Sinus
Disclaimer. This web site is for research and educational purposes only. The information given in this site is not intended to replace a therapeutic practitioner relationship.
There are three issues that I am aware of. They do overlap in some ways, which we will explain:
(1) Mould or fungus colonisation of the sinuses which I think is rare
(2) MARCoNS colonisation of the sinuses associated with excessive environmental mould exposure or antibiotic courses
(3) Staphylococci associated with Staph Toxin Illness.
(1) Mould or fungus colonisation of the sinuses which I think is rare
(2) MARCoNS colonisation of the sinuses associated with excessive environmental mould exposure or antibiotic courses
(3) Staphylococci associated with Staph Toxin Illness.
Mould or yeast in the nose or sinuses
I have seen it in a few patients and treatment was quite effective and in some cases was the main problem. How do you know if this is a problem for you? Some persons have no major local sinus symptoms so you might need to do either a swab or a therapeutic trial of antifungal medications. I don't recommend urine testing for mycotoxins at this stage as it expensive and despite Dr. Brewer's study below, I am not sure about its reliability. I think there is a likely major issue with contamination of urine samples from mycotoxins in eaten in foods. Even though there may be few, if any, local symptoms there may be many generalised symptoms from colonisation. The list of sympoms given in Brewer JH et. al., Detection of Mycotoxins in Patients with Chronic Fatigue Syndrome, Toxins (Basel). 2013 Apr 11;5(4):605-17 consists of fatigue, headache, flu-like symptoms, cognitive complaints, myalgia, arthralgia, gastrointestinal problems and various neurologic symptoms. And for the patient group studied in this reference, of whom 93% were positive for mycotoxins, the following previous diagnoses had been made: fibromyalgia, Lyme disease, peripheral neuropathy, orthostatic intolerance (including postural orthostatic tachycardia syndrome and neural-mediated hypotension), migraine, chronic dermatitis, gastroparesis, chronic abdominal pain, irritable bowel syndrome, interstitial cystitis, anxiety, depression, chemical sensitivity, vertigo, chronic sinusitis, glutenintolerance, tremor, myoclonus and cognitive dysfunction.
Another interesting study on the subject of sinus Mycotoxins and fatigue syndromes is Brewer JH et. al., Chronic Illness Associated with Mold and Mycotoxins: Is Naso-Sinus Fungal Biofilm the Culprit?, Toxins (Basel). 2014 Jan; 6(1): 66–80.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3920250/
Dr. Brewer's research is still, in my opinion, controversial and has not, to my knowledge been replicated. Nevertheless, based on my clinical experience, I believe there is a small subset of patients with fatigue from nasal fungal or yeast colonisation.
My current favourite nasal spray program for a therapeutic trial is the same as that given later in this page under the treatment section - Amphotericin with a biofilm dissolver (more information below). I certainly don't recommend oral anti-fungal medication. We are looking for an improvement in symptoms over about 3-4 weeks as a positive sign. Die-off or herx reactions can also occur and are usually a positive sign. Other clues to the fact that you may have this issue are persistent sinus troubles, especially if they are all year round, a tendency to crave sugar and a history of living or working in a mould affected building. By improvement in symptoms, I don't mean runny nose and sinus congestion (though this might improve), I am referring to improvements in energy and general well-being. I should mention that any nose spray could potentially cause side-effects. The main one to watch out for in my experience is tinnitus, which is rare except with 'BEG Spray' (Bactroban, EDTA, Gentamicin) used for nasal Staph. I don't recommend this "BEG' combination at all for any type of nasal bug treatment. Tinnitus can be hard to treat and potentially even permanent, so stop and check at the first sign of this side effect whatever nose spray you use.
Nasal swabs for fungus or yeast can be done by ordering a swab kit online from the US company microbiologydx.com and sending the sample to them for testing. The Melbourne lab called Nutripath organise a combined nasal MARCoNS and fungus/mould combined test with microbiologydx which costs around $AU300 as at April 2019. I believe these swab tests are can miss fungal or yeast that is higher up in the nasal passages. They also can give false positive results since our nasal passages filter out mould and yeast spores and so if you have been around a mouldy area and got a significant number of spores in your nose the swab could just pick these up and grow them. So these swabs need to be treated with some caution. I rarely do them. I prefer, if suspicious, to do a therapeutic trial of anti-fungal nasal spray.
Treatment of nasal fungus: Start with Xylitol nose spray which is a biofilm buster. Get it OTC or online. OTC products usually have other ingredients which can sometimes confuse things. To avoid this complication you can make xylitol yourself by adding about a 1/4 of a tsp of xylitol crystals to a nose spray bottle with some clean water added. Remake it every four days or so as this does not have any preservative in it. An alternative is a combination of EDTA 0.1% and Polysorbate, made up at a compounding pharmacy. One-two sprays both sides twice a day. Stay on this. After three days on this add in Amphotericin B nasal spray. This is a script medication that you get made up at a compounding pharmacy - Amphotericin B 0.25%. It needs to be kept refrigerated. Gradually work up to a dose of 2 sprays each side twice or three times a day. An alternative to Amphotericin is to use Nystatin and make up your own nasal spray using a diluted version of the OTC oral nystatin mouth drops. Pharmacy prices vary greatly for the Ampho spray, so if you are paying significantly more than $120 keep phoning around.
For those who wish to use something non-pharmaceutical:
I still recommend using the Xylitol as your biofilm buster. You could replace the Amphotericin by adding just one drop of tea tree oil to the xylitol/water mixture. I have read or known of people using iodine in water too. I don't recommend it as I think it is more irritating and has more risk of side effects if used regularly due to iodine being absorbed and interacting with the thyroid.
