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

CPP-ACP paste's effect on salivary conditions in patients with removable dentures

PURPOSE

Older adults with removable dentures experience high rates of both caries (when the natural dentition remains) and salivary gland dysfunction. While many commercial dental therapeutic agents target these two interrelated problems, none have been labeled for use on the fitting surface of removable dentures. Off-label use of MI Paste (GC America, Alsip, IL), a dental therapeutic containing casein-phosphopeptide-amorphous-calcium-phosphate (CPP-ACP), was investigated following its application to the fitting surface of complete denture(s) with subsequent effects on salivary conditions measured.

MATERIALS AND METHODS

Salivary flow rate and pH were recorded at baseline and 15 min following the application of 1 mL of CPP-ACP paste to the fitting surface of each participant's denture through whole saliva collection. To assess buffering capacity, equivalent volumes of 0.01 M lactic acid were added to the collected saliva samples, and pH reduction was measured. Comparisons of salivary parameters between baseline and post-CPP-ACP paste application and between subjects with and without self-reported xerostomia were conducted using a paired-sample t-test, Wilcoxon signed-rank test, or two-sample t-test as appropriate.

RESULTS

Of the 28 participants (mean age = 70.3 ± 13.7 years, 17 males), 11 reported xerostomia. CPP-ACP-paste application was associated with decreased pH reduction during acid challenge compared to baseline (0.95 ± 0.24 vs. 1.54 ± 0.53, p < 0.001), and a higher final pH following acid challenge (5.93 ± 0.34 vs. 5.40 ± 0.66, p < 0.001). While the flow rates observed at post-CPP-ACP paste application were greater than those at baseline, the difference was not statistically significant (0.67 ± 0.44 mL/min vs. 0.55 ± 0.34 mL/min, p = 0.053). No significant differences were found in any salivary parameters between participants with or without self-reports of xerostomia.

CONCLUSIONS

The findings highlight potential positive effects on salivary conditions following the application of the CPP-ACP-containing product, MI Paste, to the fitting surface of a removable complete denture as a potential caries-risk-management tool when natural dentition remains. Determining the caries-preventive clinical significance will require longer-term trials.

The effect of xylitol chewing gums and candies on caries occurrence in children: a systematic review with special reference to caries level at study baseline

PURPOSE

A systematic review of published data was carried out to assess the caries-preventive effects of xylitol chewing gums and candies in children.

METHODS

Electronic and hand searches were performed to find clinical studies on the effects of xylitol chewing gums and candies on dental caries in children (≤ 18 years). Prospective randomised or controlled clinical trials published before 2023 were included in the review.

RESULTS

The initial search identified 365 titles to be evaluated. After applying inclusion and exclusion criteria, 15 articles with either fair or low quality were reviewed. Nine articles studied chewing gums, five candies, and one both of them. In the ten evaluated xylitol chewing gum studies xylitol consumption significantly reduced caries occurrence when compared with no treatment or a placebo polyol gum. The effect was clinically significant in studies with high or moderate caries level at study baseline. The results also suggested that the caries-reducing effect of xylitol gums may differ from sorbitol/polyol gums. In five of the six heterogenous xylitol candy studies, no caries-reducing effect was found independent of caries level. In addition to caries level, also the daily xylitol dose was a confounding factor.

CONCLUSION

The present findings suggest that the caries-reducing effect of adding xylitol chewing gum to the daily diet has been well demonstrated in children and adolescents with high or moderate caries level at study baseline. Xylitol gum use could benefit subjects with active incipient caries lesions on smooth tooth surfaces.

Analysis and comparison of bioactive phytochemical composition and antibacterial property of two Ethiopian indigenous medicinal plants

Indigenous medicinal plants with naturally inherited antimicrobial properties are promising sources of antimicrobial agents. Two indigenous Ethiopian traditional medicinal plants (Rhamnus prinoide and Croton macrostachyus) extracted using different solvents and the yield percentage, phytochemical analysis and antimicrobial activity of the plant extracts were examined and compared. The results of this study revealed that Rhamnus prinoide leaf extract using aqueous methanol/ethanol (1 : 1) had the highest yield (15.12 %), a minimum inhibitory concentration of 0.625 mg/mL, and a minimum bactericidal concentration of 10 mg/mL against S. aureus. Croton macrostachyus leaves showed a yield of 14.7 ±0.37 %, a minimum inhibitory concentration of 40 mg/mL, and a minimum bactericidal concentration of 40 mg/mL against S. aureus and E. coli. GC-MS analysis revealed that aqueous methanol/ethanol (1 : 1) of Rhamnus prinoide and Croton macrostachyus leaf extracts were composed of bioactive carbohydrates, flavonoid acid phenols, and terpenoids, while Croton macrostachyus extract contained primarily phytol (30.08 %). The presence of bioactive compounds confirms the traditional use of these plant leaves to treat various diseases, including wounds, leading to the conclusion that they could be applied to textiles for wound dressing in future studies.

