These three "S words" have been buzzing around in my head lately.
As a long time sinusitis sufferer, I was astonished and thrilled to find that dairy was a big driving force for my sinusitis. "Go dairy/casein free and have virtually zero sinus infections (versus my usual 2-3 per year)? Deal." After eliminating gluten and dairy from my diet (and working hard to heal my body and my gut microbiota) I went about 8 years with only two minor sinus infections. Enter: Preschool. Now that my daughter is old enough to go to preschool my immune system and my nasal microbiota have a new challenge to face... and so far it's not going well.
Microbiota = the organisms that live in a given ecosystem. In this case, I'm referencing the bacteria, viruses, yeast, and other stuff that lives in the nose and sinuses.
Microbiome = this word is more commonly used, but usually incorrectly. The microbiome is all of the genes belonging to the organisms in an ecosystem.
Dysbiosis = an imbalance in a microbial ecosystem or different than an ideal state. This generally comes in three flavors:
Too many "bad" bacteria, yeast, viruses, and/or parasites
Not enough "good" guys like Lactobacillus species ("insufficiency dysbiosis")
A combination of both of the above
In the last 4 months I've had two bad sinus infections and it very much feels like I'm slipping back to a state of health I don't want to revisit. "I'm still dairy-less, so what gives?"
Unfortunately, looking back I know that I probably decimated all of my microbial ecosystems (including the one in my sinuses) decades ago. Many, many ear infections and sinus infections, multiple ear surgeries, UTIs, and one heck of a Lyme disease infection means I've had many human lifetimes worth of antibiotics. Many of these were as a child and teen when my microbiotas were still young and taking shape. Add to this that I took Flonase, a nasal steroid, daily for about 10 years of my life, and I'm sure I have a sub-par sinus microbiota. Thankfully, now that I'm the crunchy functional medicine doctor and NTP that I am I understand more about how to nurture these ecosystems. It's still very much an uphill battle for me, but I'm getting there.
Steroids. Symbiosis. Sinuses.
So what does conventional medicine have to offer us for sinusitis? Nothing I find appealing, that's for sure. Sure, I could take an antibiotic, but that's most likely how I got into this fine mess to begin with. There are numerous options for steroids- I was prescribed a giant jug of compounded steroids by my ENT for this infection, but haven't taken it, and there's always my old friend Flonase. Thankfully, I know more about steroids now and I understand that they most likely have a deleterious effect on the microbes there (Pubmed 1, Pubmed 2), as well as the mucosal lining and the local immune system. So what's a gal to do? What options do we have if not medications to suppress and kill?
I am starting to see the sinus microbiota like I see the gut microbiota- not generally something to be killed and punished, but something that needs to be nurtured. Should we focus our efforts on killing organisms, suppressing our immune system and it's inflammation signals, and hoping both behave the way we want them to? I think not. Rather, my current approach to both the gut and the sinuses is:
Boost and nurture the "good guys" first and foremost. Don't have it? Maybe we can supplement it (probiotics, kimchi, Lacto Sinus etc). Have it, but it's not as much as you'd like? There are numerous herbs, dietary fibers, prebiotics, and foods that can nourish and boost beneficial species of bacteria.
Boost and nurture the immune system. Want the immune system to behave? Help it accomplish it's mission, which is nearly always to kill an infection or balance an ecosystem. It can also be beneficial to quiet down histamine responses and inflammation with herbs... But remember- you're not trying to hammer it into submission, you just want to give your immune system the tools it needs to chill out and not get stuck in a dysfunctional pattern for too long.
Maybe kill the "bad bugs" a bit, preferably with something natural. I have found manuka honey nasal spray to be especially helpful this time around for the sinuses. There are tons of herbs you can use for gut dysbiosis and SIBO, of course, but be careful to not "kill" too aggressively or for too long- you'll take out some of the good guys at the same time, even with natural stuff.
Let's try to live in symbiosis with our creepy crawlies again. We were never supposed to "beat" them or dominate them. Rather, we should strive for a symbiotic relationship with our microbes which will allow all of us to thrive.
I'd love to hear what you've found helpful for sinus infections- comment below!