Ahhh..sugar, how sweet it is. Sugar is the most over-consumed carbohydrate in the world. We can’t live without it, because it has benefits like fueling our body and especially our brain but too much of it can cause multiple heath problems. So how does it all work? We process carbohydrates from the food we eat, such as fruits, vege’s. fiber and dairy products, and turn much of it into glucose. The problem occurs when we eat more foods with added sugar ( donuts, bread, candy soda, sweet fruit punch, etc), vs foods with naturally occurring sugar. The problems and disadvantages with overconsumption of sugars cannot be understated. Risks include metabolic syndrome, high cholesterol, heart disease, fatty liver disease, weight gain, dental cavities, insulin resistance and type 2 diabetes. Plus sugar can make you feel tired, cause headaches and difficulty concentrating after that quick surge of energy has fallen. So are artificial sweeteners the answer?

Certain sweeteners such as fruit juices, molasses, honey and maple syrup contain natural sugars and have some nutritional benefits. Fruits have fiber, vitamins and antioxidants, while honey and maple syrup have antioxidants and minerals such as iron, zinc, potassium and calcium.

In an effort to reduce the long-term manifestations of sugar, many people have resorted to sugar substitutes. The goal is to lower the risk of adverse health conditions but still taste that sweetness in our foods. It may seem like the best of both worlds but it actually is worse for you.

A prospective cohort study was done to study the associations between artificial sweeteners from all dietary sources such as sugar drinks, table top sweeteners and dietary products overall and also by certain molecules (aspartame, sucralose, acesulfame potassium) of artificial sweeteners and the risk of cardiovascular disease. A cohort study is a longitudinal study that follows over time a group of similar individuals who differ with respect to certain factors under study to see how these factors affect certain outcomes.

This study included over 103,000 mainly French females that were followed for an average of 9 years. A food questionnaire used 24-hour recalls which recorded what everyone ate or drank for multiple 24-hour periods. The study included all food sources of artificial sweeteners. The endpoints included all cardiovascular disease including heart disease, coronary heart disease and stroke.

The findings suggest a potential direct association between higher artificial sweetener consumption and increased cardiovascular disease risk. This study also broke down which artificial sweeteners had the greatest risk of disease. Aspartame (Equal) was associated with the greatest risk of stroke. This sweetener was found to be metabolized into many compounds, including formaldehyde. This can break down the blood-brain barrier causing risk of CNS toxicity, inflammation and stroke. BMJ Artificial Sweeteners

The other common artificial sweetener was Sucralose (Splenda). This was associated with the highest coronary heart disease risk. It is only partially absorbed chemically and has the largest effect on the microbiome. Avoid Artificial Sweeteners.

There are many harmful effects of artificial sweeteners including weight gain (the main reason people use these products!), metabolic dysregulation, inflammation, dysbiosis and endothelial dysfunction. These substances are often used in combination with other unhealthy lifestyle choices. These substances are being used more and more in our food supply especially for low calorie, low cost processed foods.

There are safer choices that I recommend:

1. Satisfy sweet cravings with fruit such as berries, bananas and mango. Try dehydrated fruits that you can chew on that gives a certain texture that may satisfy you. Skip the sodas, energy drinks and fruit juices.

2. If you must have a sweetener then consider a novel sweetener that’s derived from plants like, Stevia or Monk fruit. Yes, there are other sweeteners that come from plants, but novel sweeteners don’t lead to weight gain or blood sugar spikes and they are less processed.

3. And please…do not use Agave. It is worse than high fructose corn syrup because it is higher in fructose.

4. I would also consider a good local source of honey. It is 25% sweeter than table sugar so you need very little to get that sweet taste.

References: Rakel, D. Association intakes of artificial sweeteners with risk of cardiovascular diseases. BMJ, Practice Update. Sept 22 2022.

Leonard, J. Is honey better for you than sugar? Medical News Today. June 1, 2017.

