Anti-Inflammatory Diet

All health care starts with diet. My recommendations for a healthy diet are here:
Anti-Inflammatory Diet and Lifestyle.
There are over 190 articles on diet, inflammation and disease on this blog
(find topics using search [upper left] or index [lower right]), and
more articles by Prof. Ayers on Suite101 .

Wednesday, January 13, 2010

Rosacea, Brain Cooling and Niacin Flush

Other players include:  Cathelicidins, Prostaglandins, Cryptic Bacteria, Nerves, Gut

What does it take to make your face red?  Excessive solar exposure can lead to apoptosis of skin cells overloaded with DNA damage and trigger inflammation: vasodilation, recruitment of neutrophils, swelling, etc.  Similarly, a local infection can cause inflammation and the accumulation of neutrophils (see The Inner Life/Extravasation for slide show), lymphocytes, etc., that is observed as pus.  These are general responses that occur in skin anywhere, but the face also blushes in response to emotional cues and flushes with exercise.  Rosacea seems to involve all of these reactions to produce a variety of symptoms of wide severity.  Here I try to provide an overview of the complex physiological interactions involved in rosacea.

Rosacea is Persistent Vasodilation of the Face with Accumulation of Neutrophils

The nervous and circulatory systems of the face are unique and provide numerous triggers for inflammation.  Emotional blushing is a common trait among those who progress to rosacea, even though this type of vasodilation is not easily observed with some facial characteristics.  Thus, many rosaceans claim to have never flushed before their first outbreak, but tests of skin circulation indicate that these individuals had skin types that prohibited display of the blushing.  The face is also adapted to control brain temperature, so changes in body temperature, physical activity, etc. can also trigger flushing.

Facial Blood Circulation to Cool the Brain

The cooling of the blood as it traverses the facial skin is used to cool the brain during extensive exercise or in warm environments.  This unique adaptation also means that control of facial vasodilation can potentially be disrupted in disease and cause symptoms of pathology.  In rosacea,  the brain cooling response is disturbed (see reference below), resulting in persistent vasodilation and suggesting that the unique control of inflammation in the face is why rosacea is limited to the face.  The pattern of blood circulation in the face, however, only roughly approximates the inflammation pattern in rosacea.

Nerves to the Face

The face receives sensory branching from the trigeminal nerve.  The enervation pattern of the branches matches emotional blushing, but they also appear to approximate the pattern of reddening in rosacea.  It makes sense that rosacea involves nerve-triggered dilation of the blood vessels of the face.  One contrast between emotional blushing and rosacea is that emotional blushing does not lead to the offloading of lymphocytes, whereas rosacea produces localization of neutrophils that exacerbate and prolong inflammation.

Cathelicidin, Vitamin D Receptor, DNA Complexes, Autoinflammation

A major component of the innate immune system is the group of basic antimicrobial peptides, cathelicidins.  Cathelicidins are effective against bacteria and they are produced during inflammation and are partially controlled by the vitamin D receptor acting as a transcription factor.  Thus, part of the action of vitamin D in providing protection against disease is by enhancing cathelicidin production.  Cathelicidin action in the skin parallels the control of intestinal villi development by defensins, that are also basic antimicrobial peptides under the control of vitamin D.  Cathelicidins also form complexes with host DNA from damaged cells.  These cathelicin/DNA complexes bind to toll-like receptors (TLRs) and trigger inflammation.  This reaction has been associated with psoriasis and may explain how neutrophil damage can perpetuate inflammation in rosacea.

Niacin Flushing Implicates Arrestins

The unique circulatory system of the face also makes it susceptible to flushing with niacin, a.k.a. nicotinic acid or vitamin B3.  Niacin is cheaper and much more effective at raising HDL and lowering triglycerides and LDL than statins, but is not fully utilized because it also produces intense facial flushes.  A recent article (below) has demonstrated that the lipid benefits can be separated from the flushing and implicated beta-arrestin 1 activation by niacin binding to GPR109A (G-protein-coupled receptor) as the triggering event.  Arrestin, which is involved in clathrin-mediated endocytosis, activates phospholipase A2 that in turn releases arachidonic acid (ARA) from phospholipids.  The ARA (that got into the phospholipids as the omega-6 fatty acid in vegetable oils) is converted by COX-2 into the inflammatory prostaglandin D2.  This prostaglandin is what stimulates vasodilation.  It is possible to produce chemicals that will stimulate the lipid metabolism alterations of niacin, without producing the arrestin activation and inflammation.  Aspirin can be used to inhibit COX-2 and other parts of NFkB-mediated inflammation and eliminate the niacin flush.  It is also interesting that the modified lipid metabolism of schizophrenics also eliminates niacin flushing.  Salicylic acid, the same as the acetylsalicylic acid of Aspirin without the acetate, is also used in some topical applications to quiet the symptoms of rosacea.  Arrestin activation may be involved in rosacea.

