Are you struggling with rosacea, and curious to know about how nutrition impacts acne? Read my guide to all you need to know about diet and rosacea to find out the latest science backed information. Find out the food triggers of rosacea and how the gut microbiota may play a role.
What is Rosacea?
Rosacea is a long-term skin condition, that affects women more than men, and is more obvious with lighter skin colour. It can affect up to 15% of certain populations, with an increased prevalence in fair-skinned individuals of European descent (1).
The first signs of rosacea are:
- An intermittent redness across your nose, cheeks, forehead and chin
- A burning or stinging feeling on your skin when using water or skincare products
For more information about the symptoms see here.
Why Does Rosacea Happen?
Exactly why rosacea occurs is not known. It is thought there might be a genetic link, but no specific causative gene has been identified yet. It is probably a result of a combination of genetic risk, dysregulation of the immune system, abnormal neurological and vascular signalling, and an imbalance (dysbiosis) of micro-organisms (microbiota) leading to skin inflammation and sensitivity.
What Can Trigger Rosacea?
There are many triggers for rosacea, with some directly leading to dilatation of surface blood vessels, like hot temperatures, while others trigger skin inflammation. Both the sun and food can trigger rosacea. Although there is less research about dietary triggers in rosacea, in a survey by the National Rosacea Society of over 400 patients, 78% said they had altered their diet because of rosacea, and of these 95% reported a reduction in subsequent flares (1).
Common triggers are:
- sun exposure
- heat
- alcohol
- capsaicin
- cinemaldehyde
Sun
Sun exposure is a very common trigger for flushing and worsening of rosacea symptoms. This happens both via UV light but also by pro-inflammatory effects of vitamin D in the skin. To help reduce the triggering effects of sun, avoid the midday sunshine, cover your skin where possible and use quality high-factor sun protection that blocks both UVA and UVB.
Dietary Triggers of Rosacea
Hot drinks such as tea and coffee can trigger symptoms in up to 30% of people (1). Alcohol and foods containing capsaicin such as certain spices like cayenne pepper as well as bell peppers and chilis are also triggers. Another trigger are foods containing cinemaldehyde such as tomatoes, citrus fruits, cinnamon and chocolate.
All these triggers are thought to increase blood flow to the skin, leading to symptoms of flushing and burning.
The Gut-Skin Connection
While gut health plays an important role in immune function, there is also a connection between the microbiota of the gut and those that live on the skin. The gut has trillions of micro-organisms, while the skin is also colonised by an equally complex microbiota that varies with both genetics and the environment.
There is now accumulating evidence of the role of gut health in rosacea, but the exact role is unknown. In a large study of nearly 50,000 participants, people with rosacea were more likely to have Helicobacter pylori infection and small intestinal bacterial overgrowth (2). Small intestinal bacterial overgrowth, is just as the name describes with an increase in bacterial growth, and can lead to diarrhoea, pain and bloating. In another study people with rosacea were found to be thirteen times more likely to have small intestinal bacterial overgrowth (3). Remarkably, treatment of the bacterial overgrowth with antibiotics led to remission of rosacea in all cases, that persisted for three years. Additionally people with rosacea are more likely to have inflammatory bowel disease, both sharing a genetic overlap on histocompatibility complex class II gene HLA (DRB1*03:01).
More research is needed to understand if dietary interventions to modulate the gut microbiota may impact the skin and rosacea.
How to Improve Your Gut Health
While it is unknown if changing your gut microbiota can benefit the skin microbiota and rosacea, your gut microbiota are so important for general health, optimising your diet can only help. There are simple tips to improve your gut health, by including in your diet:
- a range of fruit and vegetables
- beans and lentils
- whole-grain carbohydrates
- fermented food such as kefir and sauerkraut
- avoiding trans fats and sweeteners
The Role of Prebiotics and Probiotics
Given the connection between gut microbiota and rosacea, the role of probiotics is an active area of research, but more information is needed.
The Role of Supplements in Rosacea
At present there is no evidence to support the role of supplements in rosacea.
Practical Tips
Try to firstly work out what your triggers are, and then avoid them where possible. Aim to eat a diet that supports optimum gut health and immunity by including the following items:
- avoid any food triggers
- fruit and vegetables
- whole-grain carbohydrates
- fermented food and drink
- beans and legumes
- avoid sweeteners and trans fats.
I hope that you have found this a helpful summary and now know about food triggers in rosacea and the importance of gut health.
References
1. Weiss E, Katta R. Diet and rosacea: the role of dietary change in the management of rosacea. Dermatol Pract Concept. 2017 Oct;7(4):31–7.
2. Egeberg A, Weinstock LB, Thyssen EP, Gislason GH, Thyssen JP. Rosacea and gastrointestinal disorders: a population-based cohort study. Br J Dermatol. 2017 Jan;176(1):100–6.
3. Drago F, De Col E, Agnoletti AF, Schiavetti I, Savarino V, Rebora A, et al. The role of small intestinal bacterial overgrowth in rosacea: A 3-year follow-up. J Am Acad Dermatol. 2016 Sep;75(3):e113–5.
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