Harnessing the power of polyol-based polyesters for biomedical innovations: synthesis, properties, and biodegradation

Polyesters based on polyols have emerged as promising biomaterials for various biomedical applications, such as tissue engineering, drug delivery systems, and regenerative medicine, due to their biocompatibility, biodegradability, and versatile physicochemical properties. This review article provides an overview of the synthesis methods, performance, and biodegradation mechanisms of polyol-based polyesters, highlighting their potential for use in a wide range of biomedical applications. The synthesis techniques, such as simple polycondensation and enzymatic polymerization, allow for the fine-tuning of polyester structure and molecular weight, thereby enabling the tailoring of material properties to specific application requirements. The physicochemical properties of polyol-based polyesters, such as hydrophilicity, crystallinity, and mechanical properties, can be altered by incorporating different polyols. The article highlights the influence of various factors, such as molecular weight, crosslinking density, and degradation medium, on the biodegradation behavior of these materials, and the importance of understanding these factors for controlling degradation rates. Future research directions include the development of novel polyesters with improved properties, optimization of degradation rates, and exploration of advanced processing techniques for fabricating scaffolds and drug delivery systems. Overall, polyol-based polyesters hold significant potential in the field of biomedical applications, paving the way for groundbreaking advancements and innovative solutions that could revolutionize patient care and treatment outcomes.

A concise review of chewing gum as an anti-cariogenic agent

Chewing gum has been endorsed as a caries preventive agent by the FDI World Dental Federation, the American Dental Association, and the European Food Safety Authority. This review discusses the mechanism and provides an update of the use of chewing gum for caries prevention. Chewing gum typically consists of a water-insoluble gum base, water-soluble added ingredients, and active ingredients. It can be classified as sugar-containing or sugar-free, as well as nonmedicated or medicated. Chewing gum prevents dental caries through a range of mechanisms, including the clearance of the oral cavity, neutralization of oral acidity, inhibition of cariogenic bacterial growth, remineralization of enamel, and reduction of appetite. Recent clinical studies have evaluated the efficacy of sugar-free chewing gum for caries prevention, with most demonstrating positive results, although some studies have reported contradictory outcomes. To achieve optimal caries prevention, it is generally recommended that individuals chew sugar-free gum for five minutes after meals, three times daily.

Rheological parameters of mixed Brazilian Cerrado fruits sugar-free preserves: the effect of body agents

The aim of this study was to evaluate the effect of the bodying agents (erythritol, sorbitol, xylitol, and polydextrose) and their mixtures on the preparation of mixed Brazilian Cerrado fruit preserves (marolo, soursop, and sweet passion fruit). Mixture design was used for product optimization and the preserves were evaluated by texture profile, stress relaxation test, and uniaxial compression test. The research data were analyzed using regression equations on SAS software. The results indicated that the rheological parameters were affected by the body agents. Erythritol should not be used as an isolated component because it provoked changes in the properties of the final product (harder and brittle preserves); xylitol and sorbitol made preserves more elastic, cohesive, and more fragile; and polydextrose showed a synergistic effect with erythritol for rupture deformation and lesser effects for hardness, adhesiveness, and gumminess.

Nanopore Identification of Alditol Epimers and Their Application in Rapid Analysis of Alditol-Containing Drinks and Healthcare Products

Alditols, which have a sweet taste but produce much lower calories than natural sugars, are widely used as artificial sweeteners. Alditols are the reduced forms of monosaccharide aldoses, and different alditols are diastereomers or epimers of each other and direct and rapid identification by conventional methods is difficult. Nanopores, which are emerging single-molecule sensors with exceptional resolution when engineered appropriately, are useful for the recognition of diastereomers and epimers. In this work, direct distinguishing of alditols corresponding to all 15 monosaccharide aldoses was achieved by a boronic acid-appended hetero-octameric Mycobacterium smegmatis porin A (MspA) nanopore (MspA-PBA). Thirteen alditols including glycerol, erythritol, threitol, adonitol, arabitol, xylitol, mannitol, sorbitol, allitol, dulcitol, iditol, talitol, and gulitol (l-sorbitol) could be fully distinguished, and their sensing features constitute a complete nanopore alditol database. To automate event classification, a custom machine-learning algorithm was developed and delivered a 99.9% validation accuracy. This strategy was also used to identify alditol components in commercially available "zero-sugar" drinks and healthcare products, suggesting their use in rapid and sensitive quality control for the food and medical industry.

