Rosacea and bowel or digestive conditions

There are many rosacea sufferers who report coexisting bowel inflammation problems. Over the years I read countless forum posts on this topic and found patients suffering from a wide range of bowel disturbances; Irritable Bowel Syndrome, Inflammatory Bowel Diseases like Crohn's Disease and ulcerative colitis, Small Intestine Bacterial Overgrowth (SIBO, when bacteria -pathogens or beneficial- are found in the small intestine), Helicobacter pylori stomach bacteria, Gastroesophageal reflux disease, general flatulence, cramps, bad digestion and bloating 

In this blog post I'll try to give an impression of the types of bowel problems rosaceans mention on public forums and websites. I'll also try to find more scientific information about the link between bowel and skin problems. I describe the rosacea problems which patients primarily suffering from bowel diseases complaint about. I describe the symptoms of these bowel conditions and how you can test if you have them. Then I look how many rosacea patients tried treating their bowel problems (for instance with Rifaximin) and what they reported about the effects of this on their rosacea. I also look at more simple things you can do to minimize your bowel problems. In my own case, my health issues started in my teens with bowel problems. I remember getting bad bowel cramps, about once every 2 or 3 weeks initially. I would sit cramped down for hours, use warm water bottles on my belly to alleviate the pain and literally sit it out. I never went to see a doctor and assumed it was benign. My belly could swell and look very bloated. When my rosacea developed, I didn't link the two together. Once I had a 3 month course of doxycycline in 2004, my bowel problems really kicked off. Suddenly eating my beloved bread would make me bloat instantly and cause cramping. I was consistently mistaken for a pregnant girl, because my belly was protruding so much. Foods like green peas, beans and unions made things worse. I didn't realize this initially, and had stuck to my 'rosacea friendly' diet of green peas, carrots, corn flakes and olive oil (I know, sounds worse than it tasted!) for a long time. I ended up at the ER with my then bf, only to be told I had no dangerous flesh eating or whatever bowel bug, but simply eaten too much beans (blush blush). I eventually saw a specialist in hospital and they did a colonoscopy. It showed that I have lymphocytic colitis -a superficial inflammation of the colon lining- and irritable bowel disease. Both were modest and needed no medical intervention, but the doctor told me to try to avoid NSAID medication and gluten, as both were associated with worsening of colitis. I now have a check up colonoscopy every 5 years, because this condition increases the risks of the formation of polyps, which in turn can develop into tumors. But I don't have other symptoms really, apart from an easily irritated belly. I had another colonoscopy in 2009 and it showed the same thing; lymphocytic colitis, in an non advanced stage: no need for medication. The lymphocytic colitis is a form of IBD, together with Crohn's disease e.a., but it is not as serious.  Ulcerative colitis is another type of IBD and the result of an abnormal response by the body's immune system. Normally, the cells and proteins that make up the immune system protect you from infection. In people with IBD, however, the immune system mistakes food, bacteria, and other materials in the intestine for foreign or invading substances. When this happens, the body sends white blood cells into the lining of the intestines, where they produce chronic inflammation and ulcerations.

The good part is that while Crohn's Disease for instance, causes infections of the bowel that are visible with the naked eye and widespread, my subtype of microscopical lymphocytic colitis is not visible with the naked eye, and only causes superficial inflammation of the bowel lining. Still, it makes the body produce more leukocytes for instance. They play a role in cytokines release, which induces vasodilation and lowers the electrical charge along the blood vessel's surface. In this article, the author states that local inflammation can spread through the body when the immune system isn´t functioning as it should: "Under normal conditions, inflammation's hallmark signs -- redness, swelling, soreness, and warmth -- stay localized and disappear as the injury or infection heals. But sometimes the immune system does not shut off, instead releasing a stream of inflammation-promoting compounds that spread throughout the body, damaging cells and tissues." With IBD, the bowel cells persistently release harmful inflammatory cytokines, causing tissue damage. I now wonder if these pro-inflammatory substances in the bowel can migrate and spread through the blood to the rest of the body perhaps, towards the skin and whether they can cause inflammation reactions elsewhere. It seems possible, from what I've read, but I'm no pro or doctor, so I'll leave it in the middle for now. But elevated inflammation markers in the blood, and inflamed bowels in this case, aren't good for overall health, and might stir up rosacea for those suffering from both conditions. My internist doctor asked me lately why I avoid gluten and when I said I thought I was allergic he asked me whether or not I was tested for that yet. I said I was told to avoid them, since I seem to have a hard time digesting gluten, and my face gets more red and inflamed when I eat them. He said masses of people are assuming they have a gluten allergy or intolerance, when in fact they haven't. He sees it all the time. The only test according to him to scientifically determine this is to take a biopt, a little piece of tissue, from the stomach wall to research it, and while he was busy doing the colonoscopy he said he would check for a gluten allergy as well. Turned out I don't have a gluten allergy... However, I do notice cramping and bloating when I eat gluten, despite his verdict and I still try to cut down my gluten intake :/ My skin is just a lot more red when I eat bread and gluten loaden foods. Maybe because grains are said by some to be pro-inflammatory.. I'm not sure. My dermatologist beliefs there is a connection between my bowel problems and rosacea. He says the inflammation in the bowel lining can mess up the system and send inflammation signals to the skin. Disturbances in food digestion can also be a part of this problem. He expected the internal doc to come with a medication, but this is not the case. I now try to take probiotics, eat healthy and high fiber foods, little sugar and gas producing foods.

I have a short list of new things I would love my derm to test me on next year:

*Do a test for SIBO and find out if I have any of these bacteria overgrowth issues in my gut.
*Testing my RNA antibodies (my ANA antibodies are already a bit elevated but want to find out RNA levels, as they can indicate if there are underlying autoimmune conditions at play).
*Measure my CRP levels in the blood: To detect silent inflammation, physicians measure blood levels of C-reactive protein (CRP), a substance found in the blood when systemic inflammation is present. When doctors find elevated CRP levels, they often do additional tests to determine what's triggering the inflammation and prescribe appropriate treatment. 
*Analysis of alkaline phosphatase activity in the blood.
I have also bought a months worth of Rifaximin, which has been lying here and still have to start using it. I will though and update below this post how I find it affecting my rosacea and my bowel. There have been some careful success reports from rosaceans using rifaximin, but for me personally none of them sounded decisively positive, yet. The cause of rosacea is still unknown, but research indicates that some cases of rosacea might be worsened by factors that trigger an auto immune response in the body, and the release of cathelicidin antimicrobial peptides. I believe that there might be many possible underlying triggers for rosacea, including inflammation in other parts of the body, auto-immune responses and allergies, hormone disturbances and so on. I wished there was more known about this aspect. There is a also certain percentage of patients who seem to have had rosacea all their lives and who always had red cheeks and very reactive facial blood vessels. They might have a genetic predisposition for the disease. But a big portion of patients seem to have developed it over the years, typically after their teens and often even later, well into their 30's or 40's. I don't know if coexisting bowel problems can act as the sole cause and instigator for rosacea, or if they are merely coincidental side problems, perhaps they are even unrelated. But my gut feeling says that bowel problems can be the engine behind the rosacea flares for some patients. There are simply too many rosacea patients with bowel problems. And in my own case there was the bowel issue first, and then the rosacea.

Rosacea patients who wrote about their coexisting rosacea and bowel disturbances

Boiling_Point wrote: "The thing is, I have Ulcerative colitis, and also constant red cheeks (Rosacea). And I haven't really thought about it until lately, that my whole situation with Rosacea probably is because of something internal, possibly because of the UC or it's medications and such."

MasK wrote: "Regarding link between Crohn's and rosacea, I know a girl who has both only 12 years old :( 

Hoboman wrote: "I've had Rosacea for many years and also have had Ulcerative colitis for about 5 years. My UC is in remission but the Rosacea came on really strong after I was diagnosed with UC. I always thought that it was a side effect of UC medication. My Rosacea is mostly just a lot of redness. It gets really bad after driving to work and my face has been in the sun. I have the windows tinted on all of my cars to and it helps."

RedFacedRedHead wrote: "I have Crohn's disease (diagnosed almost 8 years ago) and rosacea as well. My GI didn't seem surprised by rosacea showing up. My derm won't put me on any of the other oral meds b/c of the Crohn's (and related meds, of course), in fact.

Yankeerose1970 wrote:´I have an IBD (Inflammatory Bowel Disease) and I just got diagnosed with Rosacea about 3 months ago. Right now I am using Metrogel 1% and Elidel. For the most part, this is controlling my flushing but lately it seems that I am getting red again, especially around my nose. My question is: Does anyone here have an IBD (Crohn's or Ulcerative Colitis)? And if so, what other med options are acceptable? My derm told me that many of the medications that he normally prescribes he can not do for me because of my IBD.´

Mistica replied: ´There are many who consider IBD is caused in part by infection. Stealth pathogens. There are those who consider Stealth pathogens are also involved in rosacea. Have you heard of Cpn? I advise you browse around the following website. You could start off by posting in the forum and asking if others being treated for IBD could tell you about their experiences. You might be surprised at what you find. Good luck. There are other rosaceans there by the way. I am one of them. I don't have IBD though.´

MasK wrote: ´In my opinion this is another proof that the link between the intestinal health and the inflammatory skin diseases like rosacea is very close. And to answer your question I do not have IBD like UC or crohn but I have IBS and a long history of serious digestive problems.´

And MasK wrote also: ´GERD begun at the age of 15 after an accutane course prescribed for juvenile acne (that was a very bad idea, imo). I don't know if it was the consequence. Anyway, the flushes started almost at the same time. I took omeprazole during ten years, developed dysbiosis with leaky gut, persistent redness, other GI problems, allergies, runny nose, joint and muscle pains (fibromyalgia), chronic fatigue, and the seb derm appeared 1 year ago exactly when the IBS started (constipation). I was also diagnosed wit H. Pylori, treated successfully with antibiotics, but if I was aware of the alternative and effective treatments (mastic gum), I would have chose this to avoid flora destruction. I did comprehensive stool tests analysis, and they showed very low levels of gut flora, with some pathogens overgrowth, and also low levels of the substances produced by the healthy flora (short chain fatty acids, ...). I'm trying to restore the flora with kefir, yogurt, pro and probiotics, and an anti-inflammatory-type diet, meat, fish, some fats and vegetables. I take glutamine to heal the gut lining. I've also fixed the GERD problem by aiding my digestion with bitters, Trimethylglycine and zinc, to help getting sufficient stomach acid level, as GERD results from a lack of stomach acid. Obviously I stopped all antacid drugs, and I also avoid taking supplements that neutralize stomach acid, like magnesium carbonate, ...´ (..) Zinc is also a good supplement to add to your diet, as it is very important for the mucosa health. It has also antibacterial properties, help regulate hormones (useful in acne problems) is involved in the digestive juices production, ... I think 50mg of zinc picolinate or gluconate with the largest meal (to prevent nausea) is a correct dosage (or 2x 25 mg in two takes). L-Glutamine is best taken on a empty stomach at least 30 minutes before meals, like every amino acid. Replenish the flora will help restore a proper pH, fight pathogens, and help heal the gut lining, so it has to be what to focus on in the first place, in my opinion!

Laurastacey replied:´I've been wondering this for a while, i've had skin problems for quite a while but it's gotten worse over the last couple of years. Strangely as my stomach and digestive system seem to have just gone downhill! After going through it over and over again it's looking like i have a few symptoms of Coeliac Disease which apparently can occur with Rosacea. I'm going to talk about this with my doctor soon because i've been having stomach issues just as long as i've been having problems with my skin and i'm seriously starting to believe there's something else going on!´

     

Koki wrote: `Today I saw my gastro doctor and he gave the results of my biopsy: H pylori infection and microscopic colitis. I dunno if H pylori eradication will help with the rosacea but the treatment is a bunch of antibiotics for 2 weeks.. so maybe they can have an anti-inflammatory effect on my face/eyes. Geez I was healthy and had perfect skin and now all of a sudden all this inflammatory craziness everywhere [..] I was having a lot of mucus, abdominal pain, and D/C. So he just decided to do a colonoscopy and endoscopy... I thought it was a little extreme but that's how he found my lymphocytic colitis and h pylori infection. He said my type of colitis was caused by an allergic reaction, possibly triggered by the bacteria. Im taking metronidazole and some others, and If he gives me that treatment I trust him the 100%, he is a brilliant, caring doctor. (unlike the derms i've seen =/) Ah finally I got to just go to the doctor, follow the treatment, and get on with my life =)´

And Koki wrote later: ´I'm just gonna talk from my experience, my rosacea swelling is directly proportional to my stomach upsets. So after having a beautiful skin all my life (complimented by Sephora workers) and never having stomach anything... I developed hives, rosacea blepharitis and bad stomach problems during a 1 month lapse. I went to a GI dr who tested my for stomach pain and all that, and I based on my biopsy during the colonoscopy it was found I have H pylori and lymphocytic colitis. So can an immune reaction in the body cause inflammation ...?? ABSOLUTELY. At least in my case. I guess every rosacea is different, the only thing researches have found is increased inflammatory mediators´

Auburn replied: ´I never had any stomach problems until about three years ago, when I noticed my skin was reacting to fluorescent lighting. I think asymptomatic seb derm was also present then. My GI tract issues were: GERD/acid reflux (also experienced some IBS-like symptoms for a while, perhaps as a consequence of an endo-colonoscopy).´

      

Bokkie replied: ´I've been diagnosed with Leaky Gut, and after spending the last couple of days reading through a lot of posts, have started today with Glutamine twice a day also Acidophylis twice a day. I am also drinking a digestive enzyme with lunch and dinner. (I eat oats for breakfast.) Also once a day a tea spoon of apple cider vinegar in a cup of water, and once a week physilium husk in water. I have p&p and deep red cheeks rosacea, though no flushing. Very dry skin. My other problem is I have no gallbladder left and red a post by Auburn saying to stay away from bitters... (..) The digestive enzyme I take is Solgar's Digestive Enzyme.´

Artist wrote: ´Hi Gang: I"m on Cipro right now for a bladder infection and guess what. My rosacea symptoms are getting better and better. I'm further convinced SIBO (small intestinal bacterial overgrowth) plays a big part in my rosacea. See SIBO treatment info here. Note that the antibiotics best used to treat it are the same as for rosacea (metro and tetracycline), and that the diet recommended is, you guessed it, low sugar and carbs. "a diet free of simple sugars and grains/cereals and low in fruit and starchy vegetables depending on individual tolerance. This diet restricts the nutrition available for bacteria in the upper GI tract to proliferate and reduces the excess alcohols and organic acids that are produced as a result of bacterial fermentation." Cipro is another used for SIBO, although I'm not sure why it's not been tried for rosacea. There is another antibiotic used for SIBO that doesn't cross the intestines, so it doesn't go systemic. Rifaximin. Seems that would be ideal.. There was a recent study with this drug and rosacea. I'll post in a bit..Jack is up!´

Yumecouk wrote: I just saw a naturopath in the south of France while vacationing and she also believes there is a link between rosacea and the gut. He gave me capsules of Mare Milk. (... scroll to What other things you can do to minimize your bowel problems for more info from Yumecouk on this Mare Milk).´I think most naturopath or alternative medicine practitioners tend to establish a link between the gut and the facial skin problems (along with many other problems). I saw an acupuncturist last year and she immediately said that the first thing to fix for the face to get better is the gut. Same with this naturopath. She identified the intestine as my weak point and the thing to heal first and foremost for the rest to improve. So far, no change...i am going to go get a stool test soon to check for bad bacteria overgrowth...i am also going to try Pau D'Arco and finish my course of Mare Milk to see if it helps...if not, i might just give Rifaximin a shot...And i have to stop eating so much brown rice. I don't eat any sugar, processed food, gluten...but i eat lots of brown rice and i guess these bacteria must love it....why do doctors speculate h pylori might cause acne rosacea?´ 

ScarletDaria has rosacea and bowel problems and wrote about them here. 

´I have decided to document my attempts here to control rosacea by correcting gut issues. For years now I have had symptoms of IBS – bloating, gas, and chronic constipation. For a long time, I had no idea that there was a connection between the skin and the gut. For more about this, I recommend reading Chris Kresser’s work, particularly this podcast. Chris claims that all patients he has treated that have skin issues also have gut issues.´ (Read below how ScarletDaria experimented with Rifaximin and diet to address both her health problems).

I wrote here about my IBS diagnosis and wondered if people felt the two can be related. 

Krstn tested positive for H Pylori: ´Well, I've been retested for H. Pylori infection and this time breath test came back POSITIVE (I had a 20 which is the maximum score I think). After 5 days of treatment (Amoxicillin 1g, clarithromycin 500mg, omeprazol 20mg) my GI symptoms appear a little bit better (hardly noticeable) and my face unfortunately still looks red, I mean...I still have those pink patches on my cheeks and some small bumps like under the skin... If this horrible bug is not the cause of my Rosacea, then I don't have a clue what else can be...since I'm a young healthy man, 22 y/o with no other health issues, eating healthy food, no alcohol at all, never applied any creams, it's ridiculous what I'm going through. Maybe the redness in my cheeks will fade away with time, after the bacteria presence is totally eradicated... ...I've read a lot of articles saying H Pylori has nothing to do with Rosacea...I'm sad."

