If you’d rather watch a video on the nasal microbiome click here.
What is the Nasal Microbiome and Why Does it Matter?
First things first, if you’re not familiar with the term microbiome it’s a term used to describe the community of bacteria, fungi, and viruses that populate your body.
Most likely you’ve heard the term in relation to the gut microbiome.
After the Human Genome Project ended with the conclusion that we are all basically the same, genetically, researchers and health professionals were left with some questions. Among which is how do we all look, act, and feel so different if we are all less than 10% genetically different?
One of the rabbit holes we dove into was the gut microbiome.
How do the bacteria that live within us modulate our DNA and, ultimately, our health. In other words, how does our microbiome effect gene expression and how is it related to the presence or absence of disease?
The following excerpt from R. Vijay, et al published in their 2017 review of the sinonasal bacteria microbiome explains it best:
“A stable, diverse microbiome contributes to fortification of the epithelial barrier, development of innate and adaptive immune properties including immunoglobulin production [6, 7], induction of regulatory T cells , nutrient metabolism , and can stimulate formation of the mucus blanket .”
In other words, research on the gut microbiome has shown us that bacteria living inside us:
- determine the strength of the lining of our gut walls
- determine how our immune system reacts to our environment
- innate immunity: how well your body is capable of recognizing antigens and fighting them off
- adaptive immunity: how you only get chicken pox once, but later can develop shingles from the chicken pox virus)
- determine how our immune system reacts to our own body
- autoimmunity: lupus, rheumatoid arthritis, etc.
- determine how efficient our metabolism works
The gut microbiome is not the only microbiome in humans, though. There is a microbiome on the outside of your skin, inside your throat, your birth canal (or your mom’s birth canal if you’re a man), and your nasal cavity, to name a few.
Which of these can provide us inside that the gut microbiome has failed to accurately do?
Enter the sino-nasal microbiome.
Due to easier access, a more compact territory, and an equally important impact on the body as the gut microbiome, the sino-nasal microbiome has become a focus of microbial research.
The sinus and nasal microbiome are typically lumped into one category despite the nasal cavity and sinuses having different amounts and types of bacteria within the same person. Part of the reason for this is because of how new the idea of nasal microbiome research is.
This is reflected in the research as different sampling methods and locations all dubbed as sinus-nasal microbiome research.
For the purposes of this article, I’ll keep them all together with the term sino-nasal microbiome as the scientific community has, thus far.
Does the bacteria in the sino-nasal microbiome mirror the bacteria of the gut microbiome within the same person?
This was one of the very first thoughts I had when I heard researchers and healthcare professionals talking about the nasal microbiome. The answer is no.
Yes, there are generally the same types of bacteria, but the percentages of each differ widely from location to location, and a few types of bacteria are present, and others are altogether missing from either the gut or the sino-nasal biome.
Why should you care about your sino-nasal microbiome?
New research is showing a big connection between certain characteristics of people’s nasal biomes and disease, just like with the gut microbiome.
In soldiers with severe skin and soft tissue injuries (SSTIs), their nasal microbiomes had significantly less proteobacteria than their counterparts who did not have soft tissue injuries.
We know that certain types of nasal staph bacteria are associated with higher risk for skin and soft tissue injury.
This study actually showed that the presence of nasal staph was a risk factor for skin and soft tissue injuries, but that there are changes beyond just staph colonization that differentiate healthy people’s nasal microbiomes from injured or sick people’s.
Back to staph bacteria, though.
Just like people with severe skin and soft tissue injuries, individual’s with systemic inflammation have antibiotic-resistant staph in high concentrations in their nasal microbiome.
Methicillin-resistant Staphylococcus Aureus (MRSA) and Multiple Antibiotic-resistant Coagulase-negative Staphylococcus are the two that seem to cause the most problems for people.
These two types of staph can cause, not only local inflammation in the nasal cavity, but also multi-systemic, widespread inflammation that leads to chronic systemic disease.
The presence of either form of staph in the nasal cavity is also associated with poorer surgical outcomes. Prior to some neurosurgeries, MRSA is tested for and treated, even if the culture comes back negative as a preventative measure.
