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Comment by neuralengine | Hacker News Reader

Note that the authors compared blood erythritol level, not _intake_. Erythritol is also a metabolite, which is produced by the pentose phosphate pathway, and has been associated with metabolic dysfunction before.

Check out this thread: https://twitter.com/Dr__Guess/status/1630548194907021313

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Verbatim response to that tweet, from a highly qualified friend with relevant scientific expertise:

"idk that critique is pretty dismissive of the actual experimental evidence that they generated in the study… consuming an erythritol sweetened beverage raises the erythritol level in the blood to a level that clearly causes an effect on platelets, and coincides with the difference between the measured levels in the observational study… seems pretty convincing to me".

Could you please ask your friend what he would recommend for a sugar substitute ?

Monk fruit extract, without this stuff mixed in

yea, but why? it looks cool and all, but at least sugar gives you nutrients (energy calories).

The problem with modern nutrition is that people consume too much calories, not too few.

I'm pretty sure you're referring to the poor health outcomes correlating with high caloric intake, which afaict, come from people's consumption of heating oils (seed oils): https://en.wikipedia.org/wiki/Vegetable_oil

There's bound to be mixups what talking about sugars and fats. But these fuel oils are really really bad for us. We've demonized sugars unnecessarily. Right?

No, exactly opposite. Fats are good, sugars are bad.

Good fats are good, but there are bad fats too!

Get your nutrients from everything else, you don’t need sugar for nutrients, and that’s not why you put it in a chocolate cookie

The problem with monk fruit is that while it seems relatively benign on its own, many/most commercial products that claim to be "sweetened with monk fruit extract" actually have other cheaper commercial sweeteners mixed in.

If you google "monk fruit extract diarrhea" theres a good amount out there on this.

So you may switch to monk fruit thinking its a better alternative but actually be consuming erythritol anyway.

Ans that’s why I said “without the other stuff mixed in”.

If you want the lowest risk option and don't experience any of the side effects, aspartame should be your choice. A 'newer' and promising substitute is Allulose, though some people report bowel complaints.

Er... Aspartame is a NMDA receptor antagonist, but at a site where it actually increases NMDA activity. I get super panicky and jittery/feel like my nerves are physically overloaded with Aspartame. My mom would call her reactions "aspartame headaches"

Each sweetener is different and different for different people. Allulose is not metabolized by the body but is free for all those bacteria to eat! Yum! Much much more sugar for the bacteria. It does taste truly lovely though, that said. Stevia glycosides are not bad at all with the taste a bit to get used to. Sucralose is just sucrose IIRC with three chlorine atoms... substituted on it? I think? It's not taken up in your intestine but it does block the transporter in bacteria/yeast that does take it up. So, havoc on the gut flora! I'm pretty sure it kills the bacteria/yeast too. I think.

Acesulfate Potassium is okay but it activates your insulin receptors, so your blood sugar plummets. I can barely stay awake after a single diet cheerwine for that reason.

Glycine is a fun one that's expensive that no one uses. It's literally the opposite of aspartame, even binds to the same receptor at the same receptor site, just... Opposite! It's also like magnesium in which lots of people could use to have it/maybe are deficient in it...I think (don't quote me on that please! D:) I always wanted to try it dusted on a blueberry cake donut. :3

We don't talk about saccharine, but D-ribose (this one is actually caloric) is very expensive but tastes fantastic and is great for your mitochondria to boot! It's a DNA building block as well. I use it when going on ultra-long physical excursions. Blackstrap molasses is great for cutting with any of the above sweeteners for cheap caramelly roasted toasted robust flavor without many calories. Inulin, a digestible fiber is also sweet and worth a shot! (I don't think it's super cheap, but I don't think it's break the bank or no).

Oh, 70% sucralose solution is fun (and cheap!) too. It's 600x sweeter than sugar lol. It tastes almost soapy bitter it activates whatever receptors so strongly lol. I love it. Sometimes it leaks and crystalizes on the outside of the bottle. What a rush it is to have those. Oh, to see my life flash before my eyes like that again....

I use that as my emergency sweetener sparingly. I have a small bottle that's lasted me for years at this point.

Stevia from Trader Joe's is my go to. I add it to beans with molasses and some garlic infused oil and some spicy stuff and such. Yummmmmmm. Gonna have to have some of that soon!

So there you go. There's more of course (like some corn fiber of some kind IIRC), but those are a lot of the main ones. And erythritol. But I say use what's good for you. It's literally different for each person. They're drugs but boy do I like the sweet flavor, and Stevia is a good tradeoff for me that I've come to love so much.

Hope that was interesting, if you made it to this point, thanks for reading and so much love! :)))) <3 <3 <3 <3 :))))

Great write-up! Thanks for putting it all together. Just want to add: Aspartame is extensively studied, the known side effects are very well understood and the probability of undiscovered side effects is extremely low. That's why I wrote lowest-risk. That is, if you don't experience the side effects.

Why not just leave the sweetener out and get used to the real taste of things?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892765/#:~:tex...

Underrated response.

Can't you recommend someone stop drinking alcohol (for behavioral/psychological or physiological health issues) without giving him something that tastes like alcohol and inebriates you like alcohol?

Good point. This paper gets more hype then is appropriate. First it looked at a group of already very sick people:

> Over 40% had already had a heart attack. Over 15% were in heart failure. Over 25% had type 2 diabetes. Over 70% had hypertension. And over 70% had coronary artery disease! [1]

This is important because:

> people with this metabolic profile (Syndrome X) have been shown to have an overactive PPP & likely produce more erythritol (PMID: 20711518) Therefore, it is highly likely that this paper is simply a case of reverse causality. [1]

This gets underscored through:

> the authors’ finding that erythritol levels remain well above the cohort ranges for at least a day after consumption, suggests that none of the cohort patients were consuming erythritol in their diets [2]

[1] https://www.instagram.com/p/CpQspxwgqgT/ [2] https://peterattiamd.com/more-hype-than-substance-erythritol...

Here's a study from 2017 showing that adiposity (basically having a gut and/or being overweight as far as I understand) correlates to elevated levels of Erythritol in the bloodstream. n=264 and the test subjects are all college freshmen so presumably in much better overall health than the subjects of the study that's been getting hyped in the news, so definitely looking like reverse causality here: https://www.pnas.org/doi/pdf/10.1073/pnas.1620079114

Edit: From the paper -

"Erythritol was shown to be synthesized endogenously from glucose via the pentose-phosphate pathway (PPP) in stable isotope-assisted ex vivo blood incubation experiments and through in vivo conversion of erythritol to erythronate in stable isotope-assisted dried blood spot experiments. Therefore, endogenous production of erythritol from glucose may contribute to the association between erythritol and obesity observed in young adults."

that effect should be controlled for in the control group, or isn't it?

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