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What Your Doctor May Not Tell You About Rosacea + How To Fix It
March 17th 2021
by: Vincent Pedre M.D.

Do you or does someone you know have rosacea? It’s a common skin condition that typically manifests as redness in the center of the face, especially around the nose and anterior cheeks, but it can also affect the forehead and chin. It often causes visible blood vessels and small, red bumps that can be mistaken for acne, swelling of the tissue of the nose (making the nose look bigger), and swelling and redness around the eyelids.

There are four main subtypes of rosacea that can occur simultaneously or separately:
  1. Erythematotelangiectatic rosacea (ETR)
  2. Papulopustular rosacea (PPR)
  3. Phymatous rosacea (with thickening of the skin), and
  4. Ocular rosacea (around the eyes)
If you have rosacea, you may also feel burning or stinging on the face, and your skin may feel hot and tender. Rosacea symptoms aren’t always present; in fact, they may flare up for a couple of weeks to a few months and then go away for months or even years at a time.

If you go to a conventional doctor for rosacea, they will tell you that there’s no cure and that the best thing they can do is help you control symptoms during a flare-up. They will prescribe a topical antibiotic that can reduce redness of the skin and blood vessels or oral medications such as antibiotics or isotretinoin, which is typically used for acne.

But that’s not the full story on rosacea. Why?

Because conventional treatments for rosacea neglect to address the true underlying cause.

Keep reading to find out what your doctor might not tell you about rosacea and exactly what to do about this skin condition from a functional medicine perspective.

The REAL Underlying Cause of Rosacea

As we learned in last week’s blog when I talked about adult acne, there’s a well-established link between gut health and skin health. In fact, I’d go as far as to say that your skin can act as a litmus test, letting you know that something’s off with your gut before you even develop any digestive issues.

Rosacea is no exception. Rosacea is an inflammatory skin condition. In fact, studies have shown that rosacea occurs when there’s a breakdown in the innate immune system of the skin. The innate immune system is the part of the immune system that acts as our first line of defense against pathogens and toxins and any other foreign substance that comes into contact with the body and threatens to do us harm. The innate immune system is trained to detect these threats and then jump on them immediately to surround them, gobble them up, and neutralize them. As you can probably guess, this process involves an inflammatory response.

In the case of rosacea, the innate immune system gets a little confused and starts launching this attack for seemingly no good reason, which leads to chronic inflammation and the symptoms of rosacea — like swelling, redness, and pain. .

Researchers have found that an increase in cathelicidins — the antimicrobial molecules that are part of the innate immune system’s strategy for combating threats — are what cause the skin bumps in rosacea as well as the flushing and the cosmetically unappealing swollen blood vessels. Other studies have shown that cathelicidins are more abundant and present in a different form in rosacea patients compared to those who don’t have the condition.

This all goes to say that rosacea is caused by excess inflammation and dysregulation of the immune system; and as you might already know if you read my blogs and listen to my Facebook lives, 70% of the immune system lives all along the gut lining.

The Strong Connection Between Rosacea and Gut Health

You might be wondering how, if one issue affects the face and the other one is deep inside the body in your digestive system, how could gut health issues and rosacea possibly be connected? Well, as the authors of a famous study published in the journal Nature wrote: “The microbiome plays critical roles in the training and development of major components of the host’s innate and adaptive immune system…” That means that the gut microbiome plays a major role in how your innate immune system — the one that’s responsible for rosacea — is set up and functions.

In recent years, researchers have started to see real-life examples of this connection between the gut and rosacea. For example:

Rosacea & Low Stomach Acid

People with rosacea often also have low stomach acid, which means their body does not make enough stomach acid to properly digest their food. It’s not uncommon for a functional medicine doctor to suggest supplements that act as supplemental forms of stomach acid (Betaine-HCl) as part of a rosacea treatment plan. Turns out the stomach meridian in Traditional Chinese Medicine runs along both sides of the nose.

Rosacea & Digestive Disorders

In a Danish study on over 50,000 people with rosacea, researchers found that the prevalence of celiac disease, Crohn’s disease, ulcerative colitis, Helicobacter pylori infection (HPI), and irritable bowel syndrome were all higher among patients with rosacea.

Rosacea & SIBO

Small intestine bacterial overgrowth (a type of bacterial flora imbalance with an overgrowth of bacteria in the small intestine) is another issue that has arisen as a possible link to rosacea. In one study, researchers found that patients with rosacea were 13 times more likely to have SIBO. Pretty striking, isn’t it? Even more, another study showed that treating SIBO with antibiotics led to the remission of rosacea as well and that that remission was still present three years later.

Clearly, there’s a strong connection between gut health and rosacea, so any person presenting to a doctor with rosacea should have a full digestive history and work-up.

Quotation

In fact, there’s enough evidence that every single doctor in the world should be considering the gut whenever rosacea is present.

