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Do Rosacea Sufferers have Nutritional Deficiencies?

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Please Note: This post will continue to be updated as more facts are known. If you have something to add look for the reply to this topic button and add your thoughts or facts. 

Claims of Nutritional Deficiencies in Rosacea
Have you asked this question and wondered if rosacea sufferers have nutritional deficiencies? This is a common question and many answers are published on the internet. When discussing rosacea, diet triggers always come up. One may logically conclude that possibly something is deficient in the diet?  Or are we over consuming in our diet something that triggers the rosacea (i.e., too much sugar and carbohydrate) which may deplete certain essential nutrients?  

There are web sites that claim rosacea is due to a nutritional deficiency but have little, if any, clinical papers to cite their claims. For example, consider the following citations:

"Studies conducted in the 1940s (that have largely been forgotten) showed that people with rosacea have both a low amount of stomach acid and many also have B vitamin deficiencies," however, there are no citations to any clinical papers.  A google search found one paper in 1947 by Louis Tulipan, MD, which said, "that most, if not all, cases of rosacea are due to a vitamin B complex deficiency and that all the causes heretofore mentioned may be exciting or underlying factors, but are not immediately causal." [1]

Another website says, "proponents such as orthomolecular therapist Billie J. Sahley theorize that a deficiency in certain amino acids can contribute to skin problems," promoting lysine, which "plays an important role in collagen production, which is a substance your skin and other connective tissues are made of," also with no citations for any lysine deficiency in rosacea sufferers. [2]

Zest reports, "Nutritional deficiencies including EFAs, hydrochloric acid and malabsorption of B vitamins present in Rosacea sufferers," again, with no citations or proof of this claim. [3] 

Cindy Marteney writes, "Three nutritional deficiencies seem to be important with rosacea: (1) lack of enough stomach acid to digest proteins, (2) lack of the pancreatic enzyme lipase to digest fats, and (3) insufficient Vitamin B2 (riboflavin), the last deficiency being particularly interesting. It turns out that research on large doses of B-vitamins in treating rosacea has been around since at least 1929." At least Cindy cites some papers which are also listed in the end notes, but unlike Cindy, few will cite any papers that have shown nutritional deficiencies in rosacea.  

"Nutritional deficiencies including EFAs, hydrochloric acid and malabsorption of B vitamins present in Rosacea sufferers; the more we understand about these aggressors and triggers the easier long term management of Rosacea becomes." [15] 

"Rosacea may be caused by factors such as a deficiency of B-complex vitamins or hydrochloric acid (HCl) in the stomach. Some researchers suspect that yeast may cause rosacea." [16]

Photo Damage may be something to consider which WebMD suggests what nutritional supplements might help. [19]

While there are little clinical papers on this subject logic dictates that there must be something to this underlying nutritional deficiency theory for rosacea. So lets see what we do know with the following nutrients. Let's also find as many clinical papers published on this subject as possible. If you would post in this thread any clinical papers that need to be added, this would be helpful. Wouldn't it be nice to have help writing this article? That is what volunteers do, help. Please, post a clinical paper or article that substantiates that a nutritional supplement improves rosacea. We need more citations that show evidence that rosacea may be due to nutritional deficiencies. One of the goals of the RRDi is "To allow volunteer members to have a platform to voice their concerns about rosacea and to contribute information about rosacea."  Please do some research and reply to this post your findings. 

