Food & Lifestyle Choices That Can Trigger or Help Reduce Rosacea

Are you ready to take control of your rosacea? In my 35+ years as a dermatologist, I've seen firsthand how impactful the right diet and lifestyle choices can be for skin health and rosacea treatment. It's exciting to see science catching up and confirming what I've observed in my practice for decades!

I created this guide to give you practical, evidence-based strategies for building a diet to reduce and control rosacea flare-ups, calm redness, and achieve clearer, healthier skin from the inside out. As an added benefit, these choices will also help improve your overall health and vitality [10].

The Link Between Rosacea and Diet

Dermatologists have long known that some foods make rosacea worse. We call them rosacea triggers. They can fuel physiologic inflammation, leading to health problems such as heart disease, diabetes, cancer, and skin conditions such as rosacea and psoriasis. We also know that certain foods promote a gut microbiome that fights inflammation and a number of health problems associated with inflammation.

Putting together the scientific evidence surrounding diet and rosacea, we can give patients dietary recommendations on what foods they should eat and avoid to improve their rosacea.

We use the term ‘anti-inflammatory’ for diet, lifestyle, and pharceceutical interventions that reduce inflammation. We use the term ‘pro-inflammatory’ to describe choices that fuel inflammation.

Anti-Inflammatory Diet

I have used an anti-inflammatory Mediterranean Diet for many years in my practice to successfully lower the risk of rosacea and other inflammatory skin rashes such as psoriasis. It is heavily weighted towards plant-based foods, ‘good fats’, and is low in sugar (low glycemic) and high in natural fiber (an important prebiotic that helps support a healthy gut microbiome).

Scientific studies have examined a Mediterranean Diet’s specific impact on rosacea and found that it enhances response to rosacea treatment and helps reduce rosacea flareups [8,9]. The authors of one study describe a Mediterranean diet as:

The Mediterranean diet (MD) is a healthy diet pattern characterized as high intake of fruits, vegetables, whole grains, fish, legumes, and nuts; moderate consumption of alcohol; low intake of red or processed meats, and using olive oil as the main source of fat [9]

This anti-inflammatory diet is exactly what I developed over 20 years ago to guide my patients, using a pyramid to illustrate ideal food proportions. It aligns with current recommendations by doctors, dietitians, and natural health experts with the unique emphasis on the alkaline vs. acid diet balance. From my own experience, this dietary approach significantly helped manage my physiological inflammation, including both arthritis and rosacea.

Learn more about my specific alkaline Mediterranean diet recommendations and see my food pyramid.

Further Your Knowledge:

• Acne Rosacea: Dermatologist’s Natural Treatment

Foods Rich in Omega-3 Fatty Acids

Omega 3 fatty acids are a nutrient that has broad benefits to skin and have been shown to help relieve the symptoms of ocular rosacea [13]. Supplementation has also been shown to reduce rosacea like inflammation and capillary changes in mice [14].

Foods rich in omega-3 fatty acids [15] that I’ve recommended to my patience for years:

• nuts (especially walnuts)
• seeds (especially flax and chia seeds)
• oily fish ( salmon, sardines, anchovies and mackerel)
• canola and soybean oils

Dr. Bailey’s Favorite Way to Add Omega-3s

My favorite way to increase omega-3s in the diet is with freshly ground flax seeds. Flax seeds have a high content of inflammation fighting omega-3 fatty acids and they are also rich in natural fiber (a prebiotic for a healthy gut microbiome).

I grind them fresh daily in a coffee grinder and add a handful along with pumpkin seeds to my fresh fruit and yogurt breakfast. Flax seeds are an economical booster of overall health.

Read my article to learn about the health and anti-aging benefits of flax seeds.

Probiotic-Rich Foods & Rosacea

In my opinion, dietary choices that promote a healthy gut microbiome are important for people suffering from rosacea. We add probiotic rich foods to the diet as well as foods that are prebiotics, meaning they support the growth of the good gut microbes over those ‘harmful’ ones.

