Xylitol vs Erythritol – Which is Healthier?
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Our Verdict
When comparing xylitol to erythritol, we picked the xylitol.
Why?
They’re both sugar alcohols, which so far as the body is concerned are neither sugars nor alcohols in the way those words are commonly understood; it’s just a chemical term. The sugars aren’t processed as such by the body and are passed as dietary fiber, and nor is there any intoxicating effect as one might expect from an alcohol.
In terms of macronutrients, while technically they both have carbs, for all functional purposes they don’t and just have a little fiber.
In terms of micronutrients, they don’t have any.
The one thing that sets them apart is their respective safety profiles. Xylitol is prothrombotic and associated with major adverse cardiac events (CI=95, adjusted hazard ratio=1.57, range=1.12-2.21), while erythritol is also prothrombotic and more strongly associated with major adverse cardiac events (CI=95, adjusted hazard ratio=2.21, range=1.20-4.07).
So, xylitol is bad and erythritol is worse, which means the relatively “healthier” is xylitol. We don’t recommend either, though.
Studies for both:
- Xylitol is prothrombotic and associated with cardiovascular risk
- The artificial sweetener erythritol and cardiovascular event risk
Links for the specific products we compared, in case our assessment hasn’t put you off them:
Want to learn more?
You might like to read:
- The WHO’s New View On Sugar-Free Sweeteners ← the WHO’s advice is “don’t”
- Stevia vs Acesulfame Potassium – Which is Healthier? ← stevia’s pretty much the healthiest artificial sweetener around, though, if you’re going to use one
- The Fascinating Truth About Aspartame, Cancer, & Neurotoxicity ← under the cold light of science, aspartame isn’t actually as bad as it was painted a few decades ago, mostly by a viral hoax letter. Per the WHO’s advice, it’s still good to avoid sweeteners in general, however.
Take care!
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Psychology Sunday Rewind: Healing Family Rifts
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Estrangement, And How To Heal It
The following article was first published a little under six months ago, and it proved to be our most popular “Psychology Sunday” article of the year.
We republish it today, in case it might also be of value to readers who have joined us since
Having written before about how deleterious to the health loneliness and isolation can be, and what things can be done about it, we had a request to write about…
❝Reconciliation of relationships in particular estrangement mother adult daughter❞
And, this is not only an interesting topic, but a very specific one that affects more people than is commonly realized!
In fact, a recent 800-person study found that more than 43% of people experienced family estrangement of one sort or another, and a more specific study of more than 2,000 mother-child pairs found that more than 11% of mothers were estranged from at least one adult child.
So, if you think of the ten or so houses nearest to you, probably at least one of them contains a parent estranged from at least one adult child. Maybe it’s yours. Either way, we hope this article will give you some pause for thought.
Which way around?
It makes a difference to the usefulness of this article whether any given reader experiencing estrangement is the parent or the adult child. We’re going to assume the reader is the parent. It also makes a difference who did the estranging. That’s usually the adult child.
So, we’re broadly going to write with that expectation.
Why does it happen?
When our kids are small, we as parents hold all the cards. It may not always feel that way, but we do. We control our kids’ environment, we influence their learning, we buy the food they eat and the clothes they wear. If they want to go somewhere, we probably have to take them. We can even set and enforce rules on a whim.
As they grow, so too does their independence, and it can be difficult for us as parents to relinquish control, but we’re going to have to at some point. Assuming we are good parents, we just hope we’ve prepared them well enough for the world.
Once they’ve flown the nest and are living their own adult lives, there’s an element of inversion. They used to be dependent on us; now, not only do they not need us (this is a feature not a bug! If we have been good parents, they will be strong without us, and in all likelihood one day, they’re going to have to be), but also…
We’re more likely to need them, now. Not just in the “oh if we have kids they can look after us when we’re old” sense, but in that their social lives are growing as ours are often shrinking, their family growing, while ours, well, it’s the same family but they’re the gatekeepers to that now.
If we have a good relationship, this goes fine. However, it might only take one big argument, one big transgression, or one “final straw”, when the adult child decides the parent is more trouble than they’re worth.