Gut Flora, Biofilms and Cryptic Bacteria

The gut is probably involved in most cases of rosacea and bacteria are also implicated by the modification of rosacea symptoms by antibiotics.  This area has not been explored, but I suspect that gut flora controlled by diet, as well as pathogenic biofilms and cryptic bacteria, e.g. Clamydia pneumoneae, in facial tissue are involved in varying degrees in the panoply of pathologies called collectively, rosacea.  Since the bacteria in contact with the gut determine the development of the lymphocytes in the lining of the gut, e.g. Tregs vs. T cells that fight infections, pathogenic gut biofilms may disrupt the normal function of the immune system and support rosacea.  Die off and release of cell wall endotoxin from cryptic bacteria could explain the paradoxical inflammation in response to many treatments that are normally anti-inflammatory.  I have discussed in another article potential approaches to strip off biofilms.

Treatment with Anti-Inflammatory Diet

The Anti-Inflammatory Diet (AID) and Lifestyle that I advocate on this blog would seem to be a natural cure for rosacea.  It should eliminate the inflammatory background that supports rosacea and was probably essential for its development.  This diet also eliminates acne, which is directly related to the accumulation of lymphocytes to make pus.  Inflammation is also needed for the offloading of neutrophils that exacerbate inflammation in rosacea.  Vitamin D is instrumental in cathelicidin production to eliminate cryptic bacteria. 

In most cases of rosacea, the AID should be helpful.  Eliminating dietary sources of inflammation, especially vegetable oils (the source of omega-6 fatty acids that are converted into inflammatory prostaglandins), should reduce rosacea symptoms.

In advanced, severe cases, however, it appears that maintenance of the suppression of the response to cryptic bacteria is required to prevent endotoxin-based inflammation.  Thus, most treatments that decrease inflammation, e.g. omega-3 oils, vitamin D3, Vagal maneuvers, can paradoxically produce elevated inflammation.  These treatments may also inadvertantly contribute to inflammation by upsetting pathogenic interactions between bacteria and intestinal cells.  I have discussed these paradoxical ramifications in another article.

Brinnel H, Friedel J, Caputa M, Cabanac M, Grosshans E.  1989.  Rosacea: disturbed defense against brain overheating.  Arch Dermatol Res. 281(1):66-72.
Walters RW, Shukla AK, Kovacs JJ, Violin JD, DeWire SM, Lam CM, Chen JR, Muehlbauer MJ, Whalen EJ, Lefkowitz RJ.  2009.  Beta-Arrestin1 mediates nicotinic acid-induced flushing, but not its antilipolytic effect, in mice.  J Clin Invest. 119(5):1312-21.


caphuff said...

Thanks for this post, doc.

I am curious if you know of anyone who has reported improvement on an anti-inflammatory diet. My wife has rosacea of the type that seems to respond somewhat to antibiotics. These can get expensive, though, and they don't seem to "cure" it.

Dr. Art Ayers said...

Based on my understanding of the rosacea and reports of rosaceans, I would say that diet-based inflammation and the gut changes that result from that diet, are the foundation of rosacea. I would be baffled at antibiotic treatment that was not supported by an anti-inflammatory diet, including probiotics.

I would expect that your wife is also deficient in vitamin D. I would recommend that she have her serum vitD checked and adjusted with increasing doses of D3. More serious cases of rosacea exhibit flareups in response to D3 or antibiotics.

caphuff said...

Thanks again. I should clarify that she is currently on the SAD (at least in terms of sugar and wheat intake) and I am looking for ways to convince her otherwise.

Dr. Art Ayers said...

