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

Inline_DM_07.03.17For 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:

What about sucralose (Splenda)? Nope:

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.


About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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17 thoughts on “Dear Mark: HDL, Probiotics for Acne, and Artificial Sweeteneners and Weight Gain”

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  1. Great questions! Totally agree with the sweetener thing. Lately I’ve stopped putting stevia in my blended coffee in the am. I just felt like starting my day with something sweet led to sweets cravings later. And coming from someone who suffered from acne for decades, I know that adding probiotic foods (sauerkraut and Kombucha mostly) definitely helped me. But the biggest thing was just cutting out all the inflammatory carbs.

  2. Re: sweeteners – I think it’s important to remember that while these sweeteners may not spike your insulin, they continue to condition your brain to expect over-sweetened foods and may diminish your ability to taste natural flavors as sweet (like carrots). Plus there are the other psychological ‘reward’ type of triggers that say “Oh, I was good eating the sugar free version, so I can be bad now in this other way”

    1. I agree. In the past I’ve had the tendency to go overboard with the paleo/primal treats- I had a hard time stopping when I started. I gave up sugar and all sweeteners (even Stevia) six months ago and my palate has completely changed. I can’t believe how sweet vegetables are now.

      I never thought it would be possible, but I managed to lose my formerly controlling sweet tooth. It feels like freedom!

      1. Well done! Oh, that has to be a pet peeve of mine “Oh, that’s great for you, but I have a sweet tooth”. We should try to get rid of this ‘sweet tooth’ idea which seems to accept overindulgence in sugar and make it seem like people are helpless to their flavor preferences

  3. I have a somewhat gross but I believe reasonable question regarding probiotics and how to increase their numbers where ever you want them. Specifically, when it comes to increasing the intestinal flora of the colon, we are told that most of the bacteria we swallow never make it past the small intestine because they get digested. With that in mind, and thinking about the success of fecal transplants for changing a sick person’s gut bacteria, why wouldn’t a probiotic enema be a reasonable method of putting the bacteria exactly where you want them to be?

  4. Regarding adult acne, which I’ve had occasional problems with for years… I read an interesting article that completely flies in the face of conventional wisdom. Everything that’s preached by the dermatologists centers around avoiding oily products at all costs and, instead, using harsh chemicals on the skin.

    Basically, this article (link below) says to stop washing one’s face with any kind of product and simply rinse with plain water, steaming the skin gently for a few seconds with a warm wet washcloth, followed by a light application of (gasp!) sesame oil.

    With some trepidation, I decided to try this routine. I’ve only being doing it for a few days, but I noticed right away that a persistent scaly rash between my eyebrows has disappeared. I’ve also noticed that the small acne bumps on my forehead are gone. Also, using sesame oil (which is readily absorbed and contains many healing properties) to combat naturally oily skin works much better than using products that dry the skin, causing the body to produce more oil.

    This might not work for everyone, but so far I’ve been pleased with this simple, inexpensive, non-toxic regimen. I would not recommend using just any oil for treatment of acne (such as coconut oil, for example) since most oils are too heavy and can make the problem worse.

    1. Oil Cleansing Method is wonderful! I like castor oil for dissolving impurities. Olive oil is very easy to wash off. And actually, coconut oil is fantastically soothing and cleansing for the skin. As long as you rinse long enough to get it all off, any food grade oil can cleanse your skin.

      After cleansing, try moisturizing with jojoba or argan oil, or a 50/50 mix of the two. Just 2-3 drops of all spread over damp skin is all you need.

    2. I only use soap on my underarms, and use aqueous cream (non-SLS) everywhere else. For a face wash I simply rub a little cream between my hands, dissolve it in the hot water, then rub my face with a flannel.

      I moisturise with Nivea sensitive shave balm (even when not shaving). It contains witch hazel and is fantastic.

  5. Hi, Mark. I love the questions that come up on your blog. I was recently diagnosed with Factor V Leiden after my second DVT. I’m a 50 year old male, am in reasonably good shape but I do travel a lot for my job and it is a pretty high-stress environment. I’m taking a blood thinner (Xarelto) and am being told that’s for life. I’m wondering if you have food or exercise recommendations to help mitigate my risk for future blood clots. Thanks!

  6. “I’m sure something is coming down the pipe” in an article about fecal bacteria!

    Deliberate or did it just slip out?

  7. RE: Acne and probiotics –

    I have found that probiotics were able to very effectively treat my acne, to the point where I no longer get any as long as I don’t eat my two triggers, which are chocolate and wheat (and even then, it’s much milder). I have used many brands (and I’ve tried many other treatments), and the two most effective treatments for my acne (which was severe in scope but not inflammation) were accutane (isotretinoin) and Elixa probiotics (half dose every other day). I was quite surprised by the efficacy of the probiotics; they also have other benefits so they’re very preferable to accutane. I don’t really know what makes Elixa special. Could be the dose, could be the capsule, could be the strains.

    RE: HDL

    It makes sense to me that CETP inhibitors would not improve CVD. All CETP inhibitors do is shift the cholesterol load from LDL to HDL, which forces your body to make more protein/particles to deal with what looks like more cholesterol. It’s not changing the set point of HDL production relative to the amount of cholesterol your HDL particles have to deal with – if you were deficient in HDL particles for metabolic or inflammatory reasons, you would still be relatively deficient post CETP therapy, because even though you have more HDL particles, they also have more cholesterol to carry and thus won’t be able to effectively transport cholesterol back from peripheral tissues. Indeed CETP therapies are the definition of superficial solutions, taking the HDL/LDL lipid hypothesis at face value as assuming causation without really questioning why these correlations exist.

  8. As a healthy dessert business owner, I am sometimes concerned with the mental ramifications of consuming sweetened foods. The phenomenon mentioned above isn’t exactly the worry though. The issue I hear more about is the desensitization of taste buds and craving sweet things merely due to habitually consuming products sweetened with natural, calorie-free plants like stevia, monk fruit…
    I think it’s just a choice consumers have to make.
    If anyone is in Austin and you chose to consume sweeter products, check out my site for Earthchurn Ice Cream 🙂
    IG: Earthchurn
    Fbook: Earthchurn Ice Cream

  9. For David:

    if you have a lactating friend, sister, wife, etc, maybe they might be able to give you some breastmilk. This stuff is crazy. Antibiotic, probiotic, and prebiotic all in the same substance.

    I actually started adding breastmilk to some of my relaxing baths and it made my skin feel so soft. I also add it to my kid’s as he has some eczema. It seems to help him too.

  10. Firm believer that consuming a solid primal dinner doesn’t keep me curiously consuming stevia or splenda desserts

  11. All I have to add is anecdotal* evidence: I’ve tried “getting serious” about losing weight several times over the past decade, but pretty much the only success I’ve had has been in the past few months.

    My diet & exercise levels have stayed about the same – the only big change I made was to avoid artificially-sweetened drinks. I was doing a fair amount of diet soda, and a LOT of Diet Snapple (free at work :-)) – now it’s just water, coffee, tea, and those just-barely-flavored seltzers.

    Obviously I could add a little more rigor to this investigation by reintroducing “diet” drinks and seeing if the weight comes back – but I think I won’t do that 🙂