Guest guest Posted June 12, 2002 Report Share Posted June 12, 2002 Thanx Marjorie. I found your post extremely informative and question raising. I to am not so sure how much of an impact flushing makes to the course of my disease for the simple reason that I do not flush that often and that intensely. I know that I have flushing triggers such as alcohol, heat and stress--and I have been dealing with these. As for the fact that I do not readily flush, I've reasoned that I am only at the beginning of the disease and that my flushing would progress--I'm now starting to question that. I know as well, that the primary reason for my diagnosis was ocular symptoms of rosacea coupled with a papular component. This last point ties in with your discussion on the inflammatory manifestation of the disease. I find it extremely difficult to pin down foods or environmental triggers which may exacerbate my condition. It seems rather, that a combination of things results in a flare-up. I have noticed, in eating certain foods, that my chemistry changes immediately. Something in the taste results in a quick and passing lightheadedness. I experienced this just yesterday while enjoying a very tasty supper. I can't in any way though, suggest that this response results necessarily in a rosacea flare-up because, many people, probably most, experience the same effect to " good food " at times. So it seems as though we are treating this disease by merely treating its symptoms. What are the underlying causes? (I don't expect an answer, I'm not sure one exists) Worse, as this is not a life threatening disease, we are hardly on the list of heavy research and funding. And perhaps even worse, because of the immunological considerations, the disease is so individual, that potential " cures " might need be as individual as well. Deryk Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2002 Report Share Posted June 12, 2002 Thanx Marjorie. I found your post extremely informative and question raising. I to am not so sure how much of an impact flushing makes to the course of my disease for the simple reason that I do not flush that often and that intensely. I know that I have flushing triggers such as alcohol, heat and stress--and I have been dealing with these. As for the fact that I do not readily flush, I've reasoned that I am only at the beginning of the disease and that my flushing would progress--I'm now starting to question that. I know as well, that the primary reason for my diagnosis was ocular symptoms of rosacea coupled with a papular component. This last point ties in with your discussion on the inflammatory manifestation of the disease. I find it extremely difficult to pin down foods or environmental triggers which may exacerbate my condition. It seems rather, that a combination of things results in a flare-up. I have noticed, in eating certain foods, that my chemistry changes immediately. Something in the taste results in a quick and passing lightheadedness. I experienced this just yesterday while enjoying a very tasty supper. I can't in any way though, suggest that this response results necessarily in a rosacea flare-up because, many people, probably most, experience the same effect to " good food " at times. So it seems as though we are treating this disease by merely treating its symptoms. What are the underlying causes? (I don't expect an answer, I'm not sure one exists) Worse, as this is not a life threatening disease, we are hardly on the list of heavy research and funding. And perhaps even worse, because of the immunological considerations, the disease is so individual, that potential " cures " might need be as individual as well. Deryk Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2002 Report Share Posted June 12, 2002 You're welcome, Deryk. I'm reminded of the wonderful Dylan song, " My Back Pages " , in that the more I read and think about rosacea, the less I understand the relationship between flushing and inflammatory features, or how the ocular features figure in. There may or may not be anything obvious or controllable triggering your or mine or anyone's inflammation or even flushing, it may just be our underlying rosacea as it ebbs and flows in our bodies at this point in time. It may or may not be worth our time and effort and money trying to figure it all out -- but its always worthwhile managing one's skin so it's at its healthest, insuring we're at least not making everything worse with various treatments, and in being responsive to our psychological problems that can co-exist with skin conditions like rosacea, so we don't suffer needlessly on that account. You're right, we don't know rosacea's cause and so we don't know the cure. But most human afflictions aren't cured, most conditions resolve on their own, and good medical care is making the person as comfortable as possible while speeding recovery and (this part is key) preventing complications. The only conditions cured are some infectious diseases, some cancers, and some conditions that are responsive to surgery. (Incidently, that's why so many researchers search for a microbial cause for conditions, including rosacea -- if it's caused by H. pylori or mites or fungi, then it *can* be cured, unlike with other causes -- even if we understood the cause -- it's unlikely a cure will be easily found.) So most of medical care is to support the body's recovery, make the downward slope less steep, and avoid some complications that might otherwise occur. A broken bone will repair itself, but it will do so more comfortably, quicker, and with less chance of residual