MasK replied: ´Mastic gum is as powerful as all these drugs to eradicate H. Pylori infections, with no side-effects, unlike these antibiotics and PPI (omeprazole). 100mg 3 times daily on an empty stomach is enough. They will just put more problems in your GI tract. I know what I'm talking about, I took omeprazole during 10 years, stopped it 1 year and half ago, this drug let me with severe deficiencies and bacterial overgrowth. And I had H. Pylori infection, treated with these antibiotics. I don't tell your the state of my digestion now. That's why I'm totally against these sh*** now but I know doctors are always right...Just my story.´

Mrsmoof replied: ´Hang in there and keep us posted! I see my dermatologist in a couple of weeks and am going to request the following: Vitamin levels test, SIBO test, H. Pylori test, Test for low stomach acid. I will see what comes from those results and treat accordingly. Then I am going to have allergy tests done and go from there! Hopefully that will help out a lot with my Rosacea.´ (..) By the way, the test for low stomach acid is the Heidelberg capsule, and it's not easy to find a clinic which is doing this.´

Happycat replied: I have H. Pylori as well and tried everything under the sun to get rid of it, including Mastika and the test keeps coming back positive. I don't know if HP has got anything to do with my rosacea, nothing seems to make sense, when digestion is good skin is bad and there are times when they are both bad. I don't know.´

JohnDoe wrote; The last few days I've been thinking that the Helicobacter Pylori bacteria may be the cause of my rosacea. These are the facts:

- I have severe reflux problems, major symptom of the bacteria
- I almost always have a bloated feeling after eating, also a symptom
- When I drink alcohol, the next day I got almost no redness
"There are also claims that pure Alcohol taken on an empty stomach early in the morning will kill H. Pylori. Only one of my patients tried that approach, and although the symptoms did indeed disappear for a while, they eventually returned as severe as before." (See more here) [..] Next week I'm going to ask my doctor for the "triple therapy" consisting of proton pump inhibitors such as omeprazole, lansoprazole and the antibiotics clarithromycin and amoxicillin and see whether or not it will help me.´

MasK replied: ´Mastic gum and licorice root are efficient to treat H Pylori and they don't have all the side effects of the triple therapy. Triple therapy will kill your beneficial flora and lower your stomach acid, so you could experience other issues, and worsen the condition. Maintaining your stomach acid to its best level is also needed to avoid H. Pylori infection as it inhibits the acid by releasing ammonia.´

StephenB wrote: "Despite doctors telling me no link between stomach pains and rosacea time and time again after emergency surgery for burst colon after diverticulitis - guess what - no rosacea immediately and still none after 2 years with similar diet. I'd recommend everyone with rosacea to have colonoscopy as rosacea is simply an indicator of stomach issues IMHO. Regards"

Scientific information about the link between bowel- and skin problems

"Walton S, Sheth M, Wyatt EH. Department of Dermatology, Hull Royal Infirmary, Humberside, England. Although rosacea was formerly believed to be associated with gastrointestinal upsets, no one any longer finds a significant association between rosacea and the intestinal tract. We describe four patients with a combination of ulcerative colitis and rosacea. In all four, ulcerative colitis preceded the onset of severe papulopustular rosacea, and we therefore feel that the severity of rosacea could have been due to the associated bowel disorder. In one, the severity and poor initial response of rosacea to treatment was clearly related to the activity of the ulcerative colitis, and the rosacea improved only after proctocolectomy. While it is possible that this purported association is fortuitous, we report these cases in the hope that others may have seen this combination of diseases, to our knowledge previously unreported." "Rosacea and ulcerative colitis: a possible association (article)"

*I found another rosacea blog, where the author made a post about digestive problems versus rosacea. I quote: "Digestive problems have been linked to rosacea as early as 1967. In recent years, studies have suggested that a bacterium called Heliobacter pylori could be a marker of digestive problems in patients with rosacea. While some studies report a positive relationship between H. pylori and rosacea, other studies have found no significant difference between the number of H. pylori in the digestive tracts of control subjects and rosacea patients. H. pylori is a gram negative bacterium that has been thought to cause an increase in the synthesis of reactive oxygen species in the gut such as nitric oxide (NO). NO and pro-inflammatory cytokines play a role in the inflammatory processes underlying the rosacea pathology. However, no increased rate of NO synthesis could be linked to H. pylori. Studies have also looked at a possible link between H. pylori and other skin conditions, such as psoriasis, and vascular disorders. However, for most of these conditions, eradication of H. pylori failed to show any beneficial effect. For most of these studies, a variety of antibiotics was used to eradicate H. pylori." Because there is still no final conclusion on this H. Pylori, I leave it out of this blog entry discussion, and might dedicate a full thread to it some time soon hopefully.

David Pascoe wrote an interesting post about SIBO eradication leading to rosacea clearance
He comes to a sensible and critical conclusion and sub questions: `This sort of abstract just make me shake my head. If you read quickly you will think that this abstract suggests that Small Intestinal Bacterial Overgrowth (SIBO) causes rosacea. What this abstract is saying that is that rosacea sufferers seem to have a higher incidence of SIBO than non rosacea sufferers. The secondary result is that eliminating SIBO clears rosacea. Well that is no surprise ! Antibiotics interrupt the inflammatory pathway that causes the papules and pustules of rosacea. We all know that. What would be interesting to explore further would be what causes the SIBO. Could that cause point back to something triggering papules and pustules ? If you view the AbstractPlus you will see that SIBO has been linked by the same team to Scleroderma, abnormalities in acromegaly, and IBS.

Small Intestinal Bacterial Overgrowth in Rosacea: Clinical Effectiveness of Its Eradication, Clin Gastroenterol Hepatol. 2008 May 2, Parodi A, Paolino S, Greco A, Drago F, Mansi C, Rebora A, Parodi AU, Savarino V. Department of Internal Medicine, Gastroenterology Unit, University of Genoa, Genoa, Italy. CONCLUSIONS: This study demonstrated that rosacea patients have a significantly higher SIBO prevalence than controls. Moreover, eradication of SIBO induced an almost complete regression of their cutaneous lesions and maintained this excellent result for at least 9 months.

Extended Conclusion: In fact in 78% of our patients, skin lesions fully cleared an in 17.7% improved greatly 1 month after interrupting rifaximin therapy. Moreover, all rosacea patients who remained unchanged with placebo treatment and were switched to the antibiotic arm showed the same dramatic improvement of their lesions. Last, rosacea was kept in remission in 96% patients followed for at least 9 months, and this remarkable finding contrasts with the frequent relapse observed with the traditional therapies.

David went on to update on a thread on The Rosacea Support Community, where a patient tried Rifaximin and improved, but gave the additional information that Rifaximin doesn´t leave the gut and doesn´t enter the blood stream. Its anti inflammatory effects on rosacea skin can therefore only be explained as resulting from the elimination of the bowel inflammation itself. Not as a mere side effect from the antibiotic, almost like tetracycline antibiotics can clear up rosacea simply by their systematic anti inflammatory actions in the overall body. 

David asked an author called Seth to explain the test results in his own words, which resulted in a comprehensive, long explanation:

– Study 1 –

The most common way to test for bacterial overgrowth in the small-intestines is for a patient to fast and then ingest a specific carbohydrate. When the carbohydrate reaches bacteria in the intestines they will ferment it and one of the by-products will likely be hydrogen gas which can be detected in the breath. If there is overgrowth in the small-intestine there will be a premature peak of hydrogen released before the material reaches the colon (where it will be fermented regardless). However, hydrogen is not the only gas that bacteria may produce during fermentation and thus this test may give an incomplete picture. This will be returned to in their latest study. The first Italian study found that about half of rosacea patients were positive by using the hydrogen breath test, where as in healthy people they found the rate was about 5%. The probability of this result being a coincidence is less than 1 in 1000. Half of the SIBO-positive rosacea patients were treated with rifaximin, which is an antibiotic that is essentially not absorbed from the digestive tract and therefore does not enter the body or bloodstream and cannot directly reach the skin. In fact, the only likely direct effect of rifaximin is on bacteria in the intestines. In those treated patients, 20 of 28 became symptom-free and 6 more greatly improved. The other half of SIBO-positive rosacea patients were treated with placebo and showed no improvement. Again the probability of these treatment results being coincidence is less than 1 in 1000. When the placebo treated patients were switched to rifaximin, 17 of 20 cleared completely. Overall, 78% of all rifaximin treated patients became symptom-free and 18% improved greatly. Again the probability of this improvement being coincidence is less than 1 in 1000. Finally, successfully treated patients were observed for 9 months and 96% maintained symptom clearance/improvement without further intervention. Of the 2 patients who suffered relapse, SIBO proved positive again and another course of rifaximin cleared their rosacea symptoms once more. However, as mentioned at the beginning, only half of rosacea patients were found to be hydrogen producers (i.e. SIBO-positive) and the results discussed so far only relate to investigating these patients. Rifaximin was also given to patients that had tested negatively in the hydrogen breath test and disappointingly there was little evidence of any symptom improvement.

– Study 2 –

In the new study, a second type of breath test was introduced that measures methane production. They took 15 rosacea patients who were hydrogen positive (as in the first study) and 15 who were methane positive. They gave rifaximin to each group and the hydrogen producers were on average cleared of rosacea symptoms (or at least greatly improved) whereas the methane producing patients showed little or no improvement in symptoms (and no change in methane production). They then treated the methane producing patients with metronidazole (an antibiotic with a long history of usefulness in rosacea therapy and also very effective at targeting methane-producing bacteria in the intestines). Following treatment, the methane producing patients on average experienced complete symptom-clearance, or at least significant improvement and near-clearance of methane production. What is interesting about this second study is that it sheds light on why rifaximin was not able to clear rosacea in all patients in the first study. It would seem that the species/class of intestinal bacteria responsible for triggering rosacea symptoms is not specific and different bacteria appear to be responsible in different patients and therefore, different antibiotics are capable of improving symptoms. It is also interesting, since this provides an explanation for why metronidazole has in the past, demonstrated itself as an unusual, but effective treatment for rosacea. It is also interesting, as they point out, that at the very least, they have found a new way to very accurately predict the patient response to a given antibiotic therapy by their profile of hydrogen and methane breath test results. This is a new and intriguing discovery about rosacea, with important implications. This study is also inspiring, since it keeps open the possibility that intestinal bacteria may play a fundamental role in causing rosacea symptoms in all patients. - Finally, it is interesting, given the apparent diversity of bacterial species involved, that it would seem less likely that rosacea symptoms can be mediated by a specific metabolic by-product from bacteria fermentation and some other mechanism may be at work (the mechanism I favour – activation of the plasma kallikrein-kinin system >> bradykinin >> neurogenic inflammation – is outlined in my earlier study from 2004). Anyway, this summarizes what’s been demonstrated and I watch this area with hopeful interest. If anyone has any questioned let me know. I include the abstract to the second study below in case the web link is removed in the future.

David Pascoe later updated

"The study included patient with flushing and redness, but only counted skin lesions in their statistics. As they specifically noted that only these symptoms were relieved, I suspect that this means that no other benefits were noted. BTW a scanned copy (with comments) of this paper is available here."

Mike criticised Davids take on things, especially on his take that clearance of rosacea could result from the systemic anti inflammatory potential of oral antibiotics 
"Not sure you are reading the article correctly, Davo. There seem to be some non sequiturs in your reasoning. The article does indeed state that in 96% of those rosaceans who were shown to have SIBO (using fermentation tests), eradication of the overgrowth resulted in clearance of their rosacea symptoms. Of those that subsequently relapsed at nine months (4%), all had recurrence of their SIBO. Eradication of that recurrence again led to remission of their rosacea. As rifaximin has very low systemic absorption (almost all of it stays inside the GI tract and is not carried to the rest of the body), this clearance cannot be accounted for by the anti-inflammatory properties of the antibiotic. While not absolutely conclusion, this is actually fairly strong evidence that, in those rosaceans who had SIBO, the SIBO was causative. As referenced above, further studies have additionally shown that not all rosaceans with SIBO have overgrowth of the same organisms. Distinction is made between hydrogen producing bacteria (treated with rifaximin) and methane producers (resistant to rifaximin but susceptible to metronidazole).This is actually an exciting line of inquiring that has compelling initial empirical support and should be encouraged rather than disparaged by the rosacea community."

And: "This is cutting edge research not standard of care. Few dermatologists have incorporated therapies like this into their practices. Also keep in mind that in the study remission was achieved only in those rosaceans who had positive breath tests indicating overgrowth. If you don’t have SIBO, this treatment will not be curative. But if you do, it is certainly worthwhile!´Another potentially curable cause of rosacea (in some patients) is overgrowth of the demodex mite. This can be established with a skin scraping or biopsy. If you are one of the lucky few whose rosacea is caused by this mite, treatment with Elimite, Eurax, or ivermectin can be curative. Unfortunately, rosacea is a complex, multifactorial disease, and it seems that most cases of rosacea do not neatly fall into either of the above two categories. However, this not mean it cannot be controlled. I think it is the experience of most of us with this disease that we need to be our own advocates. Take the time to educate yourself about rosacea, plug into a support group or online forum, and don’t be afraid to experiment a little to find out what works for you."

Artist had some rosacea success when she treated her SIBO with Cipro, and posted further scientific info
It shows more rosaceans have SIBO, and that rifaximin cleared breakouts in 85% of the rosacea sufferers. 85% - that's HUGE! Here is the best part. Rifaximin does NOT cross into the body. It stays in the intestine. So, it doesn't even get to the skin. This is significant because we know the effects are due to getting the bacteria out of the small intestine, not the anti-inflammatory action on the skin (since it doesn't get to the skin). "After SIBO eradication we obtained a complete recovery of cutaneous lesions in 17/20 (85%) and a relevant improvement in 2/20 (10%) patients, while those treated with placebo remained unchanged (14/16) or even worsened (2/16), (p<0,001). These latter patients were subsequently switched to rifaximin therapy with complete resolution of rosacea in 14/16 and significant improvement in the remaining 2 cases."

PubMed also publishes on this same topic. ´Intestinal alkaline phosphatase: the molecular link between rosacea and gastrointestinal disease? 
"Rosacea is a common inflammatory condition of the facial skin of unknown etiology, which frequently occurs in combination with gastrointestinal disorders. Many dietary and hormonal factors are known to affect the severity of rosacea symptoms, several of which also modulate the activity of the enzyme intestinal alkaline phosphatase (IAP). The role of IAP in inhibition of an inflammatory response to intestinal bacteria suggests a mechanism by which intestinal pathologies may be linked to the skin inflammation characteristic of rosacea. Analysis of alkaline phosphatase activity is routinely performed on blood samples, and methods to quantify enzyme activity of the intestinal isoform specifically have been described.  Correlations between IAP activity and rosacea symptoms in patients and controls can thus be screened by noninvasive and inexpensive means. If IAP activity is found to be low in rosacea patients, acute symptoms could be treated with oral IAP supplementation, and trials of IAP-activating medication currently used in gastrointestinal disease could be initiated in rosacea patients. More importantly, the safe and long-term control of rosacea could be undertaken by patients themselves through dietary modifications to naturally increase IAP activity"

The Examiner writes how eliminating unhealthy gut bacteria might cure rosacea (link)
"In 2008, researchers from the University of Genoa in Genoa Italy, presented their findings on the effectiveness of eradicating rosacea in patients who tested positive for SIBO. The study involved 113 rosacea patients who were tested for SIBO. Patients positive for SIBO were treated with eirher the antibiotic Xifaxan or a placebo. Results showed that the positive SIBO rosacea patients treated with Xifaxan had significant clearing of skin lesions, whereas the placebo patients did not. When the patients receiving placebo were then switched to Xifaxan, a significant increase in clearing or complete resolution of their rosacea was noted."

This Pubmed article reports about remission of rosacea, induced by reduction of gut transit time
"Rosacea is a chronic disorder characterized by hypersensitivity of the facial vascularity, presenting with intense flushing eventually leading to chronic erythema and telangiectasia. Although the precise aetiology of rosacea is not known, numerous associations with inflammatory gastrointestinal tract disorders have been reported. Furthermore, substance P-immunoreactive neurones occur in considerably greater numbers in tissue surrounding affected blood vessels suggesting involvement of neurogenic inflammation and moreover plasma kallikrein-kinin activation is consistantly found in patients. In this report, a patient without digestive tract disease is described, who experienced complete remission of rosacea symptoms following ingestion of a material intended to sweep through the digestive tract and reduce transit time below 30 h. It is possible that intestinal bacteria are capable of plasma kallikrein-kinin activation and that flushing symptoms and the development of other characteristic features of rosacea result from frequent episodes of neurogenic inflammation caused by bradykinin-induced hypersensitization of facial afferent neurones, such as fibromyalgia, is considered."


In this blog entry the author zooms in on this study, and goes on to describe why sea buckthorn might be beneficial for rosacea and gut issues 
"Seabuckthorn has long been known for healing gastrointestinal disorders, including bacterially induced ulcers. It has also been known to heal rosacea, in particular with its anti-inflammatory actions. However, what if part of sea buckthorn's strength in treating rosacea is due to its salutary affect on the gastrointestinal system?"