5-Keto-D-Fructose, a Natural Diketone and Potential Sugar Substitute, Significantly Reduces the Viability of Prokaryotic and Eukaryotic Cells

5-Keto-D-fructose (5-KF) is a natural diketone occurring in micromolar concentrations in honey, white wine, and vinegar. The oxidation of D-fructose to 5-KF is catalyzed by the membrane-bound fructose dehydrogenase complex found in several acetic acid bacteria. Since 5-KF has a sweetening power comparable to fructose and is presumably calorie-free, there is great interest in making the diketone commercially available as a new sugar substitute. Based on a genetically modified variant of the acetic acid bacterium Gluconobacter oxydans 621H, an efficient process for the microbial production of 5-KF was recently developed. However, data on the toxicology of the compound are completely lacking to date. Therefore, this study aimed to investigate the effect of 5-KF on the viability of prokaryotic and eukaryotic cells. It was found that the compound significantly inhibited the growth of the gram-positive and gram-negative model organisms Bacillus subtilis and Escherichia coli in a concentration-dependent manner. Furthermore, cell viability assays confirmed severe cytotoxicity of 5-KF toward the colon cancer cell line HT-29. Since these effects already occurred at concentrations of 5 mM, the use of 5-KF in the food sector should be avoided. The studies performed revealed that in the presence of amines, 5-KF promoted a strong Maillard reaction. The inherent reactivity of 5-KF as well as the Maillard products formed could be the trigger for the observed inhibition of prokaryotic and eukaryotic cells.

Partial Substitution of Glucose with Xylitol Prolongs Survival and Suppresses Cell Proliferation and Glycolysis of Mice Bearing Orthotopic Xenograft of Oral Cancer

Many types of cancer have metabolic alterations with increased glycolysis. Identification of alternative sweeteners that do not fuel cancer is a novel approach to cancer control. The present study aimed to investigate the effects of xylitol on tumor growth and survival of mice bearing orthotopic xenograft of tongue cancers. The results showed that partial substitution of glucose with xylitol (glucose 0.35 g plus xylitol 2.06 g/kg body weight) non-significantly reduced tumor volume, and significantly prolonged the median survival time from 19 days in the control to 30.5 days in the xylitol group. Immunohistochemical data of the tongue tissue shows significantly lower intense-to-mild staining ratios of the proliferation marker Ki-67 in the xylitol than those of the control group (p = 0.04). Furthermore, the xylitol substitution significantly reduced the expression of the rate-limiting glycolytic enzyme, phosphofructokinase-1 (PFK-1) (p = 0.03), and showed a non-significant inhibition of PFK activity. In summary, partial substitution of glucose with xylitol at the equivalent dose to human household use of 10 g/day slows down tumor proliferation and prolongs survival of mice bearing an orthotopic oral cancer xenograft, possibly through glycolytic inhibition, with minimal adverse events. The insight warrants clinical studies to confirm xylitol as a candidate sweetener in food products for cancer survivors.

Microbial xylitol production

Xylitol is pentahydroxy sugar alcohol, existing in very trace amount in fruits and vegetables, and finds varied application in industries like food, pharmaceuticals, confectionaries, etc. and is of prime importance to health. Owing to its trace occurrence in nature and considerable increase in market demand that exceeds availability, alternate production through biotechnological and chemical approach is in process. Biochemical production involves substrates like lignocellulosic biomasses and industrial effluents and is an eco-friendly process with high dependency on physico-chemical parameters. Although the chemical processes are faster, high yielding and economical, they have a great limitation as usage of toxic chemicals and thus need to be regulated and replaced by an environment friendly approach. Microbes play a major role in xylitol production through a biotechnological process towards the development of a sustainable system. Major microbes working on assimilation of xylose for production of xylitol include Candida tropicalis, Candida maltose, Bacillus subtilis, Debaromyces hansenii, etc. The present review reports all probable microbial xylitol production biochemical pathways encompassing diverse bioprocesses involved in uptake and conversion of xylose sugars from agricultural residues and industrial effluents. A comprehensive report on xylitol occurrence and biotechnological production processes with varied substrates has been encompassed. KEY POINTS: • Xylitol from agro-industrial waste • Microbial xylose assimilation.

