Sugar alcohols (polyols) are used in food manufacturing and in medical tests and examinations. 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 (1).
The consumption of high nutritional value snacks may favorably affect the diet quality. Biscuits manufactured with oat flakes and maltitol were assessed for glycemic, insulinemic and ghrelin responses. Enrichment with inulin, a fructooligosachararide (FOS) which acts as soluble fiber, was performed in an attempt to further increase the dietary fiber content and examine potential additional postprandial benefits. Eleven healthy subjects participated in the study and consumed either 80 g oat biscuits (OB) or 81 g oat biscuits with 4% inulin (OBIN) or a solution containing 50 g of glucose (reference food), each yielding 50 g of available carbohydrates. Venous blood samples were collected before consumption and at 15, 30, 45, 60, 90, 120 and 180 min postprandially. The developed products were also evaluated for physicochemical properties, including porosity, density, texture, color, sensory attributes and microstructure (by scanning electron microscopy). Both biscuits demonstrated a low glycemic index (GI), which was found to be 32.82 ± 8.07 for OB and 45.68 ± 9.64 for OBIN. Compared to OB, OBIN demonstrated higher insulin response at 45 and 60 min and higher ghrelin suppression at 60 and 120 min postprandially (P < 0.05). Furthermore, OBIN demonstrated increased hardness and color values, lower porosity, and higher rate of starch granule gelatinization, without significantly altering the sensory attributes. Biscuits formulated with oat flakes and maltitol with or without 4% inulin can be classified as low GI foods. Inulin addition significantly lowered the ghrelin response to OBIN, suggesting an advantage of OBIN in the modulation of satiety; however, no further benefits regarding glucose and insulin responses were observed (2).
The objective of this study was to test the effect of sugar-free chewing gum sweetened with xylitol or maltitol compared to the use of a gum base or no gum on gingivitis and plaque scores under both brushing and non-brushing circumstances...In circumstances where regular brushing is performed, no effect of chewing gum was observed on bleeding and plaque scores. In the absence of brushing, chewing xylitol or maltitol gum provided a significant inhibitory effect on gingivitis scores compared to chewing gum base. The difference when compared to the group not using gum was not significant (3).
To evaluate the short-term digestive tolerance and glycaemic response of several associations of maltitol and short-chain fructo-oligosaccharides (scFOS) used to replace sugars (for example, dextrose) in foods...This study has shown that maltitol and scFOS can be used jointly when formulating sugar-free foods with the benefit to lower postprandial glycaemic response with only a small and transient increase in non-serious individual gastrointestinal symptoms (4).
The effects on plaque parameters of sugar free chewing-gums (CG) sweetened with either maltitol or xylitol were assessed to better understand the role polyols can play in dental caries prevention...Sugar free CG sweetened with either maltitol or xylitol can similarly reduce plaque acidogenicity compared to gum base through a decrease in oral bacteria presence. The use of a gum base placebo allowed to isolate effects on parameters involved in dental caries development specific to maltitol and xylitol, and to show these effects were similar (5).
References_________________________________________
(1) Gastrointestinal Disturbances Associated with the Consumption of Sugar Alcohols with Special Consideration of Xylitol: Scientific Review and Instructions for Dentists and Other Health-Care Professionals.
Mäkinen KK.
Int J Dent. 2016
(2) Evaluation of a high nutritional quality snack based on oat flakes and inulin: effects on postprandial glucose, insulin and ghrelin responses of healthy subjects.
Stamataki NS, Nikolidaki EK, Yanni AE, Stoupaki M, Konstantopoulos P, Tsigkas AP, Perrea D, Tentolouris N, Karathanos VT.
Food Funct. 2016 Jul
(3) Effects of sugar-free chewing gum sweetened with xylitol or maltitol on the development of gingivitis and plaque: a randomized clinical trial.
Keukenmeester RS, Slot DE, Rosema NA, Van Loveren C, Van der Weijden GA.
Int J Dent Hyg. 2014 Nov
(4) Digestive tolerance and postprandial glycaemic and insulinaemic responses after consumption of dairy desserts containing maltitol and fructo-oligosaccharides in adults.
Respondek F, Hilpipre C, Chauveau P, Cazaubiel M, Gendre D, Maudet C, Wagner A.
Eur J Clin Nutr. 2014 May
(5) Effects of maltitol and xylitol chewing-gums on parameters involved in dental caries development.
Thabuis C, Cheng CY, Wang X, Pochat M, Han A, Miller L, Wils D, Guerin-Deremaux L.
Eur J Paediatr Dent. 2013 Dec
