Metabolical

Continuing my reading about the human condition, and considering my plans for the next stage of post-graduate study, I thought that I would read a few modern books about nutrition. From the little that I have read, it seems that every author knows where the causes of noncommunicable diseases (NCDs) such as cancer, neurodegenerative diseases (Alzheimer’s and vascular dementia), cardiovascular diseases, and type 2 diabetes lay: metabolic disease, a by-product of the conversion of food into energy. Welcome to a minefield!

I have only read the opening chapter of the book Metabolical: the lure and the lies of processed food, nutrition, and modern medicine, so I can't comment too much about it. What I have read seems very lucid so the whole book should be interesting.

One small niggle is that even though the abbreviation NCD is introduced at the beginning (see above), every time (so far) the full term appears, along with the abbreviation. What's the point of denoting the abbreviation if it's not used? (1)

My major niggle with this book (again, only the opening chapter) and a few other books, including those by Daniel E. Lieberman, is their Americocentric view of the world. The various budgets discussed in this book, Obamacare, and percentages of morbidity come only from North America! Who says the rest of the world behaves in the same manner? 

If the premise of this book is don't eat processed food, then I would like to think that I am in a good position as the only processed foods that I eat are milk products. I am trying to find a yoghurt with no added sugar - or no sugar at all - but so far have not succeeded in my quest (I wanted to buy some goat yoghurt that is apparently sugar free but the kibbutz shop had none). I suppose that milk could also be considered a processed food. Other than that, I eat only food that I cook, such as chicken and salmon (although one could say that these are processed during their growth), quinoa, barley and salad (cucumber and bell peppers). The bread that I eat is made by someone on the kibbutz using only whole and white flour, honey, walnuts and salt (I asked him last week).

There was one nice quote that I saw in this book: Nutrition is not the same as food science. Nutrition is what happens to food between the mouth and the cell. Food science is what happens to food between the ground and the mouth. 

I couldn't resist looking for erythritol in the book, which is where I came across this passage: You drink a soda. The tongue sends a signal to the hypothalamus that says, “Hey, sugar is coming, get ready to metabolize it.” The hypothalamus then sends a signal along the vagus nerve to the pancreas, saying, “A sugar load is coming, get ready to release the insulin.” If the “sweet” signal is from a diet sweetener, the sugar never comes. What happens next? Does the pancreas say, “Oh, well . . . I’ll just chill until the next meal,” or does it say, “WTF? I’m all primed for the extra sugar. Let’s eat more to get it.” This explains why diet sweeteners (such as erythritol) do not necessarily have a positive affect on caloric intake, body fat, and metabolic disease. I would be interested to find out more about the contention that The tongue sends a signal to the hypothalamus that says, “Hey, sugar is coming". This assumes that the drink is sweet; erythritol is less sweet than table sugar on an equal weight basis, and the 'sweetened' tea that I drink isn't sweet - so does this cause the hypothalamus to signal the pancreas?

Incidentally, I should write about my recent blood tests; I was tested at the beginning of May, when the glucose level was slightly high, the potassium level was very high and the creatinine level was seriously high. This latter test concerns kidney function. My GP told me to stop using erythritol for a few weeks and then do another blood test: to quote her directly, it's better to gain weight (or not lose weight) than lose a kidney. I did another blood test a few days ago: the glucose level dropped by 1%, the potassium level dropped slightly, but most importantly the creatinine level dropped to a reasonable value. Does this mean no more erythritol? I have an appointment for my nephrologist next Sunday.

(1) Of course, had I read a bit more, then I would have come to the section entitled "Clear and present danger" that both uses the abbreviation NDC and talks about the developed and developing world. In 2011, the UN Secretary-General announced that NCDs are a bigger threat to poor countries than infectious diseases, including HIV. American corporations and our government don’t just export bad reruns of Baywatch, we also export our lifestyle, our food, and its subsequent diseases. Our first-world problem has become their third-world problem.