And, obviously, that’s going to hurt. But it’s pretty much how it pans out, according to studies:
Here be science: Tensions in the Parent and Adult Child Relationship: Links to Solidarity and Ambivalence
How to fix it, step one
First, figure out what went wrong.
Resist any urge to protect your own feelings with a defensive knee-jerk “I don’t know; I was a good, loving parent”. That’s a very natural and reasonable urge and you’re quite possibly correct, but it won’t help you here.
Something pushed them away. And, it will almost certainly have been a push factor from you, not a pull factor from whoever is in their life now. It’s easy to put the blame externally, but that won’t fix anything.
And, be honest with yourself; this isn’t a job interview where we have to present a strength dressed up as a “greatest weakness” for show.
You can start there, though! If you think “I was too loving”, then ok, how did you show that love? Could it have felt stifling to them? Controlling? Were you critical of their decisions?
It doesn’t matter who was right or wrong, or even whether or not their response was reasonable. It matters that you know what pushed them away.
How to fix it, step two
Take responsibility, and apologize. We’re going to assume that your estrangement is such that you can, at least, still get a letter to them, for example. Resist the urge to argue your case.
Here’s a very good format for an apology; please consider using this template:
The 10-step (!) apology that’s so good, you’ll want to make a note of it
You may have to do some soul-searching to find how you will avoid making the same mistake in the future, that you did in the past.
If you feel it’s something you “can’t change”, then you must decide what is more important to you. Only you can make that choice, but you cannot expect them to meet you halfway. They already made their choice. In the category of negotiation, they hold all the cards now.
How to fix it, step three
Now, just wait.
Maybe they will reply, forgiving you. If they do, celebrate!
Just be aware that once you reconnect is not the time to now get around to arguing your case from before. It will never be the time to get around to arguing your case from before. Let it go.
Nor should you try to exact any sort of apology from them for estranging you, or they will at best feel resentful, wonder if they made a mistake in reconnecting, and withdraw.
Instead, just enjoy what you have. Many people don’t get that.
If they reply with anger, maybe it will be a chance to reopen a dialogue. If so, family therapy could be an approach useful for all concerned, if they are willing. Chances are, you all have things that you’d all benefit from talking about in a calm, professional, moderated, neutral environment.
You might also benefit from a book we reviewed previously, “Parent Effectiveness Training”. This may seem like “shutting the stable door after the horse has bolted”, but in fact it’s a very good guide to relationship dynamics in general, and extensively covers relations between parents and adult children.
If they don’t reply, then, you did your part. Take solace in knowing that much.
Some final thoughts:
At the end of the day, as parents, our kids living well is (hopefully) testament to that we prepared them well for life, and sometimes, being a parent is a thankless task.
But, we (hopefully) didn’t become parents for the plaudits, after all.
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Boost Your Digestive Enzymes
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We’ll Try To Make This Easy To Digest
Do you have a digestion-related problem?
If so, you’re far from alone; around 40% of Americans have digestive problems serious enough to disrupt everyday life:
New survey finds forty percent of Americans’ daily lives are disrupted by digestive troubles
…which puts Americans just a little over the global average of 35%:
Mostly likely on account of the Standard American Diet, or “SAD” as it often gets abbreviated in scientific literature.
There’s plenty we can do to improve gut health, for example:
- Making Friends With Your Gut (You Can Thank Us Later)
- Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
- How Much Difference Do Probiotic Supplements Make?
Today we’re going to be examining digestive enzyme supplements!
What are digestive enzymes?
Digestive enzymes are enzymes that break down food into stuff we can use. Important amongst them are:
- Protease: breaks down proteins (into amino acids)
- Amylase: breaks down starches (into sugars)
- Lipase: breaks down fats (into fatty acids)
All three are available as popular supplements to aid digestion. How does the science stack up for them?