Dr. Pedre Signature

How to Treat Rosacea by Healing the Gut

If you have rosacea and this is the first time you’re hearing about this connection, you’re not alone. I had one patient — let’s call him Mark — who came in with an upset stomach after being put on Metronidazole (an antibiotic ointment) for his rosacea. He had developed irritable bowel symptoms after starting the ointment, and he was wondering if there was a possible connection between his gut issues and the ointment. In addition, he had heard about my book, and wanted to know if there was a gut-skin connection with rosacea that could heal it without having to apply an antimicrobial.

When I told him that I thought he should go off this topical remedy — even though it’s not supposed to, I suspected the antibiotic ointment was affecting his gut health — and focus on healing his gut, he was on board. Mark trusted me enough to give it a try. We took him off the ointment and put him on my HAPPY GUT® Reboot: 28-Day Cleanse Program. In just a few weeks, his gut symptoms and rosacea resolved.

So, if you have rosacea, what steps can you take to heal? I recommend starting by avoiding these extremely common triggers:

7 [Hidden] Triggers for Rosacea

1. Inflammatory & High-Histamine Foods

High Histamine Foods

It’s long been known that certain foods trigger rosacea but now that the gut-rosacea link is becoming more clear, we know why. If you’re dealing with rosacea, I recommend removing the following foods:

  • Sugar (especially refined and added sugars) 
  • Dairy products (especially milk, cheese, ice cream)
  • Processed foods (especially refined carbs)
  • High-histamine foods (like citrus, aged cheeses, and fermented foods)
  • Fried foods
  • Shellfish
  • Chocolate (especially milk)
  • Spicy foods
These foods can be inflammatory, which means they exacerbate gut health issues that might be causing your rosacea. At the same time, there are certain foods that may help heal rosacea. These include:
  • Vegetables (especially those with high water content like leafy greens
  • Unsweetened nut milks (as an alternative to dairy) 
  • Grass fed ghee 
  • Omega-3 rich wild salmon
  • Low-histamine foods (apples, pears, pomegranates, gluten-free grains))
  • Lean proteins like free-range chicken and grass-fed beef 
  • Inflammation-soothing spices (fennel, turmeric, cardamom, saffron)
By incorporating these foods into your diet as much as possible — while also eliminating as many rosacea-triggering foods as possible — you’re giving your body the best tools to fend off inflammation and bring balance back to your innate immune system.

2. Alcohol

Give up alcohol - Happy Gut Blog

Alcohol dampens the immune system and is also a gut irritant, so it makes sense that it might be a trigger for rosacea. One study on over 80,000 women found that higher levels of alcohol intake was associated with a significantly increased risk for developing rosacea. The data from that study also revealed that white wine and liquor had the strongest correlation, so if you’re a frequent drinker of cocktails or pinot grigio you may want to pay attention to how they may be linked to your skin health.

3. Medications

Prescriptions Bottles
If you have rosacea, I recommend taking stock of what medications you’re taking and how they might be sabotaging your gut health. For example, medications like birth control pills and antibiotics can disrupt the healthy balance of gut bacteria, antacids can contribute to low stomach acid, and over-the-counter pain relievers can contribute to leaky gut, which leads to inflammation and immune dysregulation.

4. Stress

Stress

Emotional stress has long been connected to an increase in rosacea flare-ups and detrimental effects on gut health. By focusing on stress management techniques like yoga and meditation, you can make major strides in eliminating rosacea triggers.

5. Caffeine

Caffeine and alcohol can not only exacerbate gut health issues, they can also trigger anxiety, sabotage your sleep, and increase overall stress levels which can put you at a higher risk for an exacerbation in symptoms.

6. Spicy Foods

Surveys on rosacea patients have revealed that spicy foods seem to be linked to flare-ups. In fact, one from the National Rosacea Society showed that spices and spicy food worsen symptoms in up to 75 percent of people with rosacea. “Spicy foods” is a pretty broad category, so according to the researchers the common denominator in problem foods was the chemical capsaicin, which is found in most hot peppers.

7. Undiagnosed Gut Health Issues

If you’ve got SIBO, yeast overgrowth or another gut health issue like Crohn’s, IBS, low stomach acid or a gluten intolerance, dealing with the gut health issue may just resolve your rosacea as well.

With my patients, the first step towards gut healing usually involves my HAPPY GUT® Reboot: 28-Day Cleanse for deep gut healing. With this cleanse, you focus on completely rebooting gut health, which can help you reduce chronic inflammation and the underlying causes of rosacea. But don’t take my word for it! I’ve had dozens of people write to me that have experienced the same thing.

That’s what happened to one instagram follower, Mavic, when she followed my 28 day protocol:

“I actually had experienced chronic hives and rosacea for a few years and have had allergy tests that would always come back negative, so it became like a frustrating thing for me. Until I found a functional medicine approach to healing, but didn’t really know how and where to start… then I saw your video on one of the blog sites. Learned about your book, bought it, and followed the 28-day gut cleanse, and I am allergy and rosacea-free! It also helped me build much healthier eating habits. So I am extremely grateful!”

If you want to get started today on healing rosacea or other chronic skin issues, START HERE.

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