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The All Natural Sugar Substitute That is Toxic for Dogs: Xylitol Awareness

get-xylitol-out
While this is not a particularly "fun" episode, this is an incredibly important one. Xylitol is an all natural sugar substitute found in an increasing number of products, including some peanut butters, and it is absolutely deadly to dogs.

I can tell you that if I didn't work at Preventive Vet, I probably wouldn't know about Xylitol toxicity (or Xylitol at all), and that is a dangerous place for a dog owner to be, which is why spreading awareness is so important. On today's show, we talk about what Xylitol is, signs that your dog may have ingested Xylitol, important steps to take (immediately) if you know or suspect that your dog has ingested Xylitol, and how you can help other dogs and their families and #GetXylitolOut.

Important Links:

Transcript below

Mia: Welcome back to another episode of Paws and Play with Dr J. I am your cohost, Mia, and Dr. J, how are you doing today?

Dr. J: I'm very well. Thank you. Good to be back with you.

Mia: Always a pleasure to be back with you. Unfortunately we are talking about a topic that is not very fun.

Dr. J: It's sweet. So there's, that.

Mia: That is true. But, it's a really, really important topic, which, it gets more and more obvious just how important it is for us to be spreading this awareness because we keep receiving stories of people losing their pets, their dogs specifically, to Xylitol.

Dr. J: Yeah.

Mia: Because we just recently received another story of Xylitol poisoning that just, I mean, I was crying at my desk for a good week over that, and you know, just thinking about it again is, it's horrifying for any dog, and family to have to go through. So we're putting a stop to this, right Dr. J?

Dr. J: That is the plan. Boy, that'd be fantastic.

Mia: Yes. So what is Xylitol, exactly? Besides something that, you know, sounds dangerous on its own.

Dr. J: It does. It sounds like a Bond villain, Odd Job and Xylitol.

Xylitol the Bond villain

No, so, Xylitol is a sugar alcohol, so it's a sugar substitute. Oh, and I guess before I go too far, just to let people know, it's spelled x-y-l-i-t-o-l. Just so that you're not looking for something that starts with a z, it starts with an x. So that can be a little bit confusing. Anyway, It's a group of molecules called sugar alcohols. So, like you don't get drunk on them or anything like that. It's just that they have a hydroxyl group on them, but...

Mia: I don't know that anybody will know what that means.

Dr. J: Probably. And I might've just butchered the word.

Mia: Just don't try to get drunk off of it.

Dr. J: Yes, exactly. Yes. Don't go around drinking a bunch of Xylitol.

Mia: You'll be sad.

Dr. J: Cuz it'll just, well it'll give you diarrhea. But so the sugar alcohols are getting more and more commonly used as sugar replacers because, and this is very important, they are all natural.

And the reason why I call that out is because there are a lot of articles, even a lot of newspaper articles, news reports, when they start reporting on Xylitol, they call it an artificial sweetener, which, it's a matter of semantics.

But what's really important is that I worry that people who are into healthful eating, who would never bring something like an artificial sweetener into their home, would then potentially let their guard down and go, well, it's not in my house, it's an artificial sweetener, when it very well might be because it's actually in a lot of healthy products, especially for people who are on like, say the ketogenic diet, or who are doing low carb, or who are diabetic and just really watching their sugars.

These things are all natural. So they could still be in a ketogenic product that says all natural, no sugar added, all natural sweeteners, things of that nature. So the fact that it's all natural is very important, just so that nobody lets their guard down. And then also realize that you might find it more commonly perhaps in health food stores.

So the sugar alcohols are great for people in that, 1: they don't spike our blood sugar as much as regular sugar. So again, for diabetics, for people that really are very sensitive to blood glucose swings going on, sugar alcohols can help and so that would be like Xylitol, Erythritol, Sorbitol, any of these ones that end in an "-ol".

And then also, Xylitol, one of the biggest reasons why it came into prominence and is still growing, is that it is potentially, purportedly — and the studies are a little bit mixed — but is good for our teeth. So it helps to prevent cavities in people.