Protease
For this, we only found animal studies like this one, but the results have been promising:
Amylase
Again, the studies for this alone (not combined with other enzymes) have been solely from animal agriculture; here’s an example:
The Effect of Exogenous Amylase Supplementation on the Nutritional Value of Peas
Lipase
Unlike for protease and amylase, now we have human studies as well, and here’s what they had to say:
❝Lipase supplementation significantly reduced stomach fullness without change of EGG.
Furthermore, lipase supplementation may be helpful in control of FD symptom such as postprandial symptoms❞
~ Dr. Seon-Young Park & Dr. Jong-Sun Rew
Read more: Is Lipase Supplementation before a High Fat Meal Helpful to Patients with Functional Dyspepsia?
(short answer: yes, it is)
More studies found the same, such as:
Lipase Supplementation before a High-Fat Meal Reduces Perceptions of Fullness in Healthy Subjects
All together now!
When we look at studies for combination supplementation of digestive enzymes, more has been done, and/but it’s (as you might expect) less specific.
The following paper gives a good rundown:
Pancrelipase Therapy: A Combination Of Protease, Amylase, & Lipase
Is it safe?
For most people it is quite safe, but if taking high doses for a long time it can cause problems, and also there may be complications if you have diabetes, are otherwise immunocompromised, or have some other conditions (listed towards the end of the above-linked paper, along with further information that we can’t fit in here).
As ever, check with your doctor/pharmacist if you’re not completely sure!
Want some?
We don’t sell them, but for your convenience, here’s an example product on Amazon that contains all three
Enjoy!
We’ll Try To Make This Easy To Digest
Do you have a digestion-related problem?
If so, you’re far from alone; around 40% of Americans have digestive problems serious enough to disrupt everyday life:
New survey finds forty percent of Americans’ daily lives are disrupted by digestive troubles
…which puts Americans just a little over the global average of 35%:
Mostly likely on account of the Standard American Diet, or “SAD” as it often gets abbreviated in scientific literature.
There’s plenty we can do to improve gut health, for example:
- Making Friends With Your Gut (You Can Thank Us Later)
- Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
- How Much Difference Do Probiotic Supplements Make?
Today we’re going to be examining digestive enzyme supplements!
What are digestive enzymes?
Digestive enzymes are enzymes that break down food into stuff we can use. Important amongst them are:
- Protease: breaks down proteins (into amino acids)
- Amylase: breaks down starches (into sugars)
- Lipase: breaks down fats (into fatty acids)
All three are available as popular supplements to aid digestion. How does the science stack up for them?
Protease
For this, we only found animal studies like this one, but the results have been promising:
Amylase
Again, the studies for this alone (not combined with other enzymes) have been solely from animal agriculture; here’s an example:
The Effect of Exogenous Amylase Supplementation on the Nutritional Value of Peas
Lipase
Unlike for protease and amylase, now we have human studies as well, and here’s what they had to say:
❝Lipase supplementation significantly reduced stomach fullness without change of EGG.
Furthermore, lipase supplementation may be helpful in control of FD symptom such as postprandial symptoms❞
~ Dr. Seon-Young Park & Dr. Jong-Sun Rew
Read more: Is Lipase Supplementation before a High Fat Meal Helpful to Patients with Functional Dyspepsia?
(short answer: yes, it is)
More studies found the same, such as:
Lipase Supplementation before a High-Fat Meal Reduces Perceptions of Fullness in Healthy Subjects
All together now!
When we look at studies for combination supplementation of digestive enzymes, more has been done, and/but it’s (as you might expect) less specific.
The following paper gives a good rundown:
Pancrelipase Therapy: A Combination Of Protease, Amylase, & Lipase
Is it safe?
For most people it is quite safe, but if taking high doses for a long time it can cause problems, and also there may be complications if you have diabetes, are otherwise immunocompromised, or have some other conditions (listed towards the end of the above-linked paper, along with further information that we can’t fit in here).
As ever, check with your doctor/pharmacist if you’re not completely sure!
Want some?
We don’t sell them, but for your convenience, here’s an example product on Amazon that contains all three
Enjoy!
