Ear Infections and Xylitol


My 7-month old has developed his first ear infection, and our doctor has started him on antibiotics. My question, however, is about the naturally-occurring substance, xylitol. It is sold in sugar-substitute form, toothpaste, and chewing gum. I recently read an article about xylitol aiding in ear infections. My question is, does this help? If so, how much and how often should I give it to my baby? He has 3 teeth, and uses a toothbrush for teething. Can I sprinkle a little of the “sugar” on the toothbrush? Thank you!
Christine Dwyer – Cincinnati, Ohio

Dr. Greene's Answer

Parents need to know about this gentle, effective solution – especially if their children get ear infections. Xylitol (pronounced zie-lit-tall) is a sweet substance found naturally in raspberries and plums. What is it, exactly, and what does it do? The xylophone is a percussion instrument consisting of a series of wooden bars of increasing lengths, which when struck makes sounds of the musical scale. The “xyl” in xylophone comes from the Greek word xylan, meaning wood. A xylophone makes sound from wood; xylitol is a sugar made from wood.

Xylitol, also called wood sugar, can be made from the cell walls of most land plants. Xylan, the naturally occurring substance that yields xylitol when refined, is found most commonly in straw, corncobs, oat hulls, cottonseed hulls, and wood. Xylitol is a common food sweetener. Unlike most sugars which have 6 carbon atoms, this naturally sweet substance has only five.

While other sugars tend to promote the growth of bacteria, xylitol has been proven to inhibit the growth of bacteria. In particular, it has been shown to be effective in preventing dental cavities by inhibiting Streptococcus mutans, the main bacteria responsible for cavities.

Since the major cause of ear infections is Streptococcus pneumoniae, a species of bacteria closely related to Streptococcus mutans, it was thought that perhaps xylitol would prove effective in preventing ear infections. Researchers from Finland tested this hypothesis and published the results of their investigation in the British Medical Journal (November 1996).

The study included 306 children in day care nurseries, most of whom had a history of repeated ear infections. Half of the children chewed xylitol-sweetened gum (2 pieces, 5 times a day — after all meals and snacks); the other half chewed ordinary gum at the same frequency. During the 2 months of the study, 21% of the regular gum chewers, but only 12% of the xylitol group, had one or more ear infections. Gum chewing by itself, by promoting swallowing and thus clearance of the middle ear, probably prevents some ear infections. The sugar in the regular-sugar-sweetened gum may have offset this effect by promoting bacterial growth in the children who chewed this ordinary gum. By contrast, in this study, xylitol dropped the incidence of ear infections by almost half!

In the xylitol group, children took a total of 8.4 grams daily. Most experienced no side effects, but two of them developed diarrhea — a known side effect of this and other sweeteners.

A small number of children, almost all of them of Jewish descent, have a congenital enzyme defect making them unable to digest xylitol. This condition is called pentosuria. There are no associated disabilities.

No treatment, and no dietary restriction, is necessary for pentosuria. The xylitol is absorbed into the body and then excreted in the urine. The only problem arising from pentosuria is that children having this sugar in the urine are sometimes mistakenly diagnosed with diabetes, and receive diabetic treatment. Pentosuria has no relationship to diabetes. Children with pentosuria could still use xylitol to prevent ear infections.

This Finnish study, making use of the natural, gentle antibiotic properties of plants, is an exciting development. A similar study conducted by the same authors in 1998 (Pediatrics) confirmed the results found.

In 2004 (Journal of Antimicrobial Chemotherapy), researchers showed that xylitol causes damage to Streptococcus pneumoniae, one of the major causes of ear infections. It is thought to work by weakening the bacteria and preventing it from growing.

A large study involving 663 children in 2007 found that the frequency of xylitol use was essential to its effectiveness. Instead of using it 5 times a day, children in the study were given a higher total daily dose (9.6 grams instead of 8.4) divided 3 times a day. Even though the total daily dose was greater, ear infections were not reduced on a 3 times a day regimen. Hence, it appears that xylitol must be used at least 5 times a day in order to effectively reduced ear infections (Pediatr Infect Dis J. 2007 May;26(5):423-7).