Ziesel, J. Facts about sugar and sugar substitutes. Johns Hopkins Medicine- Health

For many years now the primary treatment for acne has been over the counter creams and cleansers such as benzoyl peroxide/salicylic acid, Vitamin A derivatives such as Tretinoin (Retin-A), antibacterial soaps, and of course oral antibiotics.  These treatments are still being used today. But now there is new evidence in the literature on the pathophysiology of acne development. This has lead to newer natural acne treatments. We have known that acne patients and healthy controls have different compositions of skin and gut microbiota. Now we see how acne treatment can disrupt the microbiome, especially with the use of oral antibiotics. This can lead to gut dysbiosis which can lead to chronic inflammation, obesity, cancer, cardiovascular disease, neuropsychiatric conditions such as dementia, depression and anxiety. This gut dysbiosis plays an important role in inflammatory skin conditions such as acne.

One way to look at this gut imbalance is to do a stool analysis. I look for nutritional deficiencies and get labwork that includes nutrient levels, inflammatory markers, blood sugars and food allergy tests.  Some patients may have adequate amounts of zinc and omega 3 fatty acids, but many do not. Studies have found significantly lower serum zinc levels in patients with severe acne than in controls. Acne has an inflammatory component, and lower serum zinc concentrations may reflect a response to inflammation rather than a true zinc deficiency. Pantothenic acid (B5), L-carnitine and oral probiotics have also been helpful. For women, Vitamin B6 (Pyridoxine) at 50 mg/day starting 1 week prior to menses and continuing throughout menstruation showed a 72% decease of premenstrual acne flairs.

There are also topical probiotics that can be used to treat acne that use AOB (ammonia-oxidizing bacteria) as the key ingredient which is a type of bacteria already found on the skin. Our natural skin bacteria gets damaged and depleted over time due to harsh soaps and cleansers which many people use to treat acne. This live bacteria (topical probiotic) replenishes what the skin is missing with minimal side effects Mother Dirt. This is a very natural acne treatment.

For female hormonal acne and especially women who have polycystic ovarian syndrome (PCOS), I recommended D-chiro-inositol which is an isoform of inositol that reduces hyperandrogenism better than myo-inositol. D-chiro-inositol helps regulate cycles while reducing symptoms of acne and hirsutism.

Diet is extremely important when it comes to acne. I discuss when and what people eat and drink and then review their stool test results to allow a more complete understanding of what factors shape the microbiome. Common deficiencies I see in the gut is low fiber, low bacterial (probiotics), low stomach acids and low pancreatic enzymes. Acne has been associated with a diet high in refined sugar and fatty foods including processed foods and alcohol. Exacerbations of acne can result from allergic food reactions or from the effects of biologically active substances in certain foods, such as hormones in cow’s milk or amines and other chemicals in chocolate. Eating whole foods is best, in which there are no labels or ingredient lists on products such as fruits, vegetables, lean proteins, and healthy fats such as avocado, olive oils, fish and nuts/seeds. The gut is an important ecosystem that can cause non-GI symptoms such as acne, eczema, fatigue and nutrient deficiencies.

Last but certainly not least is thyroid. The thyroid gland is the “control tower” of your endocrine system. It secretes hormones into the circulatory system that regulates and controls metabolism. The endocrine system is responsible for growth, repair, metabolism (the rate at which food is burned for energy), energy and reproduction. If that system is out of balance, it can significantly effect your health. When thyroid hormone is deficient (known as hypothyroidism) the body cannot convert cholesterol to other steroids such as Pregnenolone, Progesterone and DHEA. Of all of these…Progesterone is the most important when it comes to acne.

Women have thyroid receptors on their ovaries. So if there is an underachieve thyroid, women will not ovulate as effectively and as a result will not produce adequate amounts of progesterone. This may be why many women suffer from premenstrual acne among other symptoms such as anxiety, irritability, breast tenderness or headaches. Yes, all a result of low progesterone and possibly due to a hypothyroid condition. Low thyroid function increases inflammation because it regulates skin function and how much oxygen the skin absorbs. Thyroid levels can be checked with a simple blood test. Talk to your practitioner to get tested.

Acne can be treated in a ‘wholistic” and integrative way vs mainstream pharmaceutical methods. Treatment can also give you additional benefits that you can see and feel besides clear skin.