Watch Out for Histamine

It's easy to add foods with live probiotics to your diet. The trick with rosacea is that many fermented foods are also high in histamine, a byproduct of the fermentation process. Histamine rich foods have been linked to rosacea flare ups [20]. For example:

• Kimchi
• Processed/fermented meats
• Aged cheeses

Low Histamine Foods

According to a recent study out of Canada [19] low histamine foods include:

• Kefir
• Yogurt
• Feta
• Sauerkraut

These foods are widely available. I’ve been making and promoting kefir as a healthy probiotic for years. Learn how about the benefits of kefir and how I make my own:

• Benefits of Using Kefir to Support Healthy Skin 

How It Works

The concept is that including live culture probiotic rich foods in your daily diet will help to ‘crowd out’ the bad gut bacteria, including H. pylori and others that are proven to cause a host of health problems such as diabetes, depression, heart disease, obesity and more.

Prebiotic Foods

You also want to add prebiotic foods that are high in indigestible fiber needed to promote the growth of beneficial gut microbes [16, 17]. It is as important as including probiotic rich foods when it comes to creating a healthy gut microbiome. I recommend including foods with high natural fiber such as:

• Whole grains (oats and barley)
• Whole fruits
• Vegetables (mushrooms, onions, and asparagus are great prebiotics)
• Beans [18]

I like to say that what we eat should ‘curate a healthy gut microbiome’. Including low histamine probiotic rich foods along with prebiotic rich food is good for our gut, good for our health, and good for our skin.

Grow Your Knowledge

• Best Probiotic Live Grain Milk Kefir: Dermatologist's Instructions

Gut Microbiome Connection to Rosacea

The gut microbiome connection to rosacea has been a topic I have closely watched for over 35 years. Early in my career I noted a connection between patients with severe rosacea and Helicobacter pylori stomach problems. Rosacea has long been associated with Helicobacter pylori in some studies, though treating H. pylori does not always result in clearing of rosacea. 

As I discuss in this guide, a number of gastrointestinal conditions are now associated with rosacea. They are also associated with intestinal dysbiosis (meaning the presence of too many harmful gut bacteria).

Thus, the gut microbiome-rosacea connection may be linked yet again. Our common practice of using antibiotics to control rosacea flare ups adds to the complexity of this gut microbiome/skin connection.

Gluten & Rosacea

Celiac disease is one type of gluten intolerance and it is associated with several skin conditions such as psoriasis and rosacea [21]. They share common genetic risks [23] and inflammation pathways. The connection suggests that a gluten free diet may help some people with rosacea [22].

I have celiac disease, rosacea, and psoriasis. Since entirely giving up gluten, my rosacea and subtle psoriasis symptoms have completely cleared up. It is important to understand that not everyone with rosacea has celiac. In fact, the combination is probably rare but still worth considering.  - Dr. Bailey

Gluten is a protein found in some expected but also unexpected foods:

• Grains such as wheat, barley and rye
• Soy sauce
• Most beers
• Gluten based grains are often used in sauces and sausages

Trust me, achieving a true gluten free diet is not easy. To test if gluten contributes to your rosacea you need to really achieve a gluten free diet and stick to it for a few months at least. There are no good guidelines for how long you would need to remain gluten free to really test if gluten is connected to your rosacea.

In my practice, I typically allowed 2 months for most therapeutic trials before determining whether they worked for a patient.

Related Content

• Natural Treatment and Remedies for Rosacea
• For more information on a gluten free diet, I rely on The Celiac Foundation website

Foods That May Trigger Rosacea Flare ups

Avoid specific foods that make your rosacea flare up. Rosacea-trigger foods are different for each person and lists of rosacea-trigger foods are starting points only. You really need to see what is relevant for your unique struggle with rosacea.

