Comment by vanilla-almond | Hacker News Reader

Comment by vanilla-almond | Hacker News Reader

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I use stevia as a replacement for sugar. This research is difficult to understand for a layperson like me (I'm too thick). Is anyone able to answer the questions below?

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Extract: "non-nutritive sweeteners (NNS), such as saccharin, sucralose, aspartame, acesulfame-K, and stevia, that do not contain calories and are thereby presumed to be inert and not elicit a postprandial glycemic response."

Question: Does this research confirm that stevia elicits a postprandial glycemic response? (Does stevia stimulate insulin?).

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Extract: "Notably, all four tested NNS (saccharin, sucralose, aspartame, and stevia) significantly and distinctly altered the human intestinal and oral microbiome, as would be expected for these chemically diverse compounds."

Extract: "Degradation of steviol glycosides by gut bacteria is an established component of their metabolism although some species may be more proficient than others in performing this task and thus, pre-exposure microbiome heterogeneity may conduce to differential responses to stevia."

Question: So stevia alters the human intestinal and oral microbiome. Are these changes a negative outcome and thus a concern for anyone using stevia?

[Disclaimer: Not a doctor or nutrition expert]

From what I've read about postprandial glucose levels, the question seems less about whether or not something elicits a glycemic response, but by how much and how that compares to glucose/fructose.

Another useful measure would be comparing satiation after consumption of sugar vs non-caloric sweeteners, to determine if the significant drop in calories leads to more food ingested overall.

Stevia in particular seems to be one of the lesser studied sweeteners, based on a handful of papers postprandial glucose levels doesn't seem to differ a lot compared to sugar. But there seem to be somewhat consistent findings that satiety levels remain largely the same given the same mass of ingested food ( e.g. [0][1]).

To your second question, from my view the understanding of the human microbiome is still rather poor, especially in terms of health implications on various physiological systems (including neurological), optimal composition and applicable ways to maintain it. Although the last time I checked was probably 1-2 years ago, if anyone is aware of useful new data here I would welcome a link.

[0] https://sci-hub.ee/10.3390/nu11123036

[1] https://sci-hub.ee/https://www.sciencedirect.com/science/art...

I'd argue both those studies are insufficient to come to any conclusions because people do not exist for only one day, and they do not exist in only a healthy state.

A healthy subject, say in their mid twenties, should be able to consume 60g glucose almost instantaneously and have little to no affect on blood glucose. That same subject, if they were to repeatedly do that, multiple times a day, for four decades, is highly likely to have Type 2 diabetes and a heart condition, also likely to have a kidney condition, peripheral neuropathy, macular degeneration, etc take your pick.

The interesting question is what are the long term effects. There are no positive outcomes for a long term high sugar content diet, and I argue that taking any one plant derived, or synthetic chemical, concentrating it and consuming it, is either nutritively, or medically, beneficial, or, if not beneficial, will work, at least to some extent, to tax the body by making healthy homeostatic more difficult.

As an aside, and this isn't directed at you in particular, but at the HN community, if such a thing can be said to exist, more broadly: frameworks.

What frameworks exist within which do make sense of nutritional / health information. How are we to live? What are some (any?) of these frameworks, and where should we go to read about them?

It's good you point that out. Two studies should almost never sufficient for a conclusive argument, especially not in a field where physiological variability may be more decisive than probability distributions derived from group studies (On average peanuts don't kill people but that's not a useful metric if you happen to be allergic).

In terms of informational frameworks regarding nutrition I have to say the landscape is quite bleak. Understanding broccoli or its effects on the human body make big pharma no money, publications are only slowly picking up speed with new (crowd-) funding options. Even worse, the lack of funding and publishing set a rather low barrier for food industry players to manipulate the field in their favor, which makes for even less solid ground (e.g. https://www.nytimes.com/2016/09/13/well/eat/how-the-sugar-in... ).

But there are exceptions, Rhonda Patrick comes to mind, she's mostly or fully crowdfunded, including her papers iirc. She can go very deep but is usually aimed at non specialists: https://www.youtube.com/c/FoundMyFitness/videos

And Andrew Huberman who finances his podcast through sponsors, quite dense but always trying to explain medical terms and concepts he brings up: https://www.youtube.com/c/AndrewHubermanLab

As for "how are we to live" I think a good starting point nutritionally is to try and watch/feel the body reacting to different foods and maybe reading up after something feels really good or bad to maybe gain some theoretical insights. There are no studies for your body in particular but you have full production test access pretty much all of the time (I would try to prevent restarts though).

It's a baffling thought that so much research is spent on which type of sugar water might cause the least amount of bad long term effects.

It's not like there is any medical need for the body to consume sugar water at all.

As recreation, sure, but doing something daily is routine, not recreation. That last part is the strange bit. Consume it every tenth meal and you can pick any type of sugar, an otherwise healthy individual would suffer no long term effects. Consume it every meal and you will.

As a though experiment, it would be interesting to think about how much research would be made into finding out which alcohol we could ingest 50 g of to every meal while minimizing long term damage.

It doesn't baffle me; it seems pretty obvious.

Given that huge populations are consuming sugar water daily, and given the health consequences of this, information on which type of sugar water has the least-bad long-term effects is extremely valuable for harm-reduction efforts.

