and clinical implications. Rev Endocr Metab Disord 2010; 11 (01) 61-74
  40. Flint N, Hamburg NM, Holbrook M. et al. Effects of erythritol on endothelial function in patients with type 2 diabetes mellitus: a pilot study. Acta Diabetol 2014; 51 (03) 513-516
  41. Mortensen A. Sweeteners permitted in the European Union: safety aspects. Scandinavian Journal of Food and Nutrition 2006; 50 (03) 104-116
  42. Scientific Committee for Food. Sweeteners (opinion expressed on 14 September 1984). Reports of the Scientific Committee on Food (16th series). EUR 10210 EN. Luxembourg: Commission of the European Communities. Available from: 1985
  43. Scientific Committee for Food. Erythritol (opinion expressed on 5 March 2003. Available from: 2003
  44. Boesten DMPHJ. et al. Health effects of erythritol. Nutrafoods 2015; 14: 3-9
  45. Joint FAO/WHO Expert Committee on Food Additives (JECFA). – WHO Food Additives Series 44: Sweetening Agent – Erythritol - 2000
  46. GRAS Determination of Erythritol for use in Human Food. 2018
  47. Joint FAO/WHO Expert Committee on Food Additives (JECFA). – WHO Food Additives Series 18: Sweetening Agent – Xylitol - 1983
  48. Pope E, Koren G, Bozzo P. Sugar substitutes during pregnancy. Can Fam Physician 2014; 60 (11) 1003-1005
  49. Yunginger JW, Jones RT, Kita H, Saito K, Hefle SL, Taylor SL. Allergic reactions after ingestion of erythritol-containing foods and beverages. J Allergy Clin Immunol 2001; 108 (04) 650
  50. Hino H, Kasai S, Hattori N, Kenjo K. A case of allergic urticaria caused by erythritol. J Dermatol 2000; 27 (03) 163-165
  51. Shirao K, Inoue M, Tokuda R. et al. “Bitter sweet”: a child case of erythritol-induced anaphylaxis. Allergol Int 2013; 62 (02) 269-271
  52. Sugiura S, Kondo Y, Ito K, Hashiguchi A, Takeuchi M, Koyama N. A case of anaphylaxis to erythritol diagnosed by CD203c expression-based basophil activation test. Ann Allergy Asthma Immunol 2013; 111 (03) 222-223
  53. Kurihara K, Suzuki T, Unno A, Hatano M. [Case of 5 year-old boy with anaphylaxis due to erythritol with negative prick test and positive intradermal test]. Arerugi 2013; 62 (11) 1534-1540
  54. Okamoto K, Kagami M, Kawai M. et al. Anaphylaxis to xylitol diagnosed by skin prick test and basophil activation test. Allergol Int 2019; 68 (01) 130-131
  55. Hanakawa Y, Hanakawa Y, Tohyama M, Yamasaki K, Hashimoto K. Xylitol as a causative agent of oral erosive eczema. Br J Dermatol 2005; 152 (04) 821-822
  56. Guideline: Sugars intake for adults and children. Geneva: World Health Organization; 2015
  57. Adoçantes calóricos e não calóricos. Food Ingredients Brazil. 2010; (15) 22-35

How to Cite

Nogueira-de-Almeida, C. A., & Ribas Filho, D. (2022). Positioning on the Use of Polyols as Table Sweeteners. International Journal of Nutrology, 14(2), 71–80.