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This day in history:

Blog #	Date	Title	Tags
491	21/06/2012	Dubrovnik log 7	Holiday, Dubrovnik
727	21/06/2014	Circumetnea railway (Sicily log 2)	Holiday, Sicily, Italy
957	21/06/2016	Autoharp	Musical instruments
1400	21/06/2021	Neat hack - but is it useful? (Management program)	Programming, Delphi, SQL

When life gives you lemons ...

This is a proverbial phrase used to encourage optimism and a positive can-do attitude in the face of adversity or misfortune. I, however. mean it literally. Way back when in April, I wrote for about a month, I've been buying lemon-line flavoured water from the kibbutz shop. It seems that I bought their entire stock and they haven't managed to source any more. They do have grapefruit flavoured water sweetened by erythritol, but I don't like grapefruit (apart from the taste, grapefruit and statins don't go together) and no one is buying this. As a result, I've returned to the former type of flavoured water that I used to drink; more calories, and with my erythritol experience, it's too sweet.

We have in the garden a lemon tree that has given us a good yield this year. There are more lemon trees scattered around the kibbutz, and they, like mine, drop ripe lemons every day onto the ground. Under the guise of keeping the paths clean, I pick up some of these and take them home and so we have plenty of ripe lemons in our fruit basket. Yesterday it was as if a light went on over my head: I poured a glass of cold water, added a tablespoon of erythritol then squeezed some fresh lemon juice into the glass - instant flavoured water! And at a much lower price. I intend to drink this mixture for the next few months.

I should point out that my wife squeezes lemon juice into lukewarm water without sweetening; I don't like drinking lukewarm water and the lemon juice is too 'sharp' on its own without tempering.

So, when life gives you lemons, drink freshly squeezed lemon juice.

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This day in history:

Blog #	Date	Title	Tags
366	07/06/2011	Post mortem on the HRM exam	MBA, HRM
590	07/06/2013	Barcelona log (2) - In search of Gaudi	Holiday, Barcelona
1040	07/06/2017	Rodos log 3: Filerimos and the Valley of Butterflies	Holiday, Rodos, Greece
1142	07/06/2018	Italy 2018 - Travelling to Torino	Holiday, Torino, Italy
1322	07/06/2020	Is it OK to have a PhD thesis with shortcomings and inaccuracies?	DBA
1510	07/06/2022	Italy 2022: Lecce	Holiday, Italy, Bari

One month of Erythritol

Since I last wrote on this topic, another two weeks have passed and my body's reactions to erythritol is becoming more regular and less extreme. Primarily, I have reduced my intake somewhat: the first two cups of nettle tea are sweetened with powdered erythritol, and possibly one more cup of black tea is sweetened in the same manner. After that, I use the erythritol tablets that are both sweeter (because of the sucralose) and contain less erythritol. I haven't calculated my daily intake, but it should be something like 20 g/day.

My weight went down from 84.5 kg (07/04/23) to 82.3 kg (12/05/23): a loss of 2 kg in a month. Since then, however, my weight has been slowly increasing and on Friday it was 83.1 kg. Hopefully I can maintain this weight. 

My sleep has been much better, with no need to use sleeping pills after the first few problem nights, although the weekly band practices that finish at 11pm don't help. Yesterday I got up as usual at 5:30 am, after barely six hours of sleep (I found it difficult to fall asleep on Saturday night), but felt fully awake. This morning (or last night), I had eight hours of sleep, falling asleep almost immediately last night, but took some time to awake fully. Normally I'm wide awake as soon as I rise, so this morning was slightly anomalous.

My appetite - or rather, my need to snack - has been modified by the erythritol: I feel that the physical need has been separated from the psychological need, and now I find it easy not to snack. This is very interesting.

