Digestion and Rosacea
How probiotics, prebiotics, digestive health and stress influence rosacea.
For those who remember the cantankerous comedian W.C. Fields, frequently appearing
on the tipsy side in vaudeville sketches and movies, his red, bulbous nose is often
one of the first recollections that come to mind—along with his famous line,
"...my little chickadee." This signature appearance, used to great effect
in his various roles, is thought to be the result of rosacea, a chronic, inflammatory
skin condition affecting up to 14 million in the United States, and many more worldwide.
The red, bulbous nose is but one manifestation of the condition, typically appearing
in men much more than women. The more common symptoms of rosacea—the flushed
redness of the face; accentuated small blood vessels and capillaries visible around
the nose, chin and cheeks; bumpy papules or acne-like pustules; and at times dry,
red, itchy eyes—can all appear in a range of severity, most commonly in adults
30–60 years of age, and more often in women upon entering menopause.
What causes rosacea is still largely unknown, but advances are being made in our
understanding of the molecular pathways involved. For those interested in safe natural
solutions, new research that reveals the connections between digestive health and
rosacea is particularly promising. These studies include findings on how digestive
supplements in the form of probiotics and prebiotics influence ongoing interactions
between our immune systems and digestive systems. Research continues into ways to
treat rosacea and at least manage the appearance of the skin affected, pointing
to the use of such supplements as a means to quell the inflammatory processes that
underlie inflammatory skin conditions.
Diet and Stages of Rosacea
Rosacea can manifest in phases. An individual may blush easily, with the area around
the nose flushing red from blood vessels dilating close to the skin's surface. Redness
that persists in this manner may be a sign ofpre-rosacea. The progression
of this red flushing, with swelling and the visible appearance of capillaries under
the skin (telangiectasia) may be an indication of what is calledvascular
rosacea. Skin sensitivity may increase in the area affected, and the condition
can be confused withseborrheic dermatitis, which sometimes produces flaky,
irritated skin and oily dandruff.
Inflammatory rosaceadescribes cases where the condition has progressed
to the point where persistent papules and pustules, and swollen, sensitive skin,
sometimes involving the eyelids and around the eyes (ocular rosacea) occur.
The red, bulbous nose (rhinophyma), again, most common in men, is the result
of the sebaceous glands of the nose enlarging, causing swelling and thickening of
the tissues around the nose, telangiectasia, and skin sensitivity. Thickening of
tissues on the cheeks, forehead, and chin may also be seen in some cases of rosacea.
Interviews with patients have yielded a list of potential triggers that cause flare-ups
and a worsening of their condition. Of the 1066 patients surveyed by the National
Rosacea Society 81% found exposure to the sun the most common triggering factor,
with emotional stress coming in a close second at 79%, and hot weather, 75%, a close
third. However, the cumulative effect of dietary influences was also significant.
Alcohol consumption and spicy foods were reported by a large percentage of those
interviewed as triggers, 52% and 45%, respectively. Other foods figured as common
triggers but for much less of this population of rosacea sufferers. Dairy products
were found to be trigger foods in 8%, certain vegetables 9%, certain fruits 13%,
and marinated meats 10%. Such polling cannot replace the research necessary to identify
underlying causes, but it may provide some guidance for coping with the condition.
Of the foods that patients in this survey found to be a trigger, the consumption
of liver is interesting for its value as a source of iron in the diet. A three-ounce
serving of beef or chicken liver supplies 7.5 mg or 7.3 mg, respectively, nearly
meeting the Recommended Daily Allowance for non-vegetarian and post-menopausal women
of 8 mg/day. Iron is also a nutrient assimilated from spinach, kidney, soy and lima
beans, raisins, and prunes. Each of these has been described by rosacea patients
as a possible trigger to their flare-ups. Iron that is misplaced or misused in the
body increases systemic oxidative stress, decreases antioxidant capacity, and contributes
to expression of ferritin, an iron-storage protein found in high concentrations
in rosacea lesions. Excess or misplaced iron can be a risk factor in a large number
of conditions that include rosacea, as well as supporting infection from bacteria,
fungi and some viruses.
Inflammation in the Gut and Rosacea
Other interesting connections between diet and rosacea have come to light from research
into the causes of this affliction. Inflammatory gastrointestinal tract disorders
have been associated with rosacea. It has been hypothesized that intestinal flora
may influence thekallikrein-kininsystem of proteins in the blood, which
influence inflammation and blood pressure, as well as other processes, through the
actions of the mediatorsbradykininandkallidin, vasodilators that
act on cell types throughout the body. This hypothesis is supported by evidence
of the beneficial role probiotics and prebiotics play in modulating the flora that
inhabit the human gut.