The obvious triggers to stay away from for most rosacea patients:

• Spicy foods including peppers with high levels of capsasin such as jalapeno, cheyenne and red chili peppers. 
• Alcohol - read my article, Does Alcohol and Wine Make Rosacea Worse? to learn why and what wines you may still be able to enjoy.
• Cinnamaldehyde-containing foods (tomatoes, citrus fruits, cinnamon, chocolate) which can increase skin blood flow leading to flushing
• Histamine-rich foods (aged cheese, wine, processed meats)
• Hot beverages (of note, coffee has been found to reduce rosacea [25] meaning that the hot nature of a beverage and not the fact that it is caffeinated is more important as a rosacea trigger)

Other less obvious and only vaguely connected culprits that you may want to test:

• Avocados and bananas both contain histamine. Just recently, a rosacea patient told me she figured out her flare ups were triggered by avocados. When she gave them up, her face cleared. When she did a re-challenge, her skin broke out again.
• Dairy foods
• Vanilla
• Soy sauce
• Vinegar
• Spinach
• Some white beans
• Eggplant

With rosacea flare ups it's often a matter of degree; doing strenuous exercise in the full sun on a windy day while suffering from hot flashes, after eating Mexican food and drinking a margarita, and at a time when your rosacea is already active is just asking for trouble!

How to Find Your Trigger Foods

• Try to notice if there are any specific food types that seem to be associated with your skin's flare ups.
• When you think that you've identified a trigger food, try avoiding it and observe your skin for changes.
• If your rosacea calms down, confirm your suspicion with a re-challenge.
• If your skin flares up again, you may have identified one of your true food triggers.

Read Food Labels and Identifying Potential Triggers

Read food labels and look for those ingredients that you know trigger your rosacea. If you are avoiding gluten, visit the Celiac Foundation website to learn more about gluten ingredients in foods. Remember, the best diet for rosacea is based on a true Mediterranean Diet framework and this means minimally processed whole foods. If a food label reads like you needed a PhD in food chemistry to understand what’s in a product, I typically steer clear.

Debunking Diet Myths and Rosacea

Coffee is an excellent example of a once maligned rosacea trigger that has now proven to actually be beneficial for rosacea. Alcohol is another interesting myth. Many have blamed rosacea on alcoholism because alcohol causes facial flushing in people with preexisting rosacea. It will trigger a rosacea flare up in many people with rosacea. However, one study [29] found that white wine and spirits were associated with a rosacea flare but red wine was not. The same applies to cinnamaldehyde and histamine-rich foods.

The bottom line is that every person with rosacea is unique and you need to find which foods trigger your rosacea. You will probably also find that this triggering effect will vary based on how much of the food you eat and whether your rosacea is already flaring up or is under control.

Meal Planning Ideas for Rosacea-Friendly Diets

Meal planning for a rosacea-friendly diet revolves around a Mediterranean diet framework and moderation.

You can see that I eat cinnamaldehyde and histamine-containing foods in moderation because my rosacea is controlled. If it wasn’t, I would consider eliminating them until my rosacea improved. The same is true with wine.

Lifestyle and Activity Recommendations for Rosacea

I can't overstate the importance of lifestyle choices in managing rosacea. Sadly, rosacea patients have been told that heavy exertion can worsen rosacea; they have almost been encouraged away from exercise because of the connection between exercise, facial flushing, and a rosacea flare up.

I believe a broader view is essential. A sedentary lifestyle itself may contribute to rosacea, as it's linked to common rosacea-related health issues such as elevated BMI [11], high blood pressure, and type 2 diabetes [12]. These conditions, often influenced by lifestyle, are frequently associated with rosacea.

In my opinion, an underlying inflammatory state likely drives both rosacea and its related health problems. This means we, as dermatologists, need to find the optimal sweet spot where lifestyle, including exercise, helps control your rosacea and its comorbidities.

Ultimately, lifestyle choices that counteract rosacea and its associated conditions are often anti-inflammatory and health-promoting. Rosacea, like many conditions linked to it, are related to the choices we make during each day. For instance, stress—which also disrupts healthy sleep—can trigger rosacea flares. Similarly, rosacea is connected to elevated BMI and central obesity, both influenced by diet, exercise, and stress. We also know that sun exposure and hot environments, like saunas, can cause flare-ups.