My impression is that omega-3 oils (fish oil) would be a natural way of treating general inflammation. The acute facial inflammation of rosacea seems to work similarly to liver inflammation, meaning that fish oil can cause further inflammation. The fix for this is to use the typical low carb diet that trades carbs calories for saturated fat calories. Fish oil will only work with low vegetable oil (omega-6), and is better with saturated fats.

Sugar and starch definitely contribute to rosacea. Grain may contribute to common gluten intolerance and be a major source of gut problems that contribute to rosacea.

Note that acne, a related disorder, is also effectively treated by the recommended anti-inflammatory diet.

Thanks for you comments and questions. Let me know how it works out. Rosacea is a serious disease, that gets more severe with many common treatments.

Dennis said...

"Blood entering the face travels into the brain. "

Not directly. The facial arteries are branches of the external carotid arteries. The face is drained by the facial veins. Blood supply of the brain is via the internal carotid arteries and vertebrobasilar system. Anastamoses can occur between the external and internal systems, but significant blood flow from the face to the brain would be very unusual.

Dr. Art Ayers said...

I am not well versed in anatomy, especially the specializations for cooling that have been argued in the referenced paper. I have changed the text to at least be consistent with, what I now have found to be a controversy. I added another reference in the text that still argues for facultative adjustments of facial blood flow that result in lower brain temperatures. The process seems to involve another layer of heat exchanging.

The point, with respect to rosacea, is blood flow in the face in controlled and subversion of this control may contribute to rosacea.

Thanks for the clarification.

Gv said...

Dear Doc, happy new year!
Since being "primal" when I occasionaly with friends eat a real dessert when it's bed time my upper face gets really itchy and, as a consequence, redish.
I guess it has to do with an increased insulin sensitivity of primal eating ? could that be the case?

Maria said...

Dear Dr. Ayers,
thanks a lot for your interesting articles. Last time I had atopic eczema is years ago. Solution was one or maybe all of this: n-3, nearly ZC and lots of SFA. Weeks ago I started pro-/prebiotics to improve my asthma. D3 was 40 in November. Since than I´m on 10000/d to hit the 80. Thanks again.

Anonymous said...

Was on a very very low fat diet, gained 50 pounds while on that diet even with much daily exercise. Fasting blood sugar went up to 160 at that time and rosacea with very red face and pustules appeared. Took me about a year to learn how to do a very very low carb diet (Dr. Bernstein's recommended diet) Lost 60 pounds, blood sugar controlled and no rosacea. I have been on a low carb (AID) for the last 7 years. I started taking krill oil about 3 years ago.

caphuff said...

Thanks Doc, I'll keep you posted.

Maria and Anonymous: Thanks for those success stories.

Ed Terry said...

My first does of immediate-release niacin produced intense flushing and itching for over 90% of my body. Six years later, it causes only very mild facial flushing on occasion. Any ideas why the extent and severity of the flushing decreases with chronic use?

zach said...
This comment has been removed by the author.
Anonymous said...


how do you define a "rich dessert"? I eat what I consider a rich dessert but the dessert has no sugar or starch, very few carbs but a lot of saturated fat from butter or coconut oil. Does you rich dessert have a lot of sugar and/or wheat flour?

Dr. Art Ayers said...

It is very rewarding to me to here success stories. That is why I blog.
Sorry, I deleted the other copy of your post:
"Maybe this has already been addressed somewhere, but I have never asked this question: If I eat a rich dessert (it's been many months), my face does not change color but feels like 1,000 cold needles are pricking my cheeks and forehead! It lasts for less than a minute. The sensation is immediately after swallowing and it also causes my teeth to hurt. It sounds crazy but I'd love to know what causes it. "

Gv and Zach,
These both sound like a form of rosacea and it seems that in some people the structure of the skin blocks observation of facial flushing. I would suspect that Zach doesn't (appear to) blush.

I doubt that sugar is involved. It might be readily absorbed, but there is not enough in a few bites to change blood glucose levels. In any case, sucrose is usually the sweetener and that is not quickly converted to glucose.

The typical rosacea patterns suggest facial nerve stimulation causing inflammation and various sensations. I think that this is common in rosaceans eating particular foods.

How does the presence of food triggers in the mouth/esophagus/stomach produce the rapid facial stimulation?

Is this a facial version of peanut/bee sting immunological anaphylaxis? Is it like the sudden skin flushes caused by endotoxin in scarlet fever?

I would be interested if readers have the answer.

Anonymous said...