However this 1967 article, in  in The Lancet, no increased prevalence of gastrointestinal illnesses was observed in rosacea patients
"Investigation in 62 patients with rosacea and 62 control patients with other skin disorders disclosed no difference in the prevalence of gastrointestinal illness or symptoms in the two groups.Rosacea patients were significantly heavier than the control patients. The diet in 33 patients and 33 control patients did not differ significantly. Gastric biopsies in 18 patients with rosacea and 16 control skin patients, presented " blind " to the pathologist, revealed no demonstrable differences. Jejunal biopsies in 34 patients with rosacea and 34 patients with other skin diseases, again presented " blind " to the pathologist, revealed no demonstrable consistent abnormality. One reason for the belief that the pathogenesis of rosacea is linked with gastrointestinal disorder may be that rosacea patients flush more frequently and more easily when eating or drinking than do control patients." This PDF document informs about the role of SIBO in rosacea and the clinical effectiveness of its eradication.

Dermaharmony published an article on how probiotics, prebiotics, digestive health and stress influence rosacea
"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. 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 mediatorsbrady-kininandkallidin, 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 article goes on about the beneficial effects of prebiotics." 

In this youtube video MD Leonard Weinstock talks about the link between rosacea and the gut and how treatment with Rifaximin cleared their redness and flushing. He also shows pictures of his patients, before and after their Rifaximin course

Brady Barrows replied to a rosacea patient asking about rosacea and H Pylori stomach infection
"There have been at least six micro-organisms associated with rosacea theories, one of them Helicobacter Pylori. It has been one of the more debated theories and could be listed as one of the more controversial subjects, however, it keeps coming up in clinical research papers even though many rosacea 'experts' have dismissed H Pylori with rosacea." This is just a selection of articles and studies. If you google ´Gastrointestinal + rosacea´ you will find many more links online. 

Colitis patients who complain about rosacea symptoms

On this ulcerative colitis forum, patients wrote about their rosacea symptoms

Forum moderator wrote: "I think I am going to make a doc appt soon but I was wondering how many of you suffer from Rosacea?  I started getting a rash on my upper lip and chin about a year ago.  I went to the doc for it and I was prescribed a cream that actually made it worse.  So I stopped it, the rash came and went - never went back to the doc for it.  I thought it might of been from the flouride in my toothpaste so I stopped flourinated toothpaste, went to all natural but the rash never went away completely.  So now, fast forward to now and for the past few months, the rash is now on my lower cheeks, chin, nose and upper lip with a dry feel on my lower cheek (jawbone area).  I was looking at some pics of Rosacea and it looks like Erythematotelangiectatic Rosacea.  I am already using Euchrin redness face wash and Euchrin redness cream and they help alot.  I mean this totally stinks!  I finally get my psoarasis under control when I went on 6mp and now I have to deal with this!  Anyway, I know that the websites say there is no known cause of Rosacea so I was wondering how many Uc'ers have this skin condition?"

BadGutGirl wrote: "I have it too. My rosacea started flared badly about 3 months ago, my UC about a month and a half ago. The rosacea is now on almost all of my face, neck and chest. My doctor just says "oh its adult acne, nothing you can do about it" ... *sigh*"

Potty girl replied:"I have it also, mine seems like it gets worse when I am flairing. I use a otc triple antibiotic cream, it works for me." [..] "I dont have it all the time mine kinda comes and goes it seems like with how I feel. If Im feeling bad then my face is normally red with that funky mark between my eyebrows and my cheeks get real red. but when Im feeling ok its not normally there."

Munchkindd replied:"I'm one of the lucky ones that also has Rosacea.  I actually posted something on here aboutit before, asking if anyone else had it.  I didn't get any replies, which led me to believe that I was the only one on HW that was lucky enough to have UC & Rosacea.  I was dx'd with it about 18 years ago. [..] The redness on my face varies quite a bit.  Hot weather or hot beverages, spicy foods & nerves will increase the redness, along with cold weather and cold beverages and alcoholic beverages.  If I get aggravated about something, the redness will show up almost instantly :( My dermatologist prescribed Finacea and Noritate cream for it.  I am not good at using them, I tried to be before but I didn't really notice much difference at all.  Also, when I am flaring, the redness increases." [..] "My dermatologist has done blood tests to check the a.n.a level for lupus. Sometimes it is higher than others, he hasn't tested me in probably 2 years now. Sometimes I was borderline for lupus level."  [...] "It's not that the Rosacea is related to UC, but they are both auto immune diseases. Aren't we lucky to have both??"

Forum moderator replied to that: "Is Rosacea an auto immune condition?? I was looking for that specifically when I was doing a web search but the websites said that Rosacea had no known cause including the official Rosacea support website. But it wouldn't surprise me any if it was. I seem to be getting the grab bag of auto immune conditions lately. Lordy I feel like I'm falling apart at 38 geez."

Munchkindd replied:"I haven't found any info saying that it is an auto immune disorder either. I believe my dermatologist said something like "alot of people that have UC also have Rosacea" or something similar to that, and I just took it out of context."

Charlie2 wrote: "Hi I have UC and roscea on my cheeks as well. I use rosaliac cream which does help somewhat, avoid tomatoes and wear 60 sunblock."

Piper_chris replied: "For the past month or so people have commented about my rosy cheeks. I just assumed its one of the many changes in my body due to my meds. When I read this post I looked at my cheeks closely in the mirror and looked at some photos of rosacea online, looks like I have a mild case. I don't think its bad enough to need any treatment at this point."

Tina wrote in a reply to a rosacea blog post on this topic: "I’ve had digestive issues for around 6+ years now. A lot of the signs have been pointing towards gluten intolerance but and I’ve gone off and on forms of exclusion diets over the years but never truly stuck to it. About 4 months ago I started having constant stomach distention with a variety of other digestion related issues. On top of that, my cheeks started to flush every day. For months, every day it starts around 11 a.m and will end around 3p.m. It’s pretty consistent and it accompanied by a lot of heat – it also comes on with emotional stress. So, I have to get serious about getting to the bottom of it because it’s really affecting my life. I’m on a variety of supplements and just changed brands of krill oil and coincidentally, I seem to be flushing less on a daily basis (but still really bad with emotional stress). So, I’m going to cut out the krill oil and go back to fish oil (never had issues while on that) and start a gluten intolerance diet to see if I can get some relief from the bloating, distention, flushing, etc. I may be having malabsorption issues too – vit D specifically. I’m getting retested in another month. If you have any clinical article/tests I can pass onto my dr. that would be great! Thanks!!"

Emma also replied to the blog post: "This is in line with my experience: my rosacea was awful for about two months (my main symptom is “pimples” on my cheeks and clogged pores, relatively little redness/flushing) and I couldn’t figure out why. I couldn’t think of anything I was doing different….except I had stopped taking acidophilus capsules regularly. I started again and my skin improved within TWO DAYS. Right now I take the expensive enteric-coated ones, but I’ve gotten results from less expensive brands as well."

Mimi replied: "Thanks so much for posting this information. I was just diagnosed with rosacea yesterday and have been doing research and getting scared since. When I saw this post -alkaline phosphatase- stood out to me and I went back to look at the results of my last blood tests (in May)which showed that my level of alkaline phosphatase was below normal range. I’ve been being treated for hypothyroidism, but the tests in May showed that I was taking too much thyroid medication – so Dr. Pushpakaran’s comment is also helpful to me. Thank you again for the information you provide."

Julia Busch replied: "I, too, believe the link between the intestine and rosacea may be a very huge piece of the puzzle, While triggers may include diet, emotional stress, strenuous exercise, as well as other factors, research points strongly to proliferation of intestinal bacteria."

In this forum thread for ulcerative colitis patients, coexisting rosacea was also discussed

Peace&harmony wrote: "I had Rosacea for several year and tried topical and oral antibiotics. This was before I had UC. The only bad thing a read about Rosacea was "low self esteem" and since I didn't noticed any difference from the treatments I stopped. Well...I just had an eye appointment and found out that the Rosacea can spread to the eyes!  Now I got Optical Rosacea which causes burning, stinging, and eye infections (eye infections may need antibiotic treatment)! I was only told to do warm compresses several times a week but it was recommended to follow up with a dermatologist on the Rosacea. So how can I be treated for this with UC?"

Quincy replied: "I don't think it's related to UC, but it is thought to be autoimmune disorder to some specialists/ researchers,etc. I would lean in that belief as well.  I think with one autoimmune issue, others seem to follow.  I believe tendency rather than set in stone...plus, rosacea seems to be inherited.  Is there anyone at all in your family who has it? I feel for you to have to deal with this in conjuntion with UC and other stuff...I have a friend with it and it is distressing at times for her, especially when things have exacerbated." Amd: "I just thought of something...maybe certain medications can also bring it out? or once the body has gone into "overdrive"? My friend who has it has other health issues, and she didn't get it until she had her two kids. No UC, however, but she does have allergies and genalised itching that's helped by some medications. Her mother has rosacea...but no other autoimmune issues that she knows of, but does have some circulation problems. My SIL has rosaces and many sensitivities, her daughter has rosacea and a TON of health issues. My husband has it a bit, but it's never gotten really bad. None have it in their eyes as of yet."

Wimomofthree replied: "I never had Rosacea and I got it about a year ago.  I was diagnosed with my UC in 2009.  So, I wonder."

Luv2Jump replied: "I have rosacea and none of the natural treatments worked for me (seems like there are a lot of scams out there). I used to use Metrogel and that worked ok. But there are some that believe prolonged use of topical antibiotics can lead to mrsa. You can google it to get more info. My dermatologist gave me Finacea and that works ok too. The thing that worked the best though was going gluten-free. Like UC, food and other stressors can trigger rosacea. And like UC, the triggers are different for everyone."

Eil replied: "I was diagnosed with UC about 3-1/2 months ago.  I had no prior history of UC other than my Dad, and had bleeding for approx 3 weeks before my diagnosis and starting treatment.  I am currently symptom free and take 3 lialda daily plus 1 pkt of VSL#3DS.  Since I had the colon under control, I figured I'd go to the dermatologist and get my problem skin looked at.  I was promptly diagnosed with Rosacea and prescribed Metrogel."

In this forum thread patients with Crohn's Disease write about their coexisting rosacea

Amytupelo wrote: "just in the last few months i've been having terrible breakouts on my cheeks - i've tried all kinds of things.. slightly better, but will not completely go away. I was just wondering if anyone else out there suffers from adult acne or rosacea. and if so, what type of skin products do you use?? This 'flare' has somewhat coincided with a new crohn's symptom of swollen joints. i do admit that i brought this flare on myself.. after finishing a month of antibiotics for an intestinal abscess.. i felt better than i had felt in a really long time, and i got a  little carried away with my eating/drinking. a couple weekends of drinking beers and eating hot wings totally caught up to me.   but that is why i thought that crohns and rosacea may possibly be related - both inflammatory..Anyway - anyone else's experiences or advice or opinions would be appreciated. thanks"

Artist guy replied: "I have rosacea, my dr's have never suggested cd with rosacea, I've used creames, but the best is wearing hat, I'm not sure if it's related."

Insagent replied: "I have developed what I am calling acne i would say within the last 6months on my cheeks and chin, I have NEVER had a problem with my skin, it's always been clear even as a teen (I will be 29)."  And: "U know I had better skin even when I was on pred!! Guess I need to go have mine checked out before it gets any worse! Add that to the long list of aliments! Crohns, just had sinus surgery, allergy injections, back pain, shoulder pain, eye problems now skin problems!! I feel like a hypocondriack!! ;)"

Petittarte wrote: "I have rosacea and alternate Metro Gel and Finacea. Derm doesn't want to put me on oral meds due to the crohn's."

This is another thread of Crohn's patients regarding rosacea

Seadreamer wrote: "I've had rosacea for about 14 years and have read it can be related to GI problems. Even before being diagnosed with Crohn's I've known something was going on with my bowels that wasn't normal so figured the two were related in my case. Anyone else have rosacea?"  

Imisspopcorn replied: "I don't have it but it does run on my dad's side of the family. The side where the crohn's is!!"

Soupdragon69 replied: "Yep I do. [..] I have had rosacea for many years pre crohns also."

DanSJVDavis replied: "I don't have Rosacea, but I do have Psoriasis. Came on not long after the Crohn's. I was told the same thing, that it's common with Crohn's. I think it's another of those auto-immune things. Clears up whenever they put me on prednisone. It's annoying. It sucks because I wear a lot of black clothing and it's like dandruff. Do you have dandruff? No, just Psoriasis :( "

Heb replied: "Not sure where to post the my story bit, doesn't seem much room in the profile for that, but I had UC for many years, went for my coloscopy 2 years ago and was told to deal with it within 6 months, got to the surgeon within 1 month and he said we got the cancer just in time, did a total colectomy, had a temporary ileostomy, now have an internal pouch (not a J pouch) and have had many troubles with infections so have had many rounds of antibiotics. Dr suggested probiotics, so using VSL#3 but still having infection troubles. GP thought I have either rosacea or lupus, tests came back negative but am using rosex cream for the redness. Was at the GP for more antibiotics which work well while I am on them, bit frustrating."

Peakey 1553 wrote: "yes I have rosacea and crohns but its worse if i have a drink of alcohol, my face goes bright red on my cheeks and nose."

Becca 1991 replied: "Yes!!! I do started getting it at the start of this year i use Rozex cream."

WCC wrote: "I have had Roscea since high school. Lets just say about 30 years ago. It's all inflammation related/immune issues just like your Crohns. I was prescribed Rosac cream been using it for the last six years or so and it works great."

Jenjen replied: "I've had rosacea for about 10 years now and was dx'd with Crohn's a few years ago. I've been wondering also if there is a link. My rosacea was under control for several years but recently has flared up, coincidentally at the same time as a Crohn's flare. I use prescription Desonide ointment on my face. It's a steroid and shouldn't be used for a long period of time on the face but it's all that's working right now. Thank goodness I'm a girl and can wear makeup to cover it too."

Crystalteaches replied: "I have rosacea. Just diagnosed today. Dermatologist wants me to take Oracea, but he's calling my GI doc first. It supposedly can cause GI issues and I don't need anymore of those. I have small red bumps on my face and neck." 

Archie replied: "Not sure if it's rosecea but might right cheek was really red and sore for about 6 months before I was diagnosed. I didn't think it was related Nd tried all sorts of creams etc, since I've had surgery and am in remission it's cleared up!! So must be related my bleeding gums also stopped after my resection so probably related too."

Irishtarheel replied: "I have Crohns, SIBO and rosacea (which came about in conjunction with the SIBO)...as well as some other autoimmune inflammatory situations that generally accompany Crohns  I'll stop there. Below is a link with clinical information connecting SIBO with rosacea. I am on a Low FODMAPS food plan that, so far, is keeping my SIBO in check, and my rosacea has improved as well. However, when my hormones make their big monthly transitions (2X/month) my Crohns and rosacea both tend to act up a bit, for 1-3 days as does my hand/foot arthritis. That is pretty inevitable. I've had two doctors (at renown institutions) that correlated hormone fluctuations with inflammatory response. There are certainly many variables to rosacea and the whole autoimmune system and its triggers. But consider looking at your diet for a start (do you love eating ALOT of something in particular by any chance?), or investigating your food intolerances, because they can certainly be linked to GI flare/ SIBO/rosacea in some fashion. Also, check your meds to see if one of the side effects is rosacea. You may luck out and be able to skip taking meds for rosacea if you find a food or topical connection which you can eliminate. Note that SCD Diet can be very helpful for SIBO, but it does not go far enough. For example, it allows honey, which is horrible for anyone with SIBO!! So, read up on SIBO & low FODMAPS and talk to your doctor or nutritionist about it. If you have Crohns and have had ileo-cecal resection surgery or currently have any strictures or obstructions, it is fairly common to eventually develop SIBO due to missing your ileo-cecal valve (hi-motility) or having blockage (slow-motility). I am on Low FODMAPS plan for life as a result of having had both. It's really not difficult and I feel so much better! It's the only diet I don't feel like cheating on, because it's helped so much. After years of research, SIBO, and some sound recommendations are finally on the medical profession's radar, thankfully! It's about time...Hope this helps someone out. Link for definition of SIBO: Search this forum. Dave posted links that are a great overview. Link re: rosacea and SIBO. Link and link for Low FODMAPS/SIBO:

Mogre wrote: "I was diagnosed with rosacea 15 years ago, psoriasis 10 years ago, and Crohn's one year ago, though I am sure I have had Crohn's much longer, just not diagnosed. I don't know how directly related they all are, just that my immune system is a mess."

David wrote: "Thanks. All I've found so far is that they've found people with severe rosacea often have polymorphisms in the vitamin D receptor gene."

  

In this thread patients with microscopic colitis discuss their coexisting rosacea
Sheila posted: "After reading many posts and learning a bit about histamines, I am wondering if many others with MC also have rosacea. I'm beginning to think I am sensitive to histamines but don't know yet what else I am either sensitive to or allergic to. Does any else suffer from esophageal spasm? Most of my health issues seem to involve food and eating. They also seem to run in my family with 2 of us with MC, 4 of us with esophageal spasm but only one, me, with rosacea. I don't know if I posted this in the correct place. Thanks for any help you can give. Sheila" This is just a selection of articles. If you google ´Colitis/Crohn's disease + rosacea´ you will find many more links online. 