restrictions if properly set. We don't know what causes essential high blood pressure, but we can help stave off the vascular, heart and kidney complications by keeping the pressure within normal range using diet manipulations and/or medications. We understand the pathophysiology of sarcoidosis and though we can't cure it, we know to follow without treating certain subgroups since they will live a normal life with few if any symptoms and intervening risks making the person worse, whereas other patients need early intervention even when asymptomatic to help save their kidney and lung function. When seen from that perspective, rosacea management really isn't as bleak as you describe. Also, lots of disorders have variable presentations, lupus and multiple sclerosis being two classic examples. But just because the signs and symptoms vary from person to person does not mean that the treatment needs to be individualized. Poverty affects people in different ways, with common themes but also individual manifestions -- but money cures everyone. " Ah, I was so much older then, I'm younger than that now... " Marjorie Marjorie Lazoff, MD > > Thanx Marjorie. > > I found your post extremely informative and question raising. I to am > not so sure how much of an impact flushing makes to the course of my > disease for the simple reason that I do not flush that often and that > intensely. I know that I have flushing triggers such as alcohol, heat > and stress--and I have been dealing with these. As for the fact that > I do not readily flush, I've reasoned that I am only at the beginning > of the disease and that my flushing would progress--I'm now starting > to question that. I know as well, that the primary reason for my > diagnosis was ocular symptoms of rosacea coupled with a papular > component. > > This last point ties in with your discussion on the inflammatory > manifestation of the disease. I find it extremely difficult to pin > down foods or environmental triggers which may exacerbate my > condition. It seems rather, that a combination of things results in a > flare-up. I have noticed, in eating certain foods, that my chemistry > changes immediately. Something in the taste results in a quick and > passing lightheadedness. I experienced this just yesterday while > enjoying a very tasty supper. I can't in any way though, suggest that > this response results necessarily in a rosacea flare-up because, many > people, probably most, experience the same effect to " good food " at > times. > > So it seems as though we are treating this disease by merely treating > its symptoms. What are the underlying causes? (I don't expect an > answer, I'm not sure one exists) Worse, as this is not a life > threatening disease, we are hardly on the list of heavy research and > funding. And perhaps even worse, because of the immunological > considerations, the disease is so individual, that potential " cures " > might need be as individual as well. > > Deryk Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2002 Report Share Posted June 12, 2002 You're welcome, Deryk. I'm reminded of the wonderful Dylan song, " My Back Pages " , in that the more I read and think about rosacea, the less I understand the relationship between flushing and inflammatory features, or how the ocular features figure in. There may or may not be anything obvious or controllable triggering your or mine or anyone's inflammation or even flushing, it may just be our underlying rosacea as it ebbs and flows in our bodies at this point in time. It may or may not be worth our time and effort and money trying to figure it all out -- but its always worthwhile managing one's skin so it's at its healthest, insuring we're at least not making everything worse with various treatments, and in being responsive to our psychological problems that can co-exist with skin conditions like rosacea, so we don't suffer needlessly on that account. You're right, we don't know rosacea's cause and so we don't know the cure. But most human afflictions aren't cured, most conditions resolve on their own, and good medical care is making the person as comfortable as possible while speeding recovery and (this part is key) preventing complications. The only conditions cured are some infectious diseases, some cancers, and some conditions that are responsive to surgery. (Incidently, that's why so many researchers search for a microbial cause for conditions, including rosacea -- if it's caused by H. pylori or mites or fungi, then it *can* be cured, unlike with other causes -- even if we understood the cause -- it's unlikely a cure will be easily found.) So most of medical care is to support the body's recovery, make the downward slope less steep, and avoid some complications that might otherwise occur. A broken bone will repair itself, but it will do so more comfortably, quicker, and with less chance of residual restrictions if properly set. We don't know what causes essential high blood pressure, but we can help stave off the vascular, heart and kidney complications by keeping the pressure within normal range using diet manipulations and/or medications. We understand the pathophysiology of sarcoidosis and though we can't cure it, we know to follow without treating certain subgroups since they will live a normal life with few if any symptoms and intervening risks making the person worse, whereas other patients need early intervention even when asymptomatic to help save their kidney and lung function. When seen from that perspective, rosacea management really isn't as bleak as you describe. Also, lots of disorders