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Even though this study was done in a laboratory, it gives further support for the treatment of sinusitis with bacteria and other microbes. And it could help explain why repeated courses of antibiotics don't "cure"  many chronic infections - because biofilms filled with pathogenic bacteria are signs of microbial communities out-of-whack. Which is why my family's successful chronic sinusitis treatment with kimchi (juice) containing Lactobacillus sakei is all the more impressive. From Science Daily:

Link between antibiotics, bacterial biofilms and chronic infections found

The link between antibiotics and bacterial biofilm formation leading to chronic lung, sinus and ear infections has been found, researchers report. The study results illustrate how bacterial biofilms can actually thrive, rather than decrease, when given low doses of antibiotics. Results of this study may lead to new approach for chronic ear infections in children.

This research addresses the long standing issues surrounding chronic ear infections and why some children experience repeated ear infections even after antibiotic treatment," said Paul Webster, PhD, lead author, senior staff scientist at USC and senior faculty at the Oak Crest Institute of Science. "Once the biofilm forms, it becomes stronger with each treatment of antibiotics."

During the study, non-typeable Haemophilus influenzae (NTHi) bacteria a common pathogen of humans was exposed to non-lethal doses of ampicillin, a class of antibiotics commonly used to treat respiratory, sinus and ear infections, or other beta-lactam antibiotics. The dose of the antibiotic was not enough to kill the bacteria which allowed the bacteria to react to the antibiotic by producing glycogen, a complex sugar often used by bacteria as a food source, to produce stronger biofilms when grown in the laboratory.

Biofilms are highly structured communities of microorganisms that attach to one another and to surfaces. The microorganisms group together and form a slimy, polysaccharide cover. This layer is highly protective for the organisms within it, and when new bacteria are produced they stay within the slimy layer. With the introduction of antibiotic-produced glycogen, the biofilms have an almost endless food source that can be used once antibiotic exposure has ended.

There are currently no approved treatments for biofilm-related infections. Therefore, bacteria forced into forming stronger biofilms will become more difficult to treat and will cause more severe chronic infections. Adults will suffer protracted lung infections as the bacteria hunker down into their protective slime, and children will have repeated ear infections. What may appear to be antibiotic resistance when an infection does not clear up may actually be biofilms at work.

Webster believes modern medicine needs to find ways of detecting and treating biofilm infections before the bacteria are able to form these protective structures. The difficulties of treating biofilm infections, which can be up to 1,000 times more resistant to antibiotics,have prompted some physicians to propose a gradual move away from traditional antibiotic treatments and toward non-antibiotic therapies.

The bacteria called Haemophilus influenzae are a common cause of upper respiratory tract infection. By attaching to surfaces in the body the bacteria form a biofilm. When the bacteria encounter non-lethal amounts of specific antibiotics they are stimulated to form a biofilm, a structure that causes chronic infection and which can be highly resistant to antibiotics. Credit: Paul Webster, Ph.D

Here are some more articles that I found regarding psychobiotics or the use of probiotics to affect behavior and treat psychiatric disorders.  A probiotic is a microorganism introduced into the body for its beneficial properties. Even though the articles are from 2013, they all give slightly different information about this emerging and exciting new field. Please note that psychotropic means having an effect on how the mind works (and it usually refers to drugs that affect a person's mental state). Remember that this area of research and terminology used is in its infancy. From Medscape (November 2013):

Probiotics a Potential Treatment for Mental Illness

Probiotics, which are live bacteria that help maintain a healthy digestive system, are now often promoted as an important part of dietary supplements and natural food products. "Many of the numerous health-improvement claims have yet to be supported scientifically..."

They note that the term "psychobiotic" was created as recent studies have begun to explore a possible link between probiotics and behavior.  "As a class of probiotic, these bacteria are capable of producing and delivering neuroactive substances such as gamma-aminobutyric acid [GABA] and serotonin, which act on the brain-gut axis," they write.