What are the symptoms of these bowel conditions and how you can test if you have them

-Irritable Bowel Syndrome
This is the name for a group of symptoms. Its considered a disorder of the GI tract, without the GI tract being actually damaged. Other names are spastic or nervous colon. Symptoms include abdominal pain, absominal bloating, change in stool frequency or consistency, bloating and cramping. Its estimated that 3 till 20% of the general population has IBS, but doctors are known to diagnose IBS often and sometimes prematurely. The causes of IBS are not well understood and thought to include psychological causes, GI motor problems, bacterial gastroenteritis, small intestinal bacterial overgrowth (SIBO), altered neuro-transmitter chemicals in the body and food sensitivities. I have been diagnoses with IBS and symptoms for me include abdominal bloating after eating foods like legumes and unions or drinking carbonated drinks. Also extercise and simply walking can cause my belly to swell. Idem for having tight fitted belts or pants. I usually wake up with a relatively flat stomach and find that it tends to bloat in the course of the day. Whenever you experience abdominal bloating which doesn´t change over the course of the day or week and which causes pain, please go to your doctor and ask for tests to rule out colon/ovarium cancer.

-Inflammatory Bowel Diseases like Crohn's Disease and ulcerative colitis 
Inflammatory bowel disease can give similar symptoms as IBS, but typically also include symptoms like rectal bleeding or bloody stool, together with mucus loss in the stool, cramping, bloating, pain and stool changes (often either constipation or diarrhea), ulcers and weight loss. Both diseases tend to wax and wane and involve periods of accute illness and periods of relative remission. Please see a doctor whenever you have any of these symptoms, they will look at your symptoms, history, do blood tests, they might make X-rays, do stool tests, or perform a colonoscopy where doctors look closely at the bowel lining and take biopts to research them further and look for signs of inflammation. 

-Small Intestine Bacterial Overgrowth (SIBO) 
Doctors speak of small Intestine Bacterial Overgrowth (SIBO) when bacteria's -pathogens or beneficial- are found in the small intestine and have overgrown it. Its a chronic bacterial infection of this small intestine. Here they interfere with normal digestion and food absorption, causing nutrient deficiencies, more bacterial overgrowth, gas production and flatulence. Problems arise when: They decrease proper fat absorption by deconjugating bile leading to deficiencies of vitamins A & D and fatty stools. Through the damaged lining, larger food particles not able to be fully digested, enter into the body which the immune system reacts to.  This causes food allergies/ sensitivities. Bacteria themselves can also enter the body/bloodstream.  Immune system reaction to bacteria and their cell walls (endotoxin) causes chronic fatigue and body pain and burdens the liver. Finally, the bacteria excrete acids which in high amounts can cause neurological and cognitive symptoms. A diagnosis is made by culturing bacteria from your bowel, through a sample of fluid taken from your small intestine. This sounds more simple than it is, because culturing requires a long flexible tube to be passed through the nose (yep..), down the throat and the esophagus and through the stomach, under X-ray guidance, so that fluid can be obtained from the small intestine. Apart from being uncomfortable and expensive, there are also doubt about the quality of the culturing by some labs. Another option is doing a hydrogen breath test. Bacteria living in the colon produce gas, most commonly carbon dioxide, but also smaller amounts of hydrogen and methane. Although the majority of the hydrogen and methane are used up by other bacteria's, a small amount of it is absorbed through the lining of the colon and into the blood. They then circulate in the blood and go to the lungs, where they are eliminated in the breath. They can therefore be measured with special analyzers, usually a gas chromatograph.  For a hydrogen breath test patients fast for at least 12 hours. Doctors can also measure glucose for the hydrogen breath test. Downside is that this test often only properly diagnosis 60% of patients with SIBO. There are also underlying bowel problems which can influence the outcome of this test (for instance pancreatic insufficiency and celiac sprue). The outcomes for SIBO and a condition called Rapid Intestinal Transit can look similar, making both conditions hard to distinguish from each other. When you have slow transit through the small intestine, you will need to sit 5 hours for the test, which not many people are willing to do. And Crohn´s Disease can also give a false positive SIBO test and cause similar symptoms as SIBO.

See http://www.onhealth.com/small_intestinal_bacterial_overgrowth/article.htm.

Brady Barrows just posted an interesting article about SIBO versus antibiotic use. 

"Bacterial Overgrowth"

"An article by Cathy Wong discusses how bacterial overgrowth in the small intestine can cause many health problems. One of the causes listed is taking antibiotics which most rosaceans have done. She discusses several natural methods on how to treat bacterial overgrowth. If you think that bacterial overgrowth may be a problem for you I suggest you read her article. How do you know if you have bacterial overgrowth? There are some tests to take to confirm it, for instance, taking bacterial cultures of small intestine fluid, or the lactulose hydrogen breath test. Some signs and symptoms of bacterial growth are:

*abdominal bloating and gas after meals
*pain
*constipation
*chronic loose stools or diarrhea - (studies have found 48% to 67% of people with chronic diarrhea had bacterial overgrowth. soft, foul-smelling stools that stick to the bowl)
*fatigue - megaloblastic anemia due to vitamin B12 malabsorption
*depression
*nutritional deficiency despite taking supplements
*weight loss
*abdominal pain
*mucus in stools
*bloating worse with carbs, fiber, and sugar

Some of the causes of bacterial overgrowth are: Decreased motility in the small intestine - caused by excess dietary sugar, chronic stress, and conditions such as diabetes, hypothyroidism, and scleroderma. In the United States, up to 40% of chronic diarrhea in people with diabetes is associated with bacterial overgrowth. Hypochlorhydria - as people get older, the amount of stomach acid they secrete decline. Because stomach acid is acidic and helps to kill bacteria in the small intestine, if there is less stomach acid, bacteria are more likely to proliferate. Another very common cause of hypochlorhydria is due to excessive use of antacids. Structural abnormalities in the small intestine - gastric bypass surgery, small intestinal diverticula, blind loop, intestinal obstruction, and Crohn's disease fistula are some of the structural causes of bacterial overgrowth. Other causes include immune deficiency, stress, certain medications such as steroids, antibiotics, and birth control pills, inadequate dietary fiber, and pancreatic enzyme deficiency.Treatments for bacterial overgrowth. Diet - Low carbohydrate diet (like the Rosacea Diet). Eradicate unfriendly bacteria in the small intestine using herbs such as peppermint oil. Replace - Bacterial overgrowth impairs friendly bacteria ("probiotics") and digestive enzymes. Betaine Hydrochloride. Herbs such as: enteric coated peppermint oil, Grapefruit seed extract - (for people who don't like taking capsules, grapefruit seed extract can be found in liquid form. Add a few drops to a glass of water and drink in between meals). Oregano oil capsules, Garlic, Flaxseed Oil, Berberine - goldenseal, oregon grape, Olive leaf extract Pau d'arco

Doxycycline
It has been noted by one report that "resistance to doxycycline can occur in a few days, with resistant bacteria in abundance after just seven days of treatment with 100 mg doxycyline daily," though this report wasn't about Oracea (or low dose timed released doxycycline) but instead about high dose doxycycline.Rifaximin. It has been reported that a short term treatment of Rifaximin may be an alternative to long term Oracea or Doxycycline treatment or other antibiotic."

Helicobacter pylori 

H. pylori is a spiral-shaped bacterium commonly found in the stomach. The bacteria's shape and the way they move allow them to penetrate the stomach's protective mucous lining, where they produce substances that weaken the lining and make the stomach more susceptible to damage from gastric acids. The bacteria can also attach to cells of the stomach, causing stomach inflammation (gastritis), and can stimulate the production of excess stomach acid. Although it is not known how H. pylori infection is spread, scientists believe it may be contracted through food and water. According to the National Institutes of Health, approximately 20% of people under 40 years old and half of adults over 60 years old in the U.S. are infected, with higher rates in developing countries. Having H. pylori infection doesn't necessarily mean you'll have ulcers or develop stomach cancer. In fact, most people infected with the bacteria never have symptoms or problems such as ulcers. Only a small number of people with the infection develop stomach cancer. It's not clear why some infected people develop ulcers and others don't. When H. pylori does cause symptoms, they are usually either symptoms of gastritis or peptic ulcer disease. The most common symptom of peptic ulcer disease is gnawing or burning abdominal pain, usually in the area just beneath the ribs. This pain typically gets worse when your stomach is empty and improves when you eat food, drink milk, or take an antacid. If you are a carrier of H. pylori , you may have no symptoms. If you have an ulcer or gastritis, you may have some of the following symptoms:
·                Abdominal pain
·                Bloating and fullness
·                Dyspepsia or indigestion
·                Feeling very hungry 1 to 3 hours after eating
·                Mild nausea (may be relieved by vomiting)
Several types of tests are available to help diagnose H. pylori infection and/or ulcers. These include: Upper GI (gastrointestinal) series. An X-ray of the upper GI tract -- the esophagus, stomach, and duodenum. Prior to the X-ray you must swallow a chalky liquid called barium, which makes ulcers show up on the X-ray. Endoscopy. A procedure that involves snaking a thin, flexible tube with a camera down the esophagus, through the stomach, and into the small intestine to view the upper GI tract. Blood test. A test that looks for antibodies in the blood that indicate exposure to H. pylori. Stool test. A test that uses a small sample of stool to look for evidence of infection. Urea breath test. A test used to check for the presence of a gas produced by the bacteria. The most accurate way to diagnose H. pylori is through upper endoscopy of the esophagus, stomach, and duodenum. Because this procedure is invasive, it is generally only done on people suspected to have an ulcer, or who are at high risk for ulcers or other complications from H. pylori, such as stomach cancer. Read for more information: http://www.nytimes.com/health/guides/disease/helicobacter-pylori/

Gastroesophageal reflux disease 

Gastroesophageal reflux (GER) occurs when stomach contents flow back up into the esophagus—the muscular tube that carries food and liquids from the mouth to the stomach. GER is also called acid reflux or acid regurgitation because the stomach’s digestive juices contain acid. Sometimes people with GER can taste food or acidic fluid in the back of the mouth. Refluxed stomach acid that touches the lining of the esophagus can cause heartburn. Also called acid indigestion, heartburn is an uncomfortable, burning feeling in the mid chest, behind the breastbone, or in the upper part of the abdomen—the area between the chest and the hips. Occasional GER symptoms are common, but Gastroesophageal reflux disease (GERD) is a more serious, chronic––or long lasting––form of GER. GER that occurs more than twice a week for a few weeks could be GERD, which over time can lead to more serious health problems. People with suspected GERD should see a health care provider. GER happens when the lower esophageal sphincter—the muscle that acts as a valve between the esophagus and stomach—becomes weak or relaxes when it should not, causing stomach contents to rise up into the esophagus. Other factors that can contribute to GERD include
·  obesity
·  pregnancy
·  certain medications, such as asthma medications, many antihistamines, pain killers etc
·  smoking, or inhaling secondhand smoke
A health care provider may refer people with suspected GERD to a gastroenterologist—a doctor who specializes in digestive diseases—for diagnosis and treatment. A completely accurate test for diagnosing GERD does not exist. However, several tests can help with diagnosis: Upper GI series. While a gastroenterologist does not use an upper GI series to diagnose acid reflux or GERD, the test can provide a look at the shape of the upper GI tract. An x-ray technician performs this test at a hospital and a radiologist interprets the images. Upper endoscopy. A gastroenterologist may use an upper endoscopy, also known as an esophagogastroduodenoscopy, if a person continues to have GERD symptoms despite lifestyle changes and treatment with medications. An upper endoscopy is a common test used to evaluate the severity of GERD. This procedure involves using an endoscope—a small, flexible tube with a light—to see the upper GI tract. Esophageal pH monitoring. The most accurate test to detect acid reflux, esophageal pH monitoring measures the amount of liquid or acid in the esophagus as the person goes about normal activities, including eating and sleeping. A gastroenterologist performs this test at a hospital.  Esophageal manometry. Esophageal manometry measures muscle contractions in the esophagus. A gastroenterologist may order this test when considering a person for anti-reflux surgery. The gastroenterologist passes a soft, thin tube through the person’s nose into the stomach. The person swallows as the gastroenterologist pulls the tube slowly back into the esophagus. A computer measures and records the pressure of the muscle contractions in different parts of the esophagus. The test can show if symptoms are due to a weak sphincter muscle. See for more information:   http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/

Celiac Disease

Celiac disease is an immune reaction to eating gluten, a protein found in wheat, barley and rye. If you have celiac disease, eating gluten triggers an immune response in your small intestine. Over time, this reaction produces inflammation that damages the small intestine's lining and prevents absorption of some nutrients (malabsorption).The intestinal damage can cause weight loss, bloating and sometimes diarrhea. Eventually, your brain, nervous system, bones, liver and other organs can be deprived of vital nourishment. There's no cure for celiac disease — but following a strict gluten-free diet can help manage symptoms and promote intestinal healing. Blood tests for gluten autoantibodies (These are IgA based tests accurate only while on a gluten containing diet)

·                EMA - anti-endomysial

·                TTG - anti-tissue transglutaminase

·                DGP - Deamidated Gliadin Peptide

     A small bowel biopsy to assess gut damage. For those with suspected dermatitis herpetiformis, skin biopsies will be taken of the health skin near the lesion.

Irishgenes wrote about her diagnosis on The Rosacea Forum: 
"I have no idea if they are related, but I think that IBS is really a "catch-all" diagnosis that gastroenterologists make when they have ruled out most things it could be and just don't know what it is. Makes them sound smarter than they are. If you are having a lot of pain, I would not give up and accept that diagnosis, but keep going to different doctors and looking for the real cause. I went to 6 different gastroenterologists for severe pain which was erroneously diagnosed as IBS. They kept telling me I'd have to learn to live with it. I finally went to see one of the two most famous GI doctors in the US. Turns out I really had a stricture of the "sphincter of Oddi" where the bile duct empties into the stomach. This is fairly common with people who have had gallbladder operations, but like rosacea, most doctors know little about it. I had an operation which was done by inserting a tube down my throat and was cured. [..] Another cause of your "IBS" could be endometriosis, where the lining of your uterus implants in odd places like the bowel. You shouldn't look 4 months pregnant just because of IBS. A thorough exam with a laparoscope by an EXPERT gynecologist is in order, but I don't know if you have any choice of doctors in the Netherlands." [..] "I had a barium enema, a fluroscope swallowing test, a colonoscopy, a small bowel biopsy, many fecal tests, an ultrasound, and a CT scan done by the 6 GI doctors who couldn't find what was really wrong with me. Once a doctor has made up his/her mind it is IBS, you will rarely get another opinion from them. I think they believe IBS is psychological."

How many rosacea patients tried treating their bowel problems (for instance with Rifaximin) and what did they report about the effects of this on their rosacea

G. Nase wrote: "There definitely is a link between rosacea flares and major GI disturbances like colitis and IBS. The new IBS drugs targeted to relieve IBS motility, secretion of vasodilators and pain blockade can really help female rosacea sufferers. It appears that Lotronex may work by blocking serotonin 5-HT3 receptors that are found in the gastrointestinal tract and central nervous system and which may mediate pain perception as well as gastrointestinal motility," The thing that I discount is the "Leaky Gut Syndrome" and other overemphasized naturopathic claims."

Teresa wrote: "One possible cause of "digestive" problems could be celiac's disease - a sort of allergic response by the intestines to wheat, barley, rye and possibly oat proteins, or gluten. My mother-in-law was diagnosed with it a couple years ago. Previously, she had many digestive problems along with excessive gas, bloating and diahrrea (sp?). Taking all the above foods out of her diet has helped tremendously! I actually had testing for food allergies a few years ago, and it was found that my food sensitivities included wheat, barley and rye. I know there are manyschools of thought on how accurate these tests are, but I have found great relief from acne, bloating and skin rashes by avoiding these foods. Check out Celiac on the web - it is much more common than you'd think and many of the symptoms are confused with the symptoms of other various diseases."

#The author of this rosacea blog wrote about her bowel problems in relation to her rosacea: "My digestive problems started around the same time I was diagnosed with rosacea. I did not think anything about it and thought that my digestive problems were the result of too much stress, anxiety or an allergic reaction to a particular food ingredient. I did find some foods that I reacted to (peanuts, peas, bananas), but I never knew if my digestive problems were really based on any allergies. However, my digestive problems continued and became progressively worse over time. The cramping and other GI problems became so bad, that I saw several doctors for it, including a liver specialist. The doctors could not find a particular cause of my digestive problems, however when I went to see a doctor with heavy cramping and a high fever, he thought it could be diverticulitis. My diverticulitis was treated with a heavy dose of antibiotics and the cramps and fever disappeared. However, thesymptoms of diverticulitis returned periodically and I started to look at alternative treatments. During my search for alternative treatments of my digestive problems, I came across several scientific papers about a possible association between H. pylori and rosacea and the eradication H. pylori with extracts of mastic gum. Mastic gum is the resinous gum of the Pistacia lentiscus tree and a few studies suggested it was effective against H. pylori. So I took mastic gum for a few months and my diverticulitis completely disappeared (at least the symptoms). Every time I notice any cramps, I take mastic gum capsules for a few days. While mastic gum does seem to work well for GI problems, I am not sure whether mastic gum has any effect on the redness, inflammation and swelling of the face associated with rosacea. The scientific community is still not sure whether mastic gum can eradicate H. pylori, but based on personal experiences it does seem to help with digestive issues."