have variable presentations, lupus and multiple sclerosis being two classic examples. But just because the signs and symptoms vary from person to person does not mean that the treatment needs to be individualized. Poverty affects people in different ways, with common themes but also individual manifestions -- but money cures everyone. " Ah, I was so much older then, I'm younger than that now... " Marjorie Marjorie Lazoff, MD > > Thanx Marjorie. > > I found your post extremely informative and question raising. I to am > not so sure how much of an impact flushing makes to the course of my > disease for the simple reason that I do not flush that often and that > intensely. I know that I have flushing triggers such as alcohol, heat > and stress--and I have been dealing with these. As for the fact that > I do not readily flush, I've reasoned that I am only at the beginning > of the disease and that my flushing would progress--I'm now starting > to question that. I know as well, that the primary reason for my > diagnosis was ocular symptoms of rosacea coupled with a papular > component. > > This last point ties in with your discussion on the inflammatory > manifestation of the disease. I find it extremely difficult to pin > down foods or environmental triggers which may exacerbate my > condition. It seems rather, that a combination of things results in a > flare-up. I have noticed, in eating certain foods, that my chemistry > changes immediately. Something in the taste results in a quick and > passing lightheadedness. I experienced this just yesterday while > enjoying a very tasty supper. I can't in any way though, suggest that > this response results necessarily in a rosacea flare-up because, many > people, probably most, experience the same effect to " good food " at > times. > > So it seems as though we are treating this disease by merely treating > its symptoms. What are the underlying causes? (I don't expect an > answer, I'm not sure one exists) Worse, as this is not a life > threatening disease, we are hardly on the list of heavy research and > funding. And perhaps even worse, because of the immunological > considerations, the disease is so individual, that potential " cures " > might need be as individual as well. > > Deryk Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2002 Report Share Posted June 12, 2002 You're welcome, Deryk. I'm reminded of the wonderful Dylan song, " My Back Pages " , in that the more I read and think about rosacea, the less I understand the relationship between flushing and inflammatory features, or how the ocular features figure in. There may or may not be anything obvious or controllable triggering your or mine or anyone's inflammation or even flushing, it may just be our underlying rosacea as it ebbs and flows in our bodies at this point in time. It may or may not be worth our time and effort and money trying to figure it all out -- but its always worthwhile managing one's skin so it's at its healthest, insuring we're at least not making everything worse with various treatments, and in being responsive to our psychological problems that can co-exist with skin conditions like rosacea, so we don't suffer needlessly on that account. You're right, we don't know rosacea's cause and so we don't know the cure. But most human afflictions aren't cured, most conditions resolve on their own, and good medical care is making the person as comfortable as possible while speeding recovery and (this part is key) preventing complications. The only conditions cured are some infectious diseases, some cancers, and some conditions that are responsive to surgery. (Incidently, that's why so many researchers search for a microbial cause for conditions, including rosacea -- if it's caused by H. pylori or mites or fungi, then it *can* be cured, unlike with other causes -- even if we understood the cause -- it's unlikely a cure will be easily found.) So most of medical care is to support the body's recovery, make the downward slope less steep, and avoid some complications that might otherwise occur. A broken bone will repair itself, but it will do so more comfortably, quicker, and with less chance of residual restrictions if properly set. We don't know what causes essential high blood pressure, but we can help stave off the vascular, heart and kidney complications by keeping the pressure within normal range using diet manipulations and/or medications. We understand the pathophysiology of sarcoidosis and though we can't cure it, we know to follow without treating certain subgroups since they will live a normal life with few if any symptoms and intervening risks making the person worse, whereas other patients need early intervention even when asymptomatic to help save their kidney and lung function. When seen from that perspective, rosacea management really isn't as bleak as you describe. Also, lots of disorders have variable presentations, lupus and multiple sclerosis being two classic examples. But just because the signs and symptoms vary from person to person does not mean that the treatment needs to be individualized. Poverty affects people in different ways, with common themes but also individual manifestions -- but money cures everyone. " Ah, I was so much older then, I'm younger than that now... " Marjorie Marjorie Lazoff, MD > > Thanx Marjorie. > > I found your post extremely informative and question raising. I to am > not so sure how much of an impact flushing makes to the course of my > disease for the simple reason that I do not flush that often and that > intensely. I know that I have flushing triggers