For this review, the investigators sought to examine studies that assessed whether ingesting these bacteria "in adequate amounts" could potentially lead to an effective treatment for depression and other stress-related disorders. In 1 of the preclinical studies examined, mice that ingested L rhamnosus showed reduced anxiety scores and "altered central expression" on both the GABA type A and type B receptors.

And a study of human patients with chronic fatigue syndrome showed that those who consumed an active strain of L casei 3 times a day had significantly higher improvement scores on anxiety measures than did those who received matching placebo. This provides "further support for the view that a probiotic may have psychotropic effects," write the researchers.

Still, Dr. Dinan called for caution. "What is clear at this point is that, of the large number of putative probiotics, only a small percentage have an impact on behavior and may qualify as psychobiotics," said Dr. Dinan. He added that for now, the field needs to wait for large-scale, placebo-controlled trials to provide definitive evidence of benefit and to detect which probiotics have psychobiotic potential.

Dr. Camille Zenobia wrote this in August 2013. From Real Clear Science:

Can 'Psychobiotic' Bacteria Affect Our Mood?

But what about your brain? Apparently, bacteria influence what’s going on up there, too. Within the last several years, a blossoming field of study called “microbial endocrinology” has provided some provocative insights about the relationship between our GI microbiota and our mood and behavior.

Studies in the field of microbial endocrinology have implicated GI microbes as a factor that can regulate the endocrine system. This could have both good and bad effects since the endocrine system is responsible for the production of hormones and coordinates metabolism, respiration, excretion, reproduction, sensory perception and immune function.

From Nov. 2013 Popular Science:

Forget Prozac, Psychobiotics Are The Future Of Psychiatry

The answer lies in the fact that many psychiatric illnesses are immunological in nature through chronic low level inflammation. There is a plethora of evidence showing the link between gut microbiota and inflammation and studies on probiotic strains have revealed their ability to modulate inflammation and bring back a healthy immunological function.  In this regard, by controlling inflammation through probiotic administration, there should be an effect of improved psychiatric disposition.

The authors bring up another reason why psychobiotics are so unique in comparison to most probiotics.  These strains have another incredible ability to modulate the function of the adrenal cortex, which is responsible for controlling anxiety and stress response. Probiotic strains, such as Lactobacillus helveticus and Bifdobacterium longum have shown to reduce levels of stress hormones and maintain a calmer, peaceful state.  There may be a host of other probiotic bacteria with the same ability although testing has been scant at best.

Finally, the last point in support of psychobiotics is the fact that certain strains of bacteria actually produce the chemicals necessary for a happy self.  But as these chemicals cannot find their way into the brain, another route has been found to explain why they work so well.  They stimulate cells in the gut that have the ability to signal the vagus nerve that good chemicals are in the body.  The vagus nerve then submits this information to the brain, which then acts as if the chemicals were there.  

Lately some articles have been mentioning the amazing possibility of new treatments for psychiatric disorders using bacteria as psychobiotics. Think of probiotics (microorganisms that have beneficial effects when consumed) that affect the brain. Researchers promoting the use of this term define a psychobiotic as "a live organism that, when ingested in adequate amounts, produces a health benefit in patients suffering from psychiatric illness". This new emerging field is just in its infancy. Lots of speculation and anecdotal evidence, and a few tantalizing studies.

I think the following article is a good introduction to this research area of the gut and mind/brain interaction, even though it was published in late 2013. Or you could order the newly published scholarly book "Microbial Endocrinology: The Microbiota-Gut-Brain Axis in Health and Disease" (Editors M.Lyte and J.F.Cryan) with a $189. purchase price (!).  From November 2103 NPR:

Gut Bacteria Might Guide The Workings Of Our Minds

Could the microbes that inhabit our guts help explain that old idea of "gut feelings?" There's growing evidence that gut bacteria really might influence our minds

"I'm always by profession a skeptic," says Dr. Emeran Mayer, a professor of medicine and psychiatry at the University of California, Los Angeles. "But I do believe that our gut microbes affect what goes on in our brains.Mayer thinks the bacteria in our digestive systems may help mold brain structure as we're growing up, and possibly influence our moods, behavior and feelings when we're adults. "It opens up a completely new way of looking at brain function and health and disease," he says.