Another interesting study on the subject of sinus Mycotoxins and fatigue syndromes is Brewer JH et. al., Chronic Illness Associated with Mold and Mycotoxins: Is Naso-Sinus Fungal Biofilm the Culprit?, Toxins (Basel). 2014 Jan; 6(1): 66–80.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3920250/
Dr. Brewer's research is still, in my opinion, controversial and has not, to my knowledge been replicated. Nevertheless, based on my clinical experience, I believe there is a small subset of patients with fatigue from nasal fungal or yeast colonisation.
My current favourite nasal spray program for a therapeutic trial is the same as that given later in this page under the treatment section - Amphotericin with a biofilm dissolver (more information below). I certainly don't recommend oral anti-fungal medication. We are looking for an improvement in symptoms over about 3-4 weeks as a positive sign. Die-off or herx reactions can also occur and are usually a positive sign. Other clues to the fact that you may have this issue are persistent sinus troubles, especially if they are all year round, a tendency to crave sugar and a history of living or working in a mould affected building. By improvement in symptoms, I don't mean runny nose and sinus congestion (though this might improve), I am referring to improvements in energy and general well-being. I should mention that any nose spray could potentially cause side-effects. The main one to watch out for in my experience is tinnitus, which is rare except with 'BEG Spray' (Bactroban, EDTA, Gentamicin) used for nasal Staph. I don't recommend this "BEG' combination at all for any type of nasal bug treatment. Tinnitus can be hard to treat and potentially even permanent, so stop and check at the first sign of this side effect whatever nose spray you use.
Nasal swabs for fungus or yeast can be done by ordering a swab kit online from the US company microbiologydx.com and sending the sample to them for testing. The Melbourne lab called Nutripath organise a combined nasal MARCoNS and fungus/mould combined test with microbiologydx which costs around $AU300 as at April 2019. I believe these swab tests are can miss fungal or yeast that is higher up in the nasal passages. They also can give false positive results since our nasal passages filter out mould and yeast spores and so if you have been around a mouldy area and got a significant number of spores in your nose the swab could just pick these up and grow them. So these swabs need to be treated with some caution. I rarely do them. I prefer, if suspicious, to do a therapeutic trial of anti-fungal nasal spray.
Treatment of nasal fungus: Start with Xylitol nose spray which is a biofilm buster. Get it OTC or online. OTC products usually have other ingredients which can sometimes confuse things. To avoid this complication you can make xylitol yourself by adding about a 1/4 of a tsp of xylitol crystals to a nose spray bottle with some clean water added. Remake it every four days or so as this does not have any preservative in it. An alternative is a combination of EDTA 0.1% and Polysorbate, made up at a compounding pharmacy. One-two sprays both sides twice a day. Stay on this. After three days on this add in Amphotericin B nasal spray. This is a script medication that you get made up at a compounding pharmacy - Amphotericin B 0.25%. It needs to be kept refrigerated. Gradually work up to a dose of 2 sprays each side twice or three times a day. An alternative to Amphotericin is to use Nystatin and make up your own nasal spray using a diluted version of the OTC oral nystatin mouth drops. Pharmacy prices vary greatly for the Ampho spray, so if you are paying significantly more than $120 keep phoning around.
For those who wish to use something non-pharmaceutical:
I still recommend using the Xylitol as your biofilm buster. You could replace the Amphotericin by adding just one drop of tea tree oil to the xylitol/water mixture. I have read or known of people using iodine in water too. I don't recommend it as I think it is more irritating and has more risk of side effects if used regularly due to iodine being absorbed and interacting with the thyroid.
Staph Bugs and CFS/ME and Fibromyalgia
There are two issues that I am aware of: Multiple Antibiotic Resistant Coagulase Negative Staphylococcus (MARCoNS) colonisation of the sinuses associated with Chronic Inflammatory Response Syndrome (CIRS) and Staphylococci associated with Staph Toxin Illness.
MARCoNS and CIRS
'Chronic Inflammatory Response Syndrome (CIRS) is a condition proposed and researched by Dr. Ritchie Shoemaker. In these patients, according to Shoemaker, MARCoNS tend to prevent the normalisation of Melanocyte Stimulating Hormone. For more information, please see Dr. Shoemaker's website at survivingmold.com. For basic information on mould see our page on sick buildings. Shoemaker recommends eradication of nasal and sinus MARCoNS with an antibiotic nose spray like 'BEG spray'. Note: A patient with CIRS will usually fail a VCS test (see his web site) and, according to his protocol, will need to be removed from any mould exposure and be treated with a sequestering agent like cholestyramine before anti-MARCoNS therapy is started.
I have found that some people have MARCoNS without any known mouldy building exposure. In these patients it seems related to long antibiotic courses. As noted below, the MARCoNS may cause Staph Toxin Illness in these patients. In my patients BEG spray caused too severe Herxhiemer reactions. Instead of BEG I treat it in the same way as described for Staph Toxin Illness below.
I have found that some people have MARCoNS without any known mouldy building exposure. In these patients it seems related to long antibiotic courses. As noted below, the MARCoNS may cause Staph Toxin Illness in these patients. In my patients BEG spray caused too severe Herxhiemer reactions. Instead of BEG I treat it in the same way as described for Staph Toxin Illness below.
