As the sugar substitute xylitol becomes increasingly common in household products, dogs are more likely to be accidentally poisoned. The effects from even a small dose can be life-threatening. Learn what xylitol toxicity in dogs looks like and which products to keep away your dog.

While safe for humans, xylitol is highly toxic to dogs. Xylitol can cause a hazardous drop in blood sugar, liver failure and even death in canines.

The first reported cases of xylitol poisoning in dogs date back to 2004.¹ According to the veterinary toxicosis experts at the Pet Poison Helpline, calls regarding pets poisoned by xylitol increased over 100 percent between 2015 and 2020. While chocolate has long been the top culprit in their poisoning cases, in 2020 xylitol poisoning calls ran a close second.

What is xylitol?

Xylitol is a natural sweetener used in hundreds of products including sugar-free gum, gummy vitamins and peanut butter. It can also be purchased in granulated form to use in baking and spoon into coffee like table sugar. With the popularity of limiting sugar in the diet, the number of products containing the sugar substitute xylitol has dramatically increased over recent years. 

Categorized as a sugar alcohol (along with mannitol, sorbitol, lactitol, isomalt and maltitol), xylitol is a sweetener that occurs naturally in plants in low concentration. Also known as “birch sugar” (because xylitol is often harvested from birch trees), raw xylitol is refined and used in its concentrated form to sweeten a huge variety of products.

Why xylitol use is on the rise

Studies showing that xylitol prevents dental cavities date as far back as 1975², and xylitol has long been used in sugarless chewing gum and other dental products.

40% lower in total carbohydrates and calories than table sugar, xylitol is also popular in products geared toward those following low-carb diets (such as keto) and is safe for diabetics.

While they stimulate our sweetness receptors, xylitol and other sugar alcohols do not cause the same rapid increase in blood sugar levels that real sugar does. In humans, this rapid increase normally triggers our pancreas to release the hormone insulin to regulate our blood sugar levels. Therefore, xylitol lowers the overall glycemic index (GI) of foods when used instead of sucrose or glucose.

Why is xylitol poisonous to dogs?

Sugar alcohols behave differently in dogs than they do in our bodies. Unlike humans, the insulin response after ingesting xylitol is not suppressed in dogs.

After eating xylitol, insulin rushes rapidly into your dog’s bloodstream, causing a precipitous drop in blood sugar, known clinically as hypoglycemia.

What are the symptoms of xylitol poisoning in dogs?

The most common symptom is vomiting, which typically happens first. Vomiting can be followed by telltale signs of hypoglycemia, like lethargy or staggering (similar to a diabetic episode in people). Less common are seizures.

Symptoms of xylitol toxicity in dogs include:

• Vomiting
• Lethargy
• Staggering (difficulty walking or standing)
• Tremors
• Seizures
• Sudden collapse

If you suspect your dog may have eaten xylitol, stop reading this and immediately call your veterinarian or the 24/7 Animal Poison Control Center at (855) 764-7661.

• Do not wait for a call back if after business hours. Hypoglycemia happens in minutes and must be treated by a veterinary professional immediately.
• Do not induce vomiting on your own as this could make your dog worse.

The good news is that with prompt medical attention, most dogs recover from xylitol poisoning.

How much xylitol is toxic to dogs?

Very little. While humans can ingest xylitol safely (risking only the discomfort of its mild laxative effect if we consume too much), a shockingly small amount of xylitol is dangerous to a dog. Veterinary research indicates that canines can exhibit signs of xylitol poisoning at concentrations as low as 100 milligrams (0.1 gram) per kilogram of body weight.³

“The smaller your dog, the greater the risk!”

In a retrospective study of 192 dogs⁴ treated for xylitol ingestion over five years (2007-2012), 15% developed hypoglycemia with a median ingested dose of only 0.32 grams xylitol per kilogram body weight. Fortunately, all dogs in this study survived the xylitol poisoning thanks to immediate veterinary care.

Consequences become more serious the more xylitol your dog consumes. 2006 research⁵ published in the Journal of the American Veterinary Medical Association (JAVMA) showed that dogs who ingest a larger amount (>0.5 g/kg) of xylitol can develop acute hepatic failure (liver failure) which can be fatal. A tragic example is a Hungarian Vizsla in the UK, who died of xylitol poisoning⁶ from consuming just two homemade brownies sweetened with xylitol granules.

As the absolute toxic dose of xylitol is relative to a dog’s body weight, a 10-pound dog is at far greater risk of ingesting a potentially fatal dose than a larger canine with a body weight of 100 pounds.

Chocolate vs. xylitol

You probably know that chocolate is dangerous for dogs. You may be surprised that a toxic dose of xylitol is far smaller than chocolate. Your dog would have to eat over 20 times more dark chocolate than xylitol to suffer the same toxicosis.

Gums containing xylitol pose the biggest risk to dogs

While xylitol is in many products, most of the xylitol poisoning reports received by the US Food and Drug Administration (FDA)⁷ are related to gum.

18 of the 26 cases of xylitol toxicity identified by the UK’s Small Animal Veterinary Surveillance Network (SAVSNET) between 2015 and 2018 were chewing gum ingestion.⁸

Why is this?

• Lack of awareness and easy access
  We humans treat gum as a non-food item. It’s quite common to store gum or mints on a counter or in an open purse as opposed to a closed kitchen cabinet. Curious canines have an excellent sense of smell and can easily root out a sealed package of minty gum from a bag left within their reach.

• High concentration of xylitol
  The amount of xylitol varies greatly between different brands (and even different flavors within the same brand) but has been shown to be at least 0.17 grams per piece or stick at the low end and around 1.5 gram per piece at the high end.⁹ Even at the low end, gum has a higher concentration of xylitol compared to other food and toiletries containing the sweetener.