While much research remains to be done (e.g. the optimal amounts and delivery systems), xylitol seems to be a safe and effective way to reduce the number of ear infections. I suspect it will also prove useful in preventing sinus infections, because the same bacteria are involved.

Last medical review on: November 01, 2008
About the Author
Photo of Alan Greene MD
Dr. Greene is a practicing physician, author, national and international TEDx speaker, and global health advocate. He is a graduate of Princeton University and University of California San Francisco.
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Recent Comments

Xylitol has been a godsend to my health. Since early childhood I’ve suffered from nasal infections (my mum too) and so was given Otrivin spray for my nose which helped. I actually became addicted to the Otrivin by university days. Instead of needing the spray twice a day, I began taking it thrice a day. I stopped using it and within three days, I no longer needed to use it. I just put up with the occasion of infection from then on until I came about Xylitol.
I have been using Xylitol spray (5tsp Xylitol +1/2 tsp baking soda in 250ml water as a buffer) for at least twenty years. I try to use it in all head orifices morning and night. When sprayed or dropped into my ears, I pinch my nose, and gently suck and gently blow to move it in and out of my ear passages. (I can actually taste it in my throat when doing this.) In my fifties I developed itchy eyebrow syndrome. A quick spray puts an end to that misery for about three or so months. I also imbibe a tsp of xylitol in my tea, two or three times a day, and brush my teeth with Xylitol.
In all these years I have only had three slight indications of a cold or flue when I became lackadaisical in my practice.
I suspect that colds and flues weaken the body. For this reason and so to fight the misery colds and flues present, I shall continue this practice to end days.

Rage to Bugs
Illness free I strive to be
So colds ’n flues
Darn’t bother me.
And I shall rage and roar with glee,
The end to all your misery!

In bed I dream those little bugs,
Now in misery they are wrung,
Wilfully, woefully be expunged,
Comeuppance fair, line their lair!
Such is true and only fair.
Now You lie in misery,
For I have Defeated Thee!
Namaste and care—😀

I recently heard that a puppy ate 2 pieces of Xylitol gum and had to be put to sleep because its liver started to die. This was the day after eating it.

Hi Dr. Alan thanks for this helpfull article. i think that natural remedies are the best way to treat any illness

Thank you, Dr. Greene, for your information and for choosing “green” methods to treat children. I immigrated 20 years ago to Canada from a so-called “third world country”. I was shocked to observe how many sick people/children are in Canada, despite the high life standards. Then I’ve seen that traditional medicine not only avoids natural remedies, but even rebukes them. It’s a shame. It’s true, in the country I came from was not so much food, but surely was much more natural, healthy and tasty. I feel sorry for the kids I am teaching and, as a grandmother to be I am already worried for my grandchildren’s health.

I wish you health and strength to discover more and more natural ways to treat kids.

So true, CarDu.
As a teacher of first nation’s children, I encouraged parents and children to continue their traditions and natural hunting practices to fight against the diseases and illnesses caused by the over produced food industry.
A younger brother died a few months ago because he would not listen to any suggestions that differed from his medical doctor’s advice. He was only 61. He came home from shopping, put the perishables into the fridge, left the ‘processed packaged foods’ on the kitchen table, and then went to be.
He seemed to have died peacefully, in his sleep. No autopsy was performed as he died inside his own home.
We have longevity on both sides of the family with a grand parent and great grandparents living into their late 90’s.
My father had an accident, slipping and cracking his head against the bumper of his car. He died from exposure outside his house. He was only 64. The coroner had to do a full autopsy as he had died in such a way and said that he should have lived to a hundred. Although an alcoholic, his liver and all organs were in perfect condition. That, I attribute to his good diet. He was a slim, tall, strong man.
All you can do is encourage your grandchildren to eat healthily and avoid sugars and processed food. Every meal should not be used for entertainment. We have so much time for entertainment in our cultures today. Food must be seen and used as sacred to health and soul.
Namaste and care,

Have you heard of Cracked Candy? It is a new candy made from 100% birchwood xylitol so much easier/better for kids than gums and stronger than toothpaste. It tastes yummy too :)