When is the last time you took a good look at your toenails? If it has been a while, you may be in for an unpleasant surprise-in fungal form. Toenail fungus also called onychomycosis, is a common condition that turns nails a yellow or brown color. In some cases, the nail thickens or splits and may fall off. Sufferers may experience pain around the nail and notice a foul smell. The infection is typically caused by any one of several types of fungi that feed on keratin, the protein surface of the nail. Occasionally, different yeasts and molds may cause the infection.

By age 70, almost half of Americans have had at least one affected toe. While the infection can occur in fingernails, it most often affects toenails-because feet are confined to the dark, warm environment of shoes, where fungi can thrive. The nails of the big toe and little toe are particularly susceptible, because friction from the sides of shoes can cause trauma to the nail surface, making it easier for fungi to penetrate. Nail fungus is not the same as athlete's foot-because athlete's foot affects the skin rather than the nail itself-but the two conditions may coexist and can be caused by the same type of fungus.

I find that athletes and others who commonly use gym locker rooms and showers are more likely to develop toenail fungus due to the damp floors and shared environment. Women who wear toenail polish are at increased risk because moisture can get trapped beneath the polish. Tight-fitting shoes and hosiery that rub the toenails also contribute to the problem. People with diabetes and other circulation problems that prevent infection fighting white blood cells from adequately reaching the toes are particularly susceptible to the fungus, as are people with compromised immune systems, such as those with cancer or HIV.

Toenail fungus doesn't usually clear up on its own. In fact, it tends to get more severe over time-affecting a larger portion of the nail and spreading to adjacent toes and to the other foot. Therefore, I recommend starting treatment as early as possible.

Conventional Treatments

Medical doctors generally tum to topical and oral antifungal treatments. For mild cases that involve a small area of the nail, a medicated nail polish containing an antifungal agent, such as ciclopirox (Loprox), is often prescribed. For toenail fungus that covers a large portion of a nail or affects several nails, the typical medical approach is to prescribe oral antifungal medications, such as itraconazole (Sporanox) or terbinafine (Lamisil). These are quite powerful medications and may need to be taken for up to 12 weeks until the infection clears up. In 10% to 20% of cases, the fungus returns within several months.

The most worrisome side effect of oral antifungals is liver damage. To monitor the effect of these medications, liver enzyme tests should be performed before beginning treatment and every four to six weeks during treatment. An elevation in liver enzymes means that the drugs are irritating the liver and need to be discontinued. Several patients who were being treated by other doctors have come to see me after elevated liver enzymes forced them to stop this pharmaceutical treatment. As a last resort, the nail can be surgically removed-at which point the infection will clear up, and the nail will slowly grow back.

An unusual cure

The typical natural treatment for toenail fungus is to apply tea tree oil or oregano oil. Using a cotton swab, apply nightly to the affected area, continuing treatment for eight to 12 weeks. These oils work well to clear up mild toenail fungus, but they often are not strong enough for moderate to severe cases. There is an unusual, yet effective, therapy for severe toenail fungus developed by Mark Cooper, ND, an innovative naturopathic doctor. Years ago, Dr. Cooper treated an HIV positive patient who commented on an article he had read stating that bleach killed HIV on surfaces (not in the body). Knowing that hospital bedsheets and floor surfaces are washed with bleach to kill all types of fungi, viruses and bacteria, Dr. Cooper theorized that bleach might also kill toenail fungus and clear up persistent cases of infection.

Dr. Cooper, who practices at Alpine Naturopathic Clinic in Colorado Springs, has treated hundreds of his patients with this topical bleach treatment. My patients have responded very well to it, too.

How it works: Mix one cup of household bleach with 10 cups of warm water. Soak the toes of the affected foot for three minutes, then thoroughly rinse off the bleach solution with water and dry the feet completely. Do this twice weekly, with three days between treatments. Most cases resolve in two to three months. Severe cases may take longer.

Boosting the strength of the bleach-and-water mixture beyond the one-to-10 ratio will not increase the effectiveness of the treatment-and it could irritate the skin. Nor is it wise to increase the frequency or duration of treatments. Dr. Cooper told me about a 74-year-old man who misunderstood the directions-instead of soaking his toes for three minutes, he tried to soak them for 30 minutes. The burning pain was so intense that he had to stop the soaking after 20 minutes. Obviously this treatment needs to be used with caution and should not be used when there is an open wound near the infection site.

Interesting: Bleach is composed of sodium hypochlorite (NaOCl). Household bleach usually contains 3% to 6% NaOCl, while industrial-strength bleach contains 10% to 12%. Near the end of the 19th century, after Louis Pasteur discovered its powerful effectiveness against disease-causing bacteria, bleach became popular as a disinfectant. It is still used today for household cleaning, removing laundry stains, treating waste water, sterilizing medical equipment and disinfecting hospital linens and surfaces.

Fungus-Fighting Foods & Supplements

Dr. Cooper explains that the topical bleach treatment is even more effective when combined with an antifungal diet. Avoid simple sugars (white breads, pastas, cookies and soda) and alcohol-they suppress immune function and contribute to fungal growth. Eat raw or cooked onions, shallots and leeks, plus garlic (as a food or an extract) as often as possible for their antifungal action.

I also have found that severe cases of toenail fungus, especially in people with diabetes, clear up more quickly when natural antifungal supplements are taken orally. The most potent is oregano oil. It contains plant compounds, such as carvacrol and thymol, that have strong antifungal properties. I recommend taking three doses daily for four to eight weeks. Each dose equals one 500-mg capsule... or five to 15 drops of the liquid form mixed with two to four ounces of water. Some people may experience heartburn from oregano oil, so if you are prone to heartburn, you may need to reduce the dosage. Oregano oil should not be ingested by people with active stomach ulcers (since it can irritate the stomach lining) or by pregnant or nursing women (as a general precaution). It should be given to children only under the guidance of a doctor.

How will you know when the fungal infection is gone? When the discolored nail returns to its normal hue or when the damaged nail grows out and a new nail grows in normally.

Fungus Prevention Strategies

• Wash your feet every day using calendula soap. Made from the marigold plant, it is gentle yet antiseptic. Find it in health-food stores.

• Always dry feet thoroughly with a clean towel. Do not share towels with other people.

• Keep toenails clipped short to reduce the protein surface on which fungi feed.

• Avoid going barefoot in public places. Wear plastic sandals in community showers and locker rooms and at poolside.

• Choose socks made of breathable fabrics, such as cotton. Change socks immediately after exercising and whenever feet perspire.

• Be sure your shoes are not too tight. If shoes get damp, change them promptly.

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