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Bromelain vs Inflammation & Much More
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Let’s Get Fruity
Bromelain is an enzyme* found in pineapple (and only in pineapple), that has many very healthful properties, some of them unique to bromelain.
*actually a combination of enzymes, but most often referred to collectively in the singular. But when you do see it referred to as “they”, that’s what that means.
What does it do?
It does a lot of things, for starters:
❝Various in vivo and in vitro studies have shown that they are anti-edematous, anti-inflammatory, anti-cancerous, anti-thrombotic, fibrinolytic, and facilitate the death of apoptotic cells. The pharmacological properties of bromelain are, in part, related to its arachidonate cascade modulation, inhibition of platelet aggregation, such as interference with malignant cell growth; anti-inflammatory action; fibrinolytic activity; skin debridement properties, and reduction of the severe effects of SARS-Cov-2❞
Some quick notes:
- “facilitate the death of apoptotic cells” may sound alarming, but it’s actually good; those cells need to be killed quickly; see for example: Fisetin: The Anti-Aging Assassin
- If you’re wondering what arachidonate cascade modulation means, that’s the modulation of the cascade reaction of arachidonic acid, which plays a part in providing energy for body functions, and has a role in cell structure formation, and is the precursor of assorted inflammatory mediators and cell-signalling chemicals.
- Its skin debridement properties (getting rid of dead skin) are most clearly seen when using bromelain topically (one can literally just make a pineapple poultice), but do occur from ingestion also (because of what it can do from the inside).
- As for being anti-thrombotic and fibrinolytic, let’s touch on that before we get to the main item, its anti-inflammatory properties.
If you want to read more of the above before moving on, though, here’s the full text:
Anti-thrombotic and fibrinolytic
While it does have anti-thrombotic effects, largely by its fibrinolytic action (i.e., it dissolves the fibrin mesh holding clots together), it can have a paradoxically beneficial effect on wound healing, too:
For more specifically on its wound-healing benefits:
In Vitro Effect of Bromelain on the Regenerative Properties of Mesenchymal Stem Cells
Anti-inflammatory
Bromelain is perhaps most well-known for its anti-inflammatory powers, which are so diverse that it can be a challenge to pin them all down, as it has many mechanisms of action, and there’s a large heterogeneity of studies because it’s often studied in the context of specific diseases. But, for example:
❝Bromelain reduced IL-1β, IL-6 and TNF-α secretion when immune cells were already stimulated in an overproduction condition by proinflammatory cytokines, generating a modulation in the inflammatory response through prostaglandins reduction and activation of cascade reactions that trigger neutrophils and macrophages, in addition to accelerating the healing process❞
~ Dr. Taline Alves Nobre et al.
Read in full:
Bromelain as a natural anti-inflammatory drug: a systematic review
Or if you want a more specific example, here’s how it stacks up against arthritis:
❝The results demonstrated the chondroprotective effects of bromelain on cartilage degradation and the downregulation of inflammatory cytokine (tumor necrosis factor (TNF)-α, IL-1β, IL-6, IL-8) expression in TNF-α–induced synovial fibroblasts by suppressing NF-κB and MAPK signaling❞
~ Dr. Perephan Pothacharoen et al.
Read in full:
More?
Yes more! You’ll remember from the first paper we quoted today, that it has a long laundry list of benefits. However, there’s only so much we can cover in one edition, so that’s it for today
Is it safe?
It is generally recognized as safe. However, its blood-thinning effect means it should be avoided if you’re already on blood-thinners, have some sort of bleeding disorder, or are about to have a surgery.
Additionally, if you have an allergy, this one may not be for you.
Aside from that, anything can have drug interactions, so do check with your doctor/pharmacist to be sure.
Want to try some?
You can just eat pineapples, but if you don’t enjoy that and/or wouldn’t want it every day, bromelain is available in supplement form too.
We don’t sell it, but here for your convenience is an example product on Amazon
Enjoy!
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Prolonged Grief: A New Mental Disorder?
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
The issue is not whether certain mental conditions are real—they are. It is how we conceptualize them and what we think treating them requires.