Staph Toxin Illness
This is a problem with Staph toxins in general and can in my opinion be an issue for anyone, including sufferers of CIRS. This Staph issue may include the presence of MARCoNS or just CoNS (Coagulase Negative Staphylococcus) and also other coagulase positive species of Staph that live in the sinuses, nose, skin, vagina and sometimes even the gut. I believe this Staph issue which I am about to describe is quite a common contributor to CFS/ME and Fibromyalgia. It is, in my opinion, worth considering for all persons who have had a prolonged course of antibiotics, including those treated with antibiotics for tick born diseases and for anyone exposed to an environment where they have been breathing in a higher than normal level of mould spores. Also for those found to have any sort of Staph in their nose and who has unexplained fatigue or muscle pain.
There is some relevant research on CoNS and its toxins. Nasal carriage of this bug may or may not produce local symptoms. Also there may be generalised symptoms. The fullest published symptom list that I have seen comes from Table 5.1 of a thesis done by Niel McGregor referenced later in this page. I believe this list relates to any one with Staph Toxin Illness and that it is not a complete list of possible symptoms:
Musculoskeletal symptoms
Jaw muscle pain
TMJ (jaw joint) clicking or locking
Neck/Shoulder pain or tenderness
Arm pain or tenderness
Sciatica (nerve pain down the leg)
Arthritis/Painful or stiff joints
Infectious symptoms
Swollen or tender cervical and/or axilliary lymph nodes
Night sweats
Sore throat
Recurrent sinusitis
Aphthous ulceration (mouth ulcers)
Hyperaesthesia/Paraesthesia
Clenching or grinding of the teeth
Earaches and Tinnitus
Headache and Migraine headaches
Hair loss
Irritable bowel and abdominal symptoms
Diarrhoea
Palpitations
Blood pressure problems
Faintness / dizziness
Muscle fatigue
Generalised lethargy and sleep disturbance
I diagnose Staph Toxin Illness based on history, a nasal swab showing Staph and a therapeutic trial of treatment. A standard nasal swab done by most big labs where they perform a 2-3 day culture is normally inadequate. Some types of Staph can apparently be slow growing and a two week culture is best. In Australia you can call the private test company called Nutripath and order a swab test kit. You can also contact the US company www.microbiologydx.com directly (this is the lab that Nutripath refers their specimens to). The advantage of using Nutripath is a slightly easier postage experience.
Staph bugs are considered to be a normal part of body colonization. I have read that they are found on about 55% of the population. In most people they appear to cause no trouble unless certain conditions cause the Staph to get nasty. In relation to fatigue and associated symptoms the issue is the Staph being triggered to produce toxins. Such toxins can produce a large array of symptoms including fatigue and fibromyalgia. If you have Staph in your nose with fatigue or fibro but no evidence of CIRS, or other cause found after testing, then in my opinion you may well have toxin activation going on.
Let us consider some of the evidence that the triggering of Staph toxin production can lead to CFS and/or Fibromyalgia. The following studies have associated a type of Staph toxin with chronic facial and muscle pain:
Butt Hl et al., An association of membrane-damaging toxins from coagulase-negative staphylococci and chronic orofacial muscle pain, Journal of Medical Microbiology 1998; 47:577-584
McGregor NR et al., Coagulase-negative staphylococcal membrane-damaging toxins, pain intensity, and metabolic changes in temporomandibular disorder patients with chronic muscle pain, J Orofac Pain. 2003 Spring;17(2):125-32.
Niel McGregor, lead author of the above study did a whole thesis on chronic face pain and its association with Staph (McGregor Niel Roland, CHRONIC FACE PAIN/TMD: BIOCHEMISTY AND MICROBIOLOGY, A Thesis submitted to the Faculty of Dentistry, University of Sydney for the degree of Doctor of Philosophy, esp. pages 227-228 in the original work or pages 226-227 of the Sydney Uni archive file (dated 1999). The Sydney University URL for the thesis is: http://ses.library.usyd.edu.au/handle/2123/369.)
In this thesis McGregor provides evidence for many interesting things, including:
CFS appears to be associated with delta and beta Staph toxins (p. 206).
On p. 189 he mentions that part of the Staph chromosome called the 'Accessory Gene Regulator” (arg) is responsible for toxin production and can be turned on or off by certain environmental stimuli. He mentions “Importantly a reduction in osmolarity (low sodium levels) in the medium is associated with an increase in toxin production and arg-associated RNA whilst an increase in extracellular sodium results in inhibition of arg expression (Regassa & Betley, 1993).” The reference for Regassa and Betley is: Regassa LB, Betley MJ. High sodium chloride concentrations inhibit staphylococcal enterotoxin C gene (sec) expression at the level of sec mRNA. Infect Immun 1993; 61:1581-1585.
It is interesting to study the various things that can cause a low sodium level or low osmolality. If you want to study the topic check out SIADH (Syndrome of Inappropriate Anti-Diuretic Hormone).
On p. 204 he mentions an association of toxin production with antibiotic use at the time of onset of temporomandibular pain syndrome and on page 217 he states that antibiotic use, especially prolonged antibiotic use, is associated with higher levels of delta Staph toxins. In addition on page 229 he comments that antibiotic use may select for more toxicogenic Staph species.
So, what about treatments for this Staph toxin illness causing face pain and CFS?
On page 229 of his thesis McGregor tells us that toxins produced by Staph have a low antigenicity, so the body's immune system does not readily produce antibodies against these toxins. This is why we would need a Staph toxoid vaccine enabling the body to produce antitoxin.
Has such a vaccine been tried? Yes, with very good results. See the following studies and thesis:
Andersson M, et al., Effects of staphylococcus toxoid vaccine on pain and fatigue in patients with fibromyalgia/chronic fatigue syndrome, Eur J Pain, 1998; 2(2):133-142.