Siliconmessiah wrote: I have got oral Flagyl (also known as Metronidazole) for my rosacea, made things much better for me overall. Flagyl (Metronidazole) is a common prescripted drug for rosacea in northern Europe. A two month dose of the drug knocked back my rosacea almost completely, one year later I felt my rosacea made a little "comeback". Used the rest of my Metronidazole for a month and it made it better. A good side effect of Metronidazole was that my IBS got better. Now I only use pills with Lactobacillus Plantarum, keeps my guts in shape and my IBS is totally gone. I get an occasional rosacea breakout now and then, if I don´t watch out what I eat. (fried food, french fries, chocolate, cheese, sugar)  

Artist wrote about her use of Cipro for her SIBO problems, and how this helped her with her rosacea as well: ´Hi Gang: I"m on Cipro right now for a bladder infection and guess what. My rosacea symptoms are getting better and better. I'm further convinced SIBO (small intestinal bacterial overgrowth) plays a big part in my rosacea. See SIBO treatment info here. (..) Cipro is another used for SIBO, although I'm not sure why it's not been tried for rosacea. There is another antibiotic used for SIBO that doesn't cross the intestines, so it doesn't go systemic. Rifaximin. Seems that would be ideal..!´

Artist later updated: ´Yes, I tried it (Rifaximin, SR) (with my doctor's approval, of course) and it went well. However, I had to pay for the pills and they were really expensive. The positive effect lasted about two months. Not a cure, but symptoms improved in general. I experienced similar improvement when taking Cipro sometime after that for a bladder infection. Cipro works in the same way, except it goes systemic (absorbs into your blood). I hope it helps both your rosacea and IBS. Be sure to let us know how it goes, and as with any new medication or treatment, be very careful (check with your doctor..)´

She also commented on David Pascoes blog:´SIBO causes fermentation in the small intestine, which can be a trigger for some rosaceans. I am very sensitive to fermented foods, and fermented food is listed as a trigger by the NRS. Cipro is also used for SIBO, and I noticed that while on a course of it for a bladder infection, my rosacea improved for about a month. I later tried a course of Rifaximin (after reading this study) with the same results. Specifically, the treatments greatly diminished the redness I tend to experience in the mornings when I first wake up for an hour or so. The fact that Rifaximin does not cross the intestines into the body means it never even gets to the skin, so the benefit may likely be due to eliminating the trigger of SIBO. Cheers! -Artist´

DP replied to her comment: ´I saw this abstract after researching treatments for my rosacea. Coincidently, a week later I came down with diverticulitis and was treated with 2 strong antibiotics, one was cipro the other was metro something, to clear the infection in my colon. So, I waited to see what effect the antibiotics would have on my skin and I can tell you it’s a miracle. I don’t even need cover up. FYI – I would describe my rosacea before the antibiotics as as moderate.´

ScarletDaria has rosacea and bowel 

problems and wrote about them here: 

´Initially I tried to fix my gut issues with diet. After cutting out wheat and realizing it made a huge difference in the way I feel, I went on the full blown Paleo diet in May 2011. I don’t eat any grains at all, no milk, and no sugar. I am currently not eating much starch either, so no potatoes. The idea behind any of these similar diets (paleo, SCD or GAPS) is that you remove the food source of the harmful bacteria types in your gut to starve them out of existence, and they apparently thrive on disaccharides. Many people are successful with this. However, I was finding that diet alone was not improving my skin or my gut. Any time I attempted to take probiotics or eat fermented foods my skin would break out within a day or two. I began to suspect something was really wrong. I finally went to see a Gastroenterologist in August 2012 and got tested for Fructose malabsorption and SIBO (small intestinal bacterial overgrowth.) I can handle fructose just fine, but the SIBO was undeniably positive. The doctor put me on Rifaximin 3x a day for 2 weeks. This is a strong antibiotic that is supposed to remain locally in the gut. I began to feel better, the bloating disappeared and my stomach was never flatter. My skin began to clear up, I didn’t get any further pimples during this time and redness subsided. I could only see acne scars from previous pimples. Unfortunately after finishing the antibiotic, I caught a terrible cold that took me 2 weeks to clear. Prior to this I haven’t had a cold in a long time so I’m afraid the antibiotic also wiped out some beneficial bacteria that keeps theimmune system strong. Once the cold was over, I noticed my gastro issues returning. The bloating came back and the constipation never actually went away. My skin started breaking out again! I returned to the doctor yesterday, and he suspects the SIBO is not yet gone. I am doing another round of Rifaximin.For constipation, I am going to start taking Magnesium Glycinate ( the type Chris Kresser recommends because it is absorbed well). I’ll start with 600mg a day and see if that makes a difference. I think increasing my intestinal motility makes sense.´ (...)  Took the last Rifaximin pill today so it ends my two week cycle of antibiotics. About a week in I noticed the bloating improved again. My skin also improved somewhat, my rosacea is not completely gone, but I got very few new bumps during this time.´

She later updated: ´Sadly the benefits don't seem to last. Once again my skin is breaking out and my bloating/gas has returned. While I'm on the antibiotics everything improves, but I can't stay on them forever. In fact everything I read says it should only make things worse long term. Anyway, the search continues for long term solution. Also, I went to a dermatologist for the first time, she gave me several creams to use and none of that is making a difference so far. I still think the gut issue has to be addressed.´

Mariet replied: ´If you have food allergies that make you flush, your rosacea is for sure also linked to your gut. If on the top of that you have IBS and colitis... I would be you, I would really try to find out more about that.´

LoisAnne replied: ´Do you think that going on the antibiotic Oracea would work? It is a low dosage that is supposed to be below the level of working as a true antibiotic and yet it helps with rosacea. It might not be strong enough to help with the gut issues but it is something that you could (supposedly) use safely for long term if it did help your skin. I agree that gut issues have to be involved. As I have mentioned before, when my face was at its worst, about 3 years ago, I had a routine colonoscopy and had to do the prep stuff that totally cleaned out my gut. My face cleared up for several days, the best it has ever been. I am sure it was a result of having to cleanse my intestines.´

Oopsiedaisy wrote: ´The SIBO link is interesting. When the studies first came out about a possible connection between SIBO and rosacea, I did get tested for it and, although the results showed I do not have SIBO, my doc agreed to let me try a course of Rifaximin (Xifaxan) to see if it would clear my rosacea. It had absolutely no effect whatsoever for me. I know that in some rosaceans it worked really well and they achieved clearance, but for others rosacea doesn't seem to be connected to SIBO.

Nate didn´t find clearance of his rosacea from Rifaximin: ´After having tried a course of Rifaximin and then an immediate course of Metronidazole following the failed Rifaximin treatment, I can safely say that this study is not as conclusive as it might sound. I experienced little to no clearance in the majority of my symptoms and I did follow the same dosages listed above (1200mg Rifaximin a day for 7 days and 500mg of Metro for 10 days). May others willing to try this have better luck than I.´ 

David Pascoe linked on his site to an interesting experiment by a rosacea patient who also has IBS. Red wrote about her trial with a specific type of probiotics. She reported: "Luckily, now after 4 weeks of this increase in die-off reactions, things seem to be dying down pretty well. The odd hacking asthmai-like cough that I've had for years (and which didn't clear up completely after antibiotic or high-dose Vit D3 treatment) seems to have decreased again greatly. I may be noticing some decreased food allergies already too. I still have a lot of sinus drainage, etc - which has been the hallmark of antimicrobial treatments for me, but I've notice that my skin seems to be less dried out too." I didn´t read further explicit news on her rosacea and IBS. 

Stuart wrote: ´This is very interesting and exiting! It was about three years ago that I was diagnosed with rosacea as my symptoms were getting quite bad, at about the same time I started getting bad acid reflux issues and ended up with painful esophageal ulcers. I have since been treated with doxycycline and rozex for the rosacea and nexium for the acid reflux. Both conditions are better but still definitely there. I have always suspected the two were linked but my doctor never said anything about it. I wonder if this is related. Anyone else had issues with acid reflux?

Al tried Rifaximin for the medium to severe roacea on his chin and reported: ´Here I am, 5 days or so after my Rifaximin treatment has ended and the open sores on my chin have healed up but I still have residual little pustules. I’ll report in another week or so. Of course, I’m VERY excited to have the abscesses cleared up, but am trying not to be too “on board” with this whole thing as they could have cleared up due to something else of course. One never knows. We shall see.´

Hammer asked: ´Just curious, did you do the breath test prior to using the antibiotic (to confirm the bacteria strain)?

Al replied: ´No, I spoke to my Doc about the breath test and as the drug was only $50 ( 2 weeks worth of Decaf non-fat mochas ) I just did it as I was more interested in if it solved the problem rather than if I had the problem. Very un-scientific but if it works, I’m just as happy not knowing if I had Hydrogen-breath. Looking at this again, it would have been of more value to everyone else ( less anticdotal ) if I done the test first.´

And he later updated: ´Lesions began to clear about 5 days after I finished my 10 day course of meds. Still had little white pustule things coming up here and there – but somewhat minor. Now, all lesions but one are gone, and it seems to be on the way out but has a single persistent white demon from hell inside that won’t go away. So, all-in-all, very inconclusive. Yes, I’m basically clear and no more pustules forming but I could not definitively say that it was the Rifaximin that did it, although I tried to avoid introducing any other changes (hygiene, diet etc . . . ) and I was a mess beforehand. As far as flushing goes, I did buy tampons for my daughter the other day at Safeway and was nailed by a well placed joke at the register by an employee who happened to be behind me. And I flushed. But my primary trigger is a glass of white wine which I have not had lately. I suspect that this course of treatment has nothing to do with flushing but I guess I’ll never know. Well worth the 50 bucks though. If I do not clear completely in the next few days, I do have a microscope on order thru Amazon as backup and will self-test for demodex – just for kicks.

IWillBeatThis wrote about aleviating her rosacea and (assumed) H Pylori:
´My husband is a doctor and we sat down to figure this out. It resembled an attack on your immune system, where the body tries to fight back at something, loses the battle and imflammation sets it. We discovered research on something called Helicobacter Pylori, an ugly bacteria that lives in the lining of your stomach and releases a protein called Bradykinin. This protein is known to be a vasodilator (makes your veins expand). Sure enough, when we didblood tests, I had raised Creatinine levels, and creatinine is the stuff that gets left over after your body breaks up a protein (in this case Bradykinin). We decided to try eradication therapy of H Pylori:
1. Amoxicillin (2 capsules twice a day)
2. Clarithromycin (2 capsules twice a day
3. Omeprazole (1 capsule a day)
For the first three days, nothing happened. On the fouth and fithy day, the Rosacea plaques I had on my cheeks started going away. It cleared up by day six. And on day seven, I put myself through the ulimate test- n stayed in a hot bath for an hour, WHILE drinking a glass of red wine, Two big no-no's. No red cheeks, no burning, no nothing. I will report on this thread for the next three weeks, an update every second day, to see if this lasts. Much love to all of you fellow sufferers out there....´ 

Peter replied:´Hello IWillBeatThis, The Helicobacter Pylori bacterium like the Demodex mite has been right up there on the top 10 list of the main suspected culprits for the cause of rosacea but nobody has ever been able to confirm that it does plays a part. If you Google “Helicobacter Pylori” and “Rosacea” you will find various information on studies etc: This is taken from one link: "In a study by Turkish researchers, 25 helicobacter pylori-infected rosacea patients were given treatment for H. pylori consisting of the oral antibiotics amoxicillin and metronidazole for two weeks as well as bismuth subcitrate for four weeks.(1) The severity of rosacea symptoms showed a significant decrease at the end of treatment compared with the initial scores. "It should not be surprising that rosacea symptoms may improve during treatment for H. pylori, since antibiotics have long been successfully used to treat rosacea in all patients," said Dr. Larry Millikan, chairman of dermatology, Tulane University. "Smaller dosages of oral antibiotics are routinely prescribed to bring rosacea under immediate control, along with long-term use of topical antibiotics to maintain remission." In a more recent controlled clinical study of 44 rosacea patients with H. pylori infection in the United States, half of the patients were treated for H. pylori and half were not. When examined two months after treatment, there was no statistical difference in rosacea symptoms between the treated and untreated groups.(2) Anyway the good news is that your treatment is helping and I would stick with it. It sounds like though it’s the anti-inflammatory effect of the antibiotics which is the reason rather than anything else.´

Linda SL replied: ´I know this is an older post, but my Rosacea was cured with antibiotics also almost 13 years ago. I still have the damage with broken blood vessels which I work on everday naturally. But the Rosacea is gone. The antibiotics were so strong it almost messed me up somewhere else. I couldn't even take the last dose it was so bad. But it did cure Rosacea and my ulcers. I had it so bad. I looked like I had a very bad sunburn and my friends couldn't even look at me. I think everyone should get a test for the H-Pylori. I only went to get rid of the H-Pylori because I was getting ulcers for years. I was a real mess with ulcers. I was sick of being on Zantac to keep the acid down. I knew this stuff was going to hurt me in my later years. I wanted so bad to get healthy again. I couldn't believe it!! It killed two birds with one stone. I couldn't believe it cured my rosacea, I was thrilled beyond belief. I even discussed this with a dermatologist and he agreed with me that rosacea was connected to the H-Pylori. I've been cured for 13 years now.´

IowaDavid wrote about digestive issues versus rosacea: 
"Your rosacea and IBS may be linked as two signs that your systemic inflammation is too high. I know it sounds strange, but some of us get the "fun" genes and we can't handle some of the things we put in our bodies--namely sugar, gluten, dairy products, lots of refined carbohydrates. (I don't know what your diet is like--I'm not trying to criticize you from a position of ignorance.) The thinking in a functional medicine approach is that all diseases are basically rooted in a systemic inflammatory response. Wherever we're weakest (genetically speaking) as in rosacea, is where you'll begin to see failure of your body to keep up with this chronic inflammatory response. But you see it occur in other organ systems or body parts: arthritis, neurological disorders, cardiovascular, pulmonary, etc. If you have two inflammatory disorders in two different body systems already at age 17, you may want to do some research on changing your diet to an intensive nutritional approach while minimizing those foods that cause inflammation. I know, I know--this sounds a bit crazy at first and some will think it's fringe back-to-the-earth fad nonsense. I imagine you're already careful about your diet, but perhaps not in the way that would best serve your symptoms. Check out www.terrywahls.com as a start. I hope you like your green veggies and bone broth! Seriously, though, it took me about a year of *kind of* following her program (and those of other like-minded doctors) to eat to reduce the systemic inflammatory load on my body. Once I got strict about not eating gluten, no dairy, no sugars/carbs, within a couple of weeks my asthma symptoms have started to really clear up. It's been nothing short of remarkable in terms of the correlation (I would say "cause and effect" but that may be imprecise given the data set I have to work with). Funnily enough, I didn't ever test as allergic to dairy or gluten--this is how insidious these inputs can be that produce inflammation. Chronic inflammation, at a low level, can build on itself and antagonize your weakest points (your facial blood vessels in rosacea, the lining of your colon for IBS) over an extended period until they're so sensitized, you're really stuck for answers and suffering. I'm not going to say that changing your diet along the guidelines given by Dr. Wahls will solve ALL your problems. I would bet, however, that if you learn to adopt them and can stick with it, you will feel much, much better. I'll also add that for your rosacea specifically, I would read up on low-level red light therapy, which is a way to control the inflammatory response in your face from the outside. Red light therapy (RLT) has been a huge help for my case, and I was EXTREMELY subtype 1--flushing, burning, reacting to everything. I really wish someone had been able to tell me about RLT back when I was 18 or 16 years old and pre-rosacea, so I could have halted the disorder's progress and saved myself a lot of trouble and wasted months not being able to leave my house, form or maintain relationships, or hold down a job. I have been in that world of living inside, hooked to the outside by a computer, because of this disorder, man. It sucks. It's no way to live. You can and will find the best way to treat your concerns and get your life back on track." 