On this topic, will gum disease and subsequent bone loss cause the flushing and dilation of the facial blood vessels described?

What is your recommendation and very few physicians are willing to prescribe antibiotics. How can you get these?

Anonymous said...

By the same token - is more than 2 glasses of wine per day another potential culprit?

Dr. Art Ayers said...

I don't understand the contribution of chronic dietary inflammation and gum disease, but the contribution of gum disease to chronic inflammation and degenerative diseases, e.g. heart disease, is well established. I would expect gum disease to contribute to the establishment of rosacea. The first step is to radically change your diet. I would expect you to be vitamin D deficient and have an elevated CRP. The vitamin D deficiency could be the basis for your gum disease.

The recommendation from many sources is one glass of wine for women and a maximum of two glasses for men per day. Alcohol causes leaky gut, which releases bacteria into your blood stream and contributes to liver disease and many other problems. The same is true for common NSAIDs, such as Aspirin.

The diet that I outline on my blog is simple and you can adjust to it easily. Cut back on the alcohol, trade your high carbs for saturated fat and eat plenty of meat and vegetables. Starch (bread, pasta, rice, potatoes, etc.) and especially grains (gluten) are probably your main problem. Eliminate vegetable oils (omega-6 fats) and eat fish (omega-3). Meat and vegetables with plenty of spices, is not that hard to take.

If you can tolerate the diet changes without flare ups, you should see improvements in the rosacea and in your general health.

Thanks for your questions. Let me know how it goes.

Tanya said...

I have been on aspirin and Plavix since my stroke in December (see my comment I posted here

If nattokinase serves same purpose as aspirin/Plavix (based on what I've read online) then does it also contribute to leaky gut, and if not, why not?

As for Vit D and vit D went up to 20 and CRP down from 1.4 to 0.6 (measured after stroke) while supplementing 10K units a day for a couple months. I have a tooth that is resorbing, which seems to be an autoimmune response? I am so confused as I was doing everything 'right' to reduce my inflammation and then bam a bad tooth and then a stroke.

I am wondering if the staph from my tooth infection caused clotting/biofilm in my cerebral artery? Is this even possible? Going to Mayo Clinic next week cuz it isn't a heart problem or a clotting problem. Having tooth pulled Tuesday...have been on antibiotics and mega Vit C to help clean it up. Now to clean up after the antibiotics...

Tanya said... Vit D went up from 23 to 60...

Dr. Art Ayers said...

See Stephan's article on vitD and tooth decay/dental health:
This indicates that gum infections are a separate source from your dietary inflammation. Unfortunately, oral inflammation is a common contributor to heart disease and staph contributes too.

I hope the shift to an anti-inflammatory diet help with your recovery.

Tanya said...

What has me most confused is that it was while ON anti inflamm diet and Vit D supplements that I the tooth problem and the stroke developed. I was doing everything 'right' (except perhaps too much beans/nuts) and got worse not better. It has been over a year of eating 'well', so why did things get worse instead of better? I haven't had a cavity since childhood, and then this. Seems there is something else out of whack somewhere???? T3 maybe? Adrenals?

Jacqueline said...

My Rosacea has pretty much gone away since I have been following a high fat (high sat fat)/low-carb/almost zero gluten/very low sugar diet. I gave up using my Rozex (topical metronidazole) only about 6-8 months ago though. I still get occasional acne outbreaks (one or two spots) - these are linked to the second half of the menstrual cycle. Think I probably eat too many nuts (omega-6's). Interesting about the face/brain cooling. If I do get hot with exercise in warm weather - I always feel very flushed and can feel my face radiating the heat away!
My Rosacea is/was sensitive to sun, cold air and hot spicy food (chilli).

Dr. Art Ayers said...

I have been reading about side effects of high dose vitamin D and bone resorption can occur if vitamin A is inadequate. I don't know the level of vitamin A supplement that would be needed to avoid that effect, but that may be the source of your tooth problem.

Tanya said...

I was taking a multivitamin for Vit A, but nothing more. Good to know. I am taking nothing at all but aspirin and Plavix right Rochester awaiting my appointment. Thanks for the insight.

TanyaMc said...