Zachrisson O, et al., Immune modulation with a staphylococcal preparation in fibromyalgia/chronic fatigue syndrome: relation between antibody levels and clinical improvement. Eur J Clin Microbiol Infect Dis. 2004 Feb;23(2):98-105. Epub 2004 Jan 20.
http://www.ncbi.nlm.nih.gov/pubmed/14735403
Zachrisson O, et al., Treatment with staphylococcus toxoid in fibromyalgia/chronic fatigue syndrome--a randomised controlled trial. Eur J Pain. 2002;6(6):455-66.
http://www.ncbi.nlm.nih.gov/pubmed/12413434
Thesis (in English) by Olof Zachrisson, Fibromyalgia Chronic Fatigue Syndrome - Aspects on biology, treatment, and symptom evaluation. Doctoral thesis from institute of clinical neuroscience, section of psychiatry, Gteborg University, Sweden, 2002. ISBN 91-628-5386-4.
Gottfries C, et al., Long-Term Treatment with a Staphylococcus Toxoid Vaccine in Patients with Fibromyalgia and Chronic Fatigue Syndrome, Journal of Chronic Fatigue Syndrome Vol. 13, Issue 4, 2006.
These studies all sound wonderful, but the vaccine is, to my knowledge, not available at the time of this article being written (2021). Please read Dr. Lars Lagerstrand (MD, PhD) personal testimony which I found at the meassociation.org.uk web site, dated Sept. 2009 (and also keep reading this page to understand alternative options):
Dr. Lagerstrand's personal testimony: “I am a medical doctor and associate professor working at the Karolinska University Hospital in Stockholm and a member of the committee of the Swedish Association for ME patients in Stockholm. However, I am also a patient with ME/chronic fatigue syndrome since 14 years and have been successfully treated with a vaccine against staphylococcus during the last 8 years.
“A Swedish research group has developed a treatment against ME/CFS that reduces symptoms significantly. In Sweden we have about one hundred and fifty patients with ME/CFS that have been successfully treated with a vaccine against staphylococcus. The vaccine has been given to us monthly during 5-10 years without any adverse effects. The treatment has made it possible for the majority of us to work and also to have energy left for our families, friends and even sports and outdoor life. The effectiveness of the vaccine has been proven in a double blind scientific study.
“However the vaccine is not produced anymore and most of us have been forced back to illness life. We have thus come to an absurd situation where there exists a treatment of ME/CFS, which could dramatically reduce symptoms and make life much better for millions of people all over the world."
So if the vaccine is not available any more, are there alternative options? The answer is 'yes'. This is how I currently approach the treatment of Staph Toxin Illness. In general, results have been good.
1. Be aware of the possible conditions that may have turned on the Staph toxin production in the first place and, if possible, rectify these conditions. There may still be some Staph on the body that have not yet started producing toxins.
Avoid living or working in an environment where you are breathing a higher than normal level of mould spores.
We have already mentioned low sodium or osmolality as being a trigger for toxin production (McGregor, Doctoral Thesis p. 189) and that antibiotics, especially prolonged courses, can be a trigger (ibid. p. 217). So avoid drinking too much water or having unnecessary antibiotic courses. Regarding water, don't make this an excuse to drink too little. About 35ml/kg/day is about right for most adults.
Another thesis has been done on the subject we are discussing: Fairhead, H., The Regulation of Toxin Production in Staph Aureus, Doctoral Thesis, University of Nottingham, June 1998.
In this study she gives evidence as follows:
Page 38: “In S. aureus, it has been found that deficiency of iron up-regulates activity of the accessory gene regulator and production of alpha- haemolysin”.
Page 40: “In S. aureus high salt concentrations (1.2 M NaCl) resulted in a 16-fold decrease in production of enterotoxin C (Regassa and Betley, 1993)” See also page 89 and 90 where high salt concentrations inhibited toxin production.
Page 93. Low calcium or magnesium levels cause an increase in toxin production.
So we need to try and avoid low iron, low serum sodium or osmolality (don't overdue your water intake - 35ml/kg is a good general figure for adults), low calcium and low magnesium. I recommend having blood tests to check the levels of these minerals. Also, we should only take antibiotics when we really have to and try and avoid long antibiotic courses in particular. Antibiotics should never be used for just common colds and viruses.
2. Decide if you are going to try and eradicate Staph from the nose and sinuses or just neutralize or reduce toxin production in these areas.
It must be emphasised that the approaches below are quite firmly experimental as no large scale, double-blind, placebo controlled, randomised, multi-centre trial has been conducted on the use of nose spray of xylitol, tea tree oil, coconut oil and water, combination antibiotics or probiotics in the safe and effective eradication or control of nasal Staphylococcus aureus. So, anyone wishing to try these methods must do so at their own risk (under supervision, of course, of a suitable and agreeable health care professional) or else wait until they are proven by clear, non-biased scientific studies.
For an eradication program, I recommend a gentle three step program to try and avoid severe herxing. Let me make it plain: these nasal Staph can cause major herxing if they are aggressively killed. For this reason I no longer recommend using regular antiobiotic sprays like Mupirocin and Rifampicin mixtures except in rare cases.
