rosacea blog

As I have written previously in a post about rosacea and digestive problems, many people believe that rosacea co-exists with gastrointestinal disorders. A recent paper by J. Whitehead (2009) discusses the hypothesis that rosacea and gastrointestinal symptoms can be linked through an enzyme found in the intestines, called intestinal alkaline phosphatase.

Intestinal alkaline phosphatase (IAP) is a membrane-bound enzyme found in the intestines, which function is to take away phosphate groups from a large number of molecules. For example, the absorption of the B6 vitamins pyridoxal phosphate and pyridoxamine phosphate is dependent on their dephosphorylation by intestinal alkaline phosphatase. IAP is also responsible for removing the phosphate from lipopolysaccharide (LPS), an endotoxin found on gram-negative bacteria that normally induces the fever response. A properly functioning intestinal alkaline phosphatase is important to prevent an immune response against the (good) gram-negative bacteria living in our gut.

Crohn’s disease and colitis are believed to be caused by an abnormal immune response to gram-negative bacteria in the intestine, a feature which may be shared with rosacea. Both Crohn’s disease and colitis are associated with reduced levels of intestinal alkaline phosphatase and the pathology of these diseases have been suggested to be triggered by LPS. Taking oral antibiotics for rosacea is believed to help eradicate these bacteria, resulting in a decreased immune response and subsequent improvement in rosacea symptoms.

Many people with rosacea are advised to modify their diet as many dietary triggers exist for rosacea. However, these dietary trigger factors vary from individual to individual and thus far no clinical evidence for a so-called anti-rosacea diet exists. The author of the paper further suggests that the typical Western diet (which is high in processed foods and low in fresh fruits and vegetables) results in a more acidic environment in the intestines. As its name implies, intestinal alkaline phosphatase works best in a more alkaline (or basic) environment with a pH in the range of 9-10.

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 acid phenylalanine (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] doi:10.1016/j.mehy.2009.02.049

Vitamin B6 is one of the many B vitamins and one of the best studied B vitamins. Vitamin B6 was discovered in the 1930ies and is a water-soluble vitamin that exists in many different forms, including pyridoxal, pyridoxine, pyridoxine phosphate, pyridoxamine, pyridoxal phosphate, and pyridoxamine phosphate. The active form of vitamin B6 is pyridoxal phosphate.

Vitamin B6 plays a major role in hundreds of enzymatic reactions in the body, including the synthesis of amino acids, nucleic acids (DNA/RNA), phospholipids (which are part of cell membranes), histamine, certain neurotransmitters (such as serotonin, norepinephrin, GABA), heme (the center part of hemoglobin) and the processing of carbohydrates.

Vitamin B6 is believed to have a major impact on the skin as when vitamin B6 levels are insufficient, inflammation of the skin can develop, in particular seborrheic dermatitis. Vitamin B6 used to be called anti-dermatitis factor and is also one of the main ingredients in topical treatments for seborrheic dermatitis.

Vitamin B6 deficiency
Since vitamin B6 is involved in the production of the “building blocks” for every tissue in the body, tissues that regenerate frequently such as blood and skin, are affected most when vitamin B6 is deficient. Symptoms of a vitamin B6 deficiency include anemia, fatigue and skin conditions such as eczema and (seborrheic) dermatitis.

Vitamin B6 is absorbed from our food in the intestines via passive diffusion. The absorption of B6 vitamins pyridoxal phosphate and pyridoxamine phosphate involves the dephosphorylation catalyzed by intestinal alkaline phosphatase, which is a a membrane-bound enzyme. Vitamin B6 deficiencies are relatively rare, but people with inflammatory bowel conditions (such as Crohn’s disease and celiac disease), people who drink large quantities of alcohol and people taking certain drugs (corticosteroids, anticonvulsants) are at risk for developing a vitamin B6 deficiency.

Because vitamin B6 plays a major role in the healthy functioning of our nervous system and skin, a severe deficiency of B6 can result in seizures, convulsions and inflammatory skin conditions.

Vitamin B6 is also important for the synthesis of vitamin B3 and for the absorption of vitamin B12. Foods that contain high amounts of vitamin B6 are meats, fish (tuna) and vegetables such as spinach, broccolli, Brussels sprouts, cauliflower and more. Cooked and processed food however, have lost most of the active vitamin B6 and for that reason, supplementation with vitamin B6 may be beneficial to your health if you suspect a B6 deficiency. In addition, several studies have reported that vitamin B6 supplementation can be helpful for managing symptoms of autism.

When stress takes over our lives, it can be damaging to our health. Stress not only weakens our immune system, but it also affects our skin’s barrier function. The skin’s barrier function is important for regulating the balance of water and temperature of our skin as well as blocking the entry of microorganisms.

Chronic stress activates the so-called HPA axis, which is the connection between the hypothalamus and pituitary gland in the brain and the adrenal glands on the kidneys. Activation of the HPA axis by stress leads to higher levels of the stress hormones corticotropin-releasing hormone (CRH) and cortisol, which have a profound effect on our health, skin and brain. The HPA axis is kept balanced by neurotransmitters such as serotonin, adrenaline and dopamine. However, if the HPA axis gets chronically stimulated by stress, a major imbalance in neurotransmitters can result and may lead to the development of anxiety and depression.

Research suggests that the breakdown of the skin’s barrier function (or matrix degeneration) in combination with excessive exposure to the sun, forms a central part of rosacea development. A breakdown of the collagen fibers is thought to play a major part in the degeneration of the skin’s matrix. Poor connective tissue support for blood vessels just underneath the skin can therefore result in the pooling of serum, metabolic waste and immune mediators, which over time leads to more flushing, edema, chronic erythema and telangiestacias. The involvement of a matrix breakdown in rosacea is likely, because blood vessels in rosacea are still able to respond to vasoactive substances.

An out-of-balance HPA axis (particularly prominent in depression and anxiety), results in high levels of corticotropin-releasing hormone (CRH). CRH has been shown to increase the permeability of peripheral blood vessels through the stimulation of mast cells, which in turn release immune mediators such as histamine and nitric oxide. Anti-depressant drugs are thought to “calm” an over-active HPA axis by increasing the availability of neurotransmitters such as serotonin, dopamine and adrenaline. Therefore, the use of antidepressants for a prolonged period of time may reduce the severity of rosacea symptoms. Reducing stress levels in our lives could have a significant impact on the progression and stabilization of rosacea symptoms.

Fimmel S. et al. (2008) New aspects of the pathogenesis of rosacea. Drug Discovery Today: Disease Mechanisms 5: 103-111.

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• comment on mental health in the workplace: food for thought by … – a very well written article. unfortunately mental health isn’t openly discussed as much as it should be. maybe one day it will be.