And so that's why we commonly see Xylitol, and where dogs most frequently get into it are in sugar free gums and sugar free mints. And so people are using it to help keep their own dental health good and prevent cavities and also with their kids, but then their dogs are getting into it inadvertently and it's wreaking havoc. So that's kind of a quick tour of what Xylitol is. Yeah.

Mia: Yeah. Well, it seems to be confusing to everybody because even if you go to their, not that Xylitol is a "they", but the Xylitol wikipedia page, it says that it's all natural. It says where it comes from and yet it still is listed as an artificial sweetener. So I think, you know, more than anything, it's just really, really, really important to look at all of the ingredients everywhere, every time.

Dr. J: Yeah. And I think understandably, I think people think oh sugar is the sweetener, quote unquote, you know, the natural sweetener or whatever, and everything else is an artificial sweetener because we're using it to replace the sugar. But it's really, it's not always the case. And so that, that little matter of semantics can actually be quite important.

Mia: So, why is it so dangerous to dogs? I mean it seems kind of...

Dr. J: You mean if it's okay for people.

Mia: Right? Exactly. Yeah.

Dr. J: Yeah. Um, so you know, obviously dogs are not small furry people that walk around on four legs. And we have a saying in the veterinary field that we've said, you know, cats aren't small dogs because a lot of people assume that was fine for a dog is fine for a cat and that can have devastating consequences. But it's the same to assume that dogs are people. It's the same way that like your dog could have very significant problems if they gobble up one of your Aleve tablets or something, your Advil, because they're just not going to process it the same way. And the dosages are different.

Mia: Even just grapes.

Dr. J: Yeah, exactly, grapes, raisins, current, you know, some dogs are highly sensitive to those. So they are their own creatures and they process things differently.

And what we have found out through research and through looking at the case reports — and case reports have been coming into ASPCA about Xylitol toxicity in dogs for many years. And unfortunately the number of those cases is really growing because Xylitol is getting more and more common.

But what happens in people, and I've mentioned earlier about in diabetics, it being more glycemic level friendly for diabetics because it doesn't spike our insulin. The human body doesn't look at Xylitol and go, hey, that's sugar, let's release a bunch of insulin to try and deal with the sugar influx. Well, unfortunately the dog's body, that's exactly what does happen. The dog's body, especially the pancreas where insulin is secreted from, sees that influx of Xylitol and goes, "Woop, massive infusion of sugar. Let's release a bunch of insulin."

Well, insulin's, one of its primary jobs is to get blood sugar out of the bloodstream and into the cells. And so the insulin goes out moving as much blood sugar, as much glucose out of the blood and into the cells as it can, thinking that there's an abundance when there's not.

And so what happens is very quickly, sometimes within 30 minutes, a dog's blood sugar will drop to dangerously low levels to the point where they will start staggering. They'll start vomiting, they'll start having seizures and if not treated very appropriately and quickly, they could go into a coma and they can die.

Mia: Terrifying.

Dr. J: And again, this can happen in 30 minutes. So it's completely different, the way the canine body, the dog's body reacts to it, than a person's body. And that's in a very small amount too. We've got some graphs in some of the blog posts, I'm sure we'll be sharing on the, you know, in the, in the links for this article, but it's amazing to see just how little it actually takes.

Toxic doses of xylitol based on dog size

So that's problem number one, which is quite problematic, but most dogs, if that's what they have and it's caught quickly enough and it's treated, they will do well with treatment. It's not going to be inexpensive.

Mia: And by quickly enough, you mean like immediately, right?

Dr. J: I mean, yeah, I mean honestly it's a type of thing, (if) you come home and it looks like your dog has gotten into your purse and gobbled down your gum, your IceBreakers gum, if you're not sure, that's something you've got to act on immediately anyway, because by the time you get to the vet, their blood sugars may already have plummeted and they may already be starting seizures. So really no delay.

This is one of those, along with like say GDV or Bloat in dogs, you don't wait, you go.

So, the low blood sugar, hypoglycemia, this is problem number one with what Xylitol does in dogs. Problem number two, which could be much more serious and it only takes a little bit more, is that some dogs — kind of like grapes and raisins only effect some dogs — in some dogs, Xylitol at a slightly higher amount will actually start to destroy their liver cells. And for that, there's frequently no coming back from.