- Step One is using Xylitol nose spray for three or four weeks. I recommend making it in order to avoid confusing issues from other ingredients that are added to proprietary products. Xylitol crystals are obtainable online or possibly from a health food. I think the variety made from birch is probably better than the one from corn. For a spray bottle in Australia you could get something like 'Dimatab' with a refill from a chemist and dump out the contents and clean it out then use it. Add about 1/4 teaspoon to a 20 or 30 ml nose spray bottle. Add clean water. Warm water makes it easier to dissolve. Shake before use. Use 2-3 sprays both sides twice a day. Keep in the fridge and make up a fresh batch about every four days as it does not have any preservative in it. If the above recipe really can't be made, then purchase a proprietary brand such as Xlear. Xylitol acts as a biofilm digester. Biofilm is a jelly-like mucous that the bugs live in for protection. Use of the Xylitol spray can sometimes cause some Herx reactions by enhancing your bodies natural defence system and thus killing some Staph (Zabner J, et al., The osmolyte xylitol reduces the salt concentration of airway surface liquid and may enhance bacterial killing, PNAS October 10, 2000, vol. 97 no. 21)
If you are sensitive to Xylitol or don't want to use it for some other reason then an alternative is using a coconut oil and water mixture for three or four weeks. Use only about 1/8 tsp of coconut oil per 30ml spray bottle. Use high quality, cold-pressed, virgin coconut oil. Use clean warm water in the spray bottle with the oil or use cold and then warm it up. It must be warm enough to melt the oil but NOT hot. Shake well to turn it into a water/oil mix and spray 2-3 doses each side while gently breathing in through your nose. Repeat twice a day. You will need to warm up the bottle each time you use it (unless you live in the tropics) to avoid the coconut oil solidifying. I suggest putting it in a container with warm water to melt the coconut oil (do NOT make it too hot!). As mentioned under the xylitol nose spray, for a spray bottle in Australia you could get something like 'Dimatab' with a refill from a chemist and dump out the contents and clean it out then use it. I understand these are 20ml bottles, so you would probably need a bit less than 1/8 tsp of oil. You can also buy empty spray bottles online - try Ebay for example. I do NOT recommend trying to push lumps of pure coconut oil up the nose or using a neti pot with pure liquid oil in it! This is dangerous. You may accidentally inhale enough oil into your lungs to cause pneumonia. Coconut oil and water mixture keeps quite well. I would suggest a fresh preparation each 2-3 weeks.
Some relevant studies on coconut oil:
In Fairhead's thesis (references above) she mentions on page 97 that Glycerol monohydrate reduced production of alpha-toxin. Glycerol monohydrate is found in coconut oil.
Also there is another relevant study showing that lauric acid (found abundantly in coconut oil) inhibits Staph toxins or turns off their production. Ruzin A, Novick RP, Equivalence of Lauric Acid and Glycerol Monolaurate [GML] as Inhibitors of Signal Transduction in Staphylococcus aureus, Journal of Bacteriology , May 2000, p. 2668–2671: “We found that indeed lauric acid at an equimolar concentration mimics the inhibitory effect of GML on the induction of staphylococcal beta-lactamase activity and, like GML, blocks expression of protein A and TSST-1 in S. aureus. Thus, we currently hypothesize that lauric acid might be responsible for all of the inhibitory effects of GML described so far, although GML might be active as well.”
Lauric acid and GML also inhibit Staph biofilms: Hess DJ et al., The Natural Surfactant Glycerol Monolaurate Significantly Reduces Development of Staphylococcus aureus and Enterococcus faecalis Biofilms, Surg Infect (Larchmt), 2015 Oct;16(5):538-42. doi: 10.1089/sur.2014.162. Epub 2015 Jun 25.
Please note that coconut oil also has some antifungal properties (Bergsson G, et al., In Vitro Killing of Candida albicans by Fatty Acids and Monoglycerides, Antimicrob Agents Chemother. 2001 Nov; 45(11): 3209–3212). So if you had fungal or yeast colonisation in the nose or sinuses you might get a Herxhiemer reaction from coconut oil killing it off.
- Step Two. After 2-3 weeks using the xylitol/water nose spray or the coconut oil/water nose spray, add one single drop of pure tea tree oil to your spray bottle and continue using it for another five months. Yep, five months is my recommendation otherwise the Staph may not be eradicated. Even after five months it can still be there in some cases. If you can't tolerate the tea tree oil drop then you can try diluting it by pouring out half the contents and adding more water. If this does not work you can move directly to step three. Note: one single drop of pure tea tree oil in the mixture acts as a preservative and you should only need to make a fresh batch every few weeks.
- Step Three. Finish off by using sinus rinses using a suitable probiotic and clean water. A specific species that seems good for the nose and sinuses is Lactobacillus sakei, however, I current recommend focusing on promoting biodiversity by using a high quality probiotic with many different species of Lactobacilli and Bifidobacteria in it. I recommend a least two months of daily use then twice a week maintenance. You could add the probiotic to a nasal rinse solution system such as 'Flo Nasal Rinse' to reduce the stinging that can occur. Make the solution warm rather than use cold.
For a reduction/neutralisation program:This is aimed at reducing the number of Staph and reducing the amount of active toxin and neutralising the remaining toxin. It involves simply using steps one and two above long term. Sometimes more dilute mixtures are preferred or just once a day applications.
I have found that using either the Xylitol/water/tea tree or coconut oil/water nose spray have a great side effect - they appear to reduce the tendency to catch colds and similar infections.
3. Other considerations: In some cases it is possible that Staph needs to be treated on the skin or in the vagina. One option is to rub coconut oil all over after each shower and ladies use a warm water and coconut oil douche twice or three times a week. I used L. plantarum coconut yoghurt on my skin to reduce Staph activity. A yoghurt could also be used as a kind of douche. Based on preliminary observations taking L. plantarum orally may reduce inflammation caused by Staph via an immune modulating effect. By the way, this probiotic is often found in saurkraut.
