Rosacea is an inflammatory skin reaction that where people have redness in the nose, cheeks, that can spread to the forehead, chin, ears. For some people, it stays mild, but for others, it can be very severe. Famous people who have/had rosacea include Bill Clinton, Princess Diana, Cameron Diaz, and Renee Zellweger.
Rosacea worsens with time if left untreated. It is often mistaken for acne, eczema, or a skin allergy. Where acne is related to bacterial infection, hormones, or stress, and people tend to have black or white heads, rosacea is an inflammatory, immune and vascular condition. There are several types of rosacea, and the symptoms will vary depending on the type. They include flushing, persistent redness, pimples of the face, inflamed blood vessels, excess thick facial skin around the nose, and facial swelling. A dermatologist can diagnose rosacea from other skin issues, and it’s best to not self-diagnose.
There are two main 2 components for Rosacea:
- An inflammatory response: there’s increased immune response that is either acute, chronic or both.
- Vascular reactivity: a reaction affecting the vessels in the face. When they dilate, the blood flow causes redness.
A review of the medical literature will tell you that there are no exact causes for rosacea, but we know that there are certain things associated with it:
- Proliferation of type of mite (Demodex folliculoru) that lives on the skin can start a flare by triggering an immune response. That immune response is escalated in people with rosacea
- Innate immune response is seen in people with rosacea. What that means is that the immune system is identifying something as “foreign” and targeting it, creating an inflammatory response. The innate immune response is general, and that “something” can be a pathogen like bacteria, viruses, fungi, parasites, undigested food particles (think food sensitivities), or chemical (food-related, synthetic, natural, etc).
- Environment: including sun exposure, heat, sweating, or cold wind
- Certain foods. Some people claim that certain foods like citrus, dairy, and spicy foods worsen symptoms.
- Abnormalities in facial blood vessels: it’s thought that abnormalities in the blood vessels of the face cause flushing and redness. However, that doesn’t tell us much what caused the inflammatory response.
- H. pylori infection. This bacteria that grows in the stomach stimulates the production of a protein called bradykinin that can trigger dilation of blood vessels.
Rosacea and the Gut
Studies find that people with rosacea are more likely to have celiac disease, Crohn’s disease, ulcerative colitis, small intestinal bacterial overgrowth (SIBO), and H Pylori compared to people without rosacea.
Treating SIBO and H Pylori can significantly improve rosacea–better than treatments directed for rosacea. In fact, people who have rosacea are 13 times more likely to have SIBO.
Since there’s an innate immune response that triggers inflammation, it’s safe to assume that the immune system is tagging something as foreign and must be attacked. In this process, immune cells send signals out, blood flows to the area affected, more immune cells gather to fight off this “thing” by release cytokines and other mediators including histamine, vessels dilate, and you see redness.
The “thing” that is tagged as foreign can be food, a chemical in food, or a pathogen in the gut.
When your gut is not digesting food properly, protein particles are not broken down completely. H Pylori and SIBO interfere with digestion, by the way. If you have leaky gut or intestinal permeability, these food particles can pass through the gut barrier, get tagged as foreign, and activate an immune response. This is exactly what food sensitivities are. Pathogens, like bacteria, yeast, fungi, viruses, or parasites in the gut can disrupt the immune defenses. If the gut is leaky, the by-products they release can cross the barrier and trigger an immune response inside.
With the gut lining being part of the immune system and a large barrier that protects you from foreign substances, it’s no wonder that 70-80% of immune reactions happen in the gut.
So while we can’t say that a specific bacteria or food can cause rosacea, if we find the food trigger, improve digestion, balance pathogens with good healthy bacteria, seal the gut barrier, we can significantly reduce the immune inflammatory response.
And since there’s no cure to rosacea, and the current treatment options are topical creams or laser that may or may not work, investigating the gut-skin connection is a must. It’s non-invasive and can be transformative to the skin, as well as other aspects of your health.
How do you know if you have a food sensitivity, SIBO, H Pylori, or another pathogen in the gut?
