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Sugar substitutes are big business. Less sugar can mean weight loss, improved health, diabetic control, and even reduced tooth decay. The quest for products that can sweeten and cook like sugar is ongoing. Xylitol is common sugar substitute, especially when it comes to sugarless gum. Not only does xylitol offer sweetness without calories, it also has antibacterial properties in the mouth so as to reduce periodontal disease and has been found to have far reaching health benefits in other areas of the body. Xylitol may help with osteoporosis, prevention of ear and throat infections, and may reduce the risk of endometriosis, uterine fibroids, and even breast cancer.

Sounds wonderful, and maybe it is - if you are a human. If you are a dog, xylitol is potentially lethal.

In the canine body, the pancreas confuses xylitol with real sugar and releases insulin to store the "sugar." The problem is that xylitol does not offer the extra Calories of sugar and the rush of insulin only serves to remove the real sugar from the circulation. Blood sugar levels plummet resulting in weakness, disorientation, tremors, and potentially seizures.

It does not take many sticks of gum to poison a dog, especially a small dog (see below for toxic doses). Symptoms typically begin within 30 minutes and can last for more than 12 hours. Vomiting and diarrhea may also occur.

The other reaction associated with xylitol in the canine body is actual destruction of liver tissue. How this happens remains unknown, but the doses of xylitol required to produce this effect are much higher than the hypoglycemic doses described above. Signs take longer to show up (typically 8-12 hours) and surprisingly not all dogs that experience hepatic necrosis, will have experienced hypoglycemia first. A lucky dog experiences only temporary illness but alternatively, a complete and acute liver failure can result with death following. Internal hemorrhage and inability of blood to clot is commonly involved.

Xylitol is a sugar alcohol that was developed for use in cookies, candies, cupcakes and other sweets for people who have diabetes. Xylitol is now used in a broad assortment of products intended for the general public. Among them: Jello sugar-free puddings and a wide variety of other sugar-free products, including gum, mints, chewable vitamins, oral care products, and in a granulated form used for baking. Because of its bacteria-killing properties, it is also put into some oral care products such as toothpaste.

Makers of products with xylitol say their products are designed for people, including diabetes patients, who are seeking an alternative to sugar; they were never recommended for dogs and were never intended to be ingested by dogs.

The following is a list of products that contain xylitol:

  • Orbit gum
  • Trident gum
  • Stride gum
  • Ice Breakers gum
  • Altoids
  • Biotene Mouthwash
  • Breath Rx
  • TheraBreath toothpaste & mouthwash
  • Tom's of Maine products
  • Mint Asure
  • FreshBreath capsules
  • Smint "xylicare"

This list is not complete and pet owners must read ingredient labels (especially on sugar-free products) to determine if the product contains xylitol.

The hypoglycemic dose of xylitol for dogs is considered to be approximately 0.1 gram per kilogram of body weight. A typical stick of gum contains 0.3 to 0.4 grams of xylitol, which means that a 10 lb dog could be poisoned by as little as a stick and a half of gum, or a 70 lb dog by as little as 10 and one half sticks of gum.

The dose to cause hepatic necrosis is 1 gram per kilogram of body weight, about ten times more than the above dose. In the example above, the 10 lb dog would have to find an unopened package of gum and eat it for liver destruction to occur.

Clinical signs of xylitol toxicity can develop in as few as 30 minutes after ingestion. Clinical signs may include one or more of the following:

* Vomiting/Diarrhea
* Weakness
* Ataxia/"Drunken walking" (uncoordinated movements)
* Depression
* Seizures
* Coma and death if untreated

When a dog suffers from xylitol toxicity, veterinarians will have to take a two-pronged approach to the dog's treatment.

First, if the dog ate the sugar-free gum or other food containing xylitol within the past two hours, the veterinarian will take measures to prevent the body's absorption of any additional xylitol. To prevent thedog's body from absorbing additional xylitol, the vet will usually induce vomiting in the dog and/or give the dog a charcoal-based fluid to adsorb the stomach contents.

Second, a dog with xylitol poisoning will receive supportive care to manage the effects of the xylitol. Treatment usually consists of a dextrose (sugar) intravenous drip to raise the dog's blood sugar levels and the injection of intravenous fluids for at least 24 hours.

Xylitol also affects the dog's liver, causing permanent liver damage in some dogs and possibly triggering liver failure in others. Additional treatment and monitoring is often required to help manage the affect of xylitol on the dog's liver. Liver enzyme and blood clotting tests are monitored for 2 to 3 days along with blood levels of potassium and phosphorus. Elevated blood phosphorus levels often has a poorer prognosis for the patient.

So far the ASPCA Animal Poison Control Center has no reports of xylitol toxicity in cats. At this time, feline toxicity is unknown.

The oral health benefits of xylitol do seem to hold true for dogs if appropriately low doses of xylitol are used. A product called Aquadent® has been marketed for canine oral care, specifically for dogs that do not tolerate other methods of dental home care. This product is mixed in drinking water to provide antibacterial benefits. It comes in a 500 cc (half liter) bottle that contains a total of 2.5 grams of xylitol as well as in small packets. If one follows the dosing instructions on the bottle or packet, there should be no problems.

Trouble could occur if there are animals of different sizes drinking from the same water bowl (one should dose for the smallest animal to use the bowl to be sure overdose is not possible). A dog finding the bottle and chewing it up, drinking a substantial quantity of the undiluted product could easily be poisoned depending on the dog's size.

Animal Poison Control Center

The ASPCA Animal Poison Control Center strongly urges pet owners to be especially diligent in keeping candy, gum or other foods containing xylitol out of the reach of pets. As with any potentially toxic substance, should accidental exposures occur, it is important to contact your local veterinarian or the ASPCA Animal Poison Control Center for immediate assistance. 

Keep this phone number handy: (888) 426-4435

This is the number for the ASPCA Animal Poison Control Center, a 24-hour service whereby you can speak directly to a veterinary toxicology specialist. In addition to advice, you will receive a case number which your veterinarian can use for further consultation at no additional charge.    

If you suspect your dog has ingested a product containing xylitol please call your veterinarian immediately for further instructions.

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