Rosacea is a skin condition that may cause the skin to appear red or flushed. Some individuals have pus-filled bumps that may cause stinging or burning on the face. With time, broken blood vessels may show through, causing thickening and swelling of the skin. If severe enough, it can eventually lead to issues with vision. In 2018, an estimated 415 million people suffered from rosacea worldwide.

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CC: Rosacea, Restless Legs, and Bloating

Lauren was a 20-year-old female who had struggled with skin issues for years. Since she was 14, she has been to many dermatologists to address her acne. Later, she would also be diagnosed with rosacea. The skin on her face was flushed and red, and there was swelling around her nose and below her eyes. When she was younger, she struggled with acne, which led her to be on a few courses of antibiotics and many over-the-counter medications and creams. Although her acne was mainly gone, the rosacea was at its worst. Lauren was a junior in college and played soccer on a scholarship. She was heavily involved in academics, admitting stress was always a factor for her. Her diet consisted of campus dining foods for her first two years of college, but she was now eating more whole foods was gluten-free as she could live off campus with access to a kitchen.

Aside from her skin, Lauren complained of restless legs. She had discussed this issue with her personal trainer at school and was constantly told it was because she played soccer. But Lauren felt that it was much more. Lauren had loose bowel movements multiple times throughout the day and felt bloated all the time, which she didn't think was a huge deal. She denied reflux, burping, and gas. She was constantly eating to keep up with her vigorous workouts for soccer, both on and off-season, and would snack late at night while studying.

Initial Lab Work

Genova Small Intestinal Bacterial Overgrowth Breath Test- POSITIVE

Lab Analysis

Lauren's lab work pointed to a few main concerns. Although some values were considered normal based on the lab's reference range, Lauren had functionally low omega, vitamin D, magnesium, and B12 levels. She also had high homocysteine. Abnormal values can indicate a lack of absorption or dietary intake. Low levels of omega fatty acids can affect levels of inflammation. Both vitamin D and omega deficiency can affect the skin. Low magnesium can be one of the contributors to restless leg syndrome.

Lauren tested negative for candida and had a normal thyroid panel.

Through the Genova SIBO breath test, she did test positive for both methane and hydrogen gasses. This indicates a positive SIBO test, meaning that she had bacteria growing in her small intestine, which is supposed to be a sterile area.

Both Rosacea and restless leg syndrome have been associated with SIBO.

*Disclaimer* The breath test is only about 65% accurate, as it does not account for all the gasses indicative of SIBO. There are no false positives, but patients can have false negatives.

Interventions

Lauren was put on the low FODMAP diet with an herbal supplement, Biocidin, for 4 weeks. At the end of 4 weeks, she was able to add back in foods from the restricted column, looking for any reactions for 48 hours. Keeping track of reactions, she would move on to the next food. Lauren discontinued the Biocidin and started taking Spore Daily T and GI Core (glutamine, zinc, vitamin A, various demulcent herbs) for 60 days. This was done to support gut integrity and to approach treating leaky gut. After 2 months, Lauren was instructed to switch from the Spore Daily T to Biotic Daily T, a non-spore probiotic with a more diverse selection of beneficial bacteria. She was told to snack less throughout the day and eat meals that were richer in protein and calories. This was suggested so that the Migrating Motor Complex (MMC) had a chance to clear out food debris between meals. Lack of clearing can cause issues such as SIBO.

Lauren was also given a B complex, magnesium glycinate (500 mg daily with dinner), Vitamin D (5,000 IU daily), and fish oil (2 g daily) for nutritional support.

Lauren was given adrenal adaptogens called NuAdapt, which contains a blend of Bacopa, Ashwagandha, Rhodiola, Eleuthero Root, L-theanine, and phosphatidylserine. Although Lauren's stressors in life could not be changed, the adaptogens could help make her body more resilient to stress.

Follow Up 4 Weeks Later

At the end of four weeks, Lauren came into the office with zero makeup on. She had said that this was the first time in years she felt comfortable leaving her house without needing to use some concealer or cover-up. Her rosacea was 95% gone, aside from some puffiness around her lower eyes. Her bloating was 100% gone, and her restless leg syndrome was 100% gone. Her bowel movements were no longer loose. She felt a "normal" level of soreness after exercise and games, but nothing that kept her up at night or had her concerned.

Lauren wanted to stay on the low FODMAP diet because she was concerned that if she added those foods, her face would worsen again. Lauren was assured that although foods can trigger rosacea and her symptoms, they most likely came from her gut and bacterial overgrowth. In essence, Lauren introduced the foods back after waiting 48 hours in between and was sent home with another breath test to show that the bacteria in her gut was gone.

Follow Up 2 Months Later

Genova Small Intestinal Bacterial Overgrowth Breath Test- Negative

At the follow-up, Lauren's face was still clear, bloating was still gone, and her restless leg syndrome was also still gone. She noticed she had much more energy and was playing soccer better than ever. She noticed she was able to focus much better, and she was no longer taking naps between classes. Most importantly, she was relieved that her rosacea didn't return and her breath test was negative. She continued on her gut support for another 2 months and slowly weaned off.

Summary

Small intestinal bacterial overgrowth (SIBO) can be caused by many things, including antibiotics and medication overuse, birth control, stress, mold, Lyme Disease, etc. When treating, it's important to understand the reason WHY the patient has it in the first place. In this case, a long history of antibiotic usage and stress may have been the culprits. By treating the SIBO, the patient's rosacea was resolved. Rosacea can be caused by a multitude of reasons too. This may include gut issues such as H. Pylori, mites located on the face, blood vessel issues, sun exposure/damage, inflammation, stress, etc. Restless leg syndrome is also linked to SIBO and is commonly linked to magnesium deficiency, in which many people are deficient.