So Mayer is working on just that, doing MRI scans to look at the brains of thousands of volunteers and then comparing brain structure to the types of bacteria in their guts. He thinks he already has the first clues of a connection, from an analysis of about 60 volunteers. Mayer found that the connections between brain regions differed depending on which species of bacteria dominated a person's gut. 

But other researchers have been trying to figure out a possible connection by looking at gut microbes in mice. There they've found changes in both brain chemistry and behavior. One experiment involved replacing the gut bacteria of anxious mice with bacteria from fearless mice"The mice became less anxious, more gregarious," says Stephen Collins of McMaster University in Hamilton, Ontario, who led a team that conducted the researchIt worked the other way around, too — bold mice became timid when they got the microbes of anxious ones. And aggressive mice calmed down when the scientists altered their microbes by changing their diet, feeding them probiotics or dosing them with antibiotics. 

Scientists also have been working on a really obvious question — how the gut microbes could talk to the brainA big nerve known as the vagus nerve, which runs all the way from the brain to the abdomen, was a prime suspect. And when researchers in Ireland cut the vagus nerve in mice, they no longer saw the brain respond to changes in the gut"The vagus nerve is the highway of communication between what's going on in the gut and what's going on in the brain," says John Cryan of the University College Cork in Ireland, who has collaborated with Collins.

Gut microbes may also communicate with the brain in other ways, scientists say, by modulating the immune system or by producing their own versions of neurotransmitters"I'm actually seeing new neurochemicals that have not been described before being produced by certain bacteria," says Mark Lyte of the Texas Tech University Health Sciences Center in Abilene, who studies how microbes affect the endocrine system. "These bacteria are, in effect, mind-altering microorganisms."

This research raises the possibility that scientists could someday create drugs that mimic the signals being sent from the gut to the brain, or just give people the good bacteria — probiotics — to prevent or treat problems involving the brain. Experiments to test whether changing gut microbes in humans could affect the brain are only just beginning. 

One team of researchers in Baltimore is testing a probiotic to see if it can help prevent relapses of mania among patients suffering from bipolar disorder."The idea is that these probiotic treatments may alter what we call the microbiome and then may contribute to an improvement of psychiatric symptoms," says Faith Dickerson, director of psychology at the Sheppard Pratt Health System.

Mayer also has been studying the effects of probiotics on the brain in humans. Along with his colleague Kirsten Tillisch, Mayer gave healthy women yogurt containing a probiotic and then scanned their brains. He found subtle signs that the brain circuits involved in anxiety were less reactive, according to a paper published in the journal Gastroenterology.

But Mayer and others stress that a lot more work will be needed to know whether that probiotic — or any others — really could help people feel less anxious or help solve other problems involving the brain. He says, "We're really in the early stages."

Obviously children on farms are exposed to a lot of dirt and animals, both teaming with microorganisms. But I wonder, and it's not discussed, is whether people living on dairy farms are drinking raw milk, which contains lots of microorganisms. After all, the point of milk pasteurization is to kill off bacteria. Will we go back to drinking raw milk to try to prevent allergies? From Science Daily:

Children on dairy farms run one-tenth the risk of developing allergies; Dairy farm exposure also beneficial during pregnancy

Children who live on farms that produce milk run one-tenth the risk of developing allergies as other rural children. According to researchers at The University of Gothenburg in Sweden, pregnant women may benefit from spending time on dairy farms to promote maturation of the fetal and neonatal immune system.

The occurrence of allergic diseases has risen dramatically in Western societies. One frequently cited reason is that children are less exposed to microorganisms and have fewer infections than previous generations, thereby delaying maturation of the immune system.