The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) features a new diagnosis: prolonged grief disorder—used for those who, a year after a loss, still remain incapacitated by it. This addition follows more than a decade of debate. Supporters argued that the addition enables clinicians to provide much-needed help to those afflicted by what one might simply consider a too much of grief, whereas opponents insisted that one mustn’t unduly pathologize grief and reject an increasingly medicalized approach to a condition that they considered part of a normal process of dealing with loss—a process which in some simply takes longer than in others.
By including a condition in a professional classification system, we collectively recognize it as real. Recognizing hitherto unnamed conditions can help remove certain kinds of disadvantages. Miranda Fricker emphasizes this in her discussion of what she dubs hermeneutic injustice: a specific sort of epistemic injustice that affects persons in their capacity as knowers1. Creating terms like ‘post-natal depression’ and ‘sexual harassment’, Fricker argues, filled lacunae in the collectively available hermeneutic resources that existed where names for distinctive kinds of social experience should have been. The absence of such resources, Fricker holds, put those who suffered from such experiences at an epistemic disadvantage: they lacked the words to talk about them, understand them, and articulate how they were wronged. Simultaneously, such absences prevented wrong-doers from properly understanding and facing the harm they were inflicting—e.g. those who would ridicule or scold mothers of newborns for not being happier or those who would either actively engage in sexual harassment or (knowingly or not) support the societal structures that helped make it seem as if it was something women just had to put up with.
For Fricker, the hermeneutical disadvantage faced by those who suffer from an as-of-yet ill-understood and largely undiagnosed medical condition is not an epistemic injustice. Those so disadvantaged are not excluded from full participation in hermeneutic practices, or at least not through mechanisms of social coercion that arise due to some structural identity prejudice. They are not, in other words, hermeneutically marginalized, which for Fricker, is an essential characteristic of epistemic injustice. Instead, their situation is simply one of “circumstantial epistemic bad luck”2. Still, Fricker, too, can agree that providing labels for ill-understood conditions is valuable. Naming a condition helps raise awareness of it, makes it discursively available and, thus, a possible object of knowledge and understanding. This, in turn, can enable those afflicted by it to understand their experience and give those who care about them another way of nudging them into seeking help.
Surely, if adding prolonged grief disorder to the DSM-5 were merely a matter of recognizing the condition and of facilitating assistance, nobody should have any qualms with it. However, the addition also turns intense grief into a mental disorder—something for whose treatment insurance companies can be billed. With this, significant forces of interest enter the scene. The DSM-5, recall, is mainly consulted by psychiatrists. In contrast to talk-therapists like psychotherapists or psychoanalysts, psychiatrists constitute a highly medicalized profession, in which symptoms—clustered together as syndromes or disorders—are frequently taken to require drugs to treat them. Adding prolonged grief disorder thus heralds the advent of research into various drug-based grief therapies. Ellen Barry of the New York Times confirms this: “naltrexone, a drug used to help treat addiction,” she reports, “is currently in clinical trials as a form of grief therapy”, and we are likely to see a “competition for approval of medicines by the Food and Drug Administration.”3
Adding diagnoses to the DSM-5 creates financial incentives for players in the pharmaceutical industry to develop drugs advertised as providing relief to those so diagnosed. Surely, for various conditions, providing drug-induced relief from severe symptoms is useful, even necessary to enable patients to return to normal levels of functioning. But while drugs may help suppress feelings associated with intense grief, they cannot remove the grief. If all mental illnesses were brain diseases, they might be removed by adhering to some drug regimen or other. Note, however, that ‘mental illness’ is a metaphor that carries the implicit suggestion that just like physical illnesses, mental afflictions, too, are curable by providing the right kind of physical treatment. Unsurprisingly, this metaphor is embraced by those who stand to massively benefit from what profits they may reap from selling a plethora of drugs to those diagnosed with any of what seems like an ever-increasing number of mental disorders. But metaphors have limits. Lou Marinoff, a proponent of philosophical counselling, puts the point aptly:
Those who are dysfunctional by reason of physical illness entirely beyond their control—such as manic-depressives—are helped by medication. For handling that kind of problem, make your first stop a psychiatrist’s office. But if your problem is about identity or values or ethics, your worst bet is to let someone reify a mental illness and write a prescription. There is no pill that will make you find yourself, achieve your goals, or do the right thing.