The liver is an extremely, extremely, important organ within the body is, as you might imagine, or you might hopefully know. And so when those liver cells start to die off, even though the liver has a large, what we call, reserve capacity, the body stops being able to do things like clot it's blood or make proteins that help to maintain blood pressure and keep the blood, the fluid portion of blood within the blood vessels, as well as a whole bunch of other functions. So when these dogs have what we call acute hepatic necrosis, meaning that very suddenly the liver cells start to die off, that can be really difficult to reverse once that happens. So again, underscoring the immediacy of the need for treatment

Mia: And you know, bringing back to the kind of graphics that you were talking about on our site, something that surprised me, and might surprise our audience, is that Xylitol is actually more toxic than chocolate. I mean in terms of smaller doses, right?How much Xylitol gum vs Chocolate would it take to kill a dog?

Dr. J: I mean that's, I guess it's sort of the potency, you know, and one of the graphics which people will see when they come to this is that, trying to compare the amount of dark chocolate it would take —because the darker the chocolate, the more danger it is for dogs — so comparing the amount of dark chocolate it would take to kill like a 10 pound dog, which would mean like, really significant cardiac problems, heart problems that would lead to death, comparing that to the amount of Xylitol in gum it would take, it's kind of astronomical.

I mean for a 10 pound dog, I think it's one full eight ounce dark chocolate bar, as opposed to just three pieces of gum, and we don't always know how much Xylitol is in a piece of gum, which is another huge issue that we've got and why we're trying to work on improved labeling.

But you know, some people will have a whole eight ounce dark chocolate bar in their purse, and they'll almost certainly have three pieces of gum. But when you step it up, even to say, I think the other ones on there was like a 70 pound dog, now you're talking about like eight or nine full eight ounce dark chocolate bars to kill a dog from chocolate toxicity. And most people aren't walking around with eight or nine full size dark chocolate bars in their purse or their backpack,

Mia: Unless you were me as a child.

Dr. J: I was going to say, if you are, I want to meet you. But everybody that has gum is probably walking around with a pack of gum in their purse, and it takes less than a pack of gum to have the same effect from Xylitol on a dog. So it's just that much more dangerous. Plus a lot of people know about chocolate toxicity in dogs. Not everybody still, as evidenced by the call spikes at Easter and Valentine's Day and Halloween and whatnot, but still far, far, far too few people are aware of the dangers of Xylitol.

5 Lessons Every Child Should be Taught and Shown About Living with Dogs

Mia: Yeah. Well I definitely, I had never even heard of it before starting a Preventive Vet.

Dr. J: So we've converted one, at least one! We've educated at least one.

Mia: At least a few because I don't shut up about it to the people that I know.

Dr. J: That's why we get along so well together, Mia, because nor do I.

Mia: Well, you know, because in terms of like how much of a thread it is, think about it, especially if you have kids, which I don't, but um, you know, I have nieces and nephew and you know, they're throwing things all around and you know, it doesn't matter if it's a crayon or if it's gum, or you know, maybe talking with their mouths open and then the gum falls out.

And even just like walking around the neighborhood, there's gum all over the sidewalks. If you're not paying attention, which is so easy to do. Let's say you go and like, let's say that you're a hawk like myself —

Dr. J: Not an actual hawk, because that would be cool.

Mia: Right, but you take two seconds and you go and pick up their poop, and they can already be in something else. You know, and it's just.

Dr. J: It's interesting. No, I was just going to say, because that's a question that I get pretty frequently, as far as the chewed up gum, like is that a problem? And it certainly can be, you know, because it depends on how long that person chewed the gum for, how much Xylitol was in it when it started, and then also the form that the Xylitol is in as far as the size of the crystals and things of that nature.

So what I tell people is yeah, I mean chewed up gum on the sidewalk could potentially cause significant problems for your dog if it has Xylitol in it, so you still have to treat it as a normal exposure. And again these things are stressful and expensive.

