(the whole study) Intestinal alkaline phosphatase: The molecular link between rosacea and gastrointestinal disease?

Dietary interventions for rosacea

Should IAP activity be shown to correlate with the inflamma-
tory symptoms of rosacea, then effective and low risk interventions
would be easily available to rosacea patients themselves. Despite
the difficulty in accurately calculating the net acid/base balance
of individual foods, while accounting for the varying bioavailability
of each nutrient and effects of metabolic transformation [59,60], it
has been demonstrated that the net endogenous acid production
can be closely estimated using only the total protein and potas-
sium content of food [61]. In this way, it can be shown that pro-
tein-rich meats and dairy products, and potassium-poor cereal
grains are net acid-producing foods, while foods rich in a variety
of potassium salts, such as fruits, vegetables and nuts, are net
base-producing foods, with legumes effectively neutral. By favour-
ing base-producing foods in the diet, it should be possible to pro-
vide conditions within the digestive tract for optimal IAP activity.
In addition to an alkalizing diet, specific foods providing key
nutrients to promote IAP activity could be regularly consumed,
such as oysters for zinc, orange vegetables for beta-carotene
(pro-vitamin A), and cold water fish for fish oils. Similarly, foods
high in known inhibitors of IAP activity, such as phytates and arti-
ficial sweeteners, could be reduced or avoided (see Table 1).
Regular consumption of probiotics, such as found in cultured
dairy products or lactofermented foods and drinks, may be benefi-
cial in reducing rosacea symptoms, perhaps by promoting the col-
onization of the intestinal tract with beneficial Gram-positive
bacteria, thus minimizing the overgrowth of LPS-containing
Gram-negative bacteria. Indeed, probiotics have proven beneficial
in reducing the inflammation of irritable bowel syndrome, in lim-
iting intestinal bacterial overgrowth, and in promoting a favour-
able ratio of anti-inflammatory to pro-inflammatory cytokines.

While dietary optimization would be the ideal natural and safe
approach, in patients for whom dietary modification is not feasible,
carefully titrated nutritional supplementation should also be effec-
tive in reducing rosacea symptoms. Ideally, the effects of each of
the proposed dietary modifications would be specifically assessed
for their relative benefit in reducing rosacea symptoms, but such
an IAP-promoting diet can nevertheless be implemented immedi-
ately and safely by any rosacea patient, and further optimized on
an individual level for efficacy.