Association between Dietary Factors and Constipation in Adults Living in Luxembourg and Taking Part in the ORISCAV-LUX 2 Survey

Constipation, a disorder of bowel movements, is among the most frequent gastrointestinal complaints in Western countries. Dietary constituents such as inadequate fiber intake have been related to constipation, but discrepancies exist in the findings regarding dietary factors. This study investigated the association between dietary patterns and bowel movements in adults living in Luxembourg. Data from 1431 participants from ORISCAV-LUX 2 (a cross-sectional survey) who completed a 174-item food frequency questionnaire (FFQ) were analyzed. A questionnaire-based constipation score was assessed by a validated scoring system. Confounders such as physical activity and serum/urine indicators were assessed. Women had higher constipation scores than men (p < 0.001). In food group-based regression models, a negative association was found between higher constipation score and intake of grains (Beta = −0.62, 95%CI: −1.18, −0.05) and lipid-rich foods (Beta = −0.84, 95%CI: −1.55, −0.13), while a positive association was found for sugary products (Beta = 0.54, 95%CI: 0.11, 0.97) (p < 0.05). In a nutrient-based regression model, a positive association was found between constipation score and total energy (Beta = 5.24, 95%CI: 0.37, 10.11) as well as sodium intake (Beta = 2.04, 95%CI: 0.21, 3.87), and a negative one was found for total fats (Beta = −4.17, 95%CI: −7.46, −0.89) and starch (Beta = −2.91, 95%CI: −4.47, −1.36) (p < 0.05). Interestingly, neither fruits and vegetables or dietary fiber were significantly associated with constipation. Thus, grains, lipid-rich foods, total fats and starch were associated with a lower constipation score, while sugary products, sodium, and higher energy intake were correlated with higher constipation.

Formulation and Cost-Effectiveness of Fluid Gels as an Age-Appropriate Dosage Form for Older Adults with Dysphagia

Dysphagia is associated with increased dependency and treatment costs, whereby patients resort to extemporaneous compounding that may further increase the number of adverse events and medical errors. In the management of dysphagia, increasing the bolus viscosity of medication such as fluid gels can be practiced. This study aimed to prepare and characterize the fluid gels as well as to estimate the cost of using fluid gels and compare it to the conventional practice of extemporaneous preparation of thickened liquid. Fluid gels were formulated using gellan gum and determined for physicochemical characteristics and in vitro drug release profile. The cost-based price of the fluid gel was estimated and compared to the cost of administering standard medication as well as administering thickened liquid using thickening powder. Fluid gels exhibited good physicochemical properties with the viscosity within nectar and honey consistency. A similar dissolution profile to the reference was observed for the 0.5% w/v gellan gum fluid gel and exhibiting the Higuchi release model. The price for 100 mL unit of 50 mg/mL paracetamol/acetaminophen and 20 mg/mL ibuprofen fluid gel was estimated to be about USD2.30 and USD2.37, respectively. A dose of 1000 mg paracetamol and 400 mg ibuprofen fluid gel was estimated to be about USD0.46 and USD0.47, respectively, which is lower than the cost of administering the same dose using extemporaneous thickened liquid. Fluid gels could be a cost-effective formulation for delivering medication in patients with dysphagia and can be developed on a profitable scale.

Genome-wide association mapping of lentil (Lens culinaris Medikus) prebiotic carbohydrates toward improved human health and crop stress tolerance

Lentil, a cool-season food legume, is rich in protein and micronutrients with a range of prebiotic carbohydrates, such as raffinose-family oligosaccharides (RFOs), fructooligosaccharides (FOSs), sugar alcohols (SAs), and resistant starch (RS), which contribute to lentil's health benefits. Beneficial microorganisms ferment prebiotic carbohydrates in the colon, which impart health benefits to the consumer. In addition, these carbohydrates are vital to lentil plant health associated with carbon transport, storage, and abiotic stress tolerance. Thus, lentil prebiotic carbohydrates are a potential nutritional breeding target for increasing crop resilience to climate change with increased global nutritional security. This study phenotyped a total of 143 accessions for prebiotic carbohydrates. A genome-wide association study (GWAS) was then performed to identify associated variants and neighboring candidate genes. All carbohydrates analyzed had broad-sense heritability estimates (H2) ranging from 0.22 to 0.44, comparable to those reported in the literature. Concentration ranges corresponded to percent recommended daily allowances of 2-9% SAs, 7-31% RFOs, 51-111% RS, and 57-116% total prebiotic carbohydrates. Significant SNPs and associated genes were identified for numerous traits, including a galactosyltransferase (Lcu.2RBY.1g019390) known to aid in RFO synthesis. Further studies in multiple field locations are necessary. Yet, these findings suggest the potential for molecular-assisted breeding for prebiotic carbohydrates in lentil to support human health and crop resilience to increase global food security.

