Q: I am so glad to have found D-mannose and xylitol through the Tahoma Clinic Dispensary. I have started using xylitol for all of my baking and sweetening needs. My family can’t tell the difference in the desserts. They are just glad that the cookies and pies are back...But I’m wondering if there is any problem in using xylitol every day?

––N.D.K., Sugarland, TX

Dr. Wright: I’m glad you wrote. For those who wonder what your letter is referring to, D-mannose is a “simple sugar” molecule, and xylitol a “sugar-alcohol” molecule. Both are naturally present in small quantities in human bodies, as are fructose and many other simple sugars. In general, they’re much safer and healthier than refined sugar, but there are a few things to keep in mind.

The key to safe use of these simple sugars and sugar alcohols is small quantities—as little as possible to “do the job.” For example, even though fructose is naturally present in human bodies in small quantities, in larger quantities it’s largely responsible for the significant increase in the incidence of type 2 diabetes over the last two decades.

Although some natural food stores still sell bags of pure fructose, most know to caution their customers against it. Put simply, once fructose is separated from whole fruit or other sources, it’s just another one of those “refined carbohydrates” we should avoid completely.

The same caution applies to D-mannose and xylitol. However, since these two “refined carbohydrates” have definite health benefits and therapeutic uses (xylitol reduces tooth decay dramatically and D-mannose effectively treats and prevents over 90 percent of bladder infections), if you need or want these benefits, you should only use the minimum amount necessary to achieve them, and no more.

Even though adverse effects from long term use of large quantities of these two simple sugars aren’t yet known, you don’t want to be one of the first families to find out what they will be.

The amount of D-mannose you’re using is small, and if it’s preventing recurrent bladder infection, the benefits most likely outweigh any risks.

However, please stop using xylitol for baking. Switch to stevia or lo han, both of which are non-caloric, non refined carbohydrates, and so sweet it’s difficult to use more than small quantities. They’re available in most natural food stores. Since you need much less of either of these than you would sugar, it can be tricky to get the hang of using them in recipes. But there are cookbooks and other information sources available to help you with your baking.

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