Although without connection to erythritol, I seem to have increased the distance I walk every day. Unfortunately, the walking rewards app has recognised this and has increased once again my daily target: it was originally 11,000 steps, then it increased to 11,300 and 11,600. Yesterday I saw that once again the target had increased to 11,900 steps. I've achieved this new target 10 times this month; on one day I walked 11,866 steps so I've really achieved the target 11 times - once every two days. But I doubt that most days I have sufficient spare time in order to walk enough to reach this target. Time will tell.

The results of the blood tests that I undertook a fortnight ago were so-so; my amateur eye sees that certain indicators of kidney problems are slightly high. My potassium level is also increasing. I have yet to hear back from the clinic, meaning that the professional view is that those indicators are not worrying, or possibly a result of my medications.

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This day in history:

Blog #	Date	Title	Tags
77	22/05/2007	Metadata and information	Programming
711	22/05/2014	Back to the research proposal	DBA
856	22/05/2015	Venice log 3 - Raining	Holiday, Home movies, Venice, Italy
1032	22/05/2017	Puzzle from the Guardian	Puzzles
1136	22/05/2018	Remembering the guitar	Personal

Two weeks of Erythritol

Yesterday I had my regular three month appointment with the dental hygienist. In advance, I had printed for her a copy of a short paper (maybe it was just the abstract) in Hebrew about the beneficial effects of erythritol in the mouth, primarily the reduction of dental plaque and caries. We talked a little about this sugar alcohol before she got down to work. Her first remark was that there was a definite improvement in the state of my teeth since my last appointment. As I have not changed my daily routine regarding teeth cleaning (except for substituting a toothpaste sweetened with erythritol as opposed to one sweetened with sorbitol), I can only conclude that this improvement is due to two weeks' usage of erythritol! I didn't expect it to have such an immediate effect; I was thinking of using yesterday's visit as a control, to see how much improvement there is in the next three months. Normally I have to use chlorhexidine mouth washes for a week after each treatment (this provides a continued inhibitory effect on plaque formation for up to 14 hours. The effectiveness of chlorhexidine is documented in many controlled clinical trials showing a 50% to 60% decrease in plaque, a 30% to 45% reduction in gingivitis, and a reduction in the number of oral bacteria), but the hygienist said that there was no need this time. Way to go, erythritol.

Until recently, I have always been hungry - yes, I know, I live in a pampered Western society where almost no one suffers from malnutrion, so 'hungry' here does not mean real hunger - and as a result, my hourly cups of tea (during work hours) are always accompanied by a biscuit, a slice of bread or a piece of chocolate. I realised a few days ago that I ... am ... not ... hungry! I have ceased eating between meals, without any conscious effort. I attribute this to the erythritol; as I quoted in my second blog on the topic, [erythritol]  induces gut hormone secretions that modulate satiety to promote weight loss. Indeed: it might well be that my appetite has decreased due to the action of erythritol on the gut hormone controlling satiety (leptin). Not only am I not snacking, my weight has also decreased by 1 kg in two weeks!

It would thus seem then that erythritol is having a very beneficial effect on my body. On the other hand, I have been having problems sleeping in the past week; I haven't found any paper linking erythritol with sleep problems so this may be for other reasons. I normally wake up twice in the night, go to the toilet, come back to bed then fall asleep almost immediately. In the past week, I haven't been able to resume sleeping after the second visit. I noticed that the restless leg syndrome had come back to haunt me, making it very difficult to find a suitable position for my legs. I also noticed that the skin on my legs was very dry, causing me to scratch a great deal. These problems were dealt with easily, by taking a certain type of magnesium additive that includes both vitamin B6 and vitamin E; whilst I have been taking magnesium supplements, they were without these two extra ingredients that contribute much to reducing the RLS. Skin cream took care of the dry skin. I've also started taking vitamin E capsules; these are supposed to improve the state of my skin. Not being able to fall asleep has caused me to become very tired over the past few days: it's just as well that I don't have to operate any machinery.

I have just seen my GP, who whilst impressed with the various improvements, is willing to consider that there might be a link between erythritol and sleep: I had looked at a paper that showed a link between glucose levels and sleep problems. It might be that the increase in satiety is causing lower blood glucose levels that the brain's feedback mechanism is used to and so glucose may be released, in spite of everything else, and this glucose may be causing the sleep problem. 