such as alcohol, heat > and stress--and I have been dealing with these. As for the fact that > I do not readily flush, I've reasoned that I am only at the beginning > of the disease and that my flushing would progress--I'm now starting > to question that. I know as well, that the primary reason for my > diagnosis was ocular symptoms of rosacea coupled with a papular > component. > > This last point ties in with your discussion on the inflammatory > manifestation of the disease. I find it extremely difficult to pin > down foods or environmental triggers which may exacerbate my > condition. It seems rather, that a combination of things results in a > flare-up. I have noticed, in eating certain foods, that my chemistry > changes immediately. Something in the taste results in a quick and > passing lightheadedness. I experienced this just yesterday while > enjoying a very tasty supper. I can't in any way though, suggest that > this response results necessarily in a rosacea flare-up because, many > people, probably most, experience the same effect to " good food " at > times. > > So it seems as though we are treating this disease by merely treating > its symptoms. What are the underlying causes? (I don't expect an > answer, I'm not sure one exists) Worse, as this is not a life > threatening disease, we are hardly on the list of heavy research and > funding. And perhaps even worse, because of the immunological > considerations, the disease is so individual, that potential " cures " > might need be as individual as well. > > Deryk Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 13, 2002 Report Share Posted June 13, 2002 OK--Call me skeptical - but I find this hard to believe--Chocolate will produce rosacea--but you may or may not flush from it? I'd like to see proof of that. Michele - Not a chocolate lover, but will occasionally eat my sons' M&M's! Oh and home made chocolate chip cookies! --- Brady Barrows brady.barrows@...> wrote: > For instance, one of the tripwires mentioned by the > NRS that MAY pruduce > rosacea is chocolate. If one eats a chocolate bar > it does not > necessarily produce a flush, but may produce > rosacea. The rosacea does > not immediately result but may take hours or even > days to appear or > worsen. Eating more chocolate will produce similar > results. Flushing > is not required. > __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 13, 2002 Report Share Posted June 13, 2002 OK--Call me skeptical - but I find this hard to believe--Chocolate will produce rosacea--but you may or may not flush from it? I'd like to see proof of that. Michele - Not a chocolate lover, but will occasionally eat my sons' M&M's! Oh and home made chocolate chip cookies! --- Brady Barrows brady.barrows@...> wrote: > For instance, one of the tripwires mentioned by the > NRS that MAY pruduce > rosacea is chocolate. If one eats a chocolate bar > it does not > necessarily produce a flush, but may produce > rosacea. The rosacea does > not immediately result but may take hours or even > days to appear or > worsen. Eating more chocolate will produce similar > results. Flushing > is not required. > __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 13, 2002 Report Share Posted June 13, 2002 OK--Call me skeptical - but I find this hard to believe--Chocolate will produce rosacea--but you may or may not flush from it? I'd like to see proof of that. Michele - Not a chocolate lover, but will occasionally eat my sons' M&M's! Oh and home made chocolate chip cookies! --- Brady Barrows brady.barrows@...> wrote: > For instance, one of the tripwires mentioned by the > NRS that MAY pruduce > rosacea is chocolate. If one eats a chocolate bar > it does not > necessarily produce a flush, but may produce > rosacea. The rosacea does > not immediately result but may take hours or even > days to appear or > worsen. Eating more chocolate will produce similar > results. Flushing > is not required. > __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 13, 2002 Report Share Posted June 13, 2002 I agree. How do we know that chocolate produces rosacea over time? The person who posted this assertion gave no source or reference. I try to keep an open mind, but there's so much mythology going around ... Show me the science please. trackgalcal > > For instance, one of the tripwires mentioned by the > > NRS that MAY pruduce > > rosacea is chocolate. If one eats a chocolate bar > > it does not > > necessarily produce a flush, but may produce > > rosacea. The rosacea does > > not immediately result but may take hours or even > > days to appear or > > worsen. Eating more chocolate will produce similar > > results. Flushing > > is not required. > > > > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 13, 2002 Report Share Posted June 13, 2002 Brady, I believe you are misquoting/misunderstanding NRS, but in your defense I don't believe they are clear in their presentation -- and the confusion strikes at the heart of what is meant by a trigger, and what is meant by an exacerbation of rosacea, something it sounds like (to your credit) you're struggling with as well. On the NRS's page What Is cea (www.rosacea.org/p2.html) under the section Can Anything Make cea Worse they clearly include flushing alone as within their definition of a trigger, but note that flushing can also exacerbate rosacea: " Facial lushing can make symptoms worse. It can even cause flare-ups in patients whose rosacea was under control with medications. Flushing can be triggered by many things ... hard exercise -- even menopause or some medicines. The most common triggers are: hot drinks, alcohol, spicy foods, stress, sunlight, extreme heat or cold. Experts say you should avoid anything that causes flushing. But what bothers one person may not cause a problem in another. You will need to find out what things affect you and decide if you want to change your habits to avoid them. Just remember -- flushing may affect your success in controlling rosacea. Talk to your doctor about how you can learn to identify -- and deal with -- your own flushing triggers. " In the above quote, the word 'triggers' links to a new page, " Factors That May Trigger cea Flare-Ups " . This is a confusing link, made worse by the page's title until we recognise that 'trigger' here is used as a verb, not a noun; replace 'trigger' with 'cause' and you'll see what I mean. I suspect this list of factors (tripwires) wasn't intended to be viewed exclusively as triggers (as was the noun used on the What is cea page). These are also -- in some cases primarily -- situations, exposures, and conditions that exacerbate underlying rosacea, in whatever combination of subclassifications a particular person manifests. It's a subtle, and I believe an important and verrrry confusing distinction that the NRS is making even more confusing. The overlap is understandable since some vascular or inflammatory triggers that impact rosaceans and non-rosaceans (things like the 'niacin flush' affects both rosaceans and non-rosaceans) can also exacerbate underlying rosacea in some rosaceans, under the right conditions. A few minutes in the hot sun OR a half-glass of wine can cause a transient flush in anyone, but several hours in the sun AND a jug of Wild Irish Rose in a rosacean might also induce a full rosacean exacerbation, whatever that manifestation may be, in a particular person. In others, the trigger and related condition are inseparable: a 'hot flash' can trigger a flush in rosaceans and non-rosaceans but menopause -- with its hormonal changes causing vascular instability, emotional stress, and drier skin -- can exacerbate underlying rosacea. The distinction is important because the mechanisms behind triggers are usually well-understood and apply to both rosaceans and non- rosaceans, as compared to the poorly-understood mechanisms behind these factors that exacerbate underlying rosacea. Also, we rosaceans are constantly told to avoid flushing triggers because they may worsen or hasten the underlying progression of our rosacea, separate from whether they also cause an immediate exacerbation of rosacean signs and symptoms (though as I commented in the other post, I'm not aware of the proof of this assertion, although there is clear proof we need to avoid irritative/inflammatory triggers.) In comparing this NRS list of factors to the vascular and inflammatory triggers from my last post: First, it includes all the environmental, physical and emotional stress, alcohol and spicy foods that are common flush inducers. Second, it includes nearly all the foods I talked about that contain or induce small peptide release, specifically histamine. (so much so that the last entry, " foods high in histamine " is superfluous.) The NRS list includes topicals, as I did, though I segregated them into an inflammatory subgroup; the redness that comes from topicals is not vascular in origin, but it comes from direct irritation/inflammation of skin cells. Interesting for this discussion, Brady, is what the NRS list does NOT include: it does not include any common food allergens and intolerances -- no mention of nuts, wheat (indeed, it specifically says that bread is OK), glutan, dairy products, or soy products. To be consistent with the rest of the listing, chocolate is probably included because it contains vasoactive amines, not because it's an allergen. So I don't see anything on this page that supports an allergy or intolerance link to rosacea, or other factors that support a highly restrictive diet, even a temporary elimination diet. It seems to me that the foods listed are included specifically, if not exclusively, because they might trigger a flush (in rosaceans and non- rosaceans). Like I said, this is all pretty confusing. I have a vague sense of how a trigger is different from a factor that exacerbates rosacea, but it falls apart when I try to bring it all together with what I already know and don't know about rosacea. It's a real, " the devil is in the details " situation, when we take the time to really look at the NRS list rather than just toss it off or use specific elements to defend a stance, or what we sort of understand superficially about rosacea without questioning ourselves too deeply. We're told this list was produced by the NRS but " Complied from patient histories by Dr. Wilkin. " I've come across his name before. I'm going to contact the NRS and see if I can ask Dr. Wilkins to comment on this list further. Anyway, Brady, your comments about allergy, and the relationship between allergies and flushing, in the last two paragraphs of your post are not factually correct. I genuinely appreciate some of your nuggets of truth and insight and I always enjoy your words, but still, so much of what you say in your posts and book has no reality for me. Like religious beliefs, I respect them as your beliefs, and part of showing you respect is not to challenge your belief system. They're your beliefs, and I'm glad they work for you and others. Take care. Marjorie Marjorie Lazoff, MD > Deryk and Dr Lazoff, > > Deryk I responded to your original post on Diet and triggers but my post > apparently was lost or whatever, so this time I will send a copy also