For my personal experience with getting rid of MARCoNS and the use of cultures of B subtils and L plantarum, please refer to my Bio page.
There is some relevant research on CoNS and its toxins. Nasal carriage of this bug may or may not produce local symptoms. Also there may be generalised symptoms. The fullest published symptom list that I have seen comes from Table 5.1 of a thesis done by Niel McGregor referenced later in this page. I believe this list relates to any one with Staph Toxin Illness and that it is not a complete list of possible symptoms:
Musculoskeletal symptoms
Jaw muscle pain
TMJ (jaw joint) clicking or locking
Neck/Shoulder pain or tenderness
Arm pain or tenderness
Sciatica (nerve pain down the leg)
Arthritis/Painful or stiff joints
Infectious symptoms
Swollen or tender cervical and/or axilliary lymph nodes
Night sweats
Sore throat
Recurrent sinusitis
Aphthous ulceration (mouth ulcers)
Hyperaesthesia/Paraesthesia
Clenching or grinding of the teeth
Earaches and Tinnitus
Headache and Migraine headaches
Hair loss
Irritable bowel and abdominal symptoms
Diarrhoea
Palpitations
Blood pressure problems
Faintness / dizziness
Muscle fatigue
Generalised lethargy and sleep disturbance
I diagnose Staph Toxin Illness based on history, a nasal swab showing Staph and a therapeutic trial of treatment. A standard nasal swab done by most big labs where they perform a 2-3 day culture is normally inadequate. Some types of Staph can apparently be slow growing and a two week culture is best. In Australia you can call the private test company called Nutripath and order a swab test kit. You can also contact the US company www.microbiologydx.com directly (this is the lab that Nutripath refers their specimens to). The advantage of using Nutripath is a slightly easier postage experience.
Staph bugs are considered to be a normal part of body colonization. I have read that they are found on about 55% of the population. In most people they appear to cause no trouble unless certain conditions cause the Staph to get nasty. In relation to fatigue and associated symptoms the issue is the Staph being triggered to produce toxins. Such toxins can produce a large array of symptoms including fatigue and fibromyalgia. If you have Staph in your nose with fatigue or fibro but no evidence of CIRS, or other cause found after testing, then in my opinion you may well have toxin activation going on.
Let us consider some of the evidence that the triggering of Staph toxin production can lead to CFS and/or Fibromyalgia. The following studies have associated a type of Staph toxin with chronic facial and muscle pain:
Butt Hl et al., An association of membrane-damaging toxins from coagulase-negative staphylococci and chronic orofacial muscle pain, Journal of Medical Microbiology 1998; 47:577-584
McGregor NR et al., Coagulase-negative staphylococcal membrane-damaging toxins, pain intensity, and metabolic changes in temporomandibular disorder patients with chronic muscle pain, J Orofac Pain. 2003 Spring;17(2):125-32.
Niel McGregor, lead author of the above study did a whole thesis on chronic face pain and its association with Staph (McGregor Niel Roland, CHRONIC FACE PAIN/TMD: BIOCHEMISTY AND MICROBIOLOGY, A Thesis submitted to the Faculty of Dentistry, University of Sydney for the degree of Doctor of Philosophy, esp. pages 227-228 in the original work or pages 226-227 of the Sydney Uni archive file (dated 1999). The Sydney University URL for the thesis is: http://ses.library.usyd.edu.au/handle/2123/369.)
In this thesis McGregor provides evidence for many interesting things, including:
CFS appears to be associated with delta and beta Staph toxins (p. 206).
On p. 189 he mentions that part of the Staph chromosome called the 'Accessory Gene Regulator” (arg) is responsible for toxin production and can be turned on or off by certain environmental stimuli. He mentions “Importantly a reduction in osmolarity (low sodium levels) in the medium is associated with an increase in toxin production and arg-associated RNA whilst an increase in extracellular sodium results in inhibition of arg expression (Regassa & Betley, 1993).” The reference for Regassa and Betley is: Regassa LB, Betley MJ. High sodium chloride concentrations inhibit staphylococcal enterotoxin C gene (sec) expression at the level of sec mRNA. Infect Immun 1993; 61:1581-1585.
It is interesting to study the various things that can cause a low sodium level or low osmolality. If you want to study the topic check out SIADH (Syndrome of Inappropriate Anti-Diuretic Hormone).
On p. 204 he mentions an association of toxin production with antibiotic use at the time of onset of temporomandibular pain syndrome and on page 217 he states that antibiotic use, especially prolonged antibiotic use, is associated with higher levels of delta Staph toxins. In addition on page 229 he comments that antibiotic use may select for more toxicogenic Staph species.
So, what about treatments for this Staph toxin illness causing face pain and CFS?
On page 229 of his thesis McGregor tells us that toxins produced by Staph have a low antigenicity, so the body's immune system does not readily produce antibodies against these toxins. This is why we would need a Staph toxoid vaccine enabling the body to produce antitoxin.
Has such a vaccine been tried? Yes, with very good results. See the following studies and thesis:
Andersson M, et al., Effects of staphylococcus toxoid vaccine on pain and fatigue in patients with fibromyalgia/chronic fatigue syndrome, Eur J Pain, 1998; 2(2):133-142.