What influences the sino-nasal microbiome?
There are some things that can alter the composition of your nasal microbiome and some things that apparently can’t.
Things that can:
- Smoking tobacco (present or past)
- Exposure to other inhaled irritants
- Mold toxins
- Other biotoxins like those produced by red tide and blue green algae
- History of asthma
Things that apparently cannot:
- Nasal polyps (pre- or post- op)
- Use of topical saline
- Use of topical steroids
Therefore, we ask ourselves whether or not probiotics could affect the nasal microbiome and what effect do antimicrobials (like antibiotics) have on the nasal microbiome.
As a matter of fact, we also need to ask ourselves what this research on the sino-nasal microbiome can teach us about the gut microbiome in the context of probiotic use and antimicrobial use, among other things.
How do the limitations and discoveries of the sino-nasal microbiome research change our understanding of the gut microbiome?
The presence of biofilms, take for instance, is not an unfamiliar topic in microbiology; however, it does not appear to be the focus of discussion amongst healthcare professionals in the context of the gut microbiome.
What sino-nasal microbiome research has shown is that these pathogenic forms of staph (and others) participate in the development of biofilms that protect them from eradication. That means that biofilms make it difficult to disrupt these bacteria.
These types of staph, MRSA and MARCoNS, create biofilms as a form of self-preservation. Like how a rose has thorns.
Essentially, biofilms are good for the bacteria, but bad for the host (that’s you).
That translates to the realization that sampling the microbiome which has biofilm may not be accurate since collection of bacteria would be difficult.
The bacteria are shielded by the biofilm.
That may manifest itself in the results of the research as inaccurate counts of those types of bacteria, skewing the overall percentages of each bacteria present in the microbiome.
That’s important to note, because (like I just mentioned a second ago) people with the highest staph percentages relative to all the other bacteria in their nasal biome are at higher risk for disease. Accurately determining those concentrations = accurately determining the association between pathogenic staph bacteria and disease.
Not only that, but the types of bacteria that produce biofilm are difficult to culture. Therefore, the bacteria, themselves, are elusive.
There are various sampling techniques to increase accuracy of the sample and the culture, but because the sampling techniques vary there is little homogeneity amongst the results.
The region at which the sample was taken also varies leading to mixed, inconclusive, and conflicting scientific data.
However, the biggest shortfall of microbiome research (gut and sino-nasal) is that the vast majority of it focusses on the bacteria, themselves. Due to all of the limitations mentioned above, you can see a few reasons why it’s not that practical to spend all of our effort, right now, naming and quantifying each and every bacteria within the biome.
Instead, some researchers are focused on the functional meaning of the bacteria (AKA how the bacteria cause harm).
How do bacteria in the microbiome actually cause inflammation and disease?
One way is through their extracellular vesicles.
Extracellular vesicles (EV) contain biologically active bacterial components like lipids, proteins, and nucleic acids (DNA).
That means that EV can actually be delivered to your body’s cells and modulate how your body operates on a cellular level.
Therefore, the study of exactly how these bacteria communicate with our cells and change our gene expression deserves more focus, in my opinion.
Another way that “bad bacteria” cause inflammation and disease is through the destruction of the integrity of our mucosal membranes and other epithelial barriers within our bodies.
In the case of the gut microbiome, our gut’s mucosal lining is only one cell thick.
Pathogenic bacteria set up biofilms preventing beneficial bacteria from proliferating and that causes the lining of your gut to become permeable.
Once the tight junctions of that one cell thick gut lining are compromised, proteins from undigested food can enter directly into your blood stream where they interact with your immune system in a way that is causes inflammation and is detrimental to your health.
Your gut lining can be damaged by other things, as well.
So, which comes first – damaged integrity of the mucosal lining or pathogenic bacteria colonization?
We don’t know.
It’s probably a combination of both occurring simultaneously through mechanism that overlap.
We know that some people harbor the two types of staph mentioned above without any evidence of negative health effects.
That means there has to be other factors involved beyond just the presence or absence of the pathogenic bacteria.