References: InYoung, K. Recent updates in pathophysiology and treatments in adult acne. Dermatology, Primary Care, May 25, 2022. Elsevier Inc.

Gaby, A. Acne Vulgaris. Nutritional Medicine, Second edition, 2017. Fritz Perlberg Publishing, Concord NH. pp 707-210.

Villett, M. Is low thyroid causing your “hormonal” acne? The Skincare Edit. 2019.

Amer M. Bahgat MR, Tosson Z, et al. Serum zinc in acne vulgaris. IntJ Dermatol 1982; 21: 481-484.

Snider B, Dieteman DF. Pyridoxine therapy for premenstrual acne flair. Arch Dermatol 1974; 110:130-131.

Nutrients that sound the same can be very confusing. Niacin, niacinamide, nitrates, and nicotinamide adenine dinucleotide can have differences in how they function, yet be similar in how they assist in healthy aging. So let’s start with niacin and niacinamide which are 2 forms of water soluble vitamin B3.

Niacin, also known as nicotinic acid is a vitamin essential for energy metabolism. It helps in the functioning of the digestive tract, skin and nervous system. It is also known for its benefits in reducing cholesterol, particularly people with elevated triglycerides and low HDL (good cholesterol). It is found in food sources such as fish, meat, eggs, milk, yeast, nuts, green vegetables, and beans. Niacin as a supplement can cause blood vessels to dilate which results in flushing for some people. If that’s the case, then I recommend using an extended release form that causes less flushing.

Niacinamide is the other form of B3 (Niacin) that was initially used to prevent a condition know as pellagra- a disease causing dermatitis and red lesions due to B3 deficiency. Today it is used in many skin care products to prevent acne, wrinkles and skin damage. Our body has the ability to convert niacin into niacinamide in large amounts. In high doses, niacinamide can cause skin irritation, burning, itching or redness. Topical niacinamide skin products can be as high as 10%, but studies show that there is no additional benefit compared to doses as low as 2%.

Let’s talk about nitrates. These are compounds found in beetroot and dark leafy greens like spinach and arugula. When you consume nitrates, your body converts it to nitric oxide, which allows blood vessels to dilate and lowers blood pressure. Nitric oxide is an important molecule in all aspects of aging. It increases blood perfusion and not only delivers nutrients and oxygen to tissues including the heart, but also removes waste products. It also suppresses coagulation and stops blood from getting “sticky”. Be careful because nitrates can come from processed foods, such as preservatives in bacon, cold cuts and hot dogs. You want to stay away from them due to their risk for cancer. But vegetable nitrates, such as celery, cress, lettuce, rugula and spinach are harmless and these along with other antioxidants help neutralize free radicals.

The other N-compound that assists in the aging process is Nicotinamide adenine dinucleotide (NAD+). The reduced form of NAD+ is NADH which is critical for mitochondrial production of ATP, which serves as fuel for the cells of the body. NAD+ levels decrease with age. Low levels make mitochondria more vulnerable to damage.  Low NAD+ also occurs in many neurodegenerative diseases including Alzheimer’s, Parkinson’s, cardiovascular disease and muscle atrophy. Sirtuins, which increase lifespan, need NAD+ to function properly. Sirtuins are a class of enzymes that influence aging and longevity through multiple pathways. These enzymes stop the decline in vascular endothelial function, metabolic syndrome, ischemic injury, obesity and cardiomyopathy. NAD+ can be activated with lean diets, exercise, intermittent fasting, and supplementing with NADH 5-10 mg daily. Resveratrol which is a polyphenolic compound produced in plants has been shown to activate Sirtuin. Sources are grapes and berries.

Nutrients that sound the same can be very confusing. By understanding and incorporating these nutrients in our life we can improve healthy blood flow and mitochondrial rejuvenation to help us feel healthier and more energetic as we age.

Reference: Van De Walle, G. Niacinamide: Benefits, Uses and Side effects. Healthline.com. Nov 16, 2018.

Natural Medicines Comprehensive Database: NADH. natural database.com

Meletis, C. Wilkes, K. The critical role of NAD+ and nitric oxide replenishment in anti-aging medicine. Townsendletter.com. Dec. 2021, Issue #461. p. 48-51.