What's Really Causing Rosacea?




Rosacea is characterized by a red, flushed face, and also often includes swollen skin, visible broken blood vessels (also called “spider veins”), sensitive skin, and acne-like breakouts.

It’s an extremely common skin condition, and an unpleasant one at that. However, rosacea isn’t well understood by the mainstream, resulting in treatments that simply manage the symptoms, and often aren’t even successful in doing that.

Often, those with rosacea are left trying to avoid exposure to any triggers, which is pretty difficult considering that almost anything can be a trigger of rosacea - heat, anxiety, exercise sunlight, alcohol, skincare products, and emotional stress can all trigger rosacea, as can many other factors.

But, by understanding the underlying causes of rosacea, we can fix the problem at its root rather than poorly managing symptoms.


Rosacea and Energy Balance

Virtually all chronic conditions are caused by chronic energy deficiencies, and rosacea is no exception. (I explain this in more detail in this article.)

The triggers and symptoms of rosacea perfectly exemplify this concept. The many triggers of rosacea, outside of those that are unique to having sensitive skin, are all stressors, meaning that they increase the need for energy and therefore increase energy demands. And the symptoms of rosacea are all symptoms of an inability to meet these increased energy demands.

Exercise is a perfect example of this concept. When we exercise, our energy demands are increased because our bodies require energy to move. In response to these demands, if someone’s metabolism is functioning properly, they would simply produce the additional energy that’s needed. But, this isn’t the case in rosacea. Instead, energy isn’t produced efficiently, leading to the various symptoms that are commonly seen in this condition.

When we can’t produce enough energy to deal with a stressor, like exercise, inflammation occurs. This inflammation, due to impaired energy production, is a key feature of rosacea.

The production of both lactate and nitric oxide are notable features of this impaired energy production and inflammation and are therefore responsible for many symptoms of rosacea.

Nitric oxide is one of the primary mediators of inflammation and increases the dilation of blood vessels, which increases bloodflow and the transport of nutrients to inflamed regions. In rosacea, blood flow to the inflamed areas of the face is increased 2-3 times, suggesting that the production of nitric oxide plays a major role in this symptom (1). Nitric oxide also triggers the release of histamine, which is responsible for the redness that occurs.

The lack of energy and resulting nitric oxide and lactate production also promotes the growth of new blood vessels (2, 3) and causes swelling (4, 5), two common symptoms of rosacea. These effects contribute to the thickening of the skin, or fibrosis, which is another common symptom and is directly related to the inflammation that occurs (6, 7, 8).

Considering the roles of nitric oxide and lactate, these symptoms of rosacea are indicative of a dysfunctional metabolism, resulting in the inability to meet increased energy demands that I mentioned earlier.

This dysfunctional metabolism is an extremely common issue that underlies virtually all chronic conditions, and it can be difficult to address because there are many factors that affect metabolic function.  One of the most notable factors affecting metabolic function, especially in those with rosacea, is gut health.


Rosacea and Gut Health

Gut health and metabolic function are tightly intertwined. A dysfunctional metabolism impairs gut function, which can allow for gut infections and other gut conditions to develop. These conditions then further inhibit metabolic function, leading to a vicious cycle.

Small intestinal bacterial overgrowth, or SIBO, is one of the more common gut conditions that results from a dysfunctional metabolism (9). And, unsurprisingly, SIBO plays a major role in rosacea.

Around 50% of people with rosacea have been shown to have SIBO, and treating SIBO in those with rosacea has been shown to completely resolve or at least improve the symptoms of rosacea in over 70% of people! (10, 11) But, this noteworthy finding is largely ignored.

SIBO can be difficult to get rid of, in part because if metabolic dysfunction isn’t corrected, SIBO will continue to come back. So, it’s important to address both SIBO and metabolic dysfunction together.


Correcting Metabolic Dysfunction

Correcting metabolic dysfunction is no simple task. There’s no magic pill that you can take to fix it overnight, and virtually every factor in our environment affects our metabolic function. This includes the food we eat, emotional stress, exercise, and chemicals and toxins that we’re exposed to. Skincare products also fall into this category, and using high quality skincare products is especially important for rosacea considering that those with rosacea often have extremely sensitive skin.

Because restoring metabolic function is a rather complex topic, I offer a free mini-course on rosacea, health, and energy balance to help get you started. In this mini-course I outline several of the key factors affecting our metabolic function, how they affect our health, and what you can do about them. Click here to sign up!


Jay Feldman is an independent health researcher who graduated with honours from the University of Miami with degrees in Neuroscience and Exercise Physiology.  He helps people struggling with chronic conditions and weight loss to get back in control of their health.

Find out more at www.jayfeldmanwellness.com




  1. Sibenge, Sam, and David J. Gawkrodger. “Rosacea: A study of clinical patterns, blood flow, and the role of Demodex folliculorum.” Journal of the American Academy of Dermatology, 26, no. 4, 1992, pp. 590–93. doi:10.1016/0190-9622(92)70086-U.
  2. Semenza, Gregg L. “Hypoxia-inducible factor 1: Oxygen homeostasis and disease pathophysiology.” Trends in Molecular Medicine, 7, no. 8, 2001, pp. 345–50. doi:10.1016/S1471-4914(01)02090-1.
  3. Rendl, M., et al. “Topically applied lactic acid increases spontaneous secretion of vascular endothelial growth factor by human reconstructed epidermis.” The British journal of dermatology, 145, no. 1, 2001, pp. 3–9.
  4. Leaf, A. “Cell Swelling: A Factor in Ischemic Tissue Injury.” Circulation, 48, no. 3, 1973, pp. 455–58. doi:10.1161/01.CIR.48.3.455.
  5. Liang, Danny, et al. “Cytotoxic edema: Mechanisms of pathological cell swelling.” Neurosurgical focus, 22, no. 5, 2007, E2.
  6. Lupher, Mark L., and W. Michael Gallatin. “Regulation of fibrosis by the immune system.” Advances in immunology, 89, 2006, pp. 245–88. doi:10.1016/S0065-2776(05)89006-6.
  7. Higgins, Debra F., et al. “Hypoxia-inducible factor signaling in the development of tissue fibrosis.” Cell cycle (Georgetown, Tex.), 7, no. 9, 2008, pp. 1128–32. doi:10.4161/cc.7.9.5804.
  8. Halberg, Nils, et al. “Hypoxia-inducible factor 1alpha induces fibrosis and insulin resistance in white adipose tissue.” Molecular and cellular biology, 29, no. 16, 2009, pp. 4467–83. doi:10.1128/MCB.00192-09.
  9. Patil, Anant D. “Link between hypothyroidism and small intestinal bacterial overgrowth.” Indian journal of endocrinology and metabolism, 18, no. 3, 2014, pp. 307–09. doi:10.4103/2230-8210.131155.
  10. Parodi, Andrea, et al. “Small intestinal bacterial overgrowth in rosacea: Clinical effectiveness of its eradication.” Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 6, no. 7, 2008, pp. 759–64. doi:10.1016/j.cgh.2008.02.054.
  11. Weinstock, Leonard B., and Martin Steinhoff. “Rosacea and small intestinal bacterial overgrowth: Prevalence and response to rifaximin.” Journal of the American Academy of Dermatology, 68, no. 5, 2013, pp. 875–76. doi:10.1016/j.jaad.2012.11.038.