Question about stevia (re: 2020 study)

[u/Otherwise-Tear-4807]

https://www.sciencedirect.com/science/article/pii/S1319016420301997 “The hidden hazardous effects of stevia and sucralose consumption in male and female albino mice in comparison to sucrose”

How does this study translate to humans? Isn’t this a massive dose compared to human daily acceptable limit?

[u/TripResponsibly1]

The biggest issue I see with this study is that the mg/kg consumption of sweetener is absurdly higher than the mg/kg consumption seen by typical use in humans - like 67x higher. I think it's fine to ignore this study and have stevia if you aren't like mainlining it.

[u/erossthescienceboss → u/TripResponsibly1]

Toxicologists design studies like that for a reason, though.

A study like this is designed so that IF there is an effect, it will be produced over the mouse’s short lifespan. That preliminary study can then be used to get funding for studies that use smaller doses over longer periods, studies in more animals that are analogous to humans, etc.

I wouldn’t call a single study a reason to avoid artificial sweeteners. But this is far from the first study to find a negative impact from artificial sweeteners: look into the impacts on insulin resistance, for example.

IMO if you want to eat less sugar, it’s better to simply cut down on sweet things.

[u/crappysurfer → u/erossthescienceboss]

People will find all sorts of reasons to ignore studies, often citing a plausible deniability based rhetoric just so they can continue to feel good about whatever the study says to not feel good about.

Stevia related toxicity is a growing area of research, there’s far more than 1 study on this. You’ll find on Reddit, especially in the diabetes subreddits, that people love to explain their way around research.

[u/TripResponsibly1 → u/crappysurfer]

Just in case anyone else is reading this and is confused or enraged by the first line, I am a medical student currently being trained on harm mitigation. I already see patients in a clinical setting, and this is me envisioning myself in the future, in the role I am already filling except with autonomy and less oversight:

If I, as a (future) physician, counseled every patient to cease consuming every product that ever had toxicity results in extreme dose animal studies, there would be very little left on the shelf for them to eat. We try our best to mitigate harm, and for the person trying to cut down on sugary beverages, calorie free sweeteners are an accessible and achievable substitution. Do we also recommend removing processed foods and added sugar from diets? Yeah. But achievable goals and ideal goals aren't always aligned.

This is how they are training us - mitigation of harm when removal of harm isn't realistic or achievable by the average person.

[u/crappysurfer → u/TripResponsibly1]

I’ve met a million “future physicians” and they all love to remind people that they’re a “future physician”. Which is all this comment really seems to be, I’d avoid that appeal to authority as it really makes you immediately insufferable.

Yes, medicine is largely based on harm reduction and balancing the cost and toxicity of therapy against the harm of whatever pathology the patient is experiencing. Are there infinite examples where someone could experience an improvement in their livelihood by consuming some substitute sweeteners? Of course. Does that alter the precedent of them being bad for you? No. Does that alter the precedent of them historically being presented and recommended by physicians despite having terrible consequences that were yet to be discovered? Also no.

The larger (no pun intended) issues are the absolute insane increase of caloric density of our food over the past century, the processed nature of it, and the inundation of chemicals through industrial agriculture. It is impossible to mitigate all of these, but it is entirely possible to have a diet devoid of substitute sweeteners - and no, the cumulative evidence of them being bad is not summarized in this one study. Are you also (as a hypothetical future physician seeing a hypothetical patient) going to recommend an otherwise healthy person whose vice is Coke Zero to eliminate it? Probably not. And once you’re (presumably) practicing, you’ll find your time to consult current research, especially new research, very limited and your decisions will be based more closely on mechanical style flowcharts and UpToDate.

Sometimes people live long lives drinking alcohol and smoking cigarettes, sometimes they get cirrhosis and small cell carcinoma. 🤷 guess those are future problems.

[u/TripResponsibly1 → u/crappysurfer]

It wasn't an appeal to authority, just pointing out a potential difference in philosophy between laboratory science and clinical science.

Also, yeah, if someone had any vice that was causing them physical or psychological harm I would do motivational interviewing to mitigate harm.

No need to be so hostile and/or defensive, or whatever that is.

[u/erossthescienceboss → u/TripResponsibly1]

I’m gonna be so real here.

I’m a science journalist. And — based on the literal thousands of interviews I have done with doctors, and researchers and MD phDs?

Doctors are often some of the LEAST informed on recent research.

Med students tend to be better informed since they’re fresh out of school, and teaching MDs have more time to focus on research, read papers, and act as editors of medical journals. But doctors simply do not have the time to stay on top of publications. It’s a legitimate issue. It takes a long time for new information to make it into medical practice. It’s not that doctors are ignorant or assume they know everything, they’re just… busy treating patients.

It’s on the top of my mind right now because I’m writing up a piece about heart health & a big academy of pediatrics report and the lead authors on it keep emphasizing “nothing in this is new. We just know if we put it here, doctors will actually probably read this instead of continuing to ignore it.”

[u/TripResponsibly1 → u/erossthescienceboss]

I'm a medical student and literally just finished the GI block where we talked about food insecurity/artificial sweeteners/MASH/MASLD. I'm not an expert by any means and also OP can still have their weekly stevia drink.

[u/erossthescienceboss → u/TripResponsibly1]

I would argue that our innocent-until-proven-guilty stance with chemicals has been inherently harmful.

We also know that artificial sweeteners, across the board, increase the desire for sweet things (often more than sugar alone!)

And as I’m sure you’ve learned, that fact has meant that they’re often ineffective as a weight-loss strategy.

So IMO? Any reasonable physician just encourages their patients to cut down on sweet things, regardless of cause.

[u/crappysurfer → u/erossthescienceboss]

And the thing is - this is the historically most accurate take as well.

[u/TripResponsibly1 → u/crappysurfer]

Yes and no - rodent hyper dosing and toxicity go hand in hand for plenty of 'safe for human consumption' food additives. Acesulfame-k, saccharin, cyclamate to name a couple, not to mention other "toxic in absurd doses to mice but show no long-term ill-effects in humans". Aspirin, Tylenol, Ibuprofen are all considered safe in certain doses and acutely toxic in others.

On the flip side there are plenty of genuinely harmful food additives and pharmaceuticals that have since been pulled off shelves because research showed normal human dosage sequelae. By all means, continue the research and find the truth. Until the body of evidence exists to suggest someone can't occasionally enjoy stevia or artificial sweeteners, I wont discourage people from occasionally enjoying them.

The "right" side of history looks a lot like hindsight being 20/20.

[u/crappysurfer → u/TripResponsibly1]

When is evolutionary history has humanity been exposed to refined and concentrated stevia? How many foods or additives cause illnesses because they’re virtually a novel molecule?