I came across info that Niacin is helpful in stroke recovery, which also mentioned low HDL as a primary risk factor for stroke. I have low HDL, and Niacin can raise it. It also said it can raise blood sugar slightly. Then, as I looked for for info on low HDL, I came across the assertion that

"The problem with most timed-release niacin is that they are associated with a high degree of hepatitis. There is one sustained-release version of niacin called inositol hexaniacinate, which does not cause flushing and does not appear to be associated with hepatitis."

Perhaps it adds nothing to the mix but I found it very curious.

Dr. Art Ayers said...

Sorry to take so long.
I did a quick read of the niacin/hepatitis literature. It is fascinating. The problem seems to come with either high doses of niacin or with time release niacin. In both cases the high doses in the liver disrupts lipid metabolism. It is interesting that lipid metabolism is so tied it with inflammation. BTW, the major LDL receptor binds to LDL via heparan sulfate. This ties lipid metabolism to many inflammatory diseases.

You might make sure that you have adequate saturated fats in your diet to protect your liver from lipid peroxidation during your various treatments.

Let me know how it all goes. Good luck.

TanyaMc said...

Saturated fat is not a problem for me! :-) Home grown beef in abundance, a friend with chickens thus good supply of eggs, and high fat dairy, incl. cott chz and yogurts are staples in my diet. And, they are good sources of niacin, too, so not sure I need or should add more or not.

My musculoskeletal inflammation (not joint) has returned since dropping the Plavix and going down to one baby aspirin a day. So, I am still chasing that pesky problem. Two questions: Does T3/thyroid regulate inflammation in such a way that it could be only symptom I have of low t3 (no blood test done yet)? I know aspirin causes a leaky gut, but what about the white willow bark it comes from? Does the natural form give the benefits without the side effects?

Thanks (and I wasn't concerned about the time between post and should have a life outside cyberspace!)

Dr. Art Ayers said...

Your persistent inflammation-like symptoms remain puzzling. They may result from vascular inflammation as a consequence of your atrial leak hypoxia. Some oxygen-deprived blood may intermittently lower the oxygen level of some metabolically active tissue and the resulting hypoxia may trigger inflammation. That should be remedied with plugging.

Alternatively, you are stuck with leaky gut based cryptic infections that have taken root at other temporary sites of inflammation.

I don't think that natural sources of aspirin are any different from aspirin. I don't trust plants and eating any of them routinely for their phytochemicals is questionable for me.

Thanks for your info.

TanyaMc said...

I am in agreement...the hypoxia issue has been on my mind. I was told it takes 3-6 mos for the hole to scar over. Also, that it takes 6 mos for a neurological change to manifest as well. So, in the meantime, I am going to continue working on the anti-inflamm diet/supplements (considering krill oil rather than fish oil..thoughts?) and some more phys therapy and excercise (raises HDL). Have been reading about hyperbaric oxygen treatments also as perhaps something to try to remedy the damage from stroke, optic neuritis, and even the crypic stuff? Can't hurt to try. Should have latest lab tests back soon too and hope to see where they lead.

Thanks as always for helping me in this journey!

Natural Skin Treatment said...

Thanks for the useful information…I found a few natural skin care treatments for acne, eczema, rosacea etc. I think this may be useful for you also….

rosacea dieet en voeding said...

I am a firm believer that rosacea has its origin in the gut. The liver, kidneys play a vital role in having symptoms. However it depends on what stage of rosacea you are in if food is the only factor.

Other factors can be hormones or stress related symptoms. I don't believe these are the main factors, but play a part in severity.


Patricia Donovan said...

Great Post Art,

I really like the part about niacin flushing. I think niacin flushing is one of the most overlooked ways of improving cholesterol. One great website about this health phenomenon I want to share is:

niacin flush

Anonymous said...

Dear Dr. Ayers,

I find your work with this blog really impressive and have had great help from many of your posts.