Diet and Rosacea
"Dietary triggers are frequently cited by patients as playing a role in rosacea exacerbations. At this time, patient-reported triggers fall into four categories: heat-related, alcohol-related, capsaicin-related, and cinnamaldehyde-related. One suggested mechanism of action is via activation of TRP channels, which result in neurogenic vasodilation. Diet may also impact rosacea via a gut-skin connection. While epidemiologic research supports this connection, research is underway to determine the pathophysiologic mechanisms. At this time, patients may be advised on measures to promote a healthy gut microbiome, including the importance of a fiber-rich (prebiotic) diet." [20]

Vitamin B Complex
"Taking a vitamin B complex will correct or prevent the deficiency in B vitamins occasionally noted in people with rosacea. In addition to B complex, an extra amount of vitamin B2, riboflavin, encourages the secretion of protective mucus by skin cells (thus reinforcing vitamin A), and helps eliminate cellular waste. Likewise, extra vitamin B12 is essential to the growth, repair, and replication of healthy skin cells (and other cells of the body)." [4]

"The relationship between B vitamins and rosacea is unclear, one study found it caused rosacea-like symptoms, other preliminary reports have found benefits. Preliminary reports in the 1940s claimed that rosacea improved with oral supplements or injections of B vitamins. On the other hand, one report exists of rosacea-like symptoms in a patient taking 100 mg per day of vitamin B6 and 100 mcg per day of vitamin B12; these symptoms subsided when the supplements were discontinued. More research is needed to evaluate the potential benefits or hazards of B vitamins for rosacea." [10]

Vitamin B2
In discussing riboflavin, Ron Grabowski, R.D., D.C., states "Deficiency has been associated in patients with rosacea." [11] However, no clinical paper is cited. However, one paper cites treating rosacea keratitis with riboflavin in 1940. [12] TimeistheRevelator at Reddit has done some research on this subject and collected some interesting data including thoughts by Raymond Peat, PhD, who volunteers on the RRDi MAC. 

Vitamin B3
Vitamin B3 (Niacin or nicotinic acid) can cause flushing, but there is a flush free Vitamin B3 (Niacinamide or Inositol Hexanicotinate). The NRS noted on its website, "an essential vitamin found in an extensive range of foods, including foods reported to trigger rosacea flare-ups in some individuals, such as beef liver, yeast, avocadoes and spinach. While niacin deficiency leads to pellagra -- a disease associated with skin problems, weakness and dementia -- he noted that it has also been associated with severe flushing in individuals taking large amounts as a supplement." [5]

Vitamin B6
"Vitamin B6, Selenium and Magnesium deficiencies result in the dilation of blood vessels, especially on the cheeks and nose." [14] However, no clinical papers are cited. 

Vitamin B12 (cobalamin)
"Vegans usually are aware of the lack of vitamin B12 in the their diet. B12 is generally assumed to be found only in animal products. B12 is difficult to obtain from plants but does occur in some fermented plant foods, such as tempeh, miso, etc. A B12 supplement can help assure adequate amounts in the vegan diet. B12 occurs as a molecule with an atom of cobalt at its center but does not technically come from animals or plants since microorganisms such as bacteria and algae make it. These are found in and on the foods we eat. The bacteria in the livestock’s digestive system spread the B12 vitamin throughout the flesh and milk. If you are a vegetarian who eats eggs and dairy products you will get B12 in your diet. If you are a vegan , you should think about B12 supplements. Google B12 and learn more." [6]

“B12 deficiency can potentially cause severe and irreversible damage, especially to the brain and nervous system … Recent research indicates that B12 deficiency is far more widespread than formerly believed. A large study in the US found that 39 percent had low values.” [7]

"Another common nutritional deficiency in Rosacea is vitamin B12, a large vitamin that requires a carrier molecule for transportation around the body. This carrier molecule is Intrinsic Factor and is released in the stomach in response to a sufficiently acidic environment. Vitamin B12 cannot be sufficiently absorbed or transported in the body when HCl production is insufficient. Lack of this crucial B-vitamin can cause fatigue, shortness of breath, bladder incontinence, white spots on the skin (most common on the forearms), frequent pins and needles in the hands and feet, mental confusion, depression, paranoia, headaches, nausea, vomiting, bloating, loss of appetite, weight loss, diarrhoea, constipation, and anaemia.Those following a vegetarian or vegan diet are also at risk for developing a Vitamin B12 deficiency because the best dietary sources are in animal foods. To ensure you are getting sufficient B12 in your diet include foods such as fish, meat, poultry, and eggs." [14]

"Cobalamin is an important vitamin for the proper function of the human body, and deficiency is fairly prevalent with advanced age. The dermatologist can play a role in the diagnosis of deficiency by recognizing its mucocutaneous manifestations." [17]

Vitamin D
Vitamin D has some controversy. Some papers say rosaceans have high levels of D serum while others say low serum levels. 

