Dear Mark: HDL, Probiotics for Acne, and Artificial Sweeteneners and Weight Gain

Inline_DM_07.03.17 For today’s edition of Dear Mark, I’m answering three questions. First, is HDL all it’s cracked up to be? Is HDL always good? Is it the savior? Or is the story a bit more complicated? Next, what are some good probiotic options for treating acne? Do any exist? And last but not least, what’s the relationship of artificial sweeteners, insulin, appetite, and weight gain?

Let’s go:

Carine Dubois wondered:

I am slightly concerned about the age old acceptance of HDL as the good cholesterol in light of the recent failures of HDL potentiating drugs failure to decrease CVD. Could there be more to the story such as good and bad sub fractions as with LDL …. many more studies have to be done using up dated technology before accepting the AHA recommendations as dogma

Great insight, Carine. I feel very similarly. All the HDL-boosting drugs, like torcetrapib, have failed. And not just failed to protect against cardiovascular disease and death, but actively increased the risk of disease and death. They’ve been real disasters.

However, here’s why I think the coconut oil-induced HDL increase is different than the torcetrapib-induced increase:

HDL is “good” because the actions and behaviors and foods that increase it are “good” and the actions and behaviors and foods that decrease it are “bad.” The former include exercising, eating olive oil and avocados, losing weight, and lowering excess carb intake. The latter include smoking and gaining weight. These things aren’t good or bad because of the HDL effect. They’re good or bad for dozens of reasons. Thus, absent HDL-boosting pharmaceuticals, higher HDL is “good” because you have to do “good” things to raise it.

You’re also right that HDL isn’t just HDL. There are different ways to measure. And even with HDL particle number, there’s more to the story than “higher” or “lower.” For instance, small, dense HDL particles tend to be more protective and possess more antioxidative potential than large, buoyant HDL particles. While a pharma exec might take this to mean we should be pumping out drugs that make HDL particles smaller and denser, a person like Carine would take a more nuanced exploration.

Maybe a preponderance of small, dense HDL particles indicates a large inflammatory load that needs quelling. Maybe a shift toward larger, less dense HDL particles indicates an improvement in inflammatory status. After all, the body actively manufactures HDL particles to reduce oxidative damage.

David asked:

Hi Mark, in this article

How to Support Healthy Skin Bacteria

you mentioned that a lotion containing Enterococcus faecalis SL-5 was
shown to be effective against acne. Any idea where one could buy this
bacteria (or bacteria-containing lotion) on the web? My initial
searching was not encouraging. Thanks for all you do!

Unfortunately, I, too, have been unable to track down a good source of Enterococcus faecalis SL-5. I doubt anyone else has had any real luck. The mixture used in the study was made specifically for that study. They isolated E. faecalis from human feces (the bacteria is a normal resident of the human gut) and added it to a regular lotion. I’ve never seen it replicated or a commercial version released. Too bad. I’m sure something is coming down the pipe.

That’s not all you can do, however.

In 2012, topical application of a 5% Lactobacillus plantarum extract reduced acne lesion size. There are patents for topical L. plantarum extracts, but I haven’t seen any products.

A more recent study found that oral supplementation with a liquid probiotic containing Lactobacillus rhamnosus SP-1 reduced inflammation and adult acne. An Italian pharmaceutical company named Biodue SpA provided the materials. I can’t speak for the sourcing of course, but here’s some for sale on eBay. Also, here’s bulk Lactobacillus rhamnosus SP-1 for sale. I haven’t found any from regular sources (Amazon, etc).

AOBiome is currently running in-house trials to determine if their Mother Dirt probiotic skin spray can fight acne. Anecdotes are promising, if preliminary.

Stephen Schlepmo asked:

It’s known that artificial sweeteners don’t stimulate insulin (right?) but do they somehow stimulate appetite? Hence compromising fat reduction goals?

Let’s look at the various sweeteners.

Does aspartame induce an insulin response? No:

One study found that aspartame had no effect on insulin levels.
Another also found that aspartame had no effect on the insulin response in humans, whether alone or combined with carbohydrates.
Another earlier study (full PDF) examined the effects of a diet soda-sized dose aspartame on prolactin, cortisol, growth hormone, insulin, and blood glucose levels, finding none.
Among forty-eight healthy volunteers found no evidence that aspartame has an effect on insulin levels.

What about sucralose (Splenda)? Nope:

A study where scientists shot Splenda directly into the gut showed that it does not stimulate the insulin response.
Another study found that oral dosing of sucralose did not induce a cephalic insulin response.

As for the others, a review of in vivo studies concluded that “low-energy sweeteners” do not have any effects on insulin or appetite hormones.

Yet, observational studies continue to find links between artificial sweeteners and obesity. Maybe it’s reverse causality—being overweight causes diet soda consumption. Overweight people are more likely to drink diet soda because they think it’ll help them lose weight, and intent to lose weight does predict artificial sweetener usage. But this 2016 study attempted to minimize the effect of reverse causality, and they still found strong links between artificial sweetener consumption and the risk of abdominal obesity. Those who drank the most diet soda had the biggest bellies.

And we know how bad Splenda can be for the gut biome, which plays its own role in the risk of obesity.

It’s hard to say, but I err on the side of “avoid”—even if the reason has nothing to do with insulin or appetite.

What’s easier to say is that the non-caloric-yet-natural sweeteners, like stevia or monk fruit, are better choices. Take stevia, for example. In one study where it was compared to sugar or Splenda, stevia actually reduced postprandial insulin levels, and those who ate the stevia didn’t increase calories to make up for the missing sugar calories.

All that said, there’s one surefire way non-caloric sweeteners—even natural ones—can compromise fat loss and and stimulate appetite: by compelling you to eat treats you’d otherwise shun.

Say you eat a good Primal dinner. You’re done. You’re quite full. You’d never consider tucking into a sugary bar of milk chocolate—unless it was sweetened by stevia or monk fruit or one of the sugar alcohols.

Before you know it, you’ve eaten an entire sugar-free chocolate bar that you would have ignored if it had sugar. You’ve just tacked on a few hundred calories to your total, all thanks to the stevia.

That’s it for today, folks. Take care and be well.

Let me know if you have anything to add or ask down below.