(-)-Oleocanthal Nutraceuticals for Alzheimer's Disease Amyloid Pathology: Novel Oral Formulations, Therapeutic, and Molecular Insights in 5xFAD Transgenic Mice Model

Alzheimer’s disease (AD) is a complex progressive neurodegenerative disorder affecting humans mainly through the deposition of Aβ-amyloid (Aβ) fibrils and accumulation of neurofibrillary tangles in the brain. Currently available AD treatments only exhibit symptomatic relief but do not generally intervene with the amyloid and tau pathologies. The extra-virgin olive oil (EVOO) monophenolic secoiridoid S-(–)-oleocanthal (OC) showed anti-inflammatory activity through COX system inhibition with potency comparable to the standard non-steroidal anti-inflammatory drug (NSAID) like ibuprofen. OC also showed positive in vitro, in vivo, and clinical therapeutic effects against cardiovascular diseases, many malignancies, and AD. Due to its pungent, astringent, and irritant taste, OC should be formulated in acceptable dosage form before its oral use as a potential nutraceutical. The objective of this study is to develop new OC oral formulations, assess whether they maintained OC activity on the attenuation of β-amyloid pathology in a 5xFAD mouse model upon 4-month oral dosing use. Exploration of potential OC formulations underlying molecular mechanism is also within this study scope. OC powder formulation (OC-PF) and OC-solid dispersion formulation with erythritol (OC-SD) were prepared and characterized using FT-IR spectroscopy, powder X-ray diffraction, and scanning electron microscopy (ScEM) analyses. Both formulations showed an improved OC dissolution profile. OC-PF and OC-SD improved memory deficits of 5xFAD mice in behavioral studies. OC-PF and OC-SD exhibited significant attenuation of the accumulation of Aβ plaques and tau phosphorylation in the brain of 5xFAD female mice. Both formulations markedly suppressed C3AR1 (complement component 3a receptor 1) activity by targeting the downstream marker STAT3. Collectively, these results demonstrate the potential for the application of OC-PF as a prospective nutraceutical or dietary supplement to control the progression of amyloid pathogenesis associated with AD.

Archaeal hyperthermostable mannitol dehydrogenases: A promising industrial enzymes for d-mannitol synthesis

Recently, the term healthy lifestyle connected to low-calorie diets, although it is not possible to get rid of added sugars as a source of energy, despite the close relation of added sugars to some diseases such as obesity, diabetes, etc. As a result, the sweetener market has flourished, which has led to increased demand for natural sweeteners such as polyols, including d-mannitol. Various methods have been developed to produce d-mannitol to achieve high productivity and low cost. In particular, metabolic engineering for d-mannitol considers one of the most promising approaches for d-mannitol production on the industrial scale. To date, the chemical process is not ideal for large-scale production because of its multistep mechanism involving hydrogenation and high cost. In this review, we highlight and present a comparative evaluation of the biochemical parameters that affecting d-mannitol synthesis from Thermotoga neapolitana and Thermotoga maritima mannitol dehydrogenase (MtDH) as a potential contribution for d-mannitol bio-synthesis. These species were selected because purified mannitol dehydrogenases from both strains have been reported to produce d-mannitol with no sorbitol formation under temperatures (90-120 °C).

Effects of xylitol and erythritol consumption on mutans streptococci and the oral microbiota: a systematic review

OBJECTIVE

A systematic review of published data was conducted with the aim of assessing effects of xylitol and erythritol consumption on levels of mutans streptococci (MS) and the oral microbiota.

MATERIALS AND METHODS

Electronic and hand searches were performed to find clinical microbiological studies concerning the consumption of xylitol and erythritol chewing gum or candies, and published between 2000 and 2019. Prospective randomized controlled clinical trials conducted in healthy subjects were included in the review.

