Effect of the Natural Sweetener Xylitol on Gut Hormone Secretion and Gastric Emptying in Humans: A Pilot Dose-Ranging Study.

Anne Christin Meyer-Gerspach,Jan Tack,Christoph Beglinger,Carel W Le Roux,Wout Verbeure,Jens F Rehfeld,Bolette Hartmann,Ludmilla Dellatorre-Teixeira,Ralph Peterli,Jens J Holst,Bettina K Wölnerhanssen,Jürgen Drewe

doi:10.3390/nu13010174

Abstract

Sugar consumption is associated with a whole range of negative health effects and should be reduced and the natural sweetener xylitol might be helpful in achieving this goal. The present study was conducted as a randomized, placebo-controlled, double-blind, cross-over trial. Twelve healthy, lean volunteers received intragastric solutions with 7, 17 or 35 g xylitol or tap water on four separate days. We examined effects on: gut hormones, glucose, insulin, glucagon, uric acid, lipid profile, as well as gastric emptying rates, appetite-related sensations and gastrointestinal symptoms. We found: (i) a dose-dependent stimulation of cholecystokinin (CCK), active glucagon-like peptide-1 (aGLP-1), peptide tyrosine tyrosine (PYY)-release, and decelerated gastric emptying rates, (ii) a dose-dependent increase in blood glucose and insulin, (iii) no effect on motilin, glucagon, or glucose-dependent insulinotropic peptide (GIP)-release, (iv) no effect on blood lipids, but a rise in uric acid, and (v) increased bowel sounds as only side effects. In conclusion, low doses of xylitol stimulate the secretion of gut hormones and induce a deceleration in gastric emptying rates. There is no effect on blood lipids and only little effect on plasma glucose and insulin. This combination of properties (low-glycemic sweetener which stimulates satiation hormone release) makes xylitol an attractive candidate for sugar replacement.

Highlights

Sugar consumption should be reduced in the general population according to WHO guidelines [1]
With this study we show that xylitol exhibits a combination of properties that render this sweetener an attractive sugar substitute
The main results of the study can be summarized as follows: (i) xylitol induces a dose-dependent stimulation of CCK, active glucagon-like peptide-1 (aGLP-1), and peptide tyrosine tyrosine (PYY) release, and deceleration of gastric emptying rates, (ii) xylitol leads to a dose-dependent increase in blood glucose and insulin concentrations, (iii) xylitol has no effect on motilin, glucagon or glucose-dependent insulinotropic peptide (GIP)-release, (iv) blood lipids are not affected by 35 g xylitol, but a rise in uric acid is observed, and (v) doses up to 35 g xylitol are well tolerated

Summary

Introduction

Sugar consumption should be reduced in the general population according to WHO guidelines [1]. Individuals with diabetes and obesity are recommended a sugar-free, low glycemic diet. In this context, sugar substitutes, such as low-calorie sweeteners (LCS), might be helpful. As xylitol is increasingly used as a sugar substitute, questions arise regarding metabolic effects in humans, such as for instance release of gut hormones and satiating potential. In a trial published in 1989 by Salminen et al, oral administration of 30 g xylitol in 200 mL water compared to 30 g glucose in 200 mL water resulted in a deceleration in gastric emptying [4]. Our own study group recently compared effects of acute intake of 75 g glucose, 50 g xylitol or 75 g erythritol in 300 mL water versus placebo (tap water) on gut hormones and gastric emptying. The load used in our preliminary study (50 g xylitol in 300 mL) led to bloating and diarrhea in 60–70% of all subjects up to two hours after administration [5]

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