Much more could be said about the differences between psychotherapy, psychiatry, and the newcomer in the field: philosophical counselling. Interested readers may benefit from consulting Marinoff’s work. Written in a provocative, sometimes alarmist style, it is both entertaining and—if taken with a substantial grain of salt—frequently insightful. My own view is this: from Fricker’s work, we can extract reasons to side with the proponents of adding prolonged grief disorder to the DSM-5. Creating hermeneutic resources that allow us to help raise awareness, promote understanding, and facilitate assistance is commendable. If the addition achieves that, we should welcome it. And yet, one may indeed worry that practitioners are too eager to move from the recognition of a mental condition to the implementation of therapeutic interventions that are based on the assumption that such afflictions must be understood on the model of physical disease. The issue is not whether certain mental conditions are real—they are. It is how we conceptualize them and what we think treating them requires.
No doubt, grief manifests physically. It is, however, not primarily a physical condition—let alone a brain disease. Grief is a distinctive mental condition. Apart from bouts of sadness, its symptoms typically include the loss of orientation or a sense of meaning. To overcome grief, we must come to terms with who we are or can be without the loved one’s physical presence in our life. We may need to reinvent ourselves, figure out how to be better again and whence to derive a new purpose. What is at stake is our sense of identity, our self-worth, and, ultimately, our happiness. Thinking that such issues are best addressed by popping pills puts us on a dangerous path, leading perhaps towards the kind of dystopian society Aldous Huxley imagined in his 1932 novel Brave New World. It does little to help us understand, let alone address, the moral and broader philosophical issues that trouble the bereaved and that lie at the root not just of prolonged grief but, arguably, of many so-called mental illnesses.
Footnotes:
1 For this and the following, cf. Fricker 2007, chapter 7.
2 Fricker 2007: 152
3 Barry 2022
References:
Barry, E. (2022). “How Long Should It Take to Grieve? Psychiatry Has Come Up With an Answer.” The New York Times, 03/18/2022, URL = https://www.nytimes.com/2022/03/18/health/prolonged-grief-
disorder.html [last access: 04/05/2022])
Fricker, M. (2007). Epistemic Injustice. Power & the Ethics of knowing. Oxford/New York: Oxford University Press.
Huxley, A. (1932). Brave New World. New York: Harper Brothers.
Marinoff, L. (1999). Plato, not Prozac! New York: HarperCollins Publishers.Professor Raja Rosenhagen is currently serving as Assistant Professor of Philosophy, Head of Department, and Associate Dean of Academic Affairs at Ashoka University. He earned his PhD in Philosophy from the University of Pittsburgh and has a broad range of philosophical interests (see here). He wrote this article a) because he was invited to do so and b) because he is currently nurturing a growing interest in philosophical counselling.
This article is republished from OpenAxis under a Creative Commons license. Read the original article.
Don’t Forget…
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The Science of Nutrition – by Rhiannon Lambert
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While there are a lot of conflicting dietary approaches out there, the science itself is actually fairly cohesive in most regards. This book does a lot of what we do here at 10almonds, and presents the science in a clear fashion without having any particular agenda to push.
The author is a nutritionist (BSc, MSc, RNutr) and therefore provides an up-to-date evidence-based approach for eating.
As a result, the only part of this book that brings it down in this reviewer’s opinion is the section on Intermittent Fasting. Being not strictly about nutrition, she has less expertise on that topic, and it shows.
The information is largely presented in double-page spreads each answering a particular question. Because of this, and the fact there are colorful graphic representations of information too, we do recommend the print version over Kindle*.
Bottom line: if you like the notion of real science being presented in a clear and simple fashion (we like to think our subscribers do!), then you’ll surely enjoy this book.
Click here to check out the Science of Nutrition, and get a clear overview!