I have perioral dermatitis (which is related to rosacea), redness around the mouth with an acne resembling nasty rash (pus). I've dealt with this for 15 years (got it first time then I was 16). Doc's put me on heavy (3-to 6 months tetracycline) antibiotics on and off, monitoring my liver values. This ruined my stomach and at 25 I was constantly sick (throat infections) and had poor stamina, had constant stomach pains and bad digestions issues (I was super fit, strong and heathy as a child). So 5 years ago I switched to a low carb high fat diet. I lost weight and my stomach improved significantly and the rash got less severe, with longer time between outbreaks. Now I have noticed that there are three main triggers for me:
*Business trips with high starch, big dinners (hard to avoid).
*End of summer (not sure why then rather then later in the year)
* Super strict LCHF with high Vitamin D
* & my period of course, in connection to one of the above.
- Reading your posts I assume high vit D cause die off. Last time I tried ultra-low carb carb the rash just got out of control and lasted for months after that, (May to late August) I was afraid to try it again. Then I experimented with a NSAID gel, as proposed by you (I used diclofenac diethylamine 11.6 mg/g), rubbing this on my chin morning and night time. It immediately got much better (calmed down) and was gone after 30 days. Now I am 1 week into the 6 week diet (cure for the middle-aged middle), the rash is back but manageable with the gel. I'm taking all your recommended supplements (8000 IU vitamin D) with a whole raw egg with each shake. I am considering keep using the whey shakes more then the 2 weeks for better effect destabilizing the gut flora. Keeping strictly away from sugar apart from onions and tomatoes and some raspberries.. My target is to shift the gut flora to a healthier population and lose 1 or 2 pounds maybe (in case visceral fat is involved). I also eat flax meal based on 1 dl whole flax seeds and water (with greek yoghurt) to minimize constipation and removing endo-toxins fairly quick.
Do you think if is a good idea to prolong the whey supplementation period?
I will be sure to update you on potential progress...

(Btw. low carb high fat has helped me with: few migraines, less headache in general, I'm never sick, restless leg is better, better ability to concentrate and hear, calmer, managing my weight and sugar cravings, no more yeast infections that don't go away by them selfs, better complexion, no bloating/flatulence but still some constipation).

Best regards,

Anonymous said...

The point of my post above was just to share my history with how the antiiflammatory diet and lifestyle (have taken up yoga which has helped too) have helped me and my conditions. When it was at its worst I could not walk long distances without getting cold sweaty and could not manage standing up (e.g. at concerts or at work) for too long without pain in my abdomen with spread out on my back, and I had to lie down on my stomach after each evening meal for roughly an hour to calm the cramps..
Your details/thoughts on die off with strict low carb and higher vitamin D, really concurs with what I have experienced and the advice of using a NSAID gel was really priceless. (could there be any negative effect long term using this on my face twice a day? - thinking it must be destined to loose effect, like all things do..)
Low carb has helped me with almost all my issues and now only my rash (and a stiff neck) remains. Doing an extra effort now to manage also this.
...raw egg and whey for a few weeks with high vitamin D, followed by a strict diet including inulin and pectin and then I'm actually off to India ...where I am thinking there is a multitude of bugs circulating.. hopefully not too bad once... but could be good with a little contamination right..?


Anonymous said...

To anon. Yes the two can be related if you are lacking vitamin d!I have a problem with demineralization in reference to my teeth. Curious if your teeth are thin near the gum line? Maybe starting to root from inside out. After putting all three pieces together I have come to realize exactly everything stated in this article so glad to see a doctor putting two and two together. I believe I am also gluten intolerant. Good luck!

Josh Summers said...

Wow, this is such an amazing blog, thanks so much for sharing all of this information. I'm 22 years old, and I was diagnosed with rosacea a few months back, out of nowhere I just got these horrible flare ups and red lumps etc. To be honest, it ruined my life for a period of time, it really affected me to the point that I hated going out.

I ended up having to save up to see a naturopath, which resulted in me finding out that I have SIBO, which I was told could potentially be contributing to my rosacea. I was put on a supplement program and a diet program. Here's the supplement program:

- ADP Oregano oil: Three pills three times a day
- Allimed: One pill three times a day
- L-carnitine: One pill twice a day
- B vitamin complex: One pill a day
- NAC Enhanced Antioxidant: One pill three times a day

The B vitamin and L-carnitine were added because my test showed that I was low in B vitamins and it also showed that I needed L-carnitine. The test also shows oxidative stress, so that's why the antioxidant is in there. Anyway here's my diet I tend to follow every day:

- Some fruit (strawberries, black grapes, blueberries), two sheets of seaweed, 100g almonds
- 500g minced beef, 100g asparagus/broccoli
- Lamb's hearts, kale with hemp oil
- Chicken thighs/drumsticks, a few oranges
- 100g almonds, coconut butter

It's a paleo/autoimmune/anti-inflammatory diet, and to be honest, the whole program has helped my rosacea, although I do still tend to get flushes where my face goes really red, but hey, it's a work in progress.