Some papers say rosaceans have too much Vitamin D. An actual clinical study came to this conclusion, “Patients with rosacea have relatively high serum vitamin D levels compared to control groups. The result of our study suggests that increased vitamin D levels may lead to the development of rosacea. To confirm status of vitamin D levels in patients with rosacea, larger epidemiological studies are needed.” [8]

John D Cannel, MD, reports, "Eighty-one percent of patients with rosacea report that sun exposure makes it worse. Of the many environmental triggers that exacerbate the condition, sun exposure is actually the most common. This may be because patients with rosacea have elevated levels of the antimicrobial peptide, cathelicidin, in the affected skin. Vitamin D increases cathelicidin, which may explain why sun exposure is a common environmental trigger, though researchers don’t know for sure." [9]

"I strongly recommend being tested for Vitamin D status if you have two or more of these symptoms: Rosacea, Psoriasis, depression, memory problems, panic attacks, tooth decay, and/or joint pain." [14]

"In the same spectrum of acne, another study demonstrated relatively high serum levels of vitamin D in patients with rosacea which is a common chronic skin condition affecting the face, in comparison with controls, suggesting that increased vitamin D levels may lead to the development of rosacea." [18]

Some rosaceans ignore the above clinical papers and take Vitamin D supplements, particularly D3. However, if you decide this, be sure to be aware of Vitamin D toxicity. [22]

One report showed a low vitamin D serum in a 36 year old male and states, "The rash resolved following the tapering course of cyclosporin and vitamin repletion through supplements and dietary alteration." [23]

"Serum vitamin D was lower in patients with rosacea, although serum cathelicidin was higher than that of the controls. This suggests that the role of vitamin D level in the pathogenesis of rosacea merits further investigation." [24]

Betaine Hydrochloride
"Hydrochloric acid and vitamin B complex improved some cases of rosacea in people with low stomach acid. Take only under the supervision of a healthcare practitioner.
"Some people with rosacea have been reported to produce inadequate stomach acid. In a preliminary trial, supplemental hydrochloric acid, along with vitamin B complex, improved some cases of rosacea in people with low stomach-acid production. Similarly, improvement in rosacea has been reported anecdotally after supplementation with pancreatic digestive enzymes, and a controlled study found that rosacea patients produced less pancreatic lipase than healthy people. Controlled trials are needed to evaluate the effects of hydrochloric acid and digestive enzyme supplements in rosacea. Hydrochloric acid supplements should not be taken without the supervision of a healthcare practitioner." [10] When treatment for gastrointestinal issues clears or improves rosacea, this type of rosacea is designated as a rosacea variant, Gastrointestinal Rosacea [GR].

Digestive Enzymes
"Digestive enzymes have been reported anecdotally to improve rosacea symptoms.
Some people with rosacea have been reported to produce inadequate stomach acid. In a preliminary trial, supplemental hydrochloric acid, along with vitamin B complex, improved some cases of rosacea in people with low stomach-acid production.[10] Similarly, improvement in rosacea has been reported anecdotally after supplementation with pancreatic digestive enzymes, and a controlled study found that rosacea patients produced less pancreatic lipase than healthy people. Controlled trials are needed to evaluate the effects of hydrochloric acid and digestive enzyme supplements in rosacea. Hydrochloric acid supplements should not be taken without the supervision of a healthcare practitioner." [10] 

In discussing digestive enzymes, Ron Grabowski, R.D., D.C., states, "Deficient lipase secretion has been found with rosacea." [11] However, there is no clinical paper cited. When treatment for gastrointestinal issues clears or improves rosacea, this type of rosacea is designated as a rosacea variant, Gastrointestinal Rosacea [GR].