RESULTS

The initial search identified 561 xylitol and 83 erythritol studies. After applying inclusion and exclusion criteria, 21 xylitol studies and one erythritol study were reviewed. The review identified nine xylitol studies with a fair or high quality, four conducted in children and five in adults, all demonstrating a decrease in MS levels in association with habitual consumption of xylitol. The three microbiota studies employing multispecies probe approaches revealed no effects for xylitol on the microbiota. The only erythritol study fulfilling the inclusion criteria showed no consistent effects on MS levels.

CONCLUSIONS

Xylitol consumption is likely to decrease MS counts but it may not change the overall microbiota. Xylitol shows thus properties of an oral prebiotic. More studies are needed to demonstrate the effects of erythritol on MS.

Maltitol: Analytical Determination Methods, Applications in the Food Industry, Metabolism and Health Impacts

Bulk sweetener maltitol belongs to the polyols family and there have been several dietary applications in the past few years, during which the food industry has used it in many food products: bakery and dairy products, chocolate, sweets. This review paper addresses and discusses in detail the most relevant aspects concerning the analytical methods employed to determine maltitol's food safety and industry applications, its metabolism and its impacts on human health. According to our main research outcome, we can assume that maltitol at lower doses poses little risk to humans and is a good alternative to using sucrose. However, it causes diarrhoea and foetus complications at high doses. Regarding its determination, high-performance liquid chromatography proved the primary method in various food matrices. The future role of maltitol in the food industry is likely to become more relevant as processors seek alternative sweeteners in product formulation without compromising health.

The rise of bio-inspired polymer compartments responding to pathology-related signals

Self-organized nano- and microscale polymer compartments such as polymersomes, giant unilamellar vesicles (GUVs), polyion complex vesicles (PICsomes) and layer-by-layer (LbL) capsules have increasing potential in many sensing applications. Besides modifying the physicochemical properties of the corresponding polymer building blocks, the versatility of these compartments can be markedly expanded by biomolecules that endow the nanomaterials with specific molecular and cellular functions. In this review, we focus on polymer-based compartments that preserve their structure, and highlight the key role they play in the field of medical diagnostics: first, the self-assembling abilities that result in preferred architectures are presented for a broad range of polymers. In the following, we describe different strategies for sensing disease-related signals (pH-change, reductive conditions, and presence of ions or biomolecules) by polymer compartments that exhibit stimuli-responsiveness. In particular, we distinguish between the stimulus-sensitivity contributed by the polymer itself or by additional compounds embedded in the compartments in different sensing systems. We then address necessary properties of sensing polymeric compartments, such as the enhancement of their stability and biocompatibility, or the targeting ability, that open up new perspectives for diagnostic applications.

Recent advances in the biotechnological production of erythritol and mannitol

Dietary habits that include an excess of added sugars have been strongly associated with an increased risk of obesity, heart disease, diabetes, and tooth decay. With this association in view, modern food systems aim to replace added sugars with low calorie sweeteners, such as polyols. Polyols are generally not carcinogenic and do not trigger a glycemic response. Furthermore, owing to the absence of the carbonyl group, they are more stable compared to monosaccharides and do not participate in Maillard reactions. As such, since polyols are stable at high temperatures, and they do not brown or caramelize when heated. Therefore, polyols are widely used in the diets of hypocaloric and diabetic patients, as well as other specific cases where controlled caloric intake is required. In recent years, erythritol and mannitol have gained increased importance, especially in the food and pharmaceutical industries. In these areas, research efforts have been made to improve the productivity and yield of the two polyols, relying on biotechnological manufacturing methods. The present review highlights the recent advances in the biotechnological production of erythritol and mannitol and summarizes the benefits of using the two polyols in the food and pharmaceutical industries.

Xylitol's Health Benefits beyond Dental Health: A Comprehensive Review

Xylitol has been widely documented to have dental health benefits, such as reducing the risk for dental caries. Here we report on other health benefits that have been investigated for xylitol. In skin, xylitol has been reported to improve barrier function and suppress the growth of potential skin pathogens. As a non-digestible carbohydrate, xylitol enters the colon where it is fermented by members of the colonic microbiota; species of the genus Anaerostipes have been reported to ferment xylitol and produce butyrate. The most common Lactobacillus and Bifidobacterium species do not appear to be able to grow on xylitol. The non-digestible but fermentable nature of xylitol also contributes to a constipation relieving effect and improved bone mineral density. Xylitol also modulates the immune system, which, together with its antimicrobial activity contribute to a reduced respiratory tract infection, sinusitis, and otitis media risk. As a low caloric sweetener, xylitol may contribute to weight management. It has been suggested that xylitol also increases satiety, but these results are not convincing yet. The benefit of xylitol on metabolic health, in addition to the benefit of the mere replacement of sucrose, remains to be determined in humans. Additional health benefits of xylitol have thus been reported and indicate further opportunities but need to be confirmed in human studies.