Mistica brought up the topic of fecal microbiota transplantation: "I thought this paper might be of interest to those who believe the gut plays a large role in rosacea. http://www.2ndchance.info/inflambowel-Borody2012.pdf Dr Borody is my specialist and I am being treated for gut infections. It is a long road, especially as I had great difficulty tolerating the antimicrobials. (And still do). Some time ago, during one of my 'check-in's with the medication nursing staff, I asked on behalf of the autoimmune patients in this forum, if Dr Borody's crew had ever successfully treated anyone with autoimmune disease? Or treated them without success? I was particularly interested in cases of Lupus, Connective Tissue Disease ( I have early signs of this) and Thyroid disease. Today I received an email with an attached paper citing the resolution of Idiopathic Thrombocytopenia in a patient suffering from Ulcertative Colitis, treated with a fecal transplant. I can't find links to it on the internet, so I am not sure if I am allowed to post it. Meanwhile I did a search and found the above paper, which does mention this particular case, but more importantly, mentions various other cases, including MS. I am also aware of Parkinson's patients being successfully treated. (Dr Borody treats patients with Dr Stratton's protocol for Cpn as well). I ended up in Dr Borody's office due to long term constipation, bloating, mulitple food intolerances, some intermittent abdominal pain and quite a colourful history of systemic and gut infections. Of course, my primary interest was if he could resolve my horrendous flushing and accompanying rosacea. I am not sure Dr Borody realises that many rosaceans flush, as he seemed more focused on the P&P type. He has treated many patients with this. But he was sympathetic to the gallons of blood pumping through my face ( as he termed it) and said he would be agreeable to trying to help me. I am an experiment, however. But I had exhausted all other avenues and had reached the end of the road. I am classified as disabled. Personally, I believe Cpn also plays a role in rosacea, particularly in my entire syndrome, but I failed the treatment for that, due to a nasty reaction to metronizadole, and that only leaves the gut as a potential target. I really wish there were precedents as knowing other flushers had been cured already would make this path and a transplant much easier to deal with. I have not decided what I want to do yet. There are matters to discuss.`


-Wikipedia defines Fecal microbiota transplantation (FMT) -also known as a stool transplant- as the process of transplantation of fecal bacteria from a healthy individual into a recipient. It has been proven to be a highly effective treatment for patients suffering from Clostridium difficile infection (CDI), which produces effects ranging from diarrhea to pseudomembranous colitis. Read more on it here.
-This video and article explain how Experimental fecal transplants could revolutionize treatment of bowel diseases.
-Wonder cure for gut: FDA allows fecal transplants (Link to article). A quote: ´The idea of recolonizing a troubled intestine with someone else’s “good” bacteria is far from new. In The American Journal of Gastroenterology last year, a researcher in China noted evidence of its use there in the fourth century, for patients near death from food poisoning or severe diarrhea. At about 100 trillion per person, the microorganisms making up the “gut flora” vastly outnumber the body’s cells. New recognition of their power has prompted research into their relationship to obesity, allergies, asthma and a variety of inflammatory and autoimmune disorders. At Seattle Children’s, Dr. David Suskind has just finished the first FDA-approved studies of fecal transplants in children with inflammatory bowel disease. Those with ulcerative colitis didn’t see much improvement, but seven of 10 Crohn’s patients went into remission — results similar to those of drug treatments with more potential side effects.´

Fecal therapy for Crohn´s and colitis 
Quote: ´The procedure, also known as fecal biotherapy, involves the transfer of saline-diluted fecal matter into a patient’s GI tract through an enema or nasoduodenal catheter. Repopulating the gut with healthy bacteria in this way can dramatically reduce symptoms and put some UC patients into remission, according to small case studies and anecdotal reports. These preliminary findings are raising hopes in the IBD community that this novel treatment could be a possible cure. (..) In an earlier study, the McMaster researchers found that seven of eight UC patients responded to fecal transplants and six patients remained well one year following treatment. “We’re seeing success rates of 80 to 90 per cent. This kind of clinical trial is absolutely essential for a new treatment to become astandard of care,” says Dr. Surette, who holds a Tier 1 Canada Research Chair in Interdisciplinary Microbiome Research and is well known for his research on the complex relationships between bacteria and disease.´ This treatment, fecal biotherapy, might sound gross, but it seems promising to say the least for inflammatory bowel diseases and the intestinal bug Clostridium Difficile, but whether or not it might be helpful for rosacea patients with diffuse digestive problems is unclear. I asked my dermatologist about another treatment option which seems more controversial, the transplantation of pig worms, which has helped some people with severe inflammatory bowel  and autoimmune diseases. The theory is that some autoimmune diseases are triggered by our clean and healthy lifestyle, not allowing the immune system to attack the until recently natural enemies like (ring)worm infections, something everyone in the old days was exposed to and went through. Instead, theory goes, the immune system now sometimes turns against the own body, as it is programmed to clean up and attack, but finds no worm infections anymore to fight against. Infecting the body with pig worms has resulted in the clearing of inflammatory bowel lesions in the bowel of patients and also switched off the autoimmune disease itself at times. I wanted to know if such a treatment was optional for me, and if it might help me combat my colitis/rosacea/Raynaud´s/arthritis/allergies etc. But my derm said he knew about the treatment but deemed it too risky at this stage. If I remember correctly he mentioned the risk of blood poisoning and other hefty side effects. It was not safe enough yet, was his end verdict, but he did believe in the effect of this treatment in some cases. I continue to be interested (curious) however in these treatment methods for inflammatory bowel disease and autoimmune problems, both through fecal and pig worm transplants. More information on pig worms:

Worm Eggs may heal ulcerative colitis
Upset tummy? Try some Pig Whipworms
Drinking Pig Worms to fight Crohn´s Disease
And in this article, a scientific link is made between infecting the body with intestinal worms (yeh, yuck) because they naturally calm down the immune system of their host in order to survive. Something foudn beneficial for those with rampant auto-immune conditio0ns where the immune system has gone in overdrive.

"Should You Deliberately Infect Yourself With An Intestinal Worm For Your Health?"

"Helminth therapy is a new frontier in experimental medicine, promising to cure all manner of conditions from allergies to autoimmune diseases to irritable bowel syndrome to even, possibly, autism. Here’s the catch: It is not yet recommended or approved by the FDA and there is very little interest in the treatment from members of the established medical community. This means anyone wanting to try it out for themselves will have to sign onto a clinical trial (which are sporadic and small in number), travel abroad, or look to the grey market and the unregulated, often scrupulous companies offering helminth therapy online. So what does this encouraging – if deeply controversial – therapy actually involve? The short answer: intestinal worms. Patients purposefully inject or ingest intestinal worms (aka helminths) or their larvae to reboot their immune system and calm symptoms of inflammation-related conditions. The theory goes that, in order to survive inside a human host, a helminth must regulate the body’s immune response and, by doing so, prevent it from overreacting to internal and external stimuli – the physical process behind autoimmune diseases. It sounds icky. After all, most of us have been brought up to think of intestinal worms as parasites and a harbinger of disease, sickness, and, in some cases, death. Yes, contracting worms can trigger a range of unpleasant symptoms, including diarrhea, abdominal pain, malnutrition, and fatigue. It can also impair growth and physical development in children, and in the worst case scenarios be life-threatening. Yet, the right type of helminth in the right quantities may be beneficial to its host – and perfectly safe. “Helminths are a lot like bacteria,” William Parker from Duke University’s Department of Surgery told IFLScience. “Some of them can kill you and some of them are beneficial.” Helminth advocates like Parker refer to the “Old Friend Hypothesis”, which postulates humanity has spent the majority of its existence living alongside benign microbes – and that includes non-harmful parasites and helminths. We’ve co-evolved over tens of thousands of years. In essence, we and they are “old friends”. Only recently, following the economic prosperity and technological boom kick-started by the industrial revolution, we have lost our old friends. Modern society is too clean. At least, it is in the West. More than 1.5 billion people worldwide are infected by soil-transmitted helminths, the majority in sub-Saharan Africa, the Americas, China, and East Asia, and when worm eradication programs do take place, studies show that rates of autoimmune diseases spike in the immediate aftermath.

“[Helminths] are a natural part of our environment that we’ve lost and they really need to be put back into everyone for disease prevention, we believe, not just for disease treatment,” said Parker. Parker, who has spent years studying intestinal worms’ effect on the human immune system, sees helminths as a therapy rather than a drug. He argues we will need to “reconstitute our biomes” by re-introducing helminths to our body’s natural eco-system. “We’ve essentially annihilated them all from our bodies, from our own eco-systems,” he added. “Whenever you disturb an ecosystem, sometimes it doesn’t do what it’s supposed to do.” While it may be that we can all benefit a little from an intestinal worm or two, the people who are likely to benefit most are those with inflammatory health issues – particularly those with an autoimmune disease like lupus, celiac disease, and multiple sclerosis (MS). It could also be used in treatments for digestive disorders like irritable bowel syndrome (IBS), neuropsychiatric disorders like anxiety and depression, allergies, and migraines. Some studies even point to helminth therapy as a possible avenue for people with autism: Autistic adults were more adaptable and less likely to perform repetitive actions following a 12-week program involving whipworm eggs. “The science is very solid,” explained Parker. “You look at all the stuff we’ve done with laboratory animals, for example, and it’s pretty clear that helminths, if used in the right context, can be extremely beneficial.” In the lab, helminth therapy has been shown to halt the progression of relapsing MS, relieve symptoms of IBS and celiac disease, and cure monkeys of chronic diarrhea. Speak to early adopters of the therapy and they’ll impress you with miracle stories of how it treated their previously untreatable illness, whether its allergies or ulcerative colitis. There are currently more than 4,000 people signed up to a Facebook support group. However, not everybody is convinced. Yes, helminths have benefits over drugs currently prescribed to patients with autoimmune diseases, which are immunosuppressive and can put people at risk of developing cancer and other diseases. But they come with their own set of risk: The wrong worm in the wrong dose could trigger adverse side effects, including abdominal pain and weakness. Take journalist Moises Velasquez-Manoff’s story as an example. Velasquez-Manoff took hookworms bought from Mexico to cure his alopecia and hay fever. At first, it seemed to work – his hay fever disappeared and patches of fuzzy hair began appearing on his body – but before long his hay fever returned and the hair stopped growing. The worms gave him cramps and diarrhea. These eventually cleared up but he was still feeling negative side effects months later. Academically-speaking, the field received a major setback when a study examining porcine whipworms' effectiveness as a treatment for Crohn’s disease turned out to be a massive failure, with the helminths being no more effective than a placebo. No volunteers were harmed in the process and researchers now think they know what went wrong – the formulation was off. Still, the experiment’s failure combined with helminths’ ick factor and the million-dollar cost of tunneling a treatment through the FDA pipeline has delayed further research and scientists now struggle to access funding for future clinical trials. Because there has been no large-scale double-blinded, placebo-controlled randomized trial, helminth therapy has not been approved by the FDA. Instead, intestinal worms are listed as an Investigational New Drug (IND), which basically means scientists conducting clinical trials are the only ones in the US allowed to distribute the treatment. This has only forced people to move underground (or, rather, online). Suffering from incurable, frequently painful ailments, many patients with inflammation-caused medical problems are willing to give the therapy a go – with or without FDA approval.

Meanwhile, companies are setting up shop on the Internet to supply the increasing demand. One, called wormtherapy.com, was founded by a man called Garin Aglietti, who claims he cured his own psoriasis using hookworms acquired in Belize. There is a big problem here: These businesses are largely unregulated. And while some people may be selling helminths because they genuinely believe in the health benefits, others more scrupulous may be trying to make a fast buck without having to go through the usual oversight procedures. (After all, subscriptions can cost thousands of dollars.) Furthermore, people are self-administering treatmentS without medical supervision, which can be risky even among the well-informed. What does Parker make of this? “To tell people you have to sit there and wait for the science while you have a disease that you know is going to kill you, that’s ridiculous,” he said. “We don’t condone doing it but at the same time we don’t say you should not go do this.” “Obviously we would like them to be informed and be safe about it because there is a lot of information out there,” he added. Given the current levels of interest (or rather, lack of interest) in helminth therapy from the established medical community, it looks unlikely we’ll see intestinal worms or pills made from their derivatives prescribed by your local doctor anytime soon. Yet, with increasing attention on helminths and other alternative treatments (such as fecal transplants) from people of the scientific community as well as members of the public, a worm-friendly future might not be as far off as you think. In a few years, we might think of intestinal worms like we now think of bacteria – some are good, some are bad, and some are in-between. Though, as Parker admits, this shift in mindset could prove to be “a public relations challenge”.






What other things you can do to minimize your bowel problems

There are side effects with antibiotics (exception is Oracea, low dose doxycycline, <50 mg a day) because they destroy the beneficial flora too. You need to take fermented foods and probiotic pills to restore the flora after the course. It's not a miracle in my opinion. It's just destroying the cause of the issues, which is pathogens. But after that you need to restore the flora, otherwise you will need another course of antibiotics some months later, and lack of flora can cause a lot of troubles.   

Solutionquest writes about the paleo diet he follows and how it improved his bowel issues and rosacea: "I have cut out sugar and am doing a very low carb paleo diet. Working wonders. Bowel Movements have been different-completely. My whole system feels much different actually. But yes, I distinctly remember changes occurring when taking antibiotics as well. I took them for years too! One of the main things I have noticed in doing the paleo diet is that inflammation has decreased ALL OVER MY BODY. I am much more able to do all sorts of stretches and exercises and have them feel like I am working with my body and not forcing it. Much more energy. Most of all- my face- I sometimes don't even feel like I have rosacea. And this is with the cold weather here! I am knocking on wood and staying focused on my diet- still in a very strict phase and it feels good. To let you know how "strict" I am the only thing that is remotely sugary in my diet is one squeeze of raw honey in my green tea. That's it for the sugar. Other than that it is mainly eggs, meat, vegetables and occasional snacks of nuts.Good luck!"  

Bookwatch writes about kefir and probiotics and how taking these improves his symptoms: "I've found that eating kefir grains firms up the bowels very fast, probably because they restore good flora in the gut better than most probiotic supplements and is cheaper. However, I also take Primal Defense Ultra for theLactobacillus paracasei which reduces Malassezia yeast. So you may want to consider making kefir and eating the spare grains. It's easy once you get the hang of it. If you're interested, there's information about making kefir on this website. Hope this helps.  [..]  I've been drinking kefir for about a year and have steadily improved. The only time I stopped was a week when I couldn't eat anything because of oral thrush following a long course of antibiotics. I know the kefir helped me recover and repopulate my gut. I would never want to stop drinking kefir. It's invaluable if you have gut issues."

Mistica started a thread named "Bowel disease and rosacea." She writes about using oil of oregano and Rifaximin to treat the bowel inflammation and bacterial overgrowth.

In this rosacea blog, suggestions are made in terms of diet to limit the bowel inflammation and therefore theoretically also the rosacea symptoms:

"Foods that lower IAP activity IAP enzyme is inhibited by phytates, a substance found in grains and legumes. The only way to properly get rid of phytates is to cook grains and legumes well. In addition, the amino acidphenylalanine (found in some artificial sweeteners) also inhibits intestinal alkaline phosphatase.
Foods that stimulate IAP activity. Here are a number of foods that increase intestinal alkaline phosphatase activity:

·                Short chain fatty acids such as butyrate, derived from butter or from fermentation of dietary fiber in the gut

·                Fish oils (Omega 3, 6 and 9, either as a supplement or from fresh sea food)

·                Dietary Zinc (found in oysters or as a supplement)

·                Vitamin A (as found in carrots, sweet potatoes, pumpkins)

It is further suggested to increase the gut’s alkalinity by eating a variety of fresh fruits and vegetables and stay away from hard and processed cheeses and processed meat. Finally, adding probiotics to your diet may further decrease rosacea symptoms by the colonization of the g.i. tract with beneficial gram-positive bacteria while reducing the growth of LPS containing gram-negative bacteria. Intestinal alkaline phosphatase is also stimulated by estrogen and inhibited by progesterone. For this reason, rosacea symptoms could appear during pregnancy and in women who use birth control pills. Whitehead J. (2009) Intestinal alkaline phosphatase: The molecular link between rosacea and gastrointestinal disease? Med Hypotheses [Epub ahead of print Jun 30]

MasK wrote: `Here are some articles about the link between disrupted gut flora and inflammatory bowel diseases. To reduce intestinal inflammation, you can use licorice root and yucca root. They are both steroidal anti-inflammatory. (brand NOW foods). Also the autoimmune part has to be adressed by building the adrenals, that are responsible for low affinity antibodies tagging healthy tissues. This can be done by using adaptogens likeschizandra sinensis, ashwagandha, ginseng,... and vit c + vit B5. You have to build the beneficial flora with fermented foods and prebiotics. It is also a good idea to adopt an anti-inflammatory diet, low in sugar and starches, low in harsh fibers like wheat bran, and rich in omega 3 oils (avoid omega 6 rich oils like soya, sunflower,...) and olive oil. In my opinion this is another proof that the link between the intestinal health and the inflammatory skin diseases like rosacea is very close. And to anwser your question I do not have IBD like UC or crohn but I have IBS and a long history of serious digestive problems.´

Yumecouk wrote: ´I may have another natural remedy to add to this, depending on the results i get over the next few weeks. I just saw a naturopath in the south of France while vacationing and she also believes there is a link between rosacea and the gut. He gave me capsules of Mare Milk. Apparently Mare Milk is quiet big in France and eastern Europe where it has been used for years in hospitals. It's the closest thing to human milk and it is loaded with vitamins, protein, enzymes, amino acids, minerals and other goodies not found in regular milk. More importantly, it is not allergenic so everyone should be able to handle it. But related to this thread, it plays a much bigger role than a probiotic by re-balancing the gut flora and by also repairing the gut at the same time. At least that's the claim. Will let you know if it is as helpful as they claim. 