- Food sensitivities are common. Symptoms include stomach pain, diarrhea, bloating, heartburn, brain fog, muscle and joint pain, congestion, skin issues, and many others. You can read more here about the difference between food sensitivities and allergies and the 8 things you need to know about food sensitivities.
- H Pylori is present in 50% of the population. It can cause stomach pain, nausea, indigestion, heartburn, excessive burping, gas, bloating, and may lead to stomach ulcers, gastritis, and stomach cancer if not eradicated. However, some people with H Pylori have no symptoms. If your partner has it, you may get it through kissing! It can be diagnosed through breath or stool testing.
- SIBO symptoms and include stomach pain, excessive burping, acid reflux, bloating, gas, diarrhea, and constipation. They may be similar to H Pylori. The best way to diagnose SIBO is through breath testing, although certain stool tests can give you an insight whether you have SIBO or not.
- Dysbiosis, having too many bad bugs and not enough good ones, can have many symptoms. Other than stomach pain, gas, or bloating, some people have diarrhea, some have constipation, and others a combination of both. Dysbiosis can also lead to brain fog, fatigue, muscle and joint pain, headaches, and skin issues. The best way to get a good picture of dysbiosis is advanced stool testing.
As you can see, it’s important to have more data on what’s going on in your body before you make assumptions and proceed with any diet plan, supplements, or medications to balance your gut. I run these tests for every patient in my private 1-1 nutrition therapy and coaching program. You can read more about the full program here.
If you have H Pylori or SIBO, diet is not enough to get rid of them. Conventional medical treatments involve antibiotics, while functional medicine approaches use certain therapeutic plant compounds to eradicate the bacteria while also balancing gut flora and calming the immune system. If you suspect that you have celiac disease or inflammatory bowel disease (Crohn’s or colitis), consult with a gastroenterologist. Since Crohn’s disease and colitis are inflammatory immune bowel conditions, addressing food sensitivities and gut imbalances is also part of the integrative medical nutrition approach to reducing flare up (exactly the same approach that helps with rosacea).
The best rosacea diet is one that is custom to your own food sensitivities. Until you get more testing done, there are general things you can do about your diet today that will help your skin and your gut at the same time:
- Limit or cut out sugar. Sugars, including cane sugar, honey, maple syrup, agave, and date sugar, feed microbes. If you have H Pylori, SIBO, yeast, eating sugar will make things worse. Artificial sweeteners are not good alternatives because they also cause imbalances in the gut. Stick to ½ cup fresh or fruit fruit 2 times a day instead.
- Eat more fiber, especially prebiotic fibers like under-ripe bananas, onions, garlic, asparagus, jicama, legumes, oats, oat bran, flaxseed, cooked and cooled potato. Fiber promotes a diverse healthy gut bacteria, which ultimately improve the immune system and reduce inflammation. If fiber makes your feel worse, you may need to eradicate the bacteria first and then add fiber-rich foods for long term maintenance and prevention. Diets that limit fiber like FODMAPs are not meant to be followed long-term.
- Consider probiotics. Healthy bacteria fights pathogenic bacteria and reduces inflammation in the gut. Try foods that contain probiotics like yogurt, sauerkraut, kefir, miso, and kimchi. However, these tend to also be high in histamine, which can cause redness in the face, flushing, itchiness, and digestive upset. Histamine intolerance is also related to gut inflammation. Stop fermented foods if your skin gets worse. You may do better with a probiotic supplement (this one is my favorite) and definitely want to consider a more comprehensive gut restoration approach.
- Take omega-3 fatty acids. While research is still in infancy, taking 500 mg EPA/DHA 2 times a day for 3 months can reduce rosacea symptoms. To put into perspective, a 3-ounce portion of salmon contains 500-1,500 mg of omega-3’s (depending on the type and source).
- Identify your food triggers. Certain foods seem to trigger rosacea such as hot beverages like hot coffee and tea, alcohol, spicy and hot peppers like hot sauce and black, red, cayenne pepper, citrus, chocolate, tomato, and cinnamon. If you removed those and still have flare up, I highly recommend food sensitivity testing.