A study by researchers at Sahlgrenska Academy, University of Gothenburg, monitored children until the age of three to examine maturation of the immune system in relation to allergic disease. All of the children lived in rural areas of the Västra Götaland Region, half of them on farms that produced milk. The study found that children on dairy farms ran a much lower risk of developing allergies than the other children.

"Our study also demonstrated for the first time that delayed maturation of the immune system, specifically B-cells, is a risk factor for development of allergies," says Anna-Carin Lundell, one of the researchers. Children with an allergic disease at the age of 18 and 36 months had a higher percentage of immature B-cells in their blood circulation at birth and during the first month of life. 

"We need to identify the specific factors on dairy farms that strengthen protection against allergies and appear to promote maturation of the immune system as early as the fetal stage," Ms. Lundell says.

New discoveries of what is going on in our intestines, plus a new vocabulary to understand it all. Yes, it all is amazingly complex. Bottom line: we have complex communities (bacteria, bacterial viruses or bacteriophages, etc.) living and interacting in our intestines. And only with state-of-the-art genetic analysis (DNA sequencing) can we even "see" what is going on. I highlighted really important items in bold type. From Medical Xpress:

Researchers uncover new knowledge about our intestines

Researchers from Technical University of Denmark Systems Biology have mapped 500 previously unknown microorganisms in human intestinal flora as well as 800 also unknown bacterial viruses (also called bacteriophages) which attack intestinal bacteria.

"Using our method, researchers are now able to identify and collect genomes from previously unknown microorganisms in even highly complex microbial societies. This provides us with an overview we have not enjoyed previously," says Professor Søren Brunak who has co-headed the study together with Associate Professor Henrik Bjørn Nielsen.

So far, 200-300 intestinal bacterial species have been mapped. Now, the number will be more than doubled, which could significantly improve our understanding and treatment of a large number of diseases such as type 2 diabetes, asthma and obesity.

The two researchers have also studied the mutual relations between bacteria and virusesPreviously, bacteria were studied individually in the laboratory, but researchers are becoming increasingly aware that in order to understand the intestinal flora, you need to look at the interaction between the many different bacteria found.

And when we know the intestinal bacteria interactions, we can potentially develop a more selective way to treat a number of diseases. "Ideally we will be able to add or remove specific bacteria in the intestinal system and in this way induce a healthier intestinal flora," says Søren Brunak.

From Science Daily:

Revolutionary approach to studying intestinal microbiota

Analyzing the global genome, or the metagenome of the intestinal microbiota, has taken a turn, thanks to a new approach to study developed by an international research team. This method markedly simplifies microbiome analysis and renders it more powerful. The scientists have thus been able to sequence and assemble the complete genome of 238 intestinal bacteria, 75% of which were previously unknown. 

Research carried out in recent years on the intestinal microbiota has completely overturned our vision of the human gut ecosystem. Indeed, from "simple digesters" of food, these bacteria have become major factors in understanding certain diseases such as obesity, type 2 diabetes, or Crohn's disease. Important and direct links have also been demonstrated between these bacteria and the immune system, as well as with the brain. It is estimated that 100,000 billion bacteria populate the gut of each individual (or 10 to 100 times more than the number of cells in the human body), and their diversity is considerable, estimated to around a thousand different bacterial species in the intestinal human metagenome. However, because only 15% of these bacteria were previously isolated and characterized by genome sequencing, an immense number of the microbial genes previously identified still need to be assigned to a given species.

An analysis of 396 stool samples from Danish and Spanish individuals allowed the researchers to cluster these millions of genes into 7381 co-abundance groups of genes. Approximately 10% of these groups (741) corresponded to bacterial species referred to as metagenomic species (MGS); the others corresponded to bacterial viruses (848 bacteriophages were discovered), plasmids (circular, bacterial DNA fragments) or genes which protected bacteria from viral attack (known as CRISPR sequences). 85% of these MGS constituted unknown bacteria species (or ~630 species).