If "everyone should just stop drinking soda" was actually a strategy that worked, then the problem would have already been solved. It didn't work, or hasn't worked yet, so it's worth trying to check whether the variations advertised as less-harmful are actually less-harmful or not.

Lots of people drink alcohol daily. But we don't collectively act as if that was something completely normal. We spend huge resources to spread the importance of drinking in moderation.

The same is true of sugar water too. Nobody has to stop drinking it. Just do it sensibly and it's not a problem.

Thank you for the links. I agree, it would be really useful to see more research. Newer products likes monkfruit sweetener and allulose have even less research.

I just skimmed this study but other RCTs say no to your first question:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103435/#:~:tex....

You can go down a rabbit hole with the references in this paper - I think a generally interested layperson is definitely capable of understanding papers like this. My instinct is that the hardest to understand papers are often actually so special-area related that those papers don't contain useful information except for researchers. So you can skip them.

Don't know about the second question and suspect no one else does either.

As an aside - how did you manage that transition to stevia? I despise non-sugar sweeteners and can detect them in very small amounts. For "reasons" I don't eat meat and I supplement protein intake with whey. If it wasn't for a small number of high-quality unflavored (and thus lacking artificial sweeteners) whey isolates I would probably re-introduce meat into my diet.

Not OP but what did the trick for me was a combination of the following sweeteners, listed from largest to least amount:

- erythritol (~0 calories, ~2/3s as sweet as sugar),

- xylitol (~60% of sugar calories, improves oral biome, inhibits enamel demineralization),

- stevia or sucralose for added sweetness.

After experimenting with different ratios I now rarely crave sugar at all anymore.

Another thing to consider is that the initial dopamine response to sweeteners seems to generally be lower than with sugar, but there are indications that this gap may lessen with continued use over a matter of weeks (at least in mice in a small number of studies). Andrew Huberman from Stanford brought it up in a recent episode about nutrition: https://hubermanlab.com/how-foods-and-nutrients-control-our-...

I'd like to add monk fruit to that list. Usually you wanna combine: (monk fruit OR stevia) + (erythritol OR xylitol) to get a very nice flavor. Stevia or monk fruit on their own are "flat" in sweetness but very strong. The xylitol or erythritol gives some fullness, or body.

PSA: xylitol is extremely toxic for dogs.

https://pubmed.ncbi.nlm.nih.gov/20473849/

Also it can give some people gastric problems. I don’t have an issue but know people who do.

Gastric problems to me, in other words are, a problem for my intestinal microbiome which my health depends on.

Thank you for the answers. I didn't find it difficult to transition to stevia. At first, it had a different taste from sugar (not unpleasant, much sweeter) but I got used to the taste. Some people find stevia has a bitter aftertaste. Lots of stevia products are a mixture of stevia and erythritol (like 'Truvia') to mask any bitter aftertaste. I use less stevia than sugar (about half of the sugar amount).

Are you using stevia in all places you would use sugar?

Are there any things/situations you can't use stevia for?

> Are there any things/situations you can't use stevia for?

Unrefined ground dried stevia leaf can be quite bitter depending on what it is mixed into. I find it works well in baked goods like cinnamon rolls and corn bread, but makes berry smoothies too bitter to drink.

The refined version is much less bitter-- e.g., it works in berry smoothies (but, there is a very noticeable fake sugar taste/after taste with smoothies).

In either case, mixing with a little regular sugar (naturally occurring sugar content in e.g., berry smoothies is sufficient), generally improves the favor.

And, stevia does not caramelize like sugar when cooked. E.g., replacing most of the sugar in pancake/waffle batter will result in pancakes/waffles that do not brown when cooked.

Yes, I have replaced sugar completely with stevia. I have tried different stevia brands and found them fairly similar - they are a mixture of stevia blends with erythritol.

I found one stevia brand with a 1:8 ratio (1g of stevia = 8g of Sugar i.e. 1:8 ratio). Found that too sweet for me and had a bitter aftertaste. I usually buy stevia with a 1:2 ratio (i.e. 1g of stevia = 2g of Sugar).

I use stevia in tea and coffee. Have also used stevia successfully to make cakes, cookies, and ice cream.

Not answering your questions directly, but it has been known for decades that fake sugars (NNS in the abstract) cause weight gain.

Since you asked about insulin response; (some?) artificial sweeteners seem to be safe for diabetics. There is no other group of people I can think of that should consider using these products.

On a somewhat related note, the soft drink industry has replaced some "diet" drinks with "light" versions that contain sugar and NNS.

I've found that this causes (intentional?) confusion, especially at restaurants, and multiple servers have inadvertently tried to serve our kids that stuff when we ordered things like "lemonade".

In addition to all the above, consuming NNS causes migraines for some people, and they interact badly with some medications. I disagree with the abstract's use of the term "presumed inert", but I suppose they are trying to be diplomatic.

While it does not address the root question, one benefit of sugar substitutes is that they are many times sweeter than sugar: stevia is 200-300x sweeter, resulting in less total mass consumed. My hopelessly-naive-because-biology thought is that each molecule would be metabolized a single time (by your own liver or your microbiome), resulting in less total impact on your body.

I also find using less stevia than the equivalent sugar amount. I still have a sweet tooth but I don't buy sweet foods (make my own sweet foods with stevia).

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