Anyway, the whole point of this is that I really want to get back into athletics, I went yesterday actually, I'm just concerned about the diet. After yesterday, I feel absolutely wrecked today (but I guess that's normal after having not exercised for 6 months), and I even had to sleep this afternoon. But again, I'm hardly shocked, because since this whole rosacea/SIBO, I've also been getting fatigued a lot, so maybe this training will be good for me, I just want to do it on a good diet. I mean, will a diet high in meat/fat be okay? I've always thought that to do running and stuff, you need to eat heaps of carbs?

I would just love your opinion on my program. I'm due to meet with my naturopath in a few weeks again, but I'm really concerned about all these supplements and what they're doing to my gut. I desperately want to get back to normal life, I don't want to think I'm going to be battling rosacea/gut issues forever. I want to return to studying next year, but I'm just so concerned that I'm going to be too preoccupied worrying about my health. I suppose the first thing to do is to sort out my diet.

Anyway, any advice would be much appreciated.

Josh :)

Dr. Art Ayers said...

Wow, I am glad that you find my blog comprehensive, but why do you want me to read it to you? I have written dozens of articles relevant to your plight, but you seem to be saying that it is not worth your time to actually read them and puzzle out your own cure.

You have noticed that taking a bunch of supplements to treat all of your symptoms is daunting. I keep saying that three things are most important for health:
1) Diet (just not inflammatory)
2) GUT FLORA (adapted to the diet)
3) exercise (results from getting 1&2 right)

Nothing in your treatment addresses your gut dysbiosis. I expect that you have constipation.

Your symptoms are:
vitamin deficiencies

All of these are symptoms of gut dysbiosis, damaged gut flora, with the most common cause being antibiotics. Note from my posts that most common drugs also have strong antibiotic activity and damage gut flora. Diet extremes can also damage gut flora. Figure out how you killed your flora.

Check your vitamin D level. You are deficient. Supplement and test again.

Follow Dr. BG's Animal Pharm recommendations for a 7 step cure for SIBO. That will fix your gut flora and push out SIBO.

Ask yourself how you are bringing in new bacteria to provide the inoculum to regrow your gut flora community of 200 different species of bacteria. Is hygiene eliminating your connection with the bacterial world?

I am not an MD who can take responsibility for your health. I am only a guru to point you in the direction of the true flora.

Good luck and let me know how this was for you.

Aleksandra said...

Dear Dr. Ayers,
Thank you very much for the blog. It's really hard to sort out through all the dietary guidelines, etc.
I developed Perioral dermatitis, which later resulted in rosacea around 3/4 years ago. I was trying to manage it myself, but in the end I think I made it much much worse, by using tremendous amounts of olive oil (without almost any omega-3 and whole-grain-craze). In the act of desperation I started to look for help from dermatologists. All of them advised antibiotics. I delayed is as long as I could, but after trying everything else - I decided to give it a go. Now, two months after starting on tetracycline, I obviously see some results, but now I know I made a mistake. I found this blog, and became aware that during these two months, I probably did far more harm than good. (plus I have frequent sore throat now, HPV virus, feel really bad, brain fog, depression)
I'm not sure what to do next. Where to start. I should be taking antibiotics for another month, but. Everything seems to be so confusing. Do you think that harm I did as so far, can be successfully fixed with your diet? I would really hope so. Also, do you think stopping antibiotics now is a good idea? I'm perfectly aware that you might not want to advise on medical issues, but I am only 19, and as for now my health is in terrible shape, and I have no idea who should I listen to.
I would really appreciate your answer.
Thank you once again for the blog.
Best Regards,

Isaac said...

Very comprehensive blog!

You've pretty much reinforced what I've suspected. I go into the paleo/keto scene when I started weight lifting and soon after developed some serious acne on my former clear skin.

At first I went lower and lower carbs thinking I had 'candida'. To treat that was <10g carb/day and taking oregano oil daily, no surprise, my digestion turned slugging and my skin broke out even more.

After I couldn't bear it anymore I went on a round of isotretinoin, which as you can imagine damaged my GI tract even further...

Now here I am with rosacea, constipation and a range of food intolerances.

Upon waking and until I break my fast my skin is perfectly clear, so I began self testing with macro nutrients.