Using this new approach, the researchers succeeded in reconstituting the complete genome of 238 of these unknown species, without prior culture of these bacteria. Living without oxygen, in an environment that is difficult to characterise and reproduce, most of these gut bacteria cannot be cultured in the laboratory. 

The authors also demonstrated more than 800 dependent relationships within the 7381 gene co-abundance groups; this was the case, for example, of phages which require the presence of a bacterium to survive. These dependent relationships thus enable a clearer understanding of the survival mechanisms of a micro-organism in its ecosystem. 

20131201_101300 Several people have recently written to me about kimchi and asked why I originally chose vegan kimchi over kimchi containing a seafood ingredient (typically fish or shrimp sauce) for sinusitis treatment. I have also been asked whether vegan kimchi has enough Lactobacillus sakei bacteria in it as compared to kimchi made with a seafood seasoning. (see Sinusitis Treatment Summary page and/or Sinusitis posts for in-depth discussions of Lactobacillus sakei in successful sinusitis treatment).

Korean kimchi is a fermented food typically made with cabbage and other vegetables and seasonings, and can contain some seafood (perhaps fish or shrimp sauce) as a seasoning, or just be vegan (no seafood ingredients). It can also be made using a starter culture.

These questions arose because Lactobacillus sakei (L.sakei) is commonly found on meat and fish, and plays a role in the fermentation and preservation of meat. L.sakei "outcompetes other spoilage- or disease-causing microorganisms" and so prevents them from growing. Thus it is considered beneficial and is used commercially in lactic acid starter cultures (for example, in making European salami and sausages).

L. sakei was originally isolated from sake or rice wine (thus plant origin), is found in very low levels in some fermented sauerkraut, and according to the studies I looked at, is found during fermentation in most brands of Korean kimchi.

Currently there are over 230 different strains of L.sakei isolated from meat, seafood, or vegetables from all over the world (from S. Chaillou et al 2013 study looking at population genetics of L.sakei). So this bacteria, which is found by using state of the art genetic analysis, turns out to be quite common.

So why did I only use vegan kimchi and only mention vegan kimchi in our Sinusitis Treatment method?

It's because when I first started dabbing kimchi juice in my nose about 1 1/2 years ago, I was in uncharted territory. I was desperate for something with L.sakei in it, and from my reading I found kimchi. However, putting (by dabbing or smearing) a live fermented product in my nostrils was a big unknown. When I first opened some jars, the kimchi juice would bubble and sometimes overflow and run down the sides of the jar. Would the microbes in kimchi harm or benefit me? Obviously I was conducting an experiment with unknown results.

I settled on vegan (no seafood) kimchi because a totally plant-based product sounded safer to me. I wondered what other microbes are in the kimchi with seafood. Could any of them be harmful?  And my choice of vegan kimchi turned out great.

Our experiences with kimchi are that it works amazingly well in treating sinusitis and causes no harm (as far as we can tell). This is the best I've felt in many, many years - back to normal!

But I don't know if other brands of vegan kimchi, with different recipes and ingredients and thus different microbial communities, would have worked out so well. The levels of L.sakei and other beneficial microbes in the many kimchi brands are unknown.

So now I wonder- if L. sakei is so pervasive on meat and seafood, perhaps kimchi with a seafood ingredient in it would be even better, with consistently higher amounts of L. sakei. Or maybe there is no difference between the two kinds of kimchi. Only the very expensive state-of-art genetic testing would give me the answer to that question.

Based on my successful 1 1/2 years of vegan kimchi experience, I may be willing to experiment further and try non-vegan kimchi. Or maybe not. Perhaps it is better. But I'm very cautious.... 

Lactobacilli

The human vagina is another microbial community that is nowhere as simple as earlier thought - and it's not just Lactobacillus bacteria.

From The Scientist: Characterizing the “Healthy” Vagina

For years, researchers characterized the microbial community of women’s vaginas as being dominated by Lactobacillus bacteria, which ferment carbohydrates to lactic acid, yielding a low pH that is toxic to many pathogenic microbes. When levels of Lactobacillus drop, the pH becomes more neutral, and the risk of infection rises.