The Influence of Bowel Preparation on ADC Measurements: Comparison between Conventional DWI and DWIBS Sequences

Background and objectives: The aim of the study was to assess whether there were differences between apparent diffusion coefficient (ADC) values of diffusion-weighted imaging (DWI) and diffusion-weighted imaging with background body signal suppression (DWIBS) sequences in non-prepared and prepared bowels before and after preparation with an enteric hyperosmolar agent, to assess whether ADC measurements have the potential to avoid bowel preparation and whether ADC-DWIBS has advantages over ADC-DWI. Materials and Methods: 106 adult patients without evidence of inflammatory bowel disease (IBD) underwent magnetic resonance (MR) enterography before and after bowel preparation. ADC-DWI and ADC-DWIBS values were measured in the intestinal and colonic walls demonstrating high signal intensity (SI) at DWI tracking images of b = 800 s/mm² before and after preparation. Results: There were significant difference (p < 0.0001) in both ADC-DWI and ADC-DWIBS results between non-prepared and prepared jejunum for DWI being 1.09 × 10⁻³ mm²/s and 1.76 × 10⁻³ mm²/s, respectively, and for DWIBS being 0.91 × 10⁻³ mm²/s and 1.75 × 10⁻³ mm²/s, respectively. Both ADC-DWI and DWIBS also showed significant difference between non-prepared and prepared colon (p < 0.0001), with DWI values 1.41 × 10⁻³ mm²/s and 2.13 × 10⁻³ mm²/s, and DWIBS—1.01 × 10⁻³ mm²/s and 2.04 × 10⁻³ mm²/s, respectively. No significant difference between ADC-DWI and ADC-DWIBS was found in prepared jejunum (p = 0.84) and prepared colon (p = 0.58), whereas a significant difference was found in non-prepared jejunum and non-prepared colon (p = 0.0001 in both samples). Conclusions: ADC between DWI and DWIBS does not differ in prepared bowel walls but demonstrates a difference in non-prepared bowel. ADC in non-prepared bowel is lower than in prepared bowel and possible overlap with the ADC range of IBD is possible in non-prepared bowel. ADC-DWIBS has no advantage over ADC-DWI in regard to IBD assessment.

Metabolic effects of the natural sweeteners xylitol and erythritol: A comprehensive review

Xylitol and erythritol are widely used in a variety of food and oral care products as sugar substitutes. Although a number of studies have been conducted on the health benefits of xylitol since the 1960s, erythritol only attracted the attention of researchers during the early 1990s. Historically, researchers mainly focused on the effects of xylitol and other sugar alcohols on oral and dental healthcare while the anti-diabetic or antihyperglycemic effects have only been revealed recently. Though a few reviews have been published on the health benefits of sugar alcohols in the last few decades, none of them closely evaluated the antihyperglycemic potential and underlying mechanisms, particularly with a focus on xylitol and erythritol. The current review thoroughly analyzes the anti-diabetic and antihyperglycemic effects as well as other metabolic effects of xylitol and erythritol using articles published in PubMed since the 1960s, containing research done on experimental animals and humans. This review will help researchers ascertain the controversies surrounding sugar alcohols, investigate further beneficial effects of them as well as aid food industries in exploring the possibilities of using sugar alcohols as anti-diabetic supplements in diabetic foods and food products.