to > you as well as the group. Dr. Lazoff, you have thought deeply on diet > and triggers for some time now and > your insight on this is remarkable and isn't it interesting that your > thoughts on diet brought one of your longest comments? > > However, only a minority of rosaceans desire to control their rosacea > with diet while the majority prefer medical treatment from a physician > or over the counter products. This group as well as other support type > groups like this one, (ie., seb derm group or other rosacea group), have > found no single treatment, or a variety of treatments from either a > physician or over the counter products to control their rosacea and > since these multiplicity of treatments are wanting we joined this group > to pool our findings into a common network of information. Pascoe has > gathered more support than any other rosacea group on planet earth and > more can be learned here by reading past comments than just about > anywhere else if one takes the time to read the hours and hours of > comments, or just stay in the group for a month or two and the same > comments keep repeating themselves., since the newcomers fail to read > what has already been discussed. But new information does appear once > in a while. > > The vast majority of comments do not discuss diet and triggers. I would > venture to guess that only a small percentage of the comments discuss > diet. I have always disagreed with the idea that a trigger is a flush. > I think a flush may be a trigger, but not all rosacea triggers are a > flush. A trigger has always been in my mind as resulting in rosacea, > and not necessarily a flush. Not all flushes produce rosacea triggers. > So when the NRS lists 'tripwires " and state that certain foods or > beverages may trigger flare-ups in many cases this concept seems > acceptable to most rosaceans. Tripwires or triggers do not have to > produce flushes. Tripwires and triggers produce rosacea. > > For instance, one of the tripwires mentioned by the NRS that MAY pruduce > rosacea is chocolate. If one eats a chocolate bar it does not > necessarily produce a flush, but may produce rosacea. The rosacea does > not immediately result but may take hours or even days to appear or > worsen. Eating more chocolate will produce similar results. Flushing > is not required. > > The allergy theory is different. Sometimes a flush results when eating > certain foods, which indicates an allergy usually and is almost always > an immediate reaction, facial redness or flush appearing within minutes > or hours, and when rosacea also appears there may be a connection. A > person may be allergic to chocolate and also have rosacea. Of course, > this allergy theory may be with any food. > > The reason diet and triggers or tripwires are listed by the NRS is that > there is a connection. Most of us know that something > we are eating and drinking is triggering our rosacea and that is why > comments about diet reappear in the group. As most know, we don't know > the cause, but deep down inside we know food and drink is the culprit, > or at the very least an accomplice. > > Deryk, I answered your five questions you originally proposed in my > earlier email which never got posted. If you would like > the answers to these questions from my point of view I will be happy to > respond. > > -- > Brady Barrows - webmaster for > http://www.rosaceans.com > http://groups.yahoo.com/group/rosaceans > http://www.rosacea-control.com > http://www.rosaceadiet.com > http://groups.yahoo.com/group/rosacea-diet-users-support-group > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 13, 2002 Report Share Posted June 13, 2002 Brady, I believe you are misquoting/misunderstanding NRS, but in your defense I don't believe they are clear in their presentation -- and the confusion strikes at the heart of what is meant by a trigger, and what is meant by an exacerbation of rosacea, something it sounds like (to your credit) you're struggling with as well. On the NRS's page What Is cea (www.rosacea.org/p2.html) under the section Can Anything Make cea Worse they clearly include flushing alone as within their definition of a trigger, but note that flushing can also exacerbate rosacea: " Facial lushing can make symptoms worse. It can even cause flare-ups in patients whose rosacea was under control with medications. Flushing can be triggered by many things ... hard exercise -- even menopause or some medicines. The most common triggers are: hot drinks, alcohol, spicy foods, stress, sunlight, extreme heat or cold. Experts say you should avoid anything that causes flushing. But what bothers one person may not cause a problem in another. You will need to find out what things affect you and decide if you want to change your habits to avoid them. Just remember -- flushing may affect your success in controlling rosacea. Talk to your doctor about how you can learn to identify -- and deal with -- your own flushing triggers. " In the above quote, the word 'triggers' links to a new page, " Factors That May Trigger cea Flare-Ups " . This is a confusing link, made worse by the page's title until we recognise that 'trigger' here is used as a verb, not a noun; replace 'trigger' with 'cause' and you'll see what I mean. I suspect this list of factors (tripwires) wasn't intended to be viewed exclusively as triggers (as was the noun used on the What is cea page). These are also -- in some cases primarily -- situations, exposures, and conditions that exacerbate underlying rosacea, in whatever combination of subclassifications a particular person manifests. It's