I remember discussing once with our previous GP the topic of artificial sweeteners (aspartame) and how they can have an effect on glucose levels, even though theoretically there should be no effect. He told me not to drink tea sweetened with aspartame before blood glucose tests for this reason. So my current GP wants to check the hypothesis that there is a causal link between erythritol and sleep problems: I am to stop using erythritol for a few days and to have comprehensive blood tests. She also prescribed a few sleeping tablets for those nights when I can't sleep - only a few and only for specific use. We both know the dangers in using such tablets for longer periods. This is evidence based medicine.

That said, there's a problem with the 'experiment design': if I stop using erythritol but do take the sleeping pills (because I want to sleep properly and feel normal during the day), then what is to say what the cause is. It should only be when I stop with the sleeping pills that I should also stop with the erythritol.

I was so tired that I forgot to publish this blog after having written it.

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This day in history:

Blog #	Date	Title	Tags
73	09/05/2007	Killarney Boys Of Pleasure	Soundclick, Folktronix, Lunasa
358	09/05/2011	Running a database query which automates Word in a background thread	Programming, Delphi, Office automation, background thread
479	09/05/2012	Early footage of The Band	The Band, Youtube
582	09/05/2013	More sleep analysis	CPAP
840	09/05/2015	Preparing for Florence (2)	Holiday, Florence, Italy
1028	09/05/2017	Zingers	Personal, Films
1315	09/05/2020	DBA news in May: it's getting very near the end	DBA

Passports/2

Way back when at the beginning of January, I wrote that I had made an appointment for new passports in Karmiel on 2 May: a four month wait. There have been various noises in the past month or so that new procedures will be put in place in order to shorten this wait, but I'll believe it when I see it. 

Anyway, yesterday was the long awaited date and we travelled to Karmiel by train - no problems, 2½ hours travel (we had a direct train from Tel Aviv to Karmiel). Outside the station, a taxi was waiting for us, to take us to the Interior Ministry office. I doubt that this was further than 1 km from the train station, but my wife would have had difficulty getting there. Once inside the office, we gave our identity numbers to the guard who checked that we were on today's list; indeed we were, and we settled down for a short wait.

We were dealt by the deputy manager of the branch in a side office - luck of the draw. We received excellent service; we were told that next year, it will be required that all identity documents over 10 years old will have to be replaced by new, biometric, documents - the manager filled out the necessary forms, to save us another journey next year. She also noted that I had paid twice for my passport (this was because I paid in advance in January, only to discover that this was an option only for someone who had an appointment until the end of March); she said that the period had been extended and so she would use my original payment for the passport, instead of the second payment, for twice the original amount.

After dealing with the bureaucracy, we found a nearby restaurant and had a light lunch. I was feeling as if I were abroad, having lunch outside a restaurant, then ordering a taxi to take us back to the train station. At that time of day, there are trains from Karmiel only once an hour; fortunately, we arrived there 10 minutes before a train was due to leave, not 10 minutes after a train had left.

So we were back in Bet Shemesh at about 16:45 - a long but successful day. 

Instead of coming straight home, I wanted to go to the health foods shop to buy more oat 'milk' and stinging nettle tea. Once there, I looked for sweeteners: I found several interesting items, including 310g containers of erythritol for 19.90 NIS: this works out at slightly over 61 NIS/kg. As it happens, yesterday I received a delivery of 3 kg erythritol that cost about 210 NIS, including delivery. This is more expensive than the health foods shop, so I doubt that I'll be buying from the special supplier again. On the other hand, 310g is enough for about five days, meaning that I'll have to buy two containers each week. They did not have the erythritol/sucralose tablets, but they did have a variety of other sweeteners that surprised me. Why would someone want to buy mannitol or fructose? Mannitol is used as a medicine to decrease intercranial pressure: in medical dramas, one often sees doctors using mannitol when a patient has a brain bleed. Whilst it has a lower glycemic index than table sugar, making it suitable for diabetics, it can also cause stomach problems. Erythritol does not cause such problems.