Fat and protein for breakfast means no rosacea however, this isn't sustainable because whenever I go without carbs for several days, I develop cystic acne (only on my forehead!!)

If I consume starch (cooked and cooled potato) then I have a flair. Fructose/fructans cause a greater flare and GI trouble.

My hypothesis is that some of the starch/resistant starch is feeding beneficial flora that's keeping my acne away, but either the same bacteria or other species are getting fed resulting in a rosacea flare.

Sorry for the wall of text, just though you or other readers might find this interesting :)

Anonymous said...

Would you comment on your rec'd for vegetarians. Or perhaps could "fish" be the only meat consumed (in place of other meats per your diet)?

Also, you mention emotional blushing intermittently but not sure I understand if the potential solution is same as you outline for rosacea (inflammation diet). Personally, I don't have rosacea (that I am aware of) but I do tend to blush frequently (suspect its anxiety in origin). Could it be the liver connection or gut suggested?

Thanks, and very cool info.


Dr. Art Ayers said...

I don't see a fundamental difference between doctrinaire carnivores and vegetarians. Healthy diets are possible with both, but they both require adaptation of gut flora that is usually only possible when a whole community has been involved in recruiting gut bacteria that can utilize dietary polysaccharides and sustain immune development in the gut.

Diet must provide protein and fat macronutrients to satisfy body needs and non-glycemic polysaccharide to feed the gut microbiome bacteria. That is easy for paleos who meat/fish/eggs and plenty of vegetables. It is hard for carnos and vegans/vegetarians.

Meat and fish also have polysaccharides in the form of GAGs, e.g. heparan sulfate and chondroitin sulfate, in connective tissue. GAGs can feed gut flora. Very low carb paleo enthusiasts will suffer from inadequate gut flora, unless they specifically address the acquisition of gut flora that can utilize connective tissue. Similarly, vegans or vegetarians who don't pursue gut bacteria that can utilize the available plant polysaccharides will suffer from vitamin deficiencies.

I don't care about vitamins, micronutrients and environmental toxins, because a healthy body is robust, but a healthy body requires:
1) nutrients for the body -- protein and fat
2) nutrients for gut flora -- non-glycemic, soluble fiber
3) gut bacteria adapted to dietary polysaccharides
4) sleep
5) exercise

The health hazards are processed foods (lack soluble fiber), excess hygiene (blocks access to missing gut bacteria), trans fats/vegetable oils/sugars/starch/grains, low vitamin D/inflammation.

My recommendation to vegetarians is that healthy eating with meat is easy. Most casual vegetarians eventually have health problems, since they fail to obtain adequate macro nutrition and fail to realize that the gut bacteria that they start with are not adequate to live healthily with a diet lacking meat.
So, typical vegetarians and vegans fail to feed body and gut micro biome and get sick with deficiency diseases. Culturally grounded vegans don't have problems, because they pick up both functional diets and gut flora from their community.

So fishtarians/pescatarians should do fine with macronutrients, as well as feeding their gut flora, as long as they introduce new bacteria (probiotics, fermented veggies, avoid excess hygiene) and avoid antibiotics, including stealth antibiotics in the form of other drugs.

BTW, I don't think that blushing is a problem. It is a charming form of communication that will not lead to rosacea unless there is damage to the gut and immune system. So, just like everyone, those who blush should cultivate their health.

Thanks for the questions.

Anonymous said...

I hope you come up with a cure for rosacea, it has truly ruined my life. I purchased the Lipactin with heparin and will let you know if I notice a difference. I also have Hashimoto's disease and wonder if you think there is a link? Anyways, thanks for your informative blog Dr. Ayers!

Anonymous said...

Thanks for this article. I saw a dermatologist because of some veins and redness with cold weather. He did v beam laser treatment but unfortunately I've had a full on rosacea reaction with inflammation and papules, which I never had before (and which he's never seen before). It has been a month. I can't use antibiotics but I'm on a good diet. I'm hoping my body will eventually return to normal but is there a way of quickening the process as the burning sensation, papules and redness is terrible and something I've not experienced before so it frightens me a little.

Unknown said...

My skin is often red. I would like to be able to see results just using a facial redness repair product.

gajismarts said...

I love your share about rosacea. Your helpful post is good for every person. This time i am awareness:

gajismarts said...
This comment has been removed by the author.
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