*Writer’s note: I realize I’ve two days in a row recommended this (yesterday because there are checkboxes to check, worksheets to complete, etc), but it’s not a new trend; just how it happened to be with these two books. I love my Kindle dearly, but sometimes print has the edge for one reason or another!
Don’t Forget…
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California Is Investing $500M in Therapy Apps for Youth. Advocates Fear It Won’t Pay Off.
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With little pomp, California launched two apps at the start of the year offering free behavioral health services to youths to help them cope with everything from living with anxiety to body acceptance.
Through their phones, young people and some caregivers can meet BrightLife Kids and Soluna coaches, some who specialize in peer support or substance use disorders, for roughly 30-minute virtual counseling sessions that are best suited to those with more mild needs, typically those without a clinical diagnosis. The apps also feature self-directed activities, such as white noise sessions, guided breathing, and videos of ocean waves to help users relax.
“We believe they’re going to have not just great impact, but wide impact across California, especially in places where maybe it’s not so easy to find an in-person behavioral health visit or the kind of coaching and supports that parents and young people need,” said Gov. Gavin Newsom’s health secretary, Mark Ghaly, during the Jan. 16 announcement.
The apps represent one of the Democratic governor’s major forays into health technology and come with four-year contracts valued at $498 million. California is believed to be the first state to offer a mental health app with free coaching to all young residents, according to the Department of Health Care Services, which operates the program.
However, the rollout has been slow. Only about 15,000 of the state’s 12.6 million children and young adults have signed up for the apps, school counselors say they’ve never heard of them, and one of the companies isn’t making its app available on Android phones until summer.
Advocates for youth question the wisdom of investing taxpayer dollars in two private companies. Social workers are concerned the companies’ coaches won’t properly identify youths who need referrals for clinical care. And the spending is drawing lawmaker scrutiny amid a state deficit pegged at as much as $73 billion.
An App for That
Newsom’s administration says the apps fill a need for young Californians and their families to access professional telehealth for free, in multiple languages, and outside of standard 9-to-5 hours. It’s part of Newsom’s sweeping $4.7 billion master plan for kids’ mental health, which was introduced in 2022 to increase access to mental health and substance use support services. In addition to launching virtual tools such as the teletherapy apps, the initiative is working to expand workforce capacity, especially in underserved areas.
“The reality is that we are rarely 6 feet away from our devices,” said Sohil Sud, director of Newsom’s Children and Youth Behavioral Health Initiative. “The question is how we can leverage technology as a resource for all California youth and families, not in place of, but in addition to, other behavioral health services that are being developed and expanded.”
The virtual platforms come amid rising depression and suicide rates among youth and a shortage of mental health providers. Nearly half of California youths from the ages of 12 to 17 report having recently struggled with mental health issues, with nearly a third experiencing serious psychological distress, according to a 2021 study by the UCLA Center for Health Policy Research. These rates are even higher for multiracial youths and those from low-income families.
But those supporting youth mental health at the local level question whether the apps will move the needle on climbing depression and suicide rates.
“It’s fair to applaud the state of California for aggressively seeking new tools,” said Alex Briscoe of California Children’s Trust, a statewide initiative that, along with more than 100 local partners, works to improve the social and emotional health of children. “We just don’t see it as fundamental. And we don’t believe the youth mental health crisis will be solved by technology projects built by a professional class who don’t share the lived experience of marginalized communities.”
The apps, BrightLife Kids and Soluna, are operated by two companies: Brightline, a 5-year-old venture capital-backed startup; and Kooth, a London-based publicly traded company that has experience in the U.K. and has also signed on some schools in Kentucky and Pennsylvania and a health plan in Illinois. In the first five months of Kooth’s Pennsylvania pilot, 6% of students who had access to the app signed up.
Brightline and Kooth represent a growing number of health tech firms seeking to profit in this space. They beat out dozens of other bidders including international consulting companies and other youth telehealth platforms that had already snapped up contracts in California.