We also know that people suffering from mold illness (from exposure to an inhaled irritant: mold mycotoxins) usually have nasal MARCoNS present, and often cannot heal systemic inflammation until MARCoNS is eradicated.
So, despite which occurs first, the compromised mucosal barrier or the exposure to the pathogen, it appears that once you’re sick you have to remove the pathogenic colonization to balance your microbiome and your health.
The same is true for the gut microbiome.
When you’re healthy your beneficial bacteria may be present in a high enough percentage to counteract any pathogenic species, but once that changes you have to address the pathogenic species.
Remember the soldiers with severe skin and soft tissue injuries?
While the soft tissue injury group did have significantly more staph present in their nasal microbiome, they also lacked a type of bacteria that the healthy group of soldiers had in higher amounts.
Therefore, it’s not just about the presence of staph, but also the absence of other more beneficial bacteria, probably.
The major connection between both the sino-nasal and gut microbiome and inflammation and disease
Although the nasal and gut microbiome may have vastly different compositions, one thing that effects both is that disturbance of their mucosal linings leading to inflammation and disease.
The mechanism for how this happens has not been fully elucidated, but we have some idea thanks to the study of mold illness.
Biomarkers that can indicate increase risk for compromised nasal and intestinal mucosal lining:
- High MMP-9
- Matrix metallo-protein 9 is associated with connective tissue disorders, as well as aortic aneurism
- When it’s high, collagen formation is disrupted
- High MMP-9 is a factor in gut lining permeability
- Inhaled irritants like mold mycotoxins cause high MMP-9 in many individuals
- Low MSH
- Melanocyte-stimulating hormone is a neuropeptide
- Low MSH leads to permeability of gut lining and susceptibility to nasal staph colonization
- MSH is often low in individuals who carry nasal MARCoNS
- Also associated with mold illness
- TGF beta 1
- Transforming Growth Factor beta 1 is often high in mold illness, lupus, and other inflammatory disorders
- TGF beta 1 activates pro-inflammatory Th17 cells that secrete cytokines such as IL-22 which decrease the integrity of mucosal barriers
- Defects in genes related to IL-22
- You can also be genetically predisposed to weaker mucosal membranes due to gene defects that pertain to Interleukin 22.
How can you address the health of your sino-nasal microbiome?
First of all, we need more research.
In addition to learning more about the sino-nasal microbiome, there are some things we can do, now.
- Test for MRSA and MARCoNS
There are ways to do this without a doctor. You can order the sample kit from a lab online, I trust this one, and take the sample then send it in for analysis. This is how I determined I have nasal MARCoNS. I actually did it through my doctor’s office, but this was the lab they used, and they do direct-to-consumer, too. The test not only determines the presence of staph, but also the antibiotics yours will respond to and which it is resistant to. It appears to be $85 to test for MARCoNS, an additional $100 to test for biofilm, and another $80 to culture for fungal growth. I’m pretty sure I paid $175 through my Dr.’s office and only received a MARCoNS analysis.
- Remove yourself from exposure to inhaled irritants
This is easier said than done, sometimes. If you’re in a moldy environment, you have to get out before you try to address the health of your sino-nasal microbiome, especially if you have MRSA or MARCoNS. You should not treat MARCoNS while still being exposed to mold. If you smoke, you should really stop smoking. At the very least, look into an air purifier. I use this one and you can get $75 off with this link and they also offer interest-free third party financing. It’s the best air purifier I’ve ever had and I also own an Air Oasis and IQ Air.
If you aren’t sure if your environment is moldy or not, you may want to order an ERMI test to perform and send in for analysis. ERMI is a test that was developed by EPA scientists. It stands for Environmental Relative Mold Index. It tests the dust of your home for mycotoxins whereas typical mold testing companies will come out and test the air for mold spores. A technique that has been proven inaccurate for detecting indoor mold.
It’s not the mold that hurts you, it’s the mycotoxins and the mycotoxins accumulate in the dust and the dust gets kicked-up into the air. Your ERMI report tells you which mycotoxins are present and gives you a score that lets you know how moldy your home is in comparison to all of the other homes and buildings tested. The EPA has published research on this method and it’s not infallible, but it’s the best tool we have at our disposal. Mold can hide behind walls, under carpet, and a number of other places. Just because you don’t see mold, doesn’t mean it’s not there.
