Rosacea Diet: What Foods to Eat and Avoid

Rosacea Diet: What Foods to Eat and Avoid

Diet can have a big impact on your rosacea symptoms. People often forget that food is made up of chemicals and compounds that play a role in the chemical processes within your body. Some compounds in certain foods can improve your rosacea, while some can make it worse.

There is no cure for rosacea and the underlying cause is unknown. Current research suggests genetic factors and environmental factors interact to trigger the onset of the disease.

What is rosacea?

Rosacea is a chronic inflammatory skin disease that causes flushing and redness on the face. Inflammation occurs as a result of an immune response in the body. In the case of rosacea, this immune response is dysregulated.

How can diet affect rosacea?

Inflammation can also occur in the body as a result of oxidative stress, which is a state where the body is experiencing a high level of oxidants, called free radicals, which can cause cell damage. Oxidative stress and inflammation can be impacted by certain foods in the diet, so changes to your diet can potentially improve your rosacea symptoms.

There is emerging evidence that rosacea is also underpinned by the health of the gut microbiome. The gut microbiome refers to the collection of bacteria that live in your gut. There will be a combination of good and bad bacteria making up your microbiome. The ratio of good to bad as well as the level of growth and activity of these bacteria is what determines the “health” of your microbiome.

People with rosacea are often found to have more bad bacteria and less good bacteria in their gut. Because the food you eat is digested in your gut, you have the opportunity to impact your gut-microbiome through the food in your diet.

Though limited, there is evidence that compounds found in certain foods can trigger or aggravate your rosacea symptoms. Foods contain chemical compounds that can impact signaling pathways within the body that can impact inflammation, facial flushing, and many other symptoms of rosacea.

Most of the evidence for food triggers is self-reported and appears individual–not everyone with rosacea experiences the same triggers.

What foods to eat

Antioxidants and anti-inflammatories

Due to the inflammatory nature of rosacea, reducing inflammation in the body could help alleviate symptoms. Including foods rich in antioxidants into your diet is a potential way to do this.

Antioxidants work to balance out the oxidants—a cause of inflammation—in the body, reducing the negative effects of oxidative stress and potentially impacting the underlying mechanisms of rosacea.

Examples of antioxidant foods include:

  • Berries
  • Dark leafy greens
  • Carotenoid containing fruits and vegetables (orange or red in color)
    • Carrots, bell peppers, oranges, peaches, mango, pumpkin, etc.

Other anti-inflammatory foods include omega-3 fatty acids which block inflammatory pathways within the body, reducing inflammation. Targeting these pathways by increasing omega-3s in the diet could potentially reduce rosacea symptoms, however, current research in this area is minimal.

Examples of foods containing omega-3 fatty acids include:

  • Oily fish such as salmon
  • Other seafood
  • Flax seeds
  • Chia seeds
  • Walnuts

Pre and probiotics

Growing evidence around the role of the gut microbiome in rosacea disease onset means pre and probiotics could play a big role in reducing rosacea symptoms.

Prebiotics are considered “food” for the bacteria living in the gut. They help promote bacterial growth and activity which both contribute to a healthy gut microbiome. They are important to keep the good bacteria that are already in your gut healthy, and can help reduce inflammation in the body. Prebiotics are a type of dietary fiber so a diet high in fiber could help reduce rosacea symptoms.

Examples of high fiber foods include:

  • Whole grains such as oats, barley, brown rice, quinoa, and whole-grain breads
  • Fortified cereals such as Weet-Bix and oat bran
  • Fruits and vegetables

Probiotics are foods that contain live “good” bacteria which can contribute to a healthy gut microbiome. Certain types of good bacteria found in a healthy gut-microbiome have been found to reduce inflammation in the skin of patients with rosacea. Sources of probiotics include fermented foods and supplements.

Examples of probiotic foods include:

  • Yogurt
  • Sauerkraut
  • Kombucha
  • Tempeh
  • Miso
  • Pickles

*Different types and brands of probiotics will have different concentrations of bacteria. A way to check is to look on the ingredients list for “live or active cultures.”

What foods to avoid

Trigger foods are different for everyone. A simple way to determine what foods trigger your rosacea is to keep a record of what you’ve eaten before a flare-up. Through trial and error, you will be able to learn which foods affect you most and therefore, which foods to avoid.

Alcohol

Alcohol can flare up facial flushing related to rosacea through vasodilation (expanding) of the blood vessels in the skin. Alcohol also causes inflammation, oxidative stress and affects the gut microbiome—these are mechanisms related to the underlying cause of rosacea.

The risk of aggravating your rosacea from alcohol is dose-dependent. This means that the more alcohol you drink, the more risk or damage it is doing. Because of this, it is recommended that if you have rosacea you should try to reduce or avoid alcohol to help reduce symptoms and avoid any progression of the disease.