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This day in history:

Blog #	Date	Title	Tags
477	03/05/2012	Some MBA metadata	MBA, Project management, Finance
837	03/05/2015	Preparing for Florence	Holiday, Home movies, Florence, Italy
949	03/05/2016	Grandpa No'am	Personal, Grandfather
1214	03/05/2019	Diet (part two)	Health, Diet
1314	03/05/2020	A good weekend	DBA, Kindle, Grandfather, Covid-19
1497	03/05/2022	ShoesOnLine (another pointless day-in-the-life-blog)	Shoes

Erythritol - continuing the story

Yesterday afternoon I finished all the erythritol that I had received from iHerb. This means that in 7 days I consumed 454 grams, or 65 g/day. As the recommended usage is 1 g/day/kg body weight, I used less than the recommend usage. So far, so good. But I can't really say that the tea that I sweetened with erythritol was sweet; on the other hand, it wasn't bitter or sour, nor did it have an aftertaste. 

As I had no more erythritol, I was 'forced' to use my old sweetener, saccharin, for my first few cups of tea. Since then, I've been down to the kibbutz store and bought a different type of sweetener: sucralose. As sucralose is at least 300 times sweeter than sugar on a per weight basis, obviously one needs a very small amount. It is sold in sachets, where 0.7% of the sachet is sucralose and the rest is erythritol. As each sachet weighs about 1gram, let's assume that the amount of erythritol is 1 gram. The sucralose is also not metabolised by the body.

My first cup of tea with this sweetener was very sweet but with a bitter aftertaste. I didn't notice it before, but the sachet says that one sachet is equivalent to two teaspoons of sugar; I of course put two sachets in the cup of tea. I wonder whether one sachet will give the same bitter aftertaste. I have seen on websites pellets of sucralose (see the picture on the left) - I may order this in the future. One interesting fact is that there are 200 pellets in the container, but the net weight is only 17 grams; I take this to mean that there is much less erythritol in the pellets than is in the sachets.

Sucralose is produced by the selective chlorination of sucrose (table sugar); the food scientist in me does not understand why this should make sucralose so much sweeter than sucrose. I assume that the chlorine atoms force the compound to assume a physical configuration that fits well onto the receptors on the tongue. The learned article that discusses this can be found here: I'm going to read this with interest.

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This day in history:

Blog #	Date	Title	Tags
836	01/05/2015	Vinyl log 8 - 1 May	Vinyl log, Peter Hammill, Steeleye Span

Erythritol - further remarks

Following are several items that I left out of my first blog on the topic: firstly, this sugar alcohol occurs naturally - albeit in very low concentrations - in fruit, so it is not an artificial product. That said, erythritol is produced commercially by engineered yeast fermentation of glucose. As erythritol is metabolised neither by humans nor by gut flora, it is of course good news for diabetics. Quoting one of those National Library of Medicine articles, Evidence shows erythritol has potential as a beneficial replacement for sugar in healthy and diabetic subjects as it exerts no effects on glucose or insulin and induces gut hormone secretions that modulate satiety to promote weight loss. That final statement modulate satiety to promote weight loss is very interesting to me.

A question: why is it that bacteria haven't incorporated a mutation that allows them to metabolise erythritol? I am always reading about how versatile bacteria are and how they mutate, adapting themselves to new environments. So why don't they have this mutation? And if nothing can metabolise erythritol, what happens to the erythritol that we excrete?

I have found an Israeli supplier that is cheaper than iHerb: 1 kg costs only 54 NIS, whereas I bought 454 g (1 pound) for 37 NIS. That said, I wonder whether this supplier will deliver a 1kg bag. [I ordered 3 kg with home delivery - there are also erythritol tablets at 52 NIS/800g instead of powder.]