Hydrochloric Acid
"In Rosacea, where the microvascular system is inflamed and malfunctioning, it is very common to find lower than optimum levels of Hydrochloric Acid production (stomach acid or HCl). This is a very strong acid that has many crucial roles in health maintenance. For example, it is essential to liberate nutrients from foods, and this is especially true for minerals. HCl causes minerals to become ionised (separation of atoms or molecules into their electrically active form)." [14] However, no clinical papers are cited. There is a theory that some rosacea sufferers suffer from low gastric acid. When treatment for gastrointestinal issues clears or improves rosacea, this type of rosacea is designated as a rosacea variant, Gastrointestinal Rosacea [GR].

Iodine
Mistica posts below in this thread her thoughts on iodine and flushing. Scroll down to the third post in this thread to read her thoughts on iodine. 

Lutein with Zeaxanthin
There is some anecdotal evidence that adding Lutein/Zeaxanthin to your diet may help control your rosacea.

MSM
At least one doctor recommends MSM for rosacea. More info. MSM is used for flushing avoidance in this list. One clinical paper concluded, "The combination of silymarin and S-MSM can be useful in managing symptoms and condition of rosacea skin, especially in the rosacea subtype 1 erythemato-telangiectatic phase." [21]

Omega-3
"Omega-3 fatty acids are polyunsaturated fatty acids and include eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and alpha linolenic acid (ALA). As EPA and DHA are substrates for anti-inflammatory prostaglandins that competitively inhibit pro-inflammatory pathways, they have been studied in multiple diseases [59]. Limited research is available for their use in rosacea, although one RCT found a statistically significant improvement in subjects with dry eye symptoms, some of whom had rosacea, with the use of 325 mg of EPA and 175 mg of DHA two times daily for three months."  [17]

Probiotics
While probiotics are not an essential nutrient, microorganisms in the gut are essential to life. The gut microbiome is a much studied subject with regard to microbiome-based therapeutic strategies. With the possibility of suffering from the rosacea variant, Gut Rosacea, treating rosacea with probiotics has become an accepted medically approved alternative to antibiotics. Oral and topical probiotics may improve your rosacea. 

Zinc
"In a double-blind study, zinc supplements decreased the rosacea severity by about 75%. Long-term zinc users should also take a copper supplement to prevent deficiency. In a double-blind study, supplementing with zinc (23 mg three times per day for three months) decreased the severity of rosacea by about 75%, whereas no improvement occurred in the placebo group." [10]

"Zinc sulfate was found to be a good option in the treatment of rosacea, as it was safe, effective and lacking important side-effects." [13]

End Notes 

[1] Natural Treatment for Rosacea, Dermharmony 

Arch Derm Syphilol. 1947;56(5):589-591. doi:10.1001/archderm.1947.01520110035005.
ACNE ROSACEA
A Vitamin B Complex Deficiency
LOUIS TULIPAN, M.D.

[2] Deficiency in Amino Acid in Rosacea Sufferers
by JANET RENEE, MS, RD  Last Updated: Dec 24, 2015

Billie J. Sahley, PhD, wrote the book Heal with Amino Acids and Nutrients, passed away in 2011.

[3] Acne, Rosacea and Nutrient Deficiencies
Posted by  Emma Ryall, Zest

[4] Rosacea
Whole Health Chicago, Posted on May 5, 2009 

South Med J. 1957 Feb;50(2):207-10.
Effect of vitamin B complex and S-factor on acne rosacea.
POOLE WL.