Zachrisson O, et al., Immune modulation with a staphylococcal preparation in fibromyalgia/chronic fatigue syndrome: relation between antibody levels and clinical improvement. Eur J Clin Microbiol Infect Dis. 2004 Feb;23(2):98-105. Epub 2004 Jan 20.
http://www.ncbi.nlm.nih.gov/pubmed/14735403
Zachrisson O, et al., Treatment with staphylococcus toxoid in fibromyalgia/chronic fatigue syndrome--a randomised controlled trial. Eur J Pain. 2002;6(6):455-66.
http://www.ncbi.nlm.nih.gov/pubmed/12413434
Thesis (in English) by Olof Zachrisson, Fibromyalgia Chronic Fatigue Syndrome - Aspects on biology, treatment, and symptom evaluation. Doctoral thesis from institute of clinical neuroscience, section of psychiatry, Gteborg University, Sweden, 2002. ISBN 91-628-5386-4.
Gottfries C, et al., Long-Term Treatment with a Staphylococcus Toxoid Vaccine in Patients with Fibromyalgia and Chronic Fatigue Syndrome, Journal of Chronic Fatigue Syndrome Vol. 13, Issue 4, 2006.
These studies all sound wonderful, but the vaccine is, to my knowledge, not available at the time of this article being written (2021). Please read Dr. Lars Lagerstrand (MD, PhD) personal testimony which I found at the meassociation.org.uk web site, dated Sept. 2009 (and also keep reading this page to understand alternative options):
Dr. Lagerstrand's personal testimony: “I am a medical doctor and associate professor working at the Karolinska University Hospital in Stockholm and a member of the committee of the Swedish Association for ME patients in Stockholm. However, I am also a patient with ME/chronic fatigue syndrome since 14 years and have been successfully treated with a vaccine against staphylococcus during the last 8 years.
“A Swedish research group has developed a treatment against ME/CFS that reduces symptoms significantly. In Sweden we have about one hundred and fifty patients with ME/CFS that have been successfully treated with a vaccine against staphylococcus. The vaccine has been given to us monthly during 5-10 years without any adverse effects. The treatment has made it possible for the majority of us to work and also to have energy left for our families, friends and even sports and outdoor life. The effectiveness of the vaccine has been proven in a double blind scientific study.
“However the vaccine is not produced anymore and most of us have been forced back to illness life. We have thus come to an absurd situation where there exists a treatment of ME/CFS, which could dramatically reduce symptoms and make life much better for millions of people all over the world."
So if the vaccine is not available any more, are there alternative options? The answer is 'yes'. This is how I currently approach the treatment of Staph Toxin Illness. In general, results have been good.
1. Be aware of the possible conditions that may have turned on the Staph toxin production in the first place and, if possible, rectify these conditions. There may still be some Staph on the body that have not yet started producing toxins.
Avoid living or working in an environment where you are breathing a higher than normal level of mould spores.
We have already mentioned low sodium or osmolality as being a trigger for toxin production (McGregor, Doctoral Thesis p. 189) and that antibiotics, especially prolonged courses, can be a trigger (ibid. p. 217). So avoid drinking too much water or having unnecessary antibiotic courses. Regarding water, don't make this an excuse to drink too little. About 35ml/kg/day is about right for most adults.
Another thesis has been done on the subject we are discussing: Fairhead, H., The Regulation of Toxin Production in Staph Aureus, Doctoral Thesis, University of Nottingham, June 1998.
In this study she gives evidence as follows:
Page 38: “In S. aureus, it has been found that deficiency of iron up-regulates activity of the accessory gene regulator and production of alpha- haemolysin”.
Page 40: “In S. aureus high salt concentrations (1.2 M NaCl) resulted in a 16-fold decrease in production of enterotoxin C (Regassa and Betley, 1993)” See also page 89 and 90 where high salt concentrations inhibited toxin production.
Page 93. Low calcium or magnesium levels cause an increase in toxin production.
So we need to try and avoid low iron, low serum sodium or osmolality (don't overdue your water intake - 35ml/kg is a good general figure for adults), low calcium and low magnesium. I recommend having blood tests to check the levels of these minerals. Also, we should only take antibiotics when we really have to and try and avoid long antibiotic courses in particular. Antibiotics should never be used for just common colds and viruses.
2. Decide if you are going to try and eradicate Staph from the nose and sinuses or just neutralize or reduce toxin production in these areas.
It must be emphasised that the approaches below are quite firmly experimental as no large scale, double-blind, placebo controlled, randomised, multi-centre trial has been conducted on the use of nose spray of xylitol, tea tree oil, coconut oil and water, combination antibiotics or probiotics in the safe and effective eradication or control of nasal Staphylococcus aureus. So, anyone wishing to try these methods must do so at their own risk (under supervision, of course, of a suitable and agreeable health care professional) or else wait until they are proven by clear, non-biased scientific studies.
For an eradication program, I recommend a gentle three step program to try and avoid severe herxing. Let me make it plain: these nasal Staph can cause major herxing if they are aggressively killed. For this reason I no longer recommend using regular antiobiotic sprays like Mupirocin and Rifampicin mixtures except in rare cases.