Food and Food Products on the Italian Market for Ketogenic Dietary Treatment of Neurological Diseases

The ketogenic diet (KD) is the first line intervention for glucose transporter 1 deficiency syndrome and pyruvate dehydrogenase deficiency, and is recommended for refractory epilepsy. It is a normo-caloric, high-fat, adequate-protein, and low-carbohydrate diet aimed at switching the brain metabolism from glucose dependence to the utilization of ketone bodies. Several variants of KD are currently available. Depending on the variant, KDs require the almost total exclusion, or a limited consumption of carbohydrates. Thus, there is total avoidance, or a limited consumption of cereal-based foods, and a reduction in fruit and vegetable intake. KDs, especially the more restrictive variants, are characterized by low variability, palatability, and tolerability, as well as by side-effects, like gastrointestinal disorders, nephrolithiasis, growth retardation, hyperlipidemia, and mineral and vitamin deficiency. In recent years, in an effort to improve the quality of life of patients on KDs, food companies have started to develop, and commercialize, several food products specific for such patients. This review summarizes the foods themselves, including sweeteners, and food products currently available for the ketogenic dietary treatment of neurological diseases. It describes the nutritional characteristics and gives indications for the use of the different products, taking into account their metabolic and health effects.

Exploring the microbiota and metabolites of traditional rice beer varieties of Assam and their functionalities

Rice beer is traditionally prepared and consumed by various ethnic populations in the Southeast Asian countries. To understand the probable effects of rice beer on human health, present research was aimed to study biochemical parameters, microbial diversity and metabolites of major rice beer varieties of Assam, namely Apong (Poro and Nogin), Xaaj and Joubishi. Alcoholic content of rice beer varieties varied from 9.41 to 19.33% (v/v). Free radical scavenging activity against DPPH· and ABTS⁺ were 1.94-4.14 and 1.69-3.91 mg of ascorbic acid/ml of rice beer, respectively. In relation to antioxidant activities, phenolic content varied from 2.07 to 5.40 mg gallic acid/ml of rice beer. Next-generation sequencing of 16S rDNA showed that 18 genera of bacteria were present irrespective of rice beer varieties in which lactic acid bacteria were the dominant group (90% abundance). Functional predictions based on the bacterial profiles indicated pathways, such as metabolisms of carbohydrate, amino acid, vitamins and cofactors, and xenobiotic biodegradation, to be active in the rice beer varieties. Out of 18 core bacterial genera, 7 had correlations with the predicted functions. Gas chromatography and mass spectroscopy-based metabolite analysis revealed that the metabolite profiles of the rice beer varieties consisted of 18 saccharides, 18 organic acids, 11 sugar alcohols, 8 amino acids, 1 vitamin and nutraceutical compounds thiocoumarine, carotene, oxazolidine-2-one and acetyl tyrosine. Due to the presence of potent prebiotics, probiotics and nutraceuticals, rice beer may have health benefits which need to be studied further.

The Impact of Maltitol-Sweetened Chewing Gum on the Dental Plaque Biofilm Microbiota Composition

Background: The oral cavity harbors a complex microbial ecosystem, intimately related to oral health and disease. The use of polyol-sweetened gum is believed to benefit oral health through stimulation of salivary flow and impacting oral pathogenic bacteria. Maltitol is often used as sweetener in food products. This study aimed to establish the in vivo effects of frequent consumption of maltitol-sweetened chewing gum on the dental plaque microbiota in healthy volunteers and to establish the cellular and molecular effects by in vitro cultivation and transcriptional analysis.

Results: An intervention study was performed in 153 volunteers, randomly assigned to three groups (www.trialregister.nl; NTR4165). One group was requested to use maltitol gum five times daily, one group used gum-base, and the third group did not use chewing gum. At day 0 and day 28, 24 h-accumulated supragingival plaque was collected at the lingual sites of the lower jaw and the buccal sites of the upper jaw and analyzed by 16S ribosomal rRNA gene sequencing. At day 42, 2 weeks after completion of the study, lower-jaw samples were collected and analyzed. The upper buccal plaque microbiota composition had lower bacterial levels and higher relative abundances of (facultative) aerobic species compared to the lower lingual sites. There was no difference in bacterial community structure between any of the three study groups (PERMANOVA). Significant lower abundance of several bacterial phylotypes was found in maltitol gum group compared to the gum-base group, including Actinomyces massiliensis HOT 852 and Lautropia mirabilis HOT 022. Cultivation studies confirmed growth inhibition of A. massiliensis and A. johnsonii by maltitol at levels of 1% and higher. Transcriptome analysis of A. massiliensis revealed that exposure to maltitol resulted in changes in the expression of genes linked to osmoregulation, biofilm formation, and central carbon metabolism.

Conclusion: The results showed that chewing itself only marginally impacted the plaque microbiota composition. Use of maltitol-sweetened gum lowered abundance of several bacterial species. Importantly, the species impacted play a key role in the early formation of dental biofilms. Further studies are required to establish if frequent use of maltitol gum impacts early dental-plaque biofilm development.