A scientific paper on the action of xylitol and erythritol on oral Streptococci shows that these sugar alcohols not only inhibit bacterial growth but also have some positive effect on the biofilm matrix (aka dental plaque).

Here is a general article on the pros and cons of erythritol. I don't like how the article discusses the problems with large doses of sugar alcohols - that they are generally metabolised by gut flora leading to gas and bloating - without mentioning until much later on that this is not the case with erythritol. As I wrote earlier, gut flora too do not metabolise erythritol.

Where's the downside? Apparently, erythritol, in both in vitro and in vivo assays, enhances platelet aggregation. This means that the risk of stroke and cardiac events by blocking blood vessels is increased. I take aspirin daily: this reduces the ability of blood to clot. So what happens with the concomittant usage of erythritol and aspirin? I've only read the abstract of that paper, so I don't know what were the levels of erythritol in the blood of the people being tested.

Looking through the Molecule of the Month website, I found a reference to erythritol, right at the very end.

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This day in history:

Blog #	Date	Title	Tags
34	25/04/2006	Creaking bones and aching muscles (Slouching towards Jerusalem, part 2)	Israel, Bar mitzva, Jerusalem
168	25/04/2009	Positive changes	ERP, Psychology
473	25/04/2012	Debt of Honour	MBA, Tom Clancy, Negotiation
578	25/04/2013	New TV series	TV series
1311	25/04/2020	VideoPad	Home movies, Covid-19
1388	25/04/2021	Has the culprit been found (hypertension)?	Health, Blood pressure

Erythritol - the story begins

For about a month, I've been buying lemon-line flavoured water from the kibbutz shop; what is special about this water is that it claims to have 0 calories per 100 ml, as opposed to the previous flavoured water that I used to purchase, with 15 calories/100 ml. Eventually I got around to checking what the ingredients of the 'new' flavoured water are and how it can have 0 calories/100 ml. After all, my bachelor's degree is in Food Science and my dissertation was on analytic methods for calculating the amount of xylitol in foods; xylitol is a 'sugar alcohol', sweet but not a sugar like glucose. 45 years ago, xylitol was a new and exciting sugar replacement.

The sweetener used in the flavoured water is erythritol, and like xylitol, it too is a sugar alcohol. Glucose has six carbon atoms in its structure and is thus a monosaccharide; xylitol has five and erythritol has only four. It is non-caloric as the body cannot metabolise erythritol; this in itself doesn't mean too much as often the gut flora can metabolise what we can't. If that happens, then one of the end products is gas. Interestingly, the gut flora also cannot metabolise erythritol, and so all that one ingests is excreted as is.

When I was a child, I was told not to eat sweets as they would cause holes in my teeth. Whilst this is accurate, it's not the scientific story. Bacteria in the mouth, primarily Streptococcus mutans, metabolise sugar that is left on the teeth and create lactic acid that is the factor that creates holes in the dental enamel. These bacteria also cannot metabolise erythritol.

From what I have learned so far, erythritol is the perfect sweetener (better also than any artificial sweetener), so of course I had to order some. I doubt that it is sold as is in Israel, so I had to order from IHerb. I wasn't really on the ball at first, so I only ordered the powder for use in tea. Later on, I looked for further products - toothpaste and chocolate - and ordered these. Today the powder arrived and I shall be examining its effect upon me.

The toothpaste will be interesting: anything that reduces dental plaque will be good, although I doubt that the small amount of toothpaste used each time will contribute much. I found an article in Hebrew about erythritol's dental applications that I printed for my oral hygienist.

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This day in history:

Blog #	Date	Title	Tags
33	23/04/2006	First aid	Obituary, Hospital
353	23/04/2011	The Unthanks	King Crimson, The Unthanks
577	23/04/2013	Red Rabbit	Tom Clancy
1387	23/04/2021	How to deal with shoes that are a bit too large (and are ordered without trying them on)	Shoes