Mia: Well, and another super stressful thing is that we keep talking about Xylitol and gum, but it's in so many products including some peanut butters still, which is super popular for our dogs. And you know, I always give Marshall a little in his Kong and I get him the same brand of peanut butter every single time. But I read the label every single time, just in case.

Dr. J: Yeah, recipes can change and yeah, I mean fortunately, it's not in, at this point, it's not in any big grocery store brands, but who knows what the future holds because Xylitol, I mean we've got a list on the site like a running a running list that has well over 700 products that we found xylitol in and some of them are quite common consumer products so it is very important because peanut butter is used so much with dogs, in training, in stuffing Kongs, in medicating, in distracting them while they're getting their nails done or their ears cleaned or whatever.

So it is really important for people to be aware of that, and honestly even if it's just the awareness of Xylitol and peanut butter raises awareness of Xylitol in general, that's fantastic because you can't prevent what you're not aware of and what you're not looking for. And you know, when it comes to Xylitol, it's quickly, quickly devastating and really devastating based on the stories that we're getting and, and the cases that are being seen in veterinary practices all around the country.

Mia: Right. Well, and it's also just growing in the amount of, with the Ketogenic Diet and everything that you kind of mentioned before, it's becoming more popular, and I hadn't even thought about that. I learned about it from the family who shared Lucy's story with us. I had no idea.

Dr. J: And that's a huge one because a lot of people — and what Mia is talking about, is that the woman who had lost her dog, Lucy, she lost her because she was baking zucchini bread for friends of hers at work and she was doing the right thing of trying to make a more healthful bread and incorporated Xylitol in place of sugar. And so Xylitol is available in your bulk sweetener section at most food stores. Not even just health food stores, but your regular grocery store.

So people are using it in their baking. So now if your dog counter surfs and gets into a loaf of banana bread or zucchini bread or chocolate chip cookies or whatever, now we're not necessarily just worried about the digestive upset they might have or the chocolate from the cookies, although that's typically not a ton of chocolate, depending on the size of your dog. But the Xylitol can be a monster of an issue.

Mia: Yeah. It's scary. Especially just thinking about like when you're out and about and all the stuff that's on the ground. Marshall's muzzle is too flat to put one of those Hannibal Lecter masks on. So we had mentioned a little bit earlier that dog and cat bodies are different — and also human bodies. How dangerous, if at all, is Xylitol for cats?

Dr. J: So the cool thing is that up until pretty recently we didn't know for certain, we kind of assumed that it might be toxic for cats, but we didn't know. And we based that on the fact that cats typically are a little bit more discerning about what they'll put in their mouth and they're not likely to scarf down a whole pack of gum or, you know, jump up on the counter and eat a couple loaves of zucchini bread or something like that.

Mia: Thankfully.

Dr. J: Yeah, I know! But we just really didn't know for certain. And so we assume that cats' more fastidious and discerning nature maybe was saving them. But recently there was a study out of Hungary where they actually looked at the effects of Xylitol on cats and their insulin levels in their blood sugar. And it turns out, and also their liver values, I believe they included in that. Um, it turns out that it did not have the same effect that it had in dogs. Now it's a small study of, I think it was only about six or so cats, but given the fact that—

Mia: Yeah, that's a pretty small study.

Dr. J: It is. Well, welcome to veterinary medicine. Most of our studies are typically relatively small and more retrospective.

But what we know is that in dogs that blood sugar lowering effect, that's pretty much every dog that eats that amount is going to have their blood sugar drop. So it's not like a subset of dogs. So even with six cats, the likelihood is that if it did have a blood sugar lowering effect, it would have happened, and it didn't.

But in terms of the hepatic necrosis, the liver destroying effect in dogs, because we've got a small sample size, we can't be as definitive there of saying that it definitely doesn't destroy cat lovers, but I think that the likelihood is that it does not. So I think when it comes to this, cats are not suffering the same effects as dogs from Xylitol. And we now know that.

Mia: Good. All right, so this is all pretty scary. But what I guess should we do if our dog gets into Xylitol or we think maybe they did. I mean you kind of briefly mentioned the signs to look for. And also we know that it's something that you have to jump on immediately. But is there anything that we can do like right away? Before taking them to the emergency room?