But with research revealing notable variation among women’s vaginal microbiomes, as well as some interesting dynamics of the microbial communities within a single organ, “that dogma is changing a little bit,” said Gregory Buck of the Vaginal Microbiome Consortium at Virginia Commonwealth University (VCU).

The composition and stability of the vaginal microbiome varies by race, age, even within an individual—and it’s quickly become clear that the formula for a “normal,” “healthy” microbial community cannot be computed by ratios of bacterial species. “In the past we’ve made some generalizations about what kinds of bacteria are found in the vagina, what kinds of bacteria are good or healthy or protective,” said microbial ecologist Larry Forney of the University of Idaho. “What the research is showing is there are tremendous differences between women in terms of the kinds of bacteria that are present and the changes in the communities that occur over time.

In June 2010, Forney, Jacques Ravel of the University of Maryland School of Medicine, and their collaborators published a survey of the vaginal microbiomes of nearly 400 women and found that the majority harbored bacterial communities dominated by one of four Lactobacillus strains. More than a quarter of the women studied, however, did not follow this pattern. Instead, their vaginas had fewer Lactobacillus and greater numbers of other anaerobic bacteria, although the bacterial communities always included members of genera known to produce lactic acid.

In many ways, the microbiome of these women resembled the bacterial communities of women suffering from bacterial vaginosis (BV), an infection characterized by an odorous vaginal discharge, Buck noted. “By looking at the microbial components, you’d say they have BV, but they have no clinical symptoms,” he said. “These people are not unhealthy.”

The researchers also found that the composition of a woman’s vaginal microbiome was linked to her race. Eighty percent of Asian women and nearly 90 percent of white women harbored vaginal microbiomes that were dominated by Lactobacillus, while only about 60 percent of Hispanic and black women did. Moreover, vaginal pH varied with ethnicity as well, with Hispanic and black women averaging 5.0 and 4.7, respectively, and Asian and white women averaging 4.4 and 4.2. 

This raises questions about the role of the commensal bacteria and risk of preterm labor , which has been linked to BV—and to low levels of Lactobacillus in particular—and is one-and-a-half times more common among African American women than Caucasian women.

Meanwhile, the researchers continue to sort through 40,000 swabs from more than 6,000 women to better characterize the bacterial communities living in the vagina. But Fettweis and her colleagues face a common problem in microbiome research. “In many samples, only a fraction of [the genetic sequences] align to anything we have in our databases,” she said. “So I think there’s still a lot of work to be done in terms of actually understanding: What are these organisms?”

Another question facing researchers probing the vaginal microbiome is how it is initially colonized. “Where do [the bacteria] come from?” said Forney.

Many suspect that the process occurs during vaginal childbirth. But the adolescent microbiome does not resemble that of a sexually mature woman, having far less Lactobacillus, leading some to suspect that there may be a second colonization of the vagina later in life. And if the birthing process is important to establish the vaginal microbiome, what happens in the case of C-sections? “We have more questions than answers,” Forney said.

The microbiome is also not stable later in life. It is now well known that the vaginal microbiome changes after menopause, containing fewer Lactobacillus than the vaginas of reproductive-aged women, with the notable exception of women on hormone-replacement therapies.

Moreover, recent research has revealed that the composition of the vaginal microbiome can change in as little as 24 hours.

The temporal dynamics of the vaginal microbiome raise important questions about developing microbiota-based diagnostics and therapeutics, said Forney. “If you perform a diagnostic test, would you get a different result tomorrow or the day after? In some cases, yes. How do you incorporate that into [a] decision about whether some kind of intervention is required?”