a subtle, and I believe an important and verrrry confusing distinction that the NRS is making even more confusing. The overlap is understandable since some vascular or inflammatory triggers that impact rosaceans and non-rosaceans (things like the 'niacin flush' affects both rosaceans and non-rosaceans) can also exacerbate underlying rosacea in some rosaceans, under the right conditions. A few minutes in the hot sun OR a half-glass of wine can cause a transient flush in anyone, but several hours in the sun AND a jug of Wild Irish Rose in a rosacean might also induce a full rosacean exacerbation, whatever that manifestation may be, in a particular person. In others, the trigger and related condition are inseparable: a 'hot flash' can trigger a flush in rosaceans and non-rosaceans but menopause -- with its hormonal changes causing vascular instability, emotional stress, and drier skin -- can exacerbate underlying rosacea. The distinction is important because the mechanisms behind triggers are usually well-understood and apply to both rosaceans and non- rosaceans, as compared to the poorly-understood mechanisms behind these factors that exacerbate underlying rosacea. Also, we rosaceans are constantly told to avoid flushing triggers because they may worsen or hasten the underlying progression of our rosacea, separate from whether they also cause an immediate exacerbation of rosacean signs and symptoms (though as I commented in the other post, I'm not aware of the proof of this assertion, although there is clear proof we need to avoid irritative/inflammatory triggers.) In comparing this NRS list of factors to the vascular and inflammatory triggers from my last post: First, it includes all the environmental, physical and emotional stress, alcohol and spicy foods that are common flush inducers. Second, it includes nearly all the foods I talked about that contain or induce small peptide release, specifically histamine. (so much so that the last entry, " foods high in histamine " is superfluous.) The NRS list includes topicals, as I did, though I segregated them into an inflammatory subgroup; the redness that comes from topicals is not vascular in origin, but it comes from direct irritation/inflammation of skin cells. Interesting for this discussion, Brady, is what the NRS list does NOT include: it does not include any common food allergens and intolerances -- no mention of nuts, wheat (indeed, it specifically says that bread is OK), glutan, dairy products, or soy products. To be consistent with the rest of the listing, chocolate is probably included because it contains vasoactive amines, not because it's an allergen. So I don't see anything on this page that supports an allergy or intolerance link to rosacea, or other factors that support a highly restrictive diet, even a temporary elimination diet. It seems to me that the foods listed are included specifically, if not exclusively, because they might trigger a flush (in rosaceans and non- rosaceans). Like I said, this is all pretty confusing. I have a vague sense of how a trigger is different from a factor that exacerbates rosacea, but it falls apart when I try to bring it all together with what I already know and don't know about rosacea. It's a real, " the devil is in the details " situation, when we take the time to really look at the NRS list rather than just toss it off or use specific elements to defend a stance, or what we sort of understand superficially about rosacea without questioning ourselves too deeply. We're told this list was produced by the NRS but " Complied from patient histories by Dr. Wilkin. " I've come across his name before. I'm going to contact the NRS and see if I can ask Dr. Wilkins to comment on this list further. Anyway, Brady, your comments about allergy, and the relationship between allergies and flushing, in the last two paragraphs of your post are not factually correct. I genuinely appreciate some of your nuggets of truth and insight and I always enjoy your words, but still, so much of what you say in your posts and book has no reality for me. Like religious beliefs, I respect them as your beliefs, and part of showing you respect is not to challenge your belief system. They're your beliefs, and I'm glad they work for you and others. Take care. Marjorie Marjorie Lazoff, MD > Deryk and Dr Lazoff, > > Deryk I responded to your original post on Diet and triggers but my post > apparently was lost or whatever, so this time I will send a copy also to > you as well as the group. Dr. Lazoff, you have thought deeply on diet > and triggers for some time now and > your insight on this is remarkable and isn't it interesting that your > thoughts on diet brought one of your longest comments? > > However, only a minority of rosaceans desire to control their rosacea > with diet while the majority prefer medical treatment from a physician > or over the counter products. This group as well as other support type > groups like this one, (ie., seb derm group or other rosacea group), have > found no single treatment, or a variety of treatments from either a > physician or over the counter products to control their rosacea and > since these multiplicity of treatments are wanting we joined this group > to pool our findings into a common network of information. Pascoe has > gathered more support than any other rosacea group on planet earth and > more can be learned here by reading past comments than just about > anywhere else if one takes the time to read the hours and hours of > comments, or just stay in the group for a month or two and the same > comments keep repeating