Dr. J: Some people might think to call poison control or try and make their dog vomit. There's definitely some danger in that with Xylitol, given how quickly it can come on, the problem. And if you go out of your house and you're gone for 5 minutes or 10 minutes and you come back and you realize that your dog has gotten into, say your gum that may have Xylitol in it, well you know that that probably happened within the last 5 to 10 minutes. So sure, trying to make them vomit after talking to a veterinarian or poison control, that might be a good option because you're not likely to start seeing those blood sugar lowering effects yet, and the seizures, which could put them at risk of aspiration pneumonia, of like actually getting some of that vomit down into their lungs.

Because it probably hasn't been long enough to have that effect. But if you're out of your house for an hour and you come back and you see that you don't know whether you're dog ate it right after you walked out the door, or right before you walked back in the door, or at any time between. And time is precious in these cases because Xylitol is absorbed rapidly.

We always kind of use roughly the hour to two hour mark for when stuff starts to move out of the stomach and into the intestines, by which point you can't get it back with inducing vomiting. So if it's been that long, even if it's probably been a half an hour, and certainly if it's been an hour I would just go right to your local animal emergency hospital or to your vet. Call them on the way to let them know so that they can be prepared to more safely, more effectively decontaminate your dog. Meaning more typically in this case, making them vomit or at least you know, monitoring them and also checking their blood sugar.

Because if they show up and their blood sugar is already very low, no sense of making your dog vomit most likely, because there is that risk of aspiration pneumonia and also because the Xylitol has already been absorbed and so now you've got to really take care of supporting them. So giving them supplemental dextrose, which is basically two molecules of glucose in their fluids to maintain them and try and get that blood sugar up into less dangerous levels and see while the Xylitol gets process through.

So it really is one of those things where, you know, if you know that it's been within the last few minutes, then yes, call a vet, call poison control. Get talked through the process of maybe trying to make them vomit as long as there's no other reasons why you shouldn't, but if it's been 30 minutes or there's any doubt, I'd bring them to the vet or the local E.R., and I know that gets expensive and time consuming, especially if you got multiple dogs because you never know.

Mia: Ugh what a nightmare, with the multiple dogs.

Dr. J: Totally! I mean, if there's potentially 20 pieces of gum missing, did one eat all 20 and the other one just sat there and watched and encouraged them, or did they kind of tag team and they both ate 10. Well you really don't want to risk it, so I think it's a trip to the vet for all involved.

And certainly, you know, checking blood sugar upon presentation will maybe help to determine which one or which ones did it, but still you've just got to treat it, you know, to try and minimize the impact and the complications.

Mia: So I guess besides reading over labels compulsively, what are some other things I guess that we can do to prevent Xylitol poisoning?

Dr. J: Well, I think one of the, one of the big things that I always encourage people to do, because again, we're talking mostly not exclusively, but mostly, sugar free gums and mints and a lot of those happen, a dog rummages through someone's purse or gym bag or backpack or something like that.

Always encourage people when they walk in the door, hang your bags on a sturdy coat hook or in a closet or something like that.

Don't put it on the couch. Don't drape it off the back of the chair and the dining room. Don't put it on the back of the doorknob. Put it somewhere that your dog can't get to it, like really can't get to it, because it's not all you have to worry about, it's medications, it runs the gamut of things that are in our bags that can cause problems for dogs. So hanging bags helps.

You obviously already mentioned reading labels. Maybe avoiding things that have Xylitol if you know that your dog has a penchant for going after stuff they shouldn't. Also, when you're baking, as Lucy's story highlights, if you're letting things cool, or even like bread doughs to proof, do that in a turned off oven, or in a microwave, somewhere that keeps it truly out of your dog's mouth.

Crate training is an amazing thing. A great thing, not just from a security standpoint for your pets, but also a safety standpoint. Ideally if you're getting a puppy, this would be another reason to crate train and then have them in their crate when you're out of the house so they're not going to go rummaging through.

Train them to stay out of the kitchen, because that can definitely be done. But then also really raising awareness, making sure that as many people as possible are aware of this danger, and not just people who have dogs, because our pet sitters come into our homes, cleaning people come into our homes, our friends and family come in at the holidays and many of them are carrying in their jacket pockets, or their purse, or their backpack, their luggage, Xylitol or any other number of potential pet poisons.