The study talked specifically about 3 types of bacteria that were different among the groups (severely obese, diabetics, healthy) studied: Firmicutes, Bifidobacteria, Clostridium leptum. From Science Daily:

Gut microbe levels are linked to type 2 diabetes and obesity

People with Type 2 diabetes or obesity have changes in the composition of their intestinal micro-organisms -- called the gut microbiota -- that healthy people do not have, researchers from Turkey have found.

The study lends support to other recent reports that have found an association between specific bacterial species in the human digestive system and obesity and diabetes, according to lead investigator Yalcin Basaran, MD, an endocrinologist from Gulhane Military Medical Academy School of Medicine, Ankara, Turkey.

The human digestive system contains an estimated 10 trillion to 100 trillion bacteria and other microscopic organisms, with each person housing at least 160 different species of organisms, according to Basaran. 

Basaran and his fellow researchers sought to identify the relationship between the gut microbe composition and obesity and Type 2 diabetes. Their study included 27 severely obese adults (20 men and seven women) whose body mass index, or BMI, exceeded 35 kg/m2, as well as 26 adults (18 men and eight women) with newly diagnosed Type 2 diabetes and 28 healthy control subjects (22 men and six women). 

Fecal analysis using a molecular biology technique showed that several of the most common types of bacteria in the gut were present at considerably lower levels in the obese and diabetic groups, compared with healthy controls. These reductions ranged from 4.2 to 12.5 percent in the obese patients and 10 to 11.5 percent in the diabetic patients, Basaran reported.

"Manipulation of intestinal bacteria could offer a new approach to manage obesity and Type 2 diabetes."

For those who missed it. An amusing and informative personal story (Julia Scott) about trying to cultivate a healthy skin biome. Well worth reading. Excerpts from the May 22, 2014 NY Times:

My No-Soap, No-Shampoo, Bacteria-Rich Hygiene Experiment

For most of my life, if I’ve thought at all about the bacteria living on my skin, it has been while trying to scrub them away. But recently I spent four weeks rubbing them in. I was Subject 26 in testing a living bacterial skin tonic, developed by AOBiome, a biotech start-up in Cambridge, Mass. The tonic looks, feels and tastes like water, but each spray bottle of AO+ Refreshing Cosmetic Mist contains billions of cultivated Nitrosomonas eutropha, an ammonia-oxidizing bacteria (AOB) that is most commonly found in dirt and untreated water. AOBiome scientists hypothesize that it once lived happily on us too — before we started washing it away with soap and shampoo — acting as a built-in cleanser, deodorant, anti-inflammatory and immune booster by feeding on the ammonia in our sweat and converting it into nitrite and nitric oxide.

 Because the N. eutropha are alive, he said, they would need to be kept cold to remain stable. I would be required to mist my face, scalp and body with bacteria twice a day. I would be swabbed every week at a lab, and the samples would be analyzed to detect changes in my invisible microbial community.

While most microbiome studies have focused on the health implications of what’s found deep in the gut, companies like AOBiome are interested in how we can manipulate the hidden universe of organisms (bacteria, viruses and fungi) teeming throughout our glands, hair follicles and epidermis. They see long-term medical possibilities in the idea of adding skin bacteria instead of vanquishing them with antibacterials — the potential to change how we diagnose and treat serious skin ailments. 

For my part in the AO+ study, I wanted to see what the bacteria could do quickly, and I wanted to cut down on variables, so I decided to sacrifice my own soaps, shampoo and deodorant while participating. I was determined to grow a garden of my own. Some skin bacteria species double every 20 minutes; ammonia-oxidizing bacteria are much slower, doubling only every 10 hoursAnd now the bacteria were on my skin.

I had warned my friends and co-workers about my experiment, and while there were plenty of jokes — someone left a stick of deodorant on my desk; people started referring to me as “Teen Spirit” — when I pressed them to sniff me after a few soap-free days, no one could detect a difference. Aside from my increasingly greasy hair, the real changes were invisible. By the end of the week, Jamas was happy to see test results that showed the N. eutropha had begun to settle in, finding a friendly niche within my biome.

