Copyright 2010 by Brady Barrows

Elimination Diets (sometimes also referred to Exclusion Diets) was first proposed by Dr. Albert Rowe in 1926 and expounded upon in his book, Elimination Diets and the Patient’s Allergies, published in 1941.

Rosacea Trigger Avoidance is usually what is proposed by the NRS Factors That May Trigger Rosacea Flare-Ups which includes diet triggers, of which 18 are proposed:

Foods:
Liver
Yogurt
Sour cream
Cheese (except cottage cheese)
Chocolate
Vanilla
Soy sauce
Yeast extract (bread is ok)
Vinegar
Eggplant
Avocados
Spinach
Broad-leaf beans and pods, including lima, navy or pea
Citrus fruits, including tomatoes, bananas, red plums, raisins or figs
Spicy and thermally hot foods
Foods high in histamine

Beverages:
Alcohol, especially red wine, beer, bourbon, gin, vodka or champagne
Hot drinks, including hot cider, hot chocolate, coffee or tea

While probably most rosaceans after learning about the NRS Factors That May Trigger Rosacea Flare-Ups either from what others have told them or from their physician or on the internet may try to avoid items on this list in their diet the results from avoiding these items in their diet may prove helpful to some but many report otherwise. This is because there has never been proven in any clinical study, except one, a rosacea trigger that will trigger a rosacea flare up in every case. Not one. The only exception is a study done by JK Wilkin that discovered that it was not the caffeine in coffee that produces flushing but instead the heat. [1]

Apparently some, according to this thread, feel that if a rosacean decides to try avoiding any of the rosacea diet triggers proposed by the NRS or some other source that this is an elimination diet. For example, a rosacean decides to avoid spicy and thermally hot foods then one has engaged in an elimination diet.  Dr. Michael agrees with me that this is not the case for he answers my question about this subject with the following statement:

“No, simply avoiding known or suspected triggers is not an elimination diet because this approach starts with the answer the elimination diet is designed to ask. Namely, what are my triggers or sensitivities?

A proper elimination diet involves two phases:

(1) an strict elimination phase whereby all potential offending foods and chemicals are avoided and

(2) a slow, systematic reintroduction of each potential offending food and chemical class in an attempt to identity your own individual sensitivities.” [2]

While an elimination diet may help you discover what is triggering your rosacea it is probably one of the more difficult diet approaches to take and certainly isn’t a popular one for there are few reports available that this has been successfully accomplished with rosacea. Simply avoiding certain food and drink which is what rosacea trigger avoidance is all about certainly isn’t an elimination diet. Click here for more information on rosacea triggers.

Sources

[1] Coffee a Trigger for Rosacea? Good News for Coffee Lovers!

[2] Michael_V post #3    [Michael is a physician]

Copyright 2010 Brady Barrows

Whenever the subject of trigger avoidance comes up with rosacea usually avoiding spicy food is mentioned. This is due to a 1999 survey conducted by the NRS that is usually referred to as the source of information. How was the survey conducted?

This was not a placebo controlled, double blind controlled study. This was simply a survey of rosacea sufferers who filled out a form and is purely anecdotal. The survey concluded the following according to an article in the JCAD:

“A 1999 survey by the National Rosacea Society of 3,151 rosacea patients determined different food triggers. With regard to alcohol ingestion in rosacea patients, this survey found red wine as the most likely culprit, followed by hard liquor, then beer as the least likely to cause symptoms in patients. With regard to spices, cayenne pepper aggravated rosacea 36 percent of the time, red pepper 34 percent of the time, black pepper 18 percent of the time, white pepper 9 percent of the time, and paprika 9 percent of the time.” [1]

So whenever a physician or anyone says that spicy food is a rosacea trigger they are relying on evidence that is purely anecdotal. While the survey may prove helpful it is by no means a clinical study. Just because 36 percent of the respondents of the survey said they report cayenne pepper as a rosacea trigger doesn’t mean that cayenne pepper is a rosacea trigger. All it means is that maybe it is a rosacea trigger since there is no clinical study to prove that indeed cayenne pepper is a rosacea trigger.