[5] NIACIN AND NIACINAMIDE (VITAMIN B3)
WebMD

New Study Identifies Cause of Flushing
NRS, Rosacea Review, Winter 2010

[6] Rosacea 101: Includes the Rosacea Diet 
by Brady Barrows, iUniverse, 2007

[7] Vitamin B12 Deficiency
Wikipedia

[8] Cutan Ocul Toxicol. 2014 Mar;33(1):60-2. doi: 10.3109/15569527.2013.797907. Epub 2013 May 28.
Vitamin D status in patients with rosacea.
Ekiz O1, Balta I, Sen BB, Dikilitaş MC, Ozuğuz P, Rifaioğlu EN.

[9] Sunlight and vitamin D, do they trigger rosacea?
by John Cannell, MD, Vitamin D Council, Posted on July 23, 2013

[10] Acne Rosacea (Holistic)
Supplements, Health System, University of Michigan

[11] Nutritional Considerations with Skin Disorders
Ron Grabowski, R.D., D.C., Spectracell Laboratories

[12] Arch Ophthalmol. 1940;23(5):899-907. doi:10.1001/archopht.1940.00860131019001.
ROSACEA KERATITIS AND CONDITIONS WITH VASCULARIZATION OF CORNEA TREATED WITH RIBOFLAVIN
LORAND V. JOHNSON, M.D.; ROBERT E. ECKARDT, M.S.

[13] Int J Dermatol. 2006 Jul;45(7):857-61.
Oral zinc sulfate in the treatment of rosacea: a double-blind, placebo-controlled study.
Sharquie KE, Najim RA, Al-Salman HN.

[14] Nutritional Deficiencies in Those With Rosacea
Pulse Light Clinic

[15] Acne, Rosacea and Nutrient Deficiencies
Emma Ryall, Proprietor at Zest Skin Clinic & Laser Hair Removal Swords

[16] Acne Rosacea
encyclopedia.com

[17] Am J Clin Dermatol. 2015;16(1):27-33.
A Review of Vitamin B12 in Dermatology
Jennifer Brescoll; Steven Daveluy

[18] Journal of Advanced Research
Volume 6, Issue 6, November 2015, Pages 793–804
Vitamin D and the skin: Focus on a complex relationship: A review
Wedad Z. Mostafa, Rehab A. Hegazy

[19] WebMD reports: 
Considering taking a vitamin or supplement to treat Photo-damaged skin? Below is a list of common natural remedies used to treat or reduce the symptoms of Photo-damaged skin. Follow the links to read common uses, side effects, dosage details and read user reviews for the drugs listed below.
Your search for Photo-damaged skin returned 12 matches:

ALPHA HYDROXY ACIDS Likely effective 13 User Reviews
ASTAXANTHIN Insufficient evidence 85 User Reviews
COENZYME Q-10 Insufficient evidence 175 User Reviews
DATE PALM Insufficient evidence Be the first to review it
EQUOL Insufficient evidence 3 User Reviews
GINSENG, PANAX Insufficient evidence 29 User Reviews
GLYCEROL Insufficient evidence 21 User Reviews
GREEN TEA Insufficient evidence 62 User Reviews
SOY Insufficient evidence 44 User Reviews
TYROSINE Insufficient evidence 85 User Reviews
VITAMIN C (ASCORBIC ACID) Possibly evidence 52 User Reviews
ZINC Insufficient evidence 53 User Reviews

Photo Damage is one of the theories on what causes rosacea. Also, it would be good to rule out any photo sensitive disease from rosacea.

[20] Diet and rosacea: the role of dietary change in the management of rosacea.