Hot food and beverages

The heat from hot food and drink can directly cause facial flushing from vasodilation, which can then trigger further rosacea symptoms. It is recommended that if you have rosacea, you should try to avoid eating really hot food and drinks.

Spicy foods

Specifically, a compound found in spicy food called capsaicin can trigger rosacea symptoms through vasodilation and heat production in the body—something everyone will have experienced with spicy food.

Capsaicin is found in higher amounts in spicy pepper varieties but is also present in non-spicy peppers.

Examples of foods containing capsaicin:

  • Red chili peppers
  • Cayenne pepper
  • Jalapeno peppers
  • Bell peppers
  • Paprika
  • Green peppers

Some fruits and vegetables

There are compounds in many fruits and vegetables that can aggravate rosacea symptoms. These include cinnamaldehyde, histamine, formaldehyde, and niacin. Not everybody with rosacea experiences reactions to all food identified as potential triggers—what you find to trigger a rosacea flare-up may not be what triggers someone else’s.

Cinnamaldehyde

This compound is involved in the activation of a signaling pathway associated with rosacea. Because of this, foods containing cinnamaldehyde may aggravate rosacea symptoms.

Examples of foods containing cinnamaldehyde include:

  • Apples
  • Citrus fruits
  • Carrots
  • Tomatoes
  • Lettuce
  • Spinach
  • Celery
  • Cucumbers

Histamine

This compound is involved in multiple mechanisms related to rosacea, including inflammation, immune regulation, and facial flushing. The role histamine plays in these mechanisms is well understood but less is known about the effects of dietary histamine specifically, on rosacea. While the science is not strong, many people self-report that histamine-containing foods aggravate their rosacea.

Examples of foods containing histamine include:

  • Avocado
  • Papaya
  • Bananas
  • Pineapple
  • Dried apricots, dates, figs, and sultanas
  • Tomatoes
  • Spinach
  • Eggplant

Formaldehyde

This compound plays a role in inflammation and in the burning/stinging sensation experienced by some patients with rosacea. Though little is known about the effect dietary formaldehyde has on these pathways, it is thought to be a trigger in some patients.

Examples of foods containing formaldehyde include:

  • Apples
  • Grapes
  • Plums
  • Bananas
  • Cauliflower
  • Spinach
  • Onion
  • Mushrooms

Niacin

This is more commonly known as vitamin B3 and is a well-established trigger for facial flushing and stinging related to rosacea.

Examples of foods containing niacin include:

  • Mushrooms
  • Potatoes

Cinnamon

Cinnamon contains cinnamaldehyde in large concentrations and is a commonly reported trigger food among people with rosacea. Avoiding cinnamon and cinnamon-containing foods such as many cereal products and baked goods could help avoid a flare-up.

Chocolate

Chocolate contains cinnamaldehyde and histamine. Histamine causes blood vessel dilation, which contributes to facial flushing, as well as plays a role in inflammation and immune regulation.

Meat, poultry, and seafood

Beef, pork, chicken, turkey, salmon, tuna, and anchovies all contain niacin. Beef, pork, and poultry contain formaldehyde. Lastly, smoked fish contains histamine. As you know, these compounds all potentially aggravate rosacea symptoms so these foods may be a trigger in your diet.

Takeaway

Modifying your diet to reduce inflammation and improve the health of your gut-microbiome—with increased intake of antioxidants and pre/probiotics and decreased alcohol intake—may improve your rosacea symptoms.

Hot foods, alcohol, and compounds in certain fruits, vegetables, spicy foods, meats, and chocolate may aggravate your rosacea symptoms. However, trial and error are required to determine which triggers are relevant to you.

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Brandon Kirsch
brandon.kirsch@clearifirx.com

Brandon Kirsch, MD, FAAD, is a board-certified dermatologist specializing in clinical drug development and medical innovation. He is the founder of Kirsch Dermatology in Naples, Florida and is also the Chief of Dermatology at the Naples Community Hospital. Kirsch Dermatology Website Dr. Kirsch started his career as a lawyer and holds law degrees from the University of Western Ontario (LL.B.) and Georgetown (LL.M. Securities and Financial Regulation). Dr. Kirsch completed his pre-medical studies at the University of Pennsylvania, medical school at Brown University, internship at the Mayo Clinic (Florida) and dermatology residency at the University of North Carolina. In partnership with the Mayo Clinic, he filed to patent a novel topical composition for the treatment of skin hyperpigmentation that he co-developed and also oversaw a successful pilot study of the formulation. Dr. Kirsch has experience with therapeutic drug development programs from pre-clinical to Phase 3 studies. He is licensed to practice medicine in California, Colorado, Florida, and North Carolina and law in New York and Ontario.



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