The Food and Agriculture, and the World Health Organizations of the United Nations
define probiotics as "live microorganisms which when administered in adequate
amounts confer a health benefit on the host." Prebiotics, in contrast, are
defined by the International Scientific Association for Probiotics and Prebiotics
as "non-digestible food ingredients that beneficially affect the host by selectively
stimulating the growth and/or activity of one or a limited number of bacteria that
can improve the host health." In short, probiotics supplement the flora already
active in the gut, while prebiotics nourish both native flora and any probiotic
flora added by means of supplements.
Work has shown that in the healthy intestine, microorganisms, which vastly outnumber
the eukaryotic cells of the host in a symbiotic relationship, communicate with the
host's mucosal immune system embedded in the lining of the intestine. The inseparable
nature of this relationship allows for proper digestion and efficient energy extraction
from food, while maintaining vigilance against pathogenic bacteria. This beneficial
effect extends far beyond the mucosal lining of the gut to influence systemic immunity
and the inflammatory response. Immunomodulating effects include stimulation of immunity
through promotion of antibody production, boosting pro-inflammatory cytokine expression,
and enhancement of hostdefensinproduction, an antimicrobial peptide. Suppressive
effects include down-regulating systemic inflammation, decreasing cytokine expression,
cell proliferation, and increasing "cell death," the controlled elimination
of unnecessary and redundant cells, orapoptosis.
Prebiotics are seen to exert similar systemic benefits beyond simply supporting
the gut flora. Prebiotics selectively stimulate beneficial bacteria that generate,
among other things, lactic and acetic acid, which in turn can be digested by other
beneficial bacteria. This role is thought to help out-compete potential pathogens.
Another benefit of prebiotic fermentation in the gut is the down-regulation of inflammatory
Although not yet extensively well-documented, the direct effect of probiotics on
inflammatory skin conditions is suggested by the many studies that show the direct
effects they exert on systemic immunity and inflammatory responses. Atopic dermatitis
is reduced in children whose mothers use probiotics during pregnancy. In the case
of inflammatory skin disorders, probiotics are thought to regulate the types of
immune system cells known as T cells and lymphocytes. Certain kinds of T cells become
confounded in autoimmune diseases, where they start to fail to recognize and destroy
the body's own cells and tissues. Effector lymphocytes are cells able to mount very
specific immune functions, that are also believed to be influenced by the actions
of probiotics in the diet.
Stress, Inflammation, and Rosacea
Another factor that must enter any discussion of inflammatory skin conditions, including
rosacea, is the role stress plays. The skin, endocrine, nervous, digestive, and
immune systems do not act in isolation of one another. Stress ramps up activity
along both the hypothalamic-pituitary-adrenal and gut-brain axes. This has a significant
overall effect in contributing to inflammation and the release of pro-inflammatory
Though the complexities of these various interactions are not always well understood,
the effect each one has upon the others is coming to light and must be relevant
to treatment options. In the case of rosacea, strategies to reduce emotional stress
are likely to exert a positive influence in the management of this condition.
Making a deliberate effort to learn about and maintaine a healthy diet, being mindful
of triggers to rosacea flare-ups, and including supplements beneficial to digestion
and immunity are three natural, safe ways to relieve the stress that managing rosacea
might generate. While there may not be a cure as yet for rosacea, treatment options
that get closer to the heart of the problem are available.
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Rosacea Diet (1800 calories)
The DermaHarmony rosacea diet emphasizes anti-inflammatory foods that work to reduce vascular flushing. Anti-inflammatory foods are generally plant-based, mineral dense, and minimally processed.
Natural Treatment for Rosacea
Finding effective treatments for rosacea can be a difficult and frustrating journey.
Some treatments seem to work for a while, but then the rash returns. The natural
course of the disease consists of calm times followed by flare-ups, which further
complicate trying to figure out if treatments actually worked or if the disease
was just going into a quiet period.
Characterized by redness, inflammation and pimple-like bumps on the face, rosacea
is frequently mistaken for adult acne. Due to the location and severity of rosacea,
sufferers frequently experience intense emotional distress and embarrassment.
Alkaline Diet & Rosacea
Skin diseases are reflections of overall health. It is well-known, for example,
that people who eat a non-Western diet have fewer skin diseases: including rosacea,
acne, eczema and others. This is because non-Western diets focus on more fruits
and vegetables and fewer sugars, grains, and processed foods. People eating a non-Western
diet are healthier than the average American and their skin shows it.
How We Help
At DermaHarmony, our goals are to educate chronic skin care suffers about dermatology, share what contributes to health and wellness, and support our readers in any way we can. Our programs promote healthy skin with nutritional supplements, topical treatments and dietary guidance. Learn more about our programs or call us toll-free at 1-800-827-3730. Our Support Desk is open 9:00 a.m.–6:00 p.m. ET, Monday-Friday.
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Digestion and Rosacea—Reference
Documents and Further Reading
Principal Author: C. Lucida, DermaHarmony Science Editor
Date of Publication: 06/21/2010