- Step One is using Xylitol nose spray for three or four weeks. I recommend making it in order to avoid confusing issues from other ingredients that are added to proprietary products. Xylitol crystals are obtainable online or possibly from a health food. I think the variety made from birch is probably better than the one from corn. For a spray bottle in Australia you could get something like 'Dimatab' with a refill from a chemist and dump out the contents and clean it out then use it. Add about 1/4 teaspoon to a 20 or 30 ml nose spray bottle. Add clean water. Warm water makes it easier to dissolve. Shake before use. Use 2-3 sprays both sides twice a day. Keep in the fridge and make up a fresh batch about every four days as it does not have any preservative in it. If the above recipe really can't be made, then purchase a proprietary brand such as Xlear. Xylitol acts as a biofilm digester. Biofilm is a jelly-like mucous that the bugs live in for protection. Use of the Xylitol spray can sometimes cause some Herx reactions by enhancing your bodies natural defence system and thus killing some Staph (Zabner J, et al., The osmolyte xylitol reduces the salt concentration of airway surface liquid and may enhance bacterial killing, PNAS October 10, 2000, vol. 97 no. 21)
If you are sensitive to Xylitol or don't want to use it for some other reason then an alternative is using a coconut oil and water mixture for three or four weeks. Use only about 1/8 tsp of coconut oil per 30ml spray bottle. Use high quality, cold-pressed, virgin coconut oil. Use clean warm water in the spray bottle with the oil or use cold and then warm it up. It must be warm enough to melt the oil but NOT hot. Shake well to turn it into a water/oil mix and spray 2-3 doses each side while gently breathing in through your nose. Repeat twice a day. You will need to warm up the bottle each time you use it (unless you live in the tropics) to avoid the coconut oil solidifying. I suggest putting it in a container with warm water to melt the coconut oil (do NOT make it too hot!). As mentioned under the xylitol nose spray, for a spray bottle in Australia you could get something like 'Dimatab' with a refill from a chemist and dump out the contents and clean it out then use it. I understand these are 20ml bottles, so you would probably need a bit less than 1/8 tsp of oil. You can also buy empty spray bottles online - try Ebay for example. I do NOT recommend trying to push lumps of pure coconut oil up the nose or using a neti pot with pure liquid oil in it! This is dangerous. You may accidentally inhale enough oil into your lungs to cause pneumonia. Coconut oil and water mixture keeps quite well. I would suggest a fresh preparation each 2-3 weeks.
Some relevant studies on coconut oil:
In Fairhead's thesis (references above) she mentions on page 97 that Glycerol monohydrate reduced production of alpha-toxin. Glycerol monohydrate is found in coconut oil.
Also there is another relevant study showing that lauric acid (found abundantly in coconut oil) inhibits Staph toxins or turns off their production. Ruzin A, Novick RP, Equivalence of Lauric Acid and Glycerol Monolaurate [GML] as Inhibitors of Signal Transduction in Staphylococcus aureus, Journal of Bacteriology , May 2000, p. 2668–2671: “We found that indeed lauric acid at an equimolar concentration mimics the inhibitory effect of GML on the induction of staphylococcal beta-lactamase activity and, like GML, blocks expression of protein A and TSST-1 in S. aureus. Thus, we currently hypothesize that lauric acid might be responsible for all of the inhibitory effects of GML described so far, although GML might be active as well.”
Lauric acid and GML also inhibit Staph biofilms: Hess DJ et al., The Natural Surfactant Glycerol Monolaurate Significantly Reduces Development of Staphylococcus aureus and Enterococcus faecalis Biofilms, Surg Infect (Larchmt), 2015 Oct;16(5):538-42. doi: 10.1089/sur.2014.162. Epub 2015 Jun 25.
Please note that coconut oil also has some antifungal properties (Bergsson G, et al., In Vitro Killing of Candida albicans by Fatty Acids and Monoglycerides, Antimicrob Agents Chemother. 2001 Nov; 45(11): 3209–3212). So if you had fungal or yeast colonisation in the nose or sinuses you might get a Herxhiemer reaction from coconut oil killing it off.
- Step Two. After 2-3 weeks using the xylitol/water nose spray or the coconut oil/water nose spray, add one single drop of pure tea tree oil to your spray bottle and continue using it for another five months. Yep, five months is my recommendation otherwise the Staph may not be eradicated. Even after five months it can still be there in some cases. If you can't tolerate the tea tree oil drop then you can try diluting it by pouring out half the contents and adding more water. If this does not work you can move directly to step three. Note: one single drop of pure tea tree oil in the mixture acts as a preservative and you should only need to make a fresh batch every few weeks.
- Step Three. Finish off by using sinus rinses using a suitable probiotic and clean water. A specific species that seems good for the nose and sinuses is Lactobacillus sakei, however, I current recommend focusing on promoting biodiversity by using a high quality probiotic with many different species of Lactobacilli and Bifidobacteria in it. I recommend a least two months of daily use then twice a week maintenance. You could add the probiotic to a nasal rinse solution system such as 'Flo Nasal Rinse' to reduce the stinging that can occur. Make the solution warm rather than use cold.
For a reduction/neutralisation program:This is aimed at reducing the number of Staph and reducing the amount of active toxin and neutralising the remaining toxin. It involves simply using steps one and two above long term. Sometimes more dilute mixtures are preferred or just once a day applications.
I have found that using either the Xylitol/water/tea tree or coconut oil/water nose spray have a great side effect - they appear to reduce the tendency to catch colds and similar infections.
3. Other considerations: In some cases it is possible that Staph needs to be treated on the skin or in the vagina. One option is to rub coconut oil all over after each shower and ladies use a warm water and coconut oil douche twice or three times a week. I used L. plantarum coconut yoghurt on my skin to reduce Staph activity. A yoghurt could also be used as a kind of douche. Based on preliminary observations taking L. plantarum orally may reduce inflammation caused by Staph via an immune modulating effect. By the way, this probiotic is often found in saurkraut.
For my personal experience with getting rid of MARCoNS and the use of cultures of B subtils and L plantarum, please refer to my Bio page.
Images and content © D. Bird 2017