AOBiome is not the first company to try to leverage emerging discoveries about the skin microbiome into topical products. The skin-care aisle at my drugstore had a moisturizer with a “probiotic complex,” which contains an extract of Lactobacillus, species unknown. There is even a “frozen yogurt” body cleanser whose second ingredient is sodium lauryl sulfate, a potent detergent, so you can remove your healthy bacteria just as fast as you can grow them.

Although a few studies have shown that Lactobacillus may reduce symptoms of eczema when taken orally, it does not live on the skin with any abundance, making it “a curious place to start for a skin probiotic,” said Michael Fischbach, a microbiologist at the University of California, San Francisco. Extracts are not alive, so they won’t be colonizing anything.

It doesn’t help that the F.D.A. has no regulatory definition for “probiotic” and has never approved such a product for therapeutic use. “The skin microbiome is the wild frontier,” Fischbach told me. “We know very little about what goes wrong when things go wrong and whether fixing the bacterial community is going to fix any real problems.”

I asked AOBiome which of my products was the biggest threat to the “good” bacteria on my skin. The answer was equivocal: Sodium lauryl sulfate, the first ingredient in many shampoos, may be the deadliest to N. eutropha, but nearly all common liquid cleansers remove at least some of the bacteria. Antibacterial soaps are most likely the worst culprits, but even soaps made with only vegetable oils or animal fats strip the skin of AOB.

Interesting to think of bacteria and biofilms (bacterial communities resistant to treatment) involved in stress related heart attacks. From Science Daily:

Bacteria help explain why stress, fear trigger heart attacks

Scientists believe they have an explanation for the axiom that stress, emotional shock, or overexertion may trigger heart attacks in vulnerable people. Hormones released during these events appear to cause bacterial biofilms on arterial walls to disperse, allowing plaque deposits to rupture into the bloodstream, according to research published in published in mBio®, the online open-access journal of the American Society for Microbiology.

"Our hypothesis fitted with the observation that heart attack and stroke often occur following an event where elevated levels of catecholamine hormones are released into the blood and tissues, such as occurs during sudden emotional shock or stress, sudden exertion or over-exertion" said David Davies of Binghamton University, Binghamton, New York, an author on the study.

Davies and his colleagues isolated and cultured different species of bacteria from diseased carotid arteries that had been removed from patients with atherosclerosis. Their results showed multiple bacterial species living as biofilms in the walls of every atherosclerotic (plaque-covered) carotid artery tested.

In normal conditions, biofilms are adherent microbial communities that are resistant to antibiotic treatment and clearance by the immune system. However, upon receiving a molecular signal, biofilms undergo dispersion, releasing enzymes to digest the scaffolding that maintains the bacteria within the biofilm. These enzymes have the potential to digest the nearby tissues that prevent the arterial plaque deposit from rupturing into the bloodstream. According to Davies, this could provide a scientific explanation for the long-held belief that heart attacks can be triggered by a stress, a sudden shock, or overexertion.

To test this theory they added norepinephrine, at a level that would be found in the body following stress or exertion, to biofilms formed on the inner walls of silicone tubing."At least one species of bacteria -- Pseudomonas aeruginosa -- commonly associated with carotid arteries in our studies, was able to undergo a biofilm dispersion response when exposed to norepinephrine, a hormone responsible for the fight-or-flight response in humans," said Davies. Because the biofilms are closely bound to arterial plaques, the dispersal of a biofilm could cause the sudden release of the surrounding arterial plaque, triggering a heart attack.

To their knowledge, this is the first direct observation of biofilm bacteria within a carotid arterial plaque deposit, says Davies. This research suggests that bacteria should be considered to be part of the overall pathology of atherosclerosis and management of bacteria within an arterial plaque lesion may be as important as managing cholesterol.

Note the red biofilm bacterial colonies within the diseased arterial wall:

Bacteria stained with a fluorescent bacterial DNA probe show up as red biofilm microcolonies within the green tissues of a diseased carotid arterial wall.