Rosacea , Joint Stiffness, And Unhealthy Eating Patterns Case Study

Meet Sarah a 45-year-old female and a mother of two. She owns a private school and she is the lead director at the private school so she's very fatigued and tired because she puts in a lot of hours.

Patient Presentation

She's struggled with yoyo dieting since she was 17 years old.

She had a very strict and healthy mother growing up and her mother had a lot of guidelines in place with regards to diet and lifestyle. When she was young and so when she went to university she felt the need to rebel and she started eating a lot of processed foods including salty and sweet foods which she basically binges on throughout her adult life.

She doesn't eat too much meat. So at home it's primarily vegetarian diet with a few meats once or twice a week some fish and some chicken just a couple of times a week but primarily vegetarian.

She also feels more stiff and sore over the past few years.

Clinical Presentation

  • Headaches since 2010 – 3 to 6 per month
  • Rosacea since 2000
  • Muscle soreness and stiffness since 2011
  • Bloating since 2010
  • Anxiety since 2005

Patient Goals

  • Eliminate rosacea
  • Establish Healthy Eating Patterns
  • Eliminate soreness and stiffness

Previous Treatments Rendered

  • She had seen multiple practitioners including chiropractors, acupuncturists, naturopaths and massage therapists

Clinical Pearls

  • First thing to address was the emotional component of her eating
  • Organic acid test to identify SIBO and evaluate any inflammation and energy production markers
  • Stool Test to identify cause of Rosacea
  • Dutch Test to identify adrenal hormone balance and evaluate female hormones

Functional Lab Testing

  • Here is a snapshot of her some of the findings on her Organic Acid Test
  • One of the first findings that we see here is that her beta hydroxybutyrate came back a little bit elevated
  • We definitely want to address that and look at that a little bit further
  • We definitely want to make some modifications to her diet and let her know that the binge sugar eating is probably not really benefiting her at this point because it is making her insulin resistant
  • We did see that her off alpha ketoglutarate came back high and this marker here is an indication of the acidity in her body
  • It tells us the acid alkaline balance in the body and when this is elevated we see that the body is heading towards a more acidic state
  • Definitely something that we are going to want to address
  • We do see here that her energy production markers were not that horrible
  • They were in a good range
  • We need to dig deeper in terms of where her fatigue and energy issues are coming from

  • So when we look at the next page of organic acid tests we saw that she had a lot of DL’s here which shows that these markers here were below detectable limits which means that the lab was not able to pick up on these markers here
  • What this tells us is that she very deficient in B vitamins so she would definitely benefit from some B vitamins support
  • What it also tells us is that the B vitamins are essential for running the Krebs cycle which is the way our body makes energy

  • This picture tells us about the citric acid cycle and tells us about all the factors that are required to make this cycle run in order for our body to produce energy ATP as the main unit of energy that we produce
  • If we're very deficient in B vitamins what you can see here is that she really is not going to make too much energy
  • This actually did give us some insight into why she might be feeling so tired because she just does not have enough of the cold factors to run her s Citric acid cycle


  • The next section here looks at her B12 status
  • It came back a little bit high
  • That tells us that she does not have enough B12
  • We definitely want to support her with some B12 and  make sure she's getting enough be 12 from her diet which is primarily found in meat
  • If she's okay with it, we would probably suggest that she increased her meat consumption a little bit to help address the vitamin B12 deficiency here


  • This next section looks at some of her neurotransmitters
  • We see that she's making a good amount of neurotransmitters and then it also looks at her Picolinate
  • This is a marker of inflammation in the body. So this could help explain why she has some joint pain and stiffness could also explain the fact that she has Rosacea because Rosacea can be an inflammatory condition.