themselves., since the newcomers fail to read > what has already been discussed. But new information does appear once > in a while. > > The vast majority of comments do not discuss diet and triggers. I would > venture to guess that only a small percentage of the comments discuss > diet. I have always disagreed with the idea that a trigger is a flush. > I think a flush may be a trigger, but not all rosacea triggers are a > flush. A trigger has always been in my mind as resulting in rosacea, > and not necessarily a flush. Not all flushes produce rosacea triggers. > So when the NRS lists 'tripwires " and state that certain foods or > beverages may trigger flare-ups in many cases this concept seems > acceptable to most rosaceans. Tripwires or triggers do not have to > produce flushes. Tripwires and triggers produce rosacea. > > For instance, one of the tripwires mentioned by the NRS that MAY pruduce > rosacea is chocolate. If one eats a chocolate bar it does not > necessarily produce a flush, but may produce rosacea. The rosacea does > not immediately result but may take hours or even days to appear or > worsen. Eating more chocolate will produce similar results. Flushing > is not required. > > The allergy theory is different. Sometimes a flush results when eating > certain foods, which indicates an allergy usually and is almost always > an immediate reaction, facial redness or flush appearing within minutes > or hours, and when rosacea also appears there may be a connection. A > person may be allergic to chocolate and also have rosacea. Of course, > this allergy theory may be with any food. > > The reason diet and triggers or tripwires are listed by the NRS is that > there is a connection. Most of us know that something > we are eating and drinking is triggering our rosacea and that is why > comments about diet reappear in the group. As most know, we don't know > the cause, but deep down inside we know food and drink is the culprit, > or at the very least an accomplice. > > Deryk, I answered your five questions you originally proposed in my > earlier email which never got posted. If you would like > the answers to these questions from my point of view I will be happy to > respond. > > -- > Brady Barrows - webmaster for > http://www.rosaceans.com > http://groups.yahoo.com/group/rosaceans > http://www.rosacea-control.com > http://www.rosaceadiet.com > http://groups.yahoo.com/group/rosacea-diet-users-support-group > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2002 Report Share Posted June 14, 2002 I'm not a big chocolate eater and still have rosacea. On the rare times I do eat chocolate I find no correlation to flares or breakouts. Re: Diet and triggers > I agree. How do we know that chocolate produces rosacea over > time? The person who posted this assertion gave no source or > reference. I try to keep an open mind, but there's so much > mythology going around ... Show me the science please. > > trackgalcal > > > > > > For instance, one of the tripwires mentioned by the > > > NRS that MAY pruduce > > > rosacea is chocolate. If one eats a chocolate bar > > > it does not > > > necessarily produce a flush, but may produce > > > rosacea. The rosacea does > > > not immediately result but may take hours or even > > > days to appear or > > > worsen. Eating more chocolate will produce similar > > > results. Flushing > > > is not required. > > > > > > > > > > __________________________________________________ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2002 Report Share Posted June 14, 2002 I'm not a big chocolate eater and still have rosacea. On the rare times I do eat chocolate I find no correlation to flares or breakouts. Re: Diet and triggers > I agree. How do we know that chocolate produces rosacea over > time? The person who posted this assertion gave no source or > reference. I try to keep an open mind, but there's so much > mythology going around ... Show me the science please. > > trackgalcal > > > > > > For instance, one of the tripwires mentioned by the > > > NRS that MAY pruduce > > > rosacea is chocolate. If one eats a chocolate bar > > > it does not > > > necessarily produce a flush, but may produce > > > rosacea. The rosacea does > > > not immediately result but may take hours or even > > > days to appear or > > > worsen. Eating more chocolate will produce similar > > > results. Flushing > > > is not required. > > > > > > > > > > __________________________________________________ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2002 Report Share Posted June 14, 2002 I'm not a big chocolate eater and still have rosacea. On the rare times I do eat chocolate I find no correlation to flares or breakouts. Re: Diet and triggers > I agree. How do we know that chocolate produces rosacea over > time? The person who posted this assertion gave no source or > reference. I try to keep an open mind, but there's so much > mythology going around ... Show me the science please. > > trackgalcal > > > > > > For instance, one of the tripwires mentioned by the > > > NRS that MAY pruduce > > > rosacea is chocolate. If one eats a chocolate bar > > > it does not > > > necessarily produce a flush, but may produce > > > rosacea. The rosacea does > > > not immediately result but may take hours or even > > > days to appear or > > > worsen. Eating more chocolate will produce similar > > > results. Flushing > > > is not required. > > > > > > > > > > __________________________________________________ > > Quote Link to comment Share on other sites More sharing options...
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