Realgone wrote about his treatment of H Pylori:

´I take a probiotic every day. I think I remember reading that probiotics can get rid of H. Pylori. My Naturopath prescribed it to me along with other supplements for my skin. I also did an ELILSA allergy test to find my food allergy/ sensitivities. I have had gallbladder issues for the last three years as well. I have read that H. Pylori can be the cause. I have done lots of things to clear up my skin and it is very clear now despite a recent flare up. I think Bare Minerals is the culprit this time, but other than that following this regime below has changed my life
-2 fish oil tabs a day 650/450 ratio. ProOmega by Nordic Naturals.
-Probiotic once daily. Non dairy Costco brand. TruNatur? I think
-ACES + Zinc. I took this for about a year and no longer use it. I may choose to take it once more since it is a great immunity booster
-Daily Multivitamin
-avoidance of food allergies - beet and cane sugar, and dairy. For 3 months. Now rarely if ever eat sugar and occasional dairy with no problem.
-Castor Oil Patch used at least 3 times a week for 1 month. I still do this occasionally because I find it generally beneficial. I think this also helped heal my gallbladder issues. Skin cleared up perfectly after the diet. My skin had no change until doing all this for 1 month and then until recently, no problem, but like I said, the mineral makeup might be the culprit, plus it has been very dry weather lately. Been doing nightly Bentonite clay masks day and night and this last flareup is just about gone.´

Queta replied: ´I recently tried garlic and it seems to REALLY help my rosacea. I have also noticed that a low carb/no sugar diet and probiotics help. I am wondering if I have h.pylori. I am thinking of trying a new regimen-garlic once per week, mastic gum three days, oregano oil three days, and then cycle through again. If I have any success with it I'll post again on this thread.´       

M wrote: ´My stomach has been playing up recently after coming off the probiotics and trying different foods and I think that's what's doing it, as well as the extra mirtazapine/etc. I've been reading a book about digestion and the GAPS diet and it is excellent, extremely informative and better than any other book about the workings of digestion that I've looked at before. It's making me realise that the source of so many of my bowel and depressive/anxiety problems up to now are directly linked to an inflamed bowel and poor digestion ('leaky gut' sort of thing). Why I put up w/ IBS and feeling tired all the time all my life, I have no idea! I really need to figure out how to improve my diet and integrate some of the good ideas from this book: it suggests a diet based on meat and fish stocks (amongst other things) to initially soothe and heal the gut, and combat diarrhea and other symptoms before eating all the more fibrous and acidic foods again.´

List of links to posts about rosacea versus bowel problems

*On rosacea and irritable bowel syndrome
*Selection of links on Crohn's disease and rosacea
*Colitis and rosacea article links

*Microscopic colitis and rosacea
*http://rosacea-support.org/sibo-eradication-clears-rosacea-are-you-serious.html/comment-page-1
*http://rosacea-support.org/community/viewtopic.php?f=21&t=330&hilit=SIBO&sid=b652b5b7864d30ce22133f9f12d8dfba&start=10
*About digestive problems and rosacea
*Is intestinal alkaline phosphatase a link between rosacea and gastrointestinal disease? 
*http://rosacea-support.org/community/search.php?keywords=rifaximin
*http://rosacea-support.org/community/viewtopic.php?f=13&t=3258&p=26229&hilit=rifaximin#p26229
*http://rosacea-support.org/community/viewtopic.php?f=37&t=3352&p=23823&hilit=rifaximin#p23823
*http://www.rosaceagroup.org/The_Rosacea_Forum/showthread.php?21208-Positive-H-Pylori-infection
*http://www.rosaceagroup.org/The_Rosacea_Forum/showthread.php?23702-H-Pylori
*http://www.rosaceagroup.org/The_Rosacea_Forum/showthread.php?25582-Is-Helicobacter-pylori-the-cause
*http://www.rosaceagroup.org/The_Rosacea_Forum/showthread.php?19076-Helicobacter-Pylori-my-Rosacea-has-cleared
*http://doccarnahan.blogspot.nl/2012/04/part-ii-diagnosis-and-treatment-of.html


Conclusion
This little bit of research further strengthened my beliefs that rosacea can be part of a bigger inflammatory (auto immune mediated) problem in the body. I suspect that there are such numbers of patients with Inflammatory Bowel Disease who also suffer from rosacea, because one can in theory instigate the other and act as the fuel for it. It's very frustrating and depressing to me that so little research is done in this overlapping field. We are treating our rosacea symptoms mostly (with medication or laser/IPL treatments, diets and natural anti inflammatory herbs and supplements), but are not addressing the real underlying problem. I belief that there can be many triggers and causes for rosacea, but in my case I am positive it is the auto immune inflammation that is the motor. Which would explain why I have so many inflammatory health issues: Raynaud´s disease (swollen red hands and feet), colitis, arthritis of the knees, rosacea, inflammation of the ear cartilage. On forums for IBD patients it seems plenty of them also struggle with such clusters of illnesses. It is worth finding out if you have underlying digestive problems. If so, you might find benefit -also for your rosacea- in diets and treatment options for them. As usual, everything comes down to finding your personal triggers and causes. Rosacea is frustratingly personal and requires q hugeamount of initiative and research by every patient. Please ask your dermatologists about these bowel tests and find out if you might have underlying SIBO or other bowel issues, fueling your rosacea. 

Update December 21st 2013

Nadine posted an interesting article on the influence of diet on the gut flora: New study: Gut flora changes quickly in response to diet changes. "This study just came out suggesting that changes in gut flora can happen very quickly in response to diet changes. The study is looking at plant-based vs. meat & dairy diets, but seems like it could apply to other diet changes too. This isn't directly about rosacea, but I'm thinking it could maybe point in the direction of a better understanding of how some of the food triggers work."

Starlite replied: "This is a very interesting study Nadine. Thanks so much for posting it. I remember seeing you had posted it and wanted to read it but got busy else where. I'm glad I hunted it down. It really does seem our bodies were designed to be able to eat either mostly fruit, and/or mostly nuts and greens, and/or animals based products. There's all this conflicting information on diet out there and for everyone there are testimonials of a return to health. It seems to me that it's clear that processed foods have brought an increase in disease. Some people (meaning diet experts, some medically trained, some not) say that it becomes a problem for the body to daily mix diet types. Assuming that the junk food is out of your diet... What seems to be best for people is to maybe just eat nuts and greens mostly for a week or what feels best, then go with a fruit diet for a time, then maybe fish, eggs etc.. That seem like what a real Paleo Diet would be like.. because different foods were available at different times of the year. Maybe we can't handle to shift from meal to meal. The reason I am pondering this is... My clarity of the timing on this isn't great but about 4 years ago.. maybe five I began to get off all the medications they had me on, started to take out the worst things I ate like diet sodas, you know all the nasty chemicals. Went to just a whole foods diet for a while, nothing processed, then I started to eliminate wheat and dairy, then meat until I was only eating low Glycemic Index veggies and nuts. Probably about the third year I added in colloidal silver and garlic to try and get the chronic diarrhea to stop, thinking it was a gut fungal over growth. It stop the gut cramping and pain, but it didn't help with the lose stools. I also added in turmeric to help control inflammation. At one point, as much as I didn't want to, I did a two week run on Fluconazole with no help. A year ago this month! YEAH! I treated for mites with Nu-Stock, TTO, and Zinc Oxide and got my rosacea in remission. I had made a lot of improvements, I went from barely having the strength to take a shower, to walking miles every day and then even started physical therapy to improve my painful joint range of motion. I had however lost a lot of weight and the more demands I put on my body physically, and the less nutrition I was absorbing (it got to a point the food was just going through undigested) a monster starving appetite kicked in. As in the body screaming "Find Food" "FIND FOOD!" I am certain it is at this point I should have listened to it and added back in eggs and bone broth, like suggested for the bowel disease diet. I did not because I prefer to be a vegan and I was convinced I needed to keep the toxins to a minimum. I increased protein in as many ways as possible with out adding back in animal products.

Anyway.. something like 6 to 8 months ago I went and found an awesome physician's assistant.. I LOVE this guy. Told him what I had read on here about SIBO and asked if he would be willing to do the recommended dose of Rifaximin 400 mg 3x a day for two weeks. He was willing and I started it. (Oh BTW I had been tested for everything and they could find nothing. I've got all the symptoms of Chronic Fatigue, Fibromyalgia, arthritic changes and painful inflammation in all my joints especially the hips and back, my asthma cleared up from the diet changes) Anyway.. within two days it was working, after years of serious bowel problems I was having normal "activity" :)  However, two days after I stopped the Rifaximin it all came back 10'xs worse along with incredibly painful cramping. I had all the symptoms of "C. diff" but did not test positive for it. I was devastated. I mean I lost my will to live. I know malnutrition can profoundly effect your state of mind, but the hopelessness was also about the pain and loss of success. The new Doc put me on Metronidazole 500mg 3x's a day for two weeks and right about three days near the end of the prescription the pain left and things returned to "normal." However during this time due to the intense cravings and loss of motivation I added back in bread and yogurt.. then after a holiday event sugar. Before the meds ran out I went back in to tell him what was happening and he gave me a refill for another four weeks. As much as I do not want to be taking these meds I was greatly relived and gladly took it. So that was six weeks on that and normal bowl activity for the first time in years. I started gaining weight like crazy and feeling like such a loser, so guilty.. still no will to live. Thank goodness I found this video from this little girl about binge eating.. How I STOPPED Binge Eating and how it can be triggered from starvation like events. It's possible too that the dying bacteria population is causing the demand for the foods it needs to survive. About two weeks after that six week round, the diarrhea returned and so did the painful cramping. I did not wait, but went right in. He gave me another two week prescription and three more refills for two week treatments. I have used up two of those and have one left. Have been unable to get off the wheat, dairy, and sugar, and have lost my ability to walk very far. I am so weak brushing my hair is hard. I am in so much pain I have added back in Tylenol and Ibuprofen and that doesn't even help. I have no life motivation. I didn't mean to dump this story in this thread, but there it is. Maybe because I trust you Nadine. I had been so incredibly disciplined and I can see where I went wrong, as in not getting the right nutrition at the right time. I know it's all about the gut at this point. I've told my body I will listen closer this time.. I will add back in the high nutrition foods before I ask it to give anything up.. not being at war with it.. but only the critters harming it. While all this was going on, I've had a whole lot of life losses too. Long story.. Two years ago this month I quit smoking. LOL Somehow that doesn't seem to mean much but I thought I throw that out there. :) 

Nadine replied: "I hear you about the conflicting info. Right now I'm going down yet another research rabbit-hole on sugar and high GI foods, and at some point I really need to take a look at gluten and figure out what I think about it. I don't have any medical training so I rely on my general critical thinking skills to try to sort through a sea of contradictory info. I think you're on to something when you point out how many different diets there are that people report feeling better on. One of my pet theories is that any time we go on any kind of restrictive diet, we turn our attention to our food and cut out a bunch of junk - paleo and vegan are very different diets, but they both tend to get people to cut back on junk! [..] Like you, I prefer to eat vegan from a philosophical and moral perspective. I don't mean that I think eating meat is inherently wrong, but with our industrial food system I just don't feel good about participating in milk, egg, and meat production. I wouldn't mind eating fish, but with overfishing and other environmental problems and all that...basically, where I come out is, I'll keep a vegan kitchen; that's about my comfort level. Being omnivorous when I'm out helps me socially, and also lets me relax a little, knowing I don't have to stress about missing out on something like B12 or whatever. [..] With me it has always seemed to be a yeast issue; I've never thought about SIBO for me, although when I was at my worst I did have diarrhea. Interestingly, my diarrhea didn't start until I was under treatment by a Chinese herbalist. I kept saying this one formula had caused it, and he kept saying that didn't seem true. By that point I was so confused from trying different treatment approaches, and so frustrated, and busy with other life demands, that I stopped any kind of treatment for a while and even started eating junk again - because nothing seemed to help. Later I looked back and realized no, staying away from junk was the one thing I knew did help! It's good that you found a practitioner who can work with you. I have a doc who has been pretty flexible and accommodating with me, but she really doesn't know what's going on with me, so I still feel sort of like I'm on my own. [..] Wow, good video. I've never heard that idea, that binge eating can be followed by purging not in the bulimic sense but by returning to very restrictive eating habits. Something to think about. I can definitely relate to the experience of being overtaken by the waves of an urge to eat something, especially when I'm feeling down and depressed. No donut in sight is safe!"

Update, March 19th 2014

A friend of mine has both rosacea (facial flushing, redness and burning) and bowel/stomach and digestion problems. Takes medication helps somewhat for the flushing, but triggers bad stomach cramps, which causes a right catch 22; what to do? The stomach issues might flare up the rosacea, but treating the rosacea seems to stir up the stomach problems..  Published with permission. "My stomach has taken a real turn for the worse all of a sudden. It's been griping and cramping for months, but it was tolerable. However over the  last few days it's been hurting a lot though, v v sore and I haven't been wanting to eat. However I've kept eating and taking my medication, and it's been better today but it's all sore and aggravated. I've put so much effort into my diet + eating as well as I can to counter the effects of the medication, but it's not working. I've been taking the atenolol after a meal, and chewing the clonidine to swallow with a lot of water. So I face the nightmare scenario of having to come off the medication. :((((( The beta blockers work best so I'd like to stay on them even though they upset my stomach the most. So I could try coming off the clonidine entirely and drop the mirtazapine to 15mg instead of 22.5mg. The Xyzal works too so I'd like to keep taking that, and see how that goes. I don't know what else I can do. Do you know of anyone else who's had to come off their meds for this purpose? Or how they've coped? If I have to go back to the level of flushing I had at the beginning of October I won't be able to tolerate it for very long, I was just roaring away. I really can't face it and I hoped this wouldn't happen. The only other factor that might be making a difference is that I introduced fermented cod liver oil a few weeks ago. It's high in histamine so my skin became more reactive but not too bad. I figured the vitamin D and other benefits would outweigh that shortcoming in the long run. The surface of my skin and seb derm is noticeably and considerably better on it -- I'm v surprised how much difference it's made in such a short space of time. I was taking it at night but I've halved the dose to have with my first meal of the day instead, Perhaps this will help; The only reason why I mention it is because it has a v high level of vitamin A, which stresses the liver. If my liver is stressed with the cod liver oil then it might not be coping as well with the medication, hence worsening the toxicity in my stomach. That could be happening and making things worse.

Anyway I know the atenolol is bothering my stomach a lot but I think it's helped to 'normalize' the blood vessels a bit, so they don't react to stimulus as harshly, and my nose is a lot better and calmer on it. It still flushes on and off all the time but not quite as often or as harshly. So I really don't want to stop taking it. There's also the issue that if my stomach isn't working properly then I'm probably not absorbing the medication properly anyway. I haven't been able to tolerate fruit of late sadly. I eat:
- first meal: cooked carrots, courgettes, cabbage in coconut oil + an animal fat (ghee or goose fat) + one or two eggs (soft boiled), drizzled w/ lots of olive oil. Sometimes cucumber as well. I cook the veggies down for about 20 minutes until they're really soft. Thinking about it the histamine in the egg whites prob aren't doing me good but oh well, saturated fat is good for us.
- second and third meal: either a soup w/ chicken stock or coconut milk containing a few veggies (green or stringless beans, celeriac, cauliflower, green/orange/yellow peppers, kale, celery, squash, fennel, etc ) or a couple of veggies just steamed (green beans + celeriac, say) with meat or fish (chicken, trout, salmon, sea bass, etc.)
- I used to eat a lot of rice cakes too until my stomach got too upset by them, and I eat cashew nut butter for a snack at night. Probably not such a good idea because of the histamine content but nuts are really good for you and it's sweet and I like it. :)

I'm having a bowel test done from stool samples this week, will fwd the details of that to you. They should be able to pick up traces of helicobacter from that but if not I'll ask for another test for the helicobacter at my GPs, should be easy to do. My nutritionist thinks that adding omeproazole or an equivalent medication is a v bad idea given my exact symptoms -- she says it's often prescribed wrongly and that it reduces stomach acidity so inhibits digestion and will most likely make things worse even if it masks symptoms in the short term. I think she's probably right. She'd rather I take antibiotics for the helicobacter instead (if I have it, seems likely) so I guess I'll probably do that. It is very important that your stumach calms down, obviously... any inflammation there will set off your face. Like my inflammation of the teeth issues set my face off dramatically. Now that things are healing, my face seems to normalize slighty as well, still a long way to go but there is at least improvement. But also, you need your meds to calm down the rosacea and flushing I think. Exactly. I've been thinking about this a lot, and my problem is that the actions I need to take to permanently heal the inflammation/ issues in my stomach will dramatically worsen my flushing, and vice versa. What I think I should do in an ideal world is come off the medication, switch to an elimination diet then full paleo diet w/ *lots* of high histamine foods + fermented veggies and probiotic foodstuffs to aid digestion and repopulate the gut flora and hence heal and seal the gut wall, and stick to that for 2 years as recommended by the GAPS diet protocol. But of course  you can imagine what this will do to my face. o_0 So I'm completely stuck. :( My bowel test.

