Aw fuck another sugar substitute causes strokes

Everything else
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So, I read that study.

https://www.pnas.org/doi/10.1073/pnas.1620079114#:~:text=Erythritol%20Is%20Synthesized%20from%20Glucose%20via%20the%20Pentose%20Phosphate%20Pathway.

And they walked away with the same question.

Further research is needed to understand the meaning of these findings, including the interplay between variation in endogenous erythritol synthesis and exogenous exposure to erythritol-containing foods.

So, I don’t understand how you can point to that study as saying that the Cleveland Clinic study as flawed, when the authors of the study on glucose-erythritol synthesis make the exact same caveat in their article.

In fact, the Cleveland Clinic study includes dosing a small cohort with an exogenous exposure to erythtritol and finds that the sugar substitute has a long life in the blood stream before being broken down (in healthy individuals). I also disagree that they “don’t find causation” as that is also a nearly impossible ask in nutritional studies. They did some work in vitro showing increased clotting with high erythritol levels, which is the start of the research to find a causative link.

Regardless of how erythritol is consumed or generated in the body, it doesn’t change the fact that they found in vitro evidence of clotting factors increasing with higher erythritol concentrations. That needs to be further researched immediately. It even pushes the hypothesis that this is an additive effect problem. The people who are eating more sugar, are creating more erythritol in their blood stream, and if they are also consuming sugar substitutes, they are doubling up on the concentrations of erythritol in their bloodstream.

That “Big Think” article isn’t pointing out anything about the study that the authors didn’t already address, and I would say that “controlling for diet” is nigh impossible for studies at the scale of participants they had. Getting people to eat a prescribed diet is tough, especially tough in 3000+ individuals. Also, as has been pointed out, the study was done on data already collected, and they discovered this link while looking through the data.

So, to me, calling it flawed isn’t helpful. All research is flawed to a degree.

That article also makes some mental jumps.

Even if erythritol does truly increase the risk of heart attacks and strokes, it still is replacing sugar, which almost certainly has more pernicious health effects.

Sure, but that isn’t the argument the study is trying to make, especially when there are a plethora of other sugar substitutes.

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Keep in mind in vitro a handgun kills bacteria just fine, too.

Don’t put much weight in it as evidence, is what I’m saying. Like animal models, more often than not, findings don’t translate to actual human bodies.

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Well, like I said, it was done in addition to the rest of the work on that study, which the conclusion is, we need to do more research.

The ethics of doing this kind of research in human subjects is also something that might come up, as to why a lot of studies are done in vitro and in animals.

They also got about as “in vivo” you can get without putting an actual human body in danger.

image

Again, I think that the article with the headline that the study is “flawed” very disingenuous. It is at the same level, or in my opinion actually less flawed, than most metabolic research. The arguments they give over the study can be given for literally any research into metabolic functionality.

Also, the study that the article mentions about the proposed synthesis of erythritol makes this observation:

In conclusion, we found a positive association between circulating levels of erythritol at the study baseline and the incidence of central adiposity gain in nonobese adults aged 18 y and studied over 9 mo. Moreover, we demonstrated that erythritol is constitutively synthesized in humans from glucose, most probably via E4P, which is an intermediate of the PPP. Further research is needed to understand the meaning of these findings, including the interplay between variation in endogenous erythritol synthesis and exogenous exposure to erythritol-containing foods. Further research to confirm these findings in a new cohort and to identify metabolic profiles that predict changes in adiposity in early adulthood present a unique opportunity to identify novel targets for prevention, which are very important, given the well-known difficulty of losing weight once it is gained.

Linking erythritol with weight gain in young adults. So, even if the cardiovascular risk is overstated, we have additional research showing higher levels of erythritol in the blood causing other metabolic problems. So, whether it is being consumed directly, or produced in the body, there are negative effects being associated with erythritol and “more study is needed” That paper is from 2017, and the Cleveland Clinic study is from 2023, this is the “more study” being performed.

Anyway, I think back to my biology advisor in college, and how he wanted to teach us that skepticism is very important, but there is also an unhealthy amount of skepticism too.

Analyzing the study on a recent episode of the Skeptics’ Guide to the Universe , Dr. Steven Novella, a neurologist at Yale University, warned that the research doesn’t establish cause and effect, meaning that it’s just as likely that people who consume lots of erythritol are already at higher risk of cardiovascular disease, perhaps because they are overweight and trying to diet. Novella’s co-host, Dr. F. Perry Wilson, a nephrologist at Yale University, added that we shouldn’t be thinking about the results of the study in a vacuum. Even if erythritol does truly increase the risk of heart attacks and strokes, it still is replacing sugar, which almost certainly has more pernicious health effects.

You can’t have your keto cake and eat it too guys. It can’t be held up to not having a smoking gun of “cause and effect” and then played off of “well sugar is bad too probably” without quantifying how much worse it can be. Maybe erythritol IS much worse. (That is what the research is FOR!)

Anyway, I tend to really dislike “skeptic” culture, as it often tends to be contrarian in nature, and in this case, at least, I found their “flaws” to be common to literally any study done on human metabolism and nutrition.

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I mean, there’s way, way more data about sugar being very bad in a variety of ways. It is still possible that erythritol is much worse, sure. But at this point I would still recommend it over sugar based on the preponderance of evidence. And I’d recommend other sugar substitutes over either, and neither sugar nor substitutes ideally.

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And I think this is the safest takeaway with the data we have now. Lots of reasons to believe sugar and sugar substitutes all can cause issues. Not a lot of data that says either of them provide any health benefits. But hey, sweet stuff is great and I struggle with moderation, not to mention cutting them out entirely as much as anyone.

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A prospective study would help. Of course, those take time.

Not really, given they had no idea they were going to end up looking at erythritol until they found an association. Of course, they then went on to identify the same association in an independent data set, so that’s less an issue than it might have otherwise been. Even so, it would be nice to have someone set out specifically to study all these sweeteners in a more targeted way. What that looks like, I don’t know.

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I actually have had a much easier time avoiding sweet stuff when I avoid it completely. But if I have a little bit I don’t really have the willpower to resist it.

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This is me with all starchy things, including bread, potatoes, etc.

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Have there been more studies that confirmed this since the original? I always thought this was the best tasting substitute.

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No, not really.

It takes a long time for studies to get completed or published. Years, typically. There is definitely someone researching this now, just not at a state to draw conclusions from.

I mean, if you like monkfruit extract, and it keeps you healthy, and you aren’t concerned about your heart (don’t have any known heart issues) I think it is fine to keep using it, or consuming products containing it.

The study did show that the normal consumption of it did increase clotting factors, but they didn’t tie that to the adverse events found directly.

It was an interesting study, because it showed correlation, and then showed a pretty good hypothesis on causation. But, the idea is more study is needed to link those two.

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for clarity

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Good point, but a large amount of erythritol consumption is through “monkfruit extract” which will contain added erythritol.

Make sure you are checking labels.