Your essential guide to xylitol poisoning in dogs

The 21^st century has brought diet crazes, sugar-free candies, gums, and even peanut butter to consumers around the globe. Xylitol, a commonly used natural sweetener, while touted as beneficial in most instances for humans, can have dire consequences in even small amounts when ingested by our canine friends. Familiarity with the common clinical signs and recommended treatments leads to a good prognosis despite a potential severe toxicosis risk.

Low glycemic index: great for people, bad for dogs

Xylitol is a sugar alcohol, aka a polyol. It is a carbohydrate naturally found in many fruits and vegetables. Considered a part of the FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols). It has been ballyhooed as an excellent substitute for sucrose and glucose in foods, candies, chewable vitamins, sugar-free gums, mouthwashes, and other foodstuffs. Other applications, such as an ingredient in dental fluoride treatments, liquid medications, and even nasal sprays, show xylitol is readily available and prevalent in a dog's environment. Even in people, as with most things, too much of even a good thing can have adverse effects, causing GI distress, including bloating, gas, or diarrhea.^1,2

The use of xylitol in such plentiful products isn't by chance. Numerous benefits have been demonstrated, leading to its use in multiple goods and products. Examples of some of the known benefits of xylitol in human medicine and diet include:^3–7

1. Antiplaque effects—Research suggests that this polyol lowers the risk of cavities by lowering the pathogenic Streptococcus species that develop in the oral cavity, leading to dental caries.
2. This polyol decreases inflammation of the gingiva and may reduce inflammation in other parts of the body, though additional research is ongoing.
3. It may improve teeth enamel mineralization.
4. It can stimulate digestion, though this may manifest as diarrhea and may not necessarily benefit everyone.
5. It may improve glycemic control when used in lieu of glucose, fructose, or sucrose for foods and drinks because it doesn't contribute to the same type of blood sugar spikes as sugar.
6. This lower glycemic index may aid in obesity management or lessen the risk of metabolic syndrome for those with obesity or at risk.
7. It can lower the calorie content of foods when replacing sugar since xylitol has up to 40 percent fewer calories.

However, as with most things in life, too much of anything can still do harm. Recent research suggests that xylitol in larger consumption may increase the risk of heart disease or stroke by negative impacts on the body's ability to clot blood.^6,8,9

 Xylitol toxicosis in dogs

While some people see benefits in the use of xylitol, others may develop GI upset, or as we see in dogs, much more severe concerns may arise. Xylitol is toxic to all dogs, with the risk of profound hypoglycemia and hepatic necrosis of key considerations. (Let clients know, too, some manufacturers use the term "birch sugar," for xylitol on their labels.) The intensity of the response escalates with increased dosages. Hypoglycemia may occur in any patient with adequate intake; however, liver damage is unique. Sadly, we still do not have a clear understanding of why it occurs or any predictive means to know which patients will develop hepatic necrosis. Thus, we cannot envisage in which patients we will see liver issues arise.

Unfortunately, we do not always know the amount ingested. Some products will list the amount contained in the product, but for proprietary reasons and because there are no regulations requiring it, many do not. Sugar-free gums, for example, may range from only two mg to an entire gram per piece of gum. Calculating the ingested dose is paramount to understanding what may occur in the patient clinically and to help guide treatment. This is where contacting poison control benefits you, the patient, and the client. No matter how often you have treated (or haven't treated) this condition, each product and patient are different. Getting all the relevant information off the bat is key to a successful outcome. Further, if complications arise, follow-up calls with poison control can assist further in treatment decisions and options.¹⁰