The test I recommend is called CDSA + Parasitology 2.0 from Genova Diagnostics and the website for further information is here. I have attached various attachments - a brochure, further details and an instruction pack. Please read through the attached in order to make a more informed decision on the way forward. This test evaluates digestion, absorption, gut flora, and the colonic environment, and evaluates for parasites using microscopic examination and EIA testing. The profile is indicated for all chronic GI problems, for acute bowel pattern changes, and for many systemic diseases and provides a sensitivity panel for treating pathogenic flora including candida. After having reviewed your consultation notes I feel that this test would be of significant benefit to you as it would give us a more specific patient protocol. Please let me know how you feel? I can order it on your behalf and payment is made directly to the laboratory only when they have received your samples. The cost of the test is £277. This would include a protocol designed by myself based on the results. Any supplements or herbs prescribed would be in addition to the test fee. The results would also provide us guidelines on the frequency of follow up appointments and it would give us a measure. This would also be determined by how you are feeling. Please have a think about this and we can speak further as you require. In my experience the benefits felt by the patients have covered significantly the costs incurred.

Update, June 8th 2014 

I'm reading up on the specific carbohydrate diet: "The Specific Carbohydrate Diet (SCD) is a group of foods which are grain-free, sugar-free, starch-free, and unprocessed.  While removing many foods that are toxic and digestively harmful the diet remains natural, extremely nourishing and representative of what our ancestors ate. Eating SCD is a way to “re-boot” your digestion and give you an overall health boost.  The diet will probably have you feeling better than ever even if you don’t have any intestinal damage.  But if you are one of the lucky few who needs a bit of digestive support this diet was created especially for you.

Where Did SCD Come From?

The principles of SCD were laid down by Dr. Sidney Valentine Haas as he treated Celiacs and other IBD patients in the 1950s. One of his patients was Elaine Gottschall’s daughter who at the time was very sick with ulcerative colitis.  Dr. Haas helped Elaine’s daughter to achieve lasting remission through diet and the use of fermented foods. Elaine Gottschall then dedicated her life to researching the diet – gut connection.  She coined the named the Specific Carbohydrate Diet and released the science and ground rules in her life’s work “Breaking the Vicious Cycle, Intestinal health through diet”. Breaking the Vicious Cycle is the reason we are here today and.  We are very grateful for all the hard work that Elaine put into it and we think everyone should own a copy or two.

What Science is Behind the Specific Carbohydrate Diet?

The diets guidelines are based on the fact that not everyone’s digestive tract has evolved to optimally digest complex carbohydrates and other man made food products like sugar. The main principle of the diet is that carbohydrates are classified by their chemical structure; they are monosaccharide, disaccharide, or polysaccharide. On the diet only monosaccharide carbohydrates are allowed to be eaten as all others require extra digestion steps to break the chemical bonds down to monosaccharide carbohydrates. Any food that is not properly digested causes bacterial and yeast overgrowth when undigested carbohydrates are fed on by bacteria and yeast in the intestinal tract. This starts a chain reaction of excess toxins and acids which cause irritation of the small intestine cells damaging them and causing food absorption issues which only helps to continue the cycle. The diet is an all natural way to break this cycle of bacteria and yeast overgrowth by eliminating the food sources they feed on. By working to restore gut flora to normal levels the intestinal tract is allowed to start repairing any damage by itself.

How Does the Specific Carbohydrate Diet Work?

By eliminating complex carbohydrates, lactose, sucrose and other man made ingredients from the digestive process, the body is finally allowed to start healing. As gut flora levels start to stabilize, the reduction of irritants from undigested foods, toxins and other man made ingredients allows inflammation levels to retreat. This is accomplished by beginning the diet with extremely easy to digest, natural foods. This “intro diet” starts the healing the process and then more complex foods are added back to the diet very slowly. By carefully adding foods back to the diet the Specific Carbohydrate Diet is individually tailored to each person’s state of injury and digestion abilities.

What Do I Eat Already?

Below is a quick summary of the Do’s and Do NOTS.  Please check the official list before eating something.

Eat This:

Allowed Meats: Eggs, Chicken, Turkey, Beef, Fish, Pork, Wild Game, Bacon, Lamb

Allowed Vegetables: Fresh or frozen of most commonly eaten vegetables are acceptable (asparagus, beets, broccoli, brussel sprouts, cabbage, cauliflower, carrots, celery, cucumbers, eggplant, garlic, kale, lettuce, mushrooms, onions, peas, peppers, pumpkin, spinach, squash, string Beans, tomatoes and watercress) Click here for others

Allowed Fruits: Commonly found Fresh or Frozen or dried with nothing added are acceptable (apples, avocados, bananas (ripe with black spots), berries of all kinds, coconut, dates, grapefruit, grapes, kiwi fruit, kumquats, lemons, limes, mangoes, melons, nectarines, oranges, papayas, peaches, pears, pineapples, prunes, raisins, rhubarb, tangerines) Click here for others

Dairy: SCD Yogurt, natural 30 day aged Cow and Goat cheeses (not Kraft-see below), Butter, Ghee, and Dry Curd Cottage Cheese (DCCC).

Nuts: Almonds, Pecans, Brazil, Hazelnuts, Walnuts, Cashews, Chestnuts (no additives for butters, salted mixes and flours)

Legumes: Peanuts, White beans, Navy Beans, Lentils, Split Peas, Lima beans, Kidney beans, Black beans

Spices: Most non-mixed spices are allowed, screen for anti-caking agents, and make sure the ingredients are listed.

Not This:

No CEREAL GRAINS: Wheat, Barley, Corn, Rye, Oats, Rice, Buckwheat, Millet, Triticale, Bulgur, Spelt, Quinoa

Not Allowed Meats: Ham, Processed Sausages, Lunch meats, Bratwurst, Turkey dogs, Hot dogs

Not Allowed Vegetables: Canned are not allowed due to the usual addition of sugars, processing aids and preservative chemicals.

Not Allowed Fruits: Canned and most fruit juices are not allowed due to the common addition of sweeteners, preservatives, and processing aids.

Not Allowed Legumes: Soybeans, chick peas, bean sprouts, mungbeans, fava beans, garbanzo beans

Dairy: Commercial yogurts, milk of any kind, unnatural cheeses (Kraft and most other main stream shredded cheeses fall into this group), all of the following cheeses: Cottage, Cream, Feta, Gejetost, Mozzarella, Neufchatel, Primost, Ricotta, Processed cheese spreads.

Starches/Tubers: Not allowed including Potatoes, Yams, Sweet potatoes, Arrowroot, Parsnip, Cornstarch, tapioca starch

Spices: No Curry powders, Most Onion and Garlic powders are filled with anti-caking agents.

Drink This:

Weak tea or coffee, Water, Mineral Water, Club soda, Dry Wine, Gin, Rye, Scotch, Bourbon, Vodka

Not This:

Instant coffee, Most commercial juices, Milk, Soda Pop, Sweet Wines, Flavored Liqueurs, Brandy, Sherry

Sweeten With This:

Honey

Not This:

Sugar of any kind (Cane, Coconut, Table, etc), Agave syrup, Maple syrup, artificial sweeteners.

Rosacea-Intestine Link

General History of Gastrointestinal Disease and Rosacea

The link between rosacea and the gut has been noted for many years. In 13th century England, Chaucer described obese men who liked their red wine too much and had red, flushed complexions. We now know that obesity is associated with methane producing intestinal bacteria and also results in systemic inflammation which suggests a possible relationship. In 1817, the first dermatology textbook linked acne and rosacea to dyspepsia (indigestion) and constipation. Dyspepsia was once again discussed in an 1895 textbook as an associated condition with rosacea. Additional gastrointestinal diseases and conditions were reported to be factors in rosacea from 1926 to 1989: food intolerance/allergies, achlorhydria (loss of acid production), gastritis (irritation of the stomach lining), celiac disease, nonspecific inflammatory jejunal lining disorders, chronic pancreatitis, and ulcerative colitis. A number of articles were published in the 1990’s about the stomach bacteria Helicobacter pylori, though only one strain usually found in Eastern Europe was clearly linked to rosacea. In 2000, Crohn’s disease was reported to occur with different forms of rosacea: drug-induced rosacea, papulopustular rosacea, rosacea fulminans, and granulomatous rosacea.

Rosacea, Small Intestinal Bacterial Overgrowth, and Crohn’s Disease

The first report of the relationship between rosacea and an overgrowth of bacteria in the upper small intestine was published by the Genoa, Italy investigative group in 2008. This was a remarkable study that looked carefully at the incidence of small intestinal bacterial overgrowth (SIBO) in 113 consecutive patients attending their rosacea clinic. The researchers found that 47% of the patients had a positive lactulose breath test, which reflects the presence of SIBO. When the researchers gave their patients the antibiotic rifaximin for 10 days, they observed dramatic results in these patients, who had failed to respond to many other therapies. The patients with a negative breath test did not respond to the antibiotic.

This Italian study, along with Dr. Weinstock’s experience with other SIBO conditions, tweaked his interest in rosacea. Since 2005, Dr. Weinstock discovered that restless legs syndrome (RLS or , Willis- Ekbom Disease), interstitial cystitis, and type III chronic prostatitis were associated with SIBO. Also, the Crohn’s disease patients in his practice often had SIBO, systemic inflammation, and had a positive clinical response to antibiotic therapy. When his Crohn’s disease patients who also had rosacea were given rifaximin, their skin and gastrointestinal symptoms improved. After this, he began treating a general population of rosacea patients; first, those who came in for screening colonoscopy. During the physical examination prior to the screening procedure, he would identify the presence of rosacea. These patients were given the opportunity to participate in a study to determine the incidence of SIBO and the response to rifaximin therapy. The results from this positive clinical experience were published in 2013. Currently, we are investigating the effect of rifaximin in ocular rosacea and in papulopustular rosacea. These studies are exciting because we have seen good clinical responses in these two forms of rosacea. The percentage of all rosacea patients who have SIBO as the underlying cause remains unknown. The gut is the largest immune system in our body. From our experience, the connection between the gut and the skin is critical in many patients.

http://www.gidoctor.net/bacterial-imbalance.php

Key Concepts About Small Intestinal Bacterial Overgrowth (SIBO)

• Many syndromes overlap and are caused by gut dysfunction
• Acute gastrointestinal infections trigger chronic systemic diseases by several mechanisms, including development of anti-vinculin, an autoimmune antibody, with development of nerve damage resulting in SIBO and subsequent inflammation
• SIBO underlies many poorly understood disorders, including irritable bowel syndrome (IBS), restless legs syndrome, fibromyalgia syndrome, chronic fatigue syndrome, rosacea, interstitial cystitis, and type III chronic prostatitis
• Increased intestinal permeability and inflammation are complications of SIBO
• SIBO treatment is effective for IBS and SIBO-related syndromes
• The approach to SIBO begins with the investigation for correctable underlying disorders (examples: celiac disease, Crohn’s disease, and surgical blind loops)
• Treatment of SIBO includes treatment of the underlying disorder whenever possible (most often, poor motility of the small intestine) and eradication of the excess bacteria in the small intestine with antibiotic therapy or natural herbal antibiotics, which may then followed by treatment of residual inflammation and/or intestinal permeability

Learn About Testing

Dermatology textbooks imply that there is no cure for rosacea. For up to 45% of rosacea patients, especially those with papular rosacea, pustular rosacea, and ocular rosacea, prolonged relief may be possible by taking a new direction. A simple home test kit will tell you if an alternative treatment is a reasonable choice for you. Breath tests can also be performed in your doctor’s or hospital laboratory. This test has been available since 1975; however, home testing is a recent medical development.

Information About the Breath Test

The relatively simple breath test utilizes two teaspoons of lactulose (10 grams of Kristalose) which comes in a packet to be mixed into 1 cup of water and ingested. Lactulose is a sugar that is not absorbed by the gut. Lactulose is fermented by intestinal bacteria, and the hydrogen and methane that these bacteria generate is absorbed into the blood and released by the lungs. By analyzing the amount and timing of gas in the breath, a diagnosis of small intestinal bacterial overgrowth (SIBO) can be determined.

Lactulose is most often prescribed as a laxative. Temporary side effects include diarrhea, gas, and abdominal cramping. Because lactulose is not absorbed, it will not affect diabetics.

The breath test lab charges a fee for the analysis, materials and test interpretation, which is generally billed through your insurance company. The lab requires a signed requisition from your medical provider (physician, osteopathic physician, integrative physician, chiropractor, nurse practitioner (NP, ANP), physician assistant (PA-C), or naturopathic doctor). Some labs take the responsibility for billing your insurance company but will charge for the uncovered amount.

There are several Internet sites where you can see how the breath test is performed:

• Lactulose Breath Test Video
• Easy Breathalizer (Quintron)
• Hydrogen Breath Testing

http://www.gidoctor.net/rosacea-sibo-diet.php

Rosacea-SIBO Diet

In the setting of rosacea associated with small intestinal bacterial overgrowth (SIBO), the dietary approach is to consume foods and beverages that are easily digested, so that most of the nutrients can be absorbed efficiently higher up in the intestine. This reduces nutrition that will stimulate a recurrence of the excess bacteria in the mid and upper small intestine. It is also important to avoid commonly known dietary rosacea triggers.

Complex sugars or certain artificial sugars are the nutrients that most often cause SIBO to return. This will be discussed below.

Once the antibiotic is successful in reducing excess bacteria growth in the small intestine then it is possible that higher fiber foods can be reintroduced. Fiber is comprised of carbohydrates that humans can’t digest. The normal role of colon bacteria is to help break fiber down. A certain amount of gas is naturally produced during this fermentation process. As long as fiber intake is not excessive and the bacterial counts are normalized in the small intestine then bloating and gas will not be a problem. Initially we recommend a diet that contains only modest amounts of fiber found naturally in fruits and vegetables.

Frequent eating also causes problems reducing SIBO. The normal cleaning-waves in the small intestine that gets rid of food byproducts, waste, and bacteria occur when you are not eating for more than 90 minutes. The more meals that you have per day - and this includes snacks between meals - the less time your body has to produce appropriate cleansing waves, making it easier for the bacteria to remain in the small intestine.

Adequate fluid intake throughout the day is also important. If your diet does not include enough water, it becomes more difficult for your body to have proper bowel motility.

The following guidelines should be followed so that you have the best chance of minimizing the return of SIBO.

1. Try to avoid the following sweeteners:
   
   • Fructose corn syrup (found in many prepared foods – difficult to avoid but important to reduce)
   • Sorbitol (often found in gum)
   • Sucralose (Splenda)
   • Lactose (dairy sugar found in milk, cheese, ice cream)
   You should also limit foods and food products sweetened with fruit juice, which contains fructose. This is hard because so many food products are sweetened with fructose. Try to limit your sugar intake to no more than 40 grams per day, and ideally much less. Reading food labels can help you achieve your goal.
   
   The following sugars and sweeteners are acceptable: glucose, sucrose (table sugar), Stevia, and aspartame (Equal or NutraSweet).
2. Limit or eliminate the following “high-residue” foods:
   
   • Beans (kidney beans, garbanzo beans, pinto beans, etc.)
   • Lentils
   • Peas (including split-pea soup)
   (Vegetarians may consume some of these important sources of protein)
3. Drink eight cups of water a day. A good guideline is to drink two cups of water with each of your three meals, then one cup between breakfast and lunch, and one cup between lunch and dinner.
4. Beef, fish, poultry, soy products, and eggs are acceptable foods, and are also good sources of protein. You do not need to limit these foods throughout the day. However, be sure to only eat portions that are appropriate for your body size. Most people require only about 4-8 ounces of meat per day.
5. Potatoes, pasta, rice, bread, and cereals are also acceptable. We do find that some people have difficulty with bread and pasta – you may need to experiment. It’s all right to include some of these foods at each meal. They contain carbohydrates that are well absorbed high up in the small intestine, serving as fuel for your body, not for the bacteria. A good rule of thumb is to eat no more than a half cup to one cup of these carbohydrate foods at each meal. Initially, try to keep multigrain breads to a minimum. If whole-grain breads are desired, oat and wheat fibers are better choices. Avoid wild rice.
6. Fruits should be eaten in moderation – initially no more than two servings per day. Fruits contain fructose, which is difficult to digest. Most importantly, choose fresh, not dried fruit. Dried fruits concentrate the fructose into a smaller package and it allows for more fructose ingestion because more is eaten.
7. Fresh, non-starchy vegetables should also be part of your daily food intake. Cooked or lightly steamed vegetables are preferable to raw vegetables, because they are easier to digest and absorb. Avoid large salads full of raw vegetables, as this can lead to too much residue. You can incorporate small amounts of salad, but do not eat raw vegetables exclusively as they are hard to digest. A good rule of thumb is to have three to five cups of cooked vegetables per day.
8. Dairy products are best avoided initially because of the lactose which is difficult to absorb when there is SIBO or lactose intolerance. You may tolerate lactose by the use of Lactaid pills. After taking the antibiotic, dairy products may be fine. Try almond or rice milk or Lactaid milk. Soy milk can cause gas in some people.
9. Coffee, tea, and diet soda (without Splenda) may be consumed in moderate amounts. See if hot beverages or caffeine triggers your rosacea. Regular soda is not a healthy choice – in addition to sugar there is fructose corn syrup. Red wine and alcohol are known triggers for rosacea.
10. Finally, make sure you eat a balanced diet and that your meals contain sufficient calories so that you are able to maintain your ideal body weight.