- Break the biofilm
Certain things have been proven efficacious at busting up the biofilms created by pathogenic bacteria. Birch xylitol is one. EDTA is another. EDTA is a chemical used as a preservative in food, as well as in medical practice to chelate certain +2 ions like heavy metals. You can buy xylitol nasal spray anywhere, but EDTA has to be compounded into a nasal spray after being prescribed by your doctor.
- Antimicrobial treatment
I’ve tried BEG spray (an antibiotic spray that my strain of MARCoNS was supposedly sensitive to) which contains Bactrim, EDTA and gentamycin. It did not eradicate my MARCoNS; however, I was still living in mold at the time. I have also tried Argentyn 23 silver with xylitol spray and that also did not clear my MARCoNS, though I hear it works for many people. I am now using a combination of nasal ozone insufflation at home and sinus flushes using distilled water plus salt, xylitol, and iodine. Follow my Instagram @Experimental_Betty to see me mixing up and trying various concoctions to irrigate my nasal cavity, as well as live ozone insufflations!
- Breath outdoor air
The research shows that breathing outdoor air can help increase the diversity of your sino-nasal microbiome in a beneficial way. Just make sure you’re breathing clean air. Go to the beach or the woods, but be careful not to visit the beach during red tide or blue green algae and avoid the woods immediately after controlled burning.
- Be around animals
The research also shows that breathing dog dander, as well as zoo animal dander can increase the health of your nasal-microbiome (of course probably not if you are allergic to either). The one thing you NEVER EVER want to do is kiss your dog on the mouth, though. Dogs carry MARCoNS and if you’re working hard to make your microbiome healthy, you don’t want to kiss your dog and undo all of your hard work. Plus it’s gross.
- VIP nasal spray
One way to help restore the integrity of your microbiome is through vasoactive intestinal peptide nasal spray. It’s a prescription that requires compounding, it’s not cheap, and most doctors have never heard of it. I was fortunate enough to be able to sweet talk my doc into ordering it for me before she left to move back to New York as some kind of act of amnesty or something. Being the good steward of her goodwill that I am, I diluted it down to a 1:10 ratio since I am taking it before the recommended point in the treatment. Technically, you should wait until you’re out of mold exposure, have detoxed for several months, and eradicated MARCoNS.
Sidebar: the researcher that does all of the work with VIP for long-term use in chronic inflammatory response syndrome (mold illness) would prefer you not try to get VIP nasal prescribed out of order in treatment or even at all, really. Since very few doctors truly understand the off-label use of VIP, he feels it could be dangerous in the wrong (although well-meaning) hands. If you misuse VIP nasal spray serious issues can result including elevated lipase and pancreatitis. If used correctly, the research has shown VIP to be safe and effective.
To sum it all up, the nasal microbiome is just as important, if not more important than the gut microbiome.
Pathogenic bacteria found in the sinus and nasal cavity can predispose you to local and systemic inflammation as well as chronic illness.
Although research on the sino-nasal microbiome is still in its infancy, we can already determine some factors that seem to affect it and others which don’t.
One of the main things that can negatively impact the sino-nasal microbiome is exposure to inhaled irritants, especially mycotoxins produced by mold.
If you are in a moldy environment and are experiencing unexplained health problems, or health problems that may have a diagnosis, but are not improving, you may want to explore your sino-nasal microbiome’s health.
If you don’t know where to start, but are interested in feeling better head over to my Work with Me tab or just shoot me an email for a free consult.
And if you want to watch me biohack my sino-nasal microbiome, follow me on Instagram @ Experimental_Betty to witness all of the ways I am biohacking my MARCoNS and mold illness.
*I know it’s not really considered good form to just slap some review articles at the end of a publication without references, throughout. I’m kind of tired/lazy right now from treating my own mold illness after recent re-exposure. All of the info above came from these sources, though. I’ll do better next time, I promise J