Although the service is intended to be free with no insurance requirement, Brightline’s app, BrightLife Kids, is folded into and only accessible through the company’s main app, which asks for insurance information and directs users to paid licensed counseling options alongside the free coaching. After KFF Health News questioned why the free coaching was advertised below paid options, Brightline reordered the page so that, even if a child has high-acuity needs, free coaching shows up first.
The apps take an expansive view of behavioral health, making the tools available to all California youth under age 26 as well as caregivers of babies, toddlers, and children 12 and under. When KFF Health News asked to speak with an app user, Brightline connected a reporter with a mother whose 3-year-old daughter was learning to sleep on her own.
‘It’s Like Crickets’
Despite being months into the launch and having millions in marketing funds, the companies don’t have a definitive rollout timeline. Brightline said it hopes to have deployed teams across the state to present the tools in person by midyear. Kooth said developing a strategy to hit every school would be “the main focus for this calendar year.”
“It’s a big state — 58 counties,” Bob McCullough of Kooth said. “It’ll take us a while to get to all of them.”
So far BrightLife Kids is available only on Apple phones. Brightline said it’s aiming to launch the Android version over the summer.
“Nobody’s really done anything like this at this magnitude, I think, in the U.S. before,” said Naomi Allen, a co-founder and the CEO of Brightline. “We’re very much in the early innings. We’re already learning a lot.”
The contracts, obtained by KFF Health News through a records request, show the companies operating the two apps could earn as much as $498 million through the contract term, which ends in June 2027, months after Newsom is set to leave office. And the state is spending hundreds of millions more on Newsom’s virtual behavioral health strategy. The state said it aims to make the apps available long-term, depending on usage.
The state said 15,000 people signed up in the first three months. When KFF Health News asked how many of those users actively engaged with the app, it declined to say, noting that data would be released this summer.
KFF Health News reached out to nearly a dozen California mental health professionals and youths. None of them were aware of the apps.
“I’m not hearing anything,” said Loretta Whitson, executive director of the California Association of School Counselors. “It’s like crickets.”
Whitson said she doesn’t think the apps are on “anyone’s” radar in schools, and she doesn’t know of any schools that are actively advertising them. Brightline will be presenting its tool to the counselor association in May, but Whitson said the company didn’t reach out to plan the meeting; she did.
Concern Over Referrals
Whitson isn’t comfortable promoting the apps just yet. Although both companies said they have a clinical team on staff to assist, Whitson said she’s concerned that the coaches, who aren’t all licensed therapists, won’t have the training to detect when users need more help and refer them to clinical care.
This sentiment was echoed by other school-based social workers, who also noted the apps’ duplicative nature — in some counties, like Los Angeles, youths can access free virtual counseling sessions through Hazel Health, a for-profit company. Nonprofits, too, have entered this space. For example, Teen Line, a peer-to-peer hotline operated by Southern California-based Didi Hirsch Mental Health Services, is free nationwide.
While the state is also funneling money to the schools as part of Newsom’s master plan, students and school-based mental health professionals voiced confusion at the large app investment when, in many school districts, few in-person counseling roles exist, and in some cases are dwindling.
Kelly Merchant, a student at College of the Desert in Palm Desert, noted that it can be hard to access in-person therapy at her school. She believes the community college, which has about 15,000 students, has only one full-time counselor and one part-time bilingual counselor. She and several students interviewed by KFF Health News said they appreciated having engaging content on their phone and the ability to speak to a coach, but all said they’d prefer in-person therapy.
“There are a lot of people who are seeking therapy, and people close to me that I know. But their insurances are taking forever, and they’re on the waitlist,” Merchant said. “And, like, you’re seeing all these people struggle.”
Fiscal conservatives question whether the money could be spent more effectively, like to bolster county efforts and existing youth behavioral health programs.
Republican state Sen. Roger Niello, vice chair of the Senate Budget and Fiscal Review Committee, noted that California is forecasted to face deficits for the next three years, and taxpayer watchdogs worry the apps might cost even more in the long run.
“What starts as a small financial commitment can become uncontrollable expenses down the road,” said Susan Shelley of the Howard Jarvis Taxpayers Association.
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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