  • This next section here shows us some markers of bacterial overgrowth
  • Her indican is shifted to the right, so is her hippurate and D-Lactate
  • We definitely want to address small intestinal bacterial overgrowth and see if she has any issues in this department here because one of her main symptoms is bloating so definitely something that we're going to want to address at some point

  • This here is a snapshot of her stool test so she didn't have any bacterial or parasitic or fungal overgrowth which was great but when we look at the additional tests that are performed on the stool test we see that her secretary IgA is low which tells us that her immune system in her gut is low
  • Definitely something that we're going to want to strengthen and then her anti-gliadin came back high here
  • This tells us that she definitely has a strong reaction to gluten, and gliadin is one of the main proteins in gluten
  • Her body is definitely not happy with having gluten in the body. Definitely want to address and kind of emphasize remaining on the gluten free diet
  • We also see that the elastase is low and this is a pancreatic enzyme so we probably want to give her some pancreatic enzyme support to help her digest or carbohydrates a little better
  • That's probably why we also saw that beta hydroxybutyrate marker come back elevated on the organic acid test probably because she's not breaking down her carbohydrates very efficiently as an energy source as
  • That test also came back positive for fecal occult blood
  • Whenever we see this positive and if the patient doesn't have any type of IBD which is inflammatory bowel disease we definitely want to refer out
  • This was definitely something I want to attract her attention and ensure that she did get this evaluated and double checked through her doctor and through a primary care physician

  • The next test here is her Dutch Hormone Test
  • Those first box looks at her total DHEA production
  • DHEA was quite elevated here which tells us that there is something inflammatory going on in her body. Definitely something that we're going to want to address
  • It could be because of the gluten. It could also be because she did have some inflammatory markers going on an organic acid test.
  • Her waking cortisol is quite high and then we also see that her afternoon and nighttime cortisol are a little bit on the higher side as well
  • We want to address the high cortisol which could be a reason why she feels anxious all the time when cortisol is high we are going to feel anxious all the time
  • We can see that she's favoring the cortisol pathway a little bit more than cortisol cortisone so cortisone is one of the metabolites of cortisol and we see that she's producing
  • She's favoring the more active cortisol pathway and she's not really deactivating her cortisol into cortisone


  • When we look at her female hormones we see that her progesterone is on the higher side
  • We see that her DHEA is high
  • So this is DHEA sulfate which is the metabolite of DHEA.
  • So we do see that that's on the higher side


  • We see that testosterone is on the higher side as well
  • When we look at how her body is clearing out testosterone we see that she's slightly favoring the more potent androgen side
  • We want to ask her about some symptoms about high testosterone such as acne aggression anger
  • We want to basically see if she's got thinning hair on the scalp but then she has overgrowth of hair in areas where it shouldn't really be like on her chest or sometimes on her face


  • We also see that her estrogen metabolites are on the higher side as well
  • For a premenopausal female we estradiol is one of the main estrogen cells produced and we see that it's a little bit on the higher side
  • When we look at it the way she's metabolizing estrogen we see that she's metabolizing it very well
  • She's going down the two hydroxy pathway which is the more favored protective pathway, that's good
  • When we take a look at her methylation which is basically the way her body clears out estrogen we see that it's a little bit on the low side
  • We definitely want to support methylation here because she's not clearing out all this high estrogen very well
  • Her body is basically taking out the garbage but the garbage man is not coming to take that garbage from the curb so that garbage is just accumulating on the curb there
  • We want to address this here and make sure that we are getting her to methylate a little bit better and detox by the estrogen a little bit better

Clinical and Lifestyle Protocol

  • Avoid gluten, dairy and sugar
  • Referral to transformational coach to get to the root cause of eating patterns
  • Referral for occult blood
  • Go to bed by 10pm
  • Avoid blue light
  • Daily Meditation

Supplement Recommendations

  • Saccharomyces to help improve the immune function in the gut
  • Digestive Enzyme Support
  • B Vitamins Support
  • Support High Cortisol
  • Help Clear Out Estrogen

Outcomes – 30 Day Follow Up

  • No bloating
  • Digestion improved
  • Rosacea improved
  • Weight improved
  • Dealing with stress better
  • She is more rested

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