So, how can you integrate these insights into a practical lifestyle plan to manage your rosacea?

Lifestyle Triggers

• Stress: A major trigger for rosacea. Most rosacea patients turn beet red when they are upset, embarrassed, or nervous. The pimples and inflammatory rash of rosacea often follow.
• Holidays: Rosacea also flares up during the holidays, which for many of us are stressful.
• Temperature extremes, sun, and strong chapping wind: Saunas, hot tubs, the weather, indoor temperatures, and high exertional exercise that can cause you to get overheated.
• Facial flushing conditions: Menopausal hot flashes and niacin supplement flushing can also cause rosacea flare ups.
• Sun exposure on your rosacea prone skin can cause flare ups. [27]
• Weight gain and central waistline circumference are directly associated with worsening rosacea. [26]

Dermatologist’s Actionable Lifestyle Advice to Help Control Rosacea

Sun Protection

Sun exposure is clearly linked to rosacea flare ups. Avoid direct sun exposure to your facial skin. This means using a non-irritating zinc oxide sunscreen (choose from my matte tinted or invisible sunscreen) daily and combining that with wearing sun protection hats and sun avoidance.

Here’s How:

I have extensive tips on sun protecting your skin:

• Best Sun Protection Tips on How to Enjoy the Outdoors from a Dermatologist

Skin Care

Follow the 4-Step Rosacea Skincare Routine

Rosacea affects people in different ways. With my extensive experience treating patients for over 35 years, I've developed the Rosacea Therapy Skin Care Kit to help you avoid skin care triggers and take control of your rosacea. My own complexion is rosacea-prone and I depend on these products to stay rosacea-free - even if/when I get into some of the rosacea triggers.

Use these products by following my 4 step rosacea skincare routine.

Here is a short overview of the steps:

1. Cleanse by alternating a pH balanced Extremely Gentle Foaming Facial Cleanser during the day and Calming Zinc Bar Soap at night
2. Correct and calm rosacea inflammation twice daily with Green Tea Antioxidant Skin Therapy after cleansing
3. Hydrate skin to help heal rosacea-damaged and fragile skin barrier with Daily Hydrating Moisturizing Face Cream
4. Protect skin from UV triggered rosacea flare ups with the mineral-based broad spectrum Sheer Strength Pure Physical Matte Tinted Facial Sunscreen, SPF 50

The Role of Exercise

Create a regular gentle to moderate exercise routine to help achieve and maintain a healthy weight and counter overall physiologic inflammation linked to many of the rosacea comorbidities [30]. But, don’t exercise to the point where you get overheated and your face turns red. Watch the weather forecast if you are going to exercise outdoors and avoid excessive wind, heat, and sun. In some parts of the world, this may mean finding an indoor workout routine.

As your skin starts to heat up, use a cool towel or spritz of cool water to constrict your facial capillaries and reduce flushing. Again, moderation and consistency are important with your exercise routine.

Stress and the Impact on Your Skin Health

Try to reduce the amount of stress in your life. Only you know what this means for you and how to go about it. I’ve written about stress’s effect on skin conditions, including some of my tips to help reduce stress in our lives.

I'm a big fan of yoga for stress reduction and have written about yoga’s health and anti-aging benefits. Other stress reduction options include mindfulness meditation, biofeedback, taking time to be outdoors, spending time with friends who don't cause you stress, being less demanding of yourself, and living life more slowly.

Finding a stress reducing hobby is helpful. For me it is gardening. Doing what you can to avoid or manage your stress level has the added benefit of lowering overall physiologic inflammation that leads to many other health problems.

Stress reduction also includes getting adequate sleep. Make sleep a priority and try to get a good night’s sleep every night, even if that’s easier said than done.

Temperature Sensitivity and Rosacea

Avoid overheating your skin in hot environments such as saunas. When you are exposed to excessive heat, dampen your facial skin with a cool wet cloth or a spritz of cool water. This will cause the facial capillaries to close and reduce flushing. Repeat this as necessary to reduce facial redness.