What a rosacea suffer needs to remember is that any proposed trigger is simply that, a proposed trigger. What triggers rosacea is an individual thing. Trigger avoidance is not an exact science and while it may prove helpful one must realize its limitations.

Every trigger proposed on the 1999 NRS survey is just a proposed trigger that MAY trigger rosacea. There has never been found one rosacea trigger that in every case produces a rosacea flare up. Not one.

Conclusion: Spicy food may be a rosacea trigger.

Source:

[1] The Role of Diet in Acne and Rosacea
September 2008
by Jonette E. Keri, MD, PhD, and Adena E. Rosenblatt
J Clin Aesthetic Derm. 2008;1(3):22–26

Copyright 201o Brady Barrows

When discussing rosacea the subject of triggers always comes up. There is some confusion over what a rosacea trigger is because many misunderstand the difference between a rosacea flare up and flushing. A rosacea flare up is a pronounced erythma or redness which can be, but not always, accompanied by papules and pustules. Flushing is a when the skin, usually the face, becomes red and, or hot due to blood rushing to the face. Many confuse flushing with rosacea but actually flushing is a sign of rosacea just as papules and pustules are a sign. Not all rosacea sufferers exhibit pronounced or frequent flushing any more than exhibiting papules and pustules. Some rosacea sufferers may not exhibit any pustules and papules but simply have erythma. Erythma is the distinguishing hallmark of rosacea and flushing is usually the other distinguishing mark. But not all rosacea sufferers have pronounced flushing or flush any more than the general public just as not all rosacea sufferers exhibit papules and pustules. A rosacea sufferer may blush or flush and and the erythma or redness remains and aggravates the rosacea. Hence, rosacea triggers are broken down into two types:
Rosacea Flare Up Triggers and Flushing Triggers

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For More Information on Rosacea Flare Up Triggers

For More information on Flushing Triggers

The other confusion about rosacea triggers is that when a rosacea newbie reads or hears about certain triggers should be avoided from reputable physicians and rosacea organizations they may think that these triggers are set in stone and have been clinically established as absolute triggers. This is far from the truth and actually there has been only one known clinical study on a rosacea trigger done on thermal flushing. All the other proposed rosacea triggers are purely anecdotal. What does ‘anecdotal’ mean?

anecdotal |ˌanikˈdōtl|
adjective
(of an account) not necessarily true or reliable, because based on personal accounts rather than facts or research : while there was much anecdotal evidence there was little hard fact | these claims were purely anecdotal.

When a doctor mentions rosacea triggers based upon a list compiled by the NRS or other source without explaining that triggers are anecdotal it implies to a rosacea newbie that these triggers are set in stone and surely must be true. The truth of the matter is that trigger avoidance isn’t an exact science except for the one trigger that was indeed investigated with the Wilkin report that concluded:

“It is concluded that the active agent causing flushing in coffee at 60 degrees C is heat, not caffeine.”

Oral thermal-induced flushing in erythematotelangiectatic rosacea.
Wilkin JK; J Invest Dermatol. 1981 Jan;76(1):15-8.

If every trigger was investigated as coffee was the list might be reduced. The first three on the NRS list, liver, yogurt and sour cream are an example of how anecdotal this list is:

http://www.rosacea.org/patients/materials/triggers.php

Another survey, which is anecdotal said the the most common triggers were:

Sun exposure
Emotional stress
Hot weather
Wind
Heavy exercise
Alcohol consumption
Hot baths
Cold weather
Spicy foods

http://www.rosacea.org/patients/materials/triggersgraph.php

The above survey listed this as ‘the most common factors’ by percentages and ‘spicy foods’ was the eighth most common. Maybe a clinical study will be done on spicy foods eventually.

A more recent survey by the NRS lists a variety of heat sources as triggers. [1]

[1] Study: Variety of heat sources can trigger rosacea flares
Jun 1, 2010, By: Bill Gillette
Dermatology Times E-News