With some flavors containing 1.5 grams of xylitol per piece, Hershey’s Ice Breakers gum contains the most xylitol, followed by Trident and Spry gums (with 0.2 grams per piece).¹⁰ A single piece of any of these gums contains enough xylitol to cause hypoglycemia in a young puppy or in tiny breeds like Chihuahuas. Just three pieces of Ice Breakers gum is sufficient to poison giant breeds like Bernese mountain dogs (see table below).

Number of chewing gum that can cause hypoglycemia in dogs

Foods and other products that contain xylitol

Gums containing xylitol

Most gums, mints and breath strips are sweetened with sugar alcohols like xylitol. It’s safest to assume that any sugar-free gum contains xylitol.

Chewing gum brands sweetened with xylitol include:

• Ice Breakers
• Starbucks gum and mints
• Dentyne
• Wrigley’s Extra Ice
• Glee
• Trident
• Mentos
• Orbit
• Spry
• Nicorette or other smoking cessation gums

Peanut Butter with xylitol

This is an especially important category because you may use peanut butter for administering medication or for training your dog.

As awareness has increased about xylitol toxicity in dogs, many manufacturers have responded by reformulating their peanut butters with other sweeteners. As of May 2021, national brands such as Jif, Skippy, Smuckers and Peter Pan peanut butters are all xylitol-free.

Brands of nut butters that still contain xylitol:

• Go Nuts, Co. flavored almond and peanut butters
• Krush Nutrition
• Nuts 'N More peanut and almond spreads

Carefully check jars of peanut butter to be sure that xylitol is not on the ingredients list.

Chocolates and candies containing xylitol

• Healthy Chocolate Co: Health 4Living Xylitol COQ10 Chocolate
• Dr. John’s Healthy Sweets: lollipops, hard candies, chocolates, caramel and taffy

Diabetic-friendly foods containing xylitol

Often these will be in a separate section of the supermarket or drugstore with other diabetic-friendly items. It’s safest to assume that anything labeled “sugar free,” “sugarless,” or “low-sugar” might contain xylitol.

• Sugar-free puddings: Jell-O, Barry Farm, Nicks
• Jams: Nature’s Hollow, Focus Nutrition, Xylabrands
• Sugar-free Condiments: Ketchup and BBQ sauce

THC-infused edibles can contain xylitol

If cannabis is legal in your area, your dog may be exposed to edible products such as candies, gums or mints that have been infused with the compound THC. Known as “edibles,” these products often contain xylitol and can be very dangerous if consumed by your dog.

Dental products containing xylitol

As xylitol sweetens but doesn’t contribute to tooth decay the way table sugar (sucrose) does, it’s widely used by dental hygiene brands in formulations of toothpaste, whitening gels, breath strips and mouthwash. Even products for children and labeled “natural” contain xylitol.

As with chewing gum, it’s safe to assume all oral care products contain xylitol and keep them safely out of reach of pets.

Popular toothpaste and mouthwash brands containing xylitol are:

• Tom’s of Maine
• Trader Joe’s
• JASON
• Walgreens
• Kiss my Face
• Hello
• ACT mouthwash
• CVS Pharmacy and Walgreens breath strips

Prescription meds and supplements containing xylitol

Many medications and over-the-counter supplements contain xylitol, particularly chewable, gummy or liquid formulas.

• Bach Flower Rescue Pastilles and Chewing Gum
  This is important to note because Bach Flower homeopathic tinctures have been used on animals for many years, and some consumers may assume all their products are safe for use on animals.
• Most chewable or gummy supplements (vitamins, probiotics, fiber, calcium, coQ10) contain xylitol.
• Abilify
• Gabapentin
• Children’s Allegra

This is by no means an exhaustive list, as hundreds of retail products contain xylitol as of this writing. Hopefully this provides an education as to the major product categories to watch out for to prevent accidental xylitol ingestion.

How to prevent xylitol poisoning in dogs

Be vigilant. It’s safest to assume that anything artificially sweetened could have xylitol in it and should be kept securely out of any dog’s reach.

Never leave any food items which may contain xylitol on a table or kitchen counter where your dog might be able to get hold of it.

Keep your dog safe from the dangers of xylitol by doing the following:

• Keep bathroom counters clear: Keep all dental care products (toothpaste, mouthwash), medications, and supplements in cabinets safely out of harm’s way.
• Check food labels (especially peanut butter) for xylitol: Carefully check the ingredient label of any nut butter or food item you feed to your dog. Better yet, avoid xylitol products altogether and buy high-quality dog treats for training instead of human food.
• Watch for open purses and bags: Be especially wary of purses and bags left on chairs or tables as they’re often where sugar-free gum or breath mints are lurking. Because even a few pieces of chewing gum with xylitol can poison your dog, you may want to move your guests’ belongings out of reach as a precautionary measure.
• Never use human toothpaste on your dog’s teeth: Always use toothpaste formulated specifically for dogs to clean your canine’s teeth (ask your veterinarian for recommendations).
• Alert your caregivers: Make sure to advise anyone watching your dog in your absence of the dangers of xylitol. This could include your kids, parents, grandparents, dog sitter or house sitter.

In short

Xylitol poisoning is sadly on the increase as the sugar substitute finds its way into more food and dental products. If accidentally ingested, xylitol can cause sudden and severe illness in canines. As a toxic dose can be as small as a few pieces of gum, pet owners need to be careful to protect their dogs from xylitol poisoning.

Do you know a dog who was poisoned by xylitol? If so, what did the dog eat and how much? Did it change anything about your habits? Let us know in the comments.