[21] J Cosmet Dermatol. 2008 Mar;7(1):8-14
Combined effects of silymarin and methylsulfonylmethane in the management of rosacea: clinical and instrumental evaluation.
Berardesca E, Cameli N, Cavallotti C, Levy JL, Piérard GE, de Paoli Ambrosi G

[22] What is vitamin D toxicity, and should I worry about it since I take supplements?
Answer From Katherine Zeratsky, R.D., L.D., Mayo Clinic

[23] Integr Med (Encinitas). 2017 Oct; 16(5): 58–62.
PMCID: PMC6438092 PMID: 30936806
Discrete and Coalescing Pustules Masking Severe Recalcitrant Rosacea Due to Demodex
Megan Vissing, MD, Chase Wilson, MD, Nico Mousdicas, MD, MBCHB, and Stefanie Ali, MD

[24] Ann Dermatol. 2018 Apr;30(2):136-142. doi: 10.5021/ad.2018.30.2.136. Epub 2018 Feb 21.
A Study on Vitamin D and Cathelicidin Status in Patients with Rosacea: Serum Level and Tissue Expression.
Park BW, Ha JM, Cho EB, Jin JK, Park EJ, Park HR, Kang HJ, Ko SH, Kim KH, Kim KJ.

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I'd like to mention iodine. 

I was found to be iodine deficient by two spot urine tests. There is debate about which test is the more accurate. The 24 hour urine collection, after taking a very high dose of iodine. Or the spot test. Each camp will offer proof as to which test should be the favoured one.

Those in the 50 mg dose camp insist there are never any side effects. I would beg to differ. Too much iodine can cause flushing even in non flushers and  anecdotal reports of this can be found in forums. Like many triggers, it can cause persistent flushing. And of course there are the thyroid issues, but they don't seem to be as prevalent as official literature suggests.

However, lower doses can be helpful. I had a difficult time adjusting to iodine, but the biggest improvement I had was a significant reduction in flushing. In particular, nose flushing. My nose flushing used to be hell and uncontrollable. These days it is much milder. 

I take several supplements but it was the iodine that made the quickest and most obvious impact.

(Iodine+niacinamide+vitamin C). I took all separately initially.

What is interesting, is that a quick google can turn up  anecdotal reports from menopausal women who found their hot flashes reduced or completely resolved following iodine supplementation.

There are users who have triggered flushing too, so I tend to think testing for deficiency is prudent before trialling iodine.

There are a few breast cancer survivors who report the same benefit.

So one must consider, aside from thyroid health,  what role or roles does iodine have in vasodilation, hormonal balance and vascular health?

My physician (and others) have noted the potent anti inflammatory effects of iodine.

I have regular blood tests including a full thyroid panel to monitor thyroid function as I developed Hashimoto's due to iodine deficiency and my on going gut flora issues. I also had lowish zinc and borderline low retinol, but it has been pointed out to me by my physician and my scientist mentors, that tests for nutritional deficiencies aren't overly accurate, not unless someone is extremely deficient.

It is interesting to note, that some of the worst flushers on the forum, have thyroid disease -  and nutritional deficiencies and insufficiencies have been linked to thyroid dysfunction. Along with gut issues.

Then there is the query as to whether blood serum levels are reflective of cellular levels. Personally I think this is an area which needs exploration.

As usual, multiple questions and no answers. Alas.

 

 

 

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Thanks Mistica for your post on iodine. I have added iodine to the first post mentioning your post. My wife takes kelp drops. I don't have any flushing issues since I take Carvedilol. 

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"Ledesma suggested I undergo a micronutrient testing to determine if any supplements could help me to better control my blood sugar and potentially improve my health in other ways. I underwent a blood draw for the SpectraCell Micronutrient Test, a comprehensive test of the biochemical function of vitamins, minerals, amino acids and antioxidants. It seemed like the best way to find out my specific nutritional deficiencies and not take a typical shotgun approach to choosing a wide array of nutrients. The MNT test retails for more than $1,500. I was surprised to find Medicare covered nearly all of it. My cost would be $88. Ledesma said we would balance the nutrients and address any borderline or deficient nutrients."

A Patient's Journey: There's a Vitamin for That
Howard Wolinsky may have the most expensive urine in Chicago, by Howard Wolinsky, Contributing Writer, MedPage Today

 

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