Mia: Yeah, not just that, but — this gave me a flashback to my Brooklyn days when people would come over, like a roommate's friend, and decide to give Marshall things that I didn't say was okay. I'd like walk in and, you know, people do that. They have no idea and they think that they're just being nice to the dog, but they have no idea they could be poisoning it.

Dr. J: Totally. And to that point, there are actually yogurts and ice cream out there that have Xylitol in it. So you know, it's not even like — because obviously people would probably go, well they're not going to give them their gum. Well yeah, but they might share a yogurt or they might share some of their ice cream.

So just raising awareness of the presence of this thing, of this sweetener called Xylitol, and making sure people know that it is all natural, so it is in a lot of products that you might not otherwise think it would be if it were an artificial sweetener.

You know, and I think that raising awareness helps. I mean, we've got a few petitions on the site that just are asking for improved labeling to try and help people, because a lot of times that's kind of your biggest prevention point, is at the point in the store where you're looking between different gums, but also if your dog does get into it, it's nice if you're able to turn over the packaging and see something that says Xylitol very clearly, or maybe even something that says, "Contains Xylitol, keep away from dogs."

I think people just need a fighting chance and awareness is crucial there. Whether it be before and/or in the moment. That'll help.

Mia: Definitely. Well, we'll make sure to include the links to our petitions. Is there anything else that we've missed? I mean, we could go on and on about the different products that have it.

Dr. J: 700 plus of them!

Mia: Yeah, and growing. Is there anything else that we've missed other than telling everybody to stand at the corner with a sign shouting to the world about Xylitol?

Dr. J: Beware of Xylitol! No, I think we've covered most of the things that I think I want for people to really be aware of. Again, a lot of this is also covered in the articles and then the graphics. We've got a downloadable awareness poster that veterinary practices can hang in their offices, even dog training facilities, pet stores, all of those things.

And you know, if anyone listening is involved in a company that produces a product with Xylitol, this isn't necessarily a war on Xylitol, but just really, I mean, your customers, your dog loving customers really need a fighting chance. So some improvements in labeling will go a long way to saving lives and preventing heartbreak. And it truly is devastating and heartbreaking.

Mia: Yeah, and some companies have actually already stepped up to that, which is awesome.

Dr. J: And again, they just need, they just need to be aware. You know, I mean, they're not doing this maliciously, where they're going, let's use this sweetener because it'll kill dogs. There's many reasons that I'm sure they're using it, but I think if they realize the severity of the problem and how common it is that, hopefully they would reconsider it because it's also a goodwill marketing thing of saying we value our customers and we want to help them protect their whole family. So there's a business case for it too, if not just the humanitarian case.

Mia: Right. And we'll attack it from every angle.

Dr. J: There you go. Nonstop. Love it.

Mia: Well, thank you so much for helping to spread this awareness and you know, ensure that a bunch more lives are saved because like you said, you can't stop it if you don't know that it needs to be stopped.

Dr. J: Yeah. Yeah. Well, hopefully, hopefully it's helping.

Mia: Well it's definitely helping. And I know that even the family who shared Lucy's story was really happy that we're getting the word out there because they don't want this to happen to anybody else and neither do we. So together we can make it happen.

Topics: paws and play, Xylitol, common products toxic to dogs, Dog Health, Dog Safety, #IfOnlyIKnew, puppy tips, adult dog tips, puppy proofing

Please do not ask emergency or other specific medical questions about your pets in the blog comments. As an online informational resource, Preventive Vet is unable to and does not provide specific medical advice or counseling. A thorough physical exam, patient history, and an established veterinary-patient-client relationship is required to provide specific medical advice. If you are worried that your pet is having an emergency or if you have specific medical questions related to your pet’s current or chronic medical conditions, please contact or visit your veterinarian, an animal-specific poison control hotline, or your local emergency veterinary care center.

Please share your experiences and stories, your opinions and feedback about this blog, or what you've learned that you'd like to share with others.

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