Diet

See my recommendations above.

Health Conditions Linked to Rosacea that Support a Diet and Lifestyle Connection

Some of the most common lifestyle-related conditions are also linked to rosacea:

• high blood pressure
• dyslipidemia (elevated fats in your blood such as cholesterol and triglycerides)
• cardiovascular disease [1]
• Type 2 Diabetes [2]
• obesity

In the same context, rosacea is also associated with

• an elevated BMI [3]
• central weight gain independent of BMI [4]

A number of gastrointestinal conditions are also associated with rosacea [21]:

• gastroesophageal reflux (GERD) [5]
• irritable bowel disease
• inflammatory bowel disease
• small intestine bacterial overgrowth (SIBO)
• celiac disease
• H. pylori infection

Gut-Rosacea Connection

The gut-rosacea connection becomes interesting in the context of the gut microbiome, which I discuss above. These gastrointestinal conditions are associated with intestinal dysbiosis [6,7, 28], as is rosacea, obesity, and a number of autoimmune conditions such as rheumatoid arthritis, multiple sclerosis, and type 1 diabetes [23]. While these are uncommon conditions compared to rosacea, the connection is fascinating and worth noting if you have other symptoms to suggest autoimmune issues.

Also interestingly, treating SIBO or H. pylori infections have been shown to also provide therapeutic benefit to rosacea [21]. There is definitely a gut-skin relationship with rosacea and I discuss this in the context of diet in this guide.

The bottom line is that I see puzzle pieces starting to fit together into some strong diet and lifestyle recommendations for rosacea and its related conditions. I discuss them in this guide and give you actional recommendations based on my conclusions.

Integrating Diet and Lifestyle with Rosacea Treatment

Based on over 35 years of clinical experience and emerging scientific evidence, I know you can control your rosacea effectively with targeted diet, lifestyle, and skincare changes. This guide provides practical food and nothing but the best lifestyle and skincare choices that can either trigger or help reduce rosacea symptoms.

Use an ‘all of the above’ approach to manage rosacea, especially if your rosacea is hard to control.

• Follow the lifestyle and diet changes I outlined above
• Combine them with an entirely non-irritating rosacea friendly skin care routine that helps restore the weakened skin barrier characteristic of rosacea prone skin
• Wear mineral zinc oxide sunscreen daily
• Ask your treating doctor to integrate any topical or oral prescription medicines into this routine, if medications are necessary

My Rosacea Skin Care Kit gives you everything you need for a non-irritating skin care routine that helps fight rosacea. I’ve used it as the foundation and added prescription medicines into this routine for years in my dermatology practice.

My goal is to teach you how to build a personalized approach to calm redness and manage your rosacea from the inside out, truly transforming your complexion.

A rosacea friendly diet follows a healthy Mediterranean Diet I described above. Include a low-histamine probiotic rich food such as kefir or yogurt, fresh fruits and vegetables, healthy oils, flax seeds, and oily fish such as salmon. Exercise moderation in your alcohol consumption, identify foods that trigger your unique rosacea, and avoid or eat them only in moderation when your rosacea is controlled. Consider a gluten free diet if you think it is right for you.

Following my rosacea skincare routine will help you avoid skin care triggers, take control of, and heal  your rosacea.

We now understand the power of diet in supporting a healthy gut microbiome and controlling - or fueling - inflammatory health problems including skin problems such as rosacea and general health conditions such as heart disease, hypertension, diabetes, cancer, dementia and others. Rosacea has been linked to some of these conditions, making a healthy diet even more urgently important in rosacea management.

If your rosacea is well controlled with diet and supportive skin care you may be able to sneak up on your skin and ask it to tolerate a small amount of these triggers.

Further your knowledge: Understanding Rosacea - Symptoms, Types, Triggers & Treatment

Learn How to Use Foods for a Healthy Skin

• 30 Day Dietary Challenge for Your Health and Complexion
• The Alkaline Mediterranean Diet for Overall Health and Beauty
• Diet to Heal Acne; Dermatologist’s Advice 

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