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It's official. This month is 5 whole years being free of chronic sinusitis and off all antibiotics! Yes, that's correct - 5 whole years for all 4 family members, and our sinuses feel great!

Back in February 2013 - first I, and then the rest of my family, started using easy do-it-yourself sinusitis treatments containing the probiotic (beneficial bacteria) Lactobacillus sakei. Now we only treat with a L. sakei  product when occasionally needed - and it still works great. And it still feels miraculous.

After reading the original ground-breaking research on sinusitis done by Abreu et al (2012), it led to me trying L. sakei as a sinusitis treatment. Of course, there is an entire community of microbes (bacteria, fungi, viruses) that live in healthy sinuses - the sinus microbiome - but L. sakei seems to be a key one for sinus health. Since that original 2012 study, other studies have also found that in people with chronic sinusitis, the sinus microbial community is out of whack (dysbiosis). 

The one thing different this past year is that our sinus microbial community (sinus microbiome) seems better. If we need to treat (for example, after a virus that goes into sinusitis), then all four of us noticed that we need to use much less of a product than in the past. Incredibly little. So it seems that our sinus microbial community has definitely improved over time.

The post The One Probiotic That Treats Sinusitis (originally posted January 2015 and with many updates since then) contains information using my family's experiences (lots of self-experimentation!) and all the information that people have given me over the years. Thanks everyone! The post has a list of brands and products with L. sakei, treatment results, as well as information about some other promising probiotics (beneficial bacteria).

Thank you all who have contacted me  - whether publicly or privately. Please keep writing and tell me what has worked or hasn't worked for you as a sinusitis treatment. If you find another bacteria or microbe or product that works for you - please let me know. It all adds to the sinusitis treatment knowledge base. I will keep posting updates. 

(NOTE: I wrote our background story - Sinusitis Treatment Story back in December 2013, and there is also a  Sinusitis Treatment Summary page with the various treatment methods quickly discussed. One can also click on SINUSITIS under CATEGORIES to see more posts about what is going on in the world of sinusitis research.)

A recent study tested a variety of probiotic (beneficial) Lactobacillus and Bifidobacteria species of bacteria as a treatment for chronic sinusitis. Unfortunately, it found that the microbes tested had NO effect on chronic sinusitis symptoms. It was a nice study conducted in Sweden, with 21 people with chronic sinusitis (but without nasal polyps) randomly assigned to receive a nasal spray (that they used 2 x daily for 14 days) containing either a mixture of 13 bacteria or a "sham" nasal spray. No one knew who received what, and then after a few weeks they did a crossover - meaning who got what was switched for another 2 weeks.

But...the main finding is that after 14 days of using the nasal sprays, there was no improvement in either group, no improvement in symptoms, no effect on the sinus "microbial flora", and no effect on inflammation. In fact, 2 individuals wound up taking antibiotics while testing the bacteria nasal spray. In other words, a big fat zero.

The bacteria tested were what the researchers called a honeybee lactic acid (LAB) microbiome, with both Lactobacillus and Bifidobacteria species: Lactobacillus apinorumL. melliferL. mellis, L. kimbladiiL. melliventrisL. helsingborgensisL. kullabergensisL. kunkeei, L. apisBifidobacterium asteroidesB. coryneforme, Bifidobacterium Bin7N, and Bifidobacterium Hma3N. These species are not typically found in probiotic supplements.

Why did they choose those strains of bacteria? Because "in vitro" testing (meaning in a test tube or culture dish) suggested that they would be effective against the pathogenic bacteria frequently found in chronic sinusitis (that they were antimicrobial). But real world testing in actual humans in this study showed that those specific Lactobacillus and Bifidobacteria microbes had no effect on sinusitis symptoms. Their premise was good - that the sinus microbiome was "disturbed" or out of whack (dysbiosis) in chronic sinusitis, but unfortunately they chose the wrong bacteria to test as a treatment.

The SNOT-22 questionnaire that asked questions of sinusitis sufferers at several points in the study to see if there was improvement in sinusitis symptoms, is one typically given to those with chronic sinusitis. [By the way, when reviewing the questionnaire, I realized it left out some major sinusitis symptoms such as "gagging on phlegm", "waking up with sore throat", "teeth hurt", "headache" - all of which are frequently mentioned by many contacting me, and which I remember well from pre-L. sakei days. In other words - it is incomplete, yet it is the questionnaire typically used to assess quality of life and symptoms for those with chronic sinusitis.]

The researchers end the journal article by stating "Further studies are warranted to explore whether other tentative probiotic assemblages [other bacterial species] can confer positive health effects to patients suffering from inflammatory conditions of the upper airways." Huh... If only they had asked...  I've been writing about Lactobacillus sakei as an excellent treatment for chronic sinusitis since 2013 (based on results of Abreu et al study), and I've been getting positive feedback from others about L. sakei since early 2014. For those who find that L. sakei works as a sinusitis treatment, the results seem miraculous - typically with major improvement within a few days. (Please note: Perhaps other microbes may also work as a sinusitis treatment.) Excerpts from Laryngoscope Investigative Otolaryngology:

Clinical efficacy of a topical lactic acid bacterial microbiome in chronic rhinosinusitis: A randomized controlled trial

A locally disturbed commensal microbiome might be an etiological factor in chronic rhinosinusitis (CRS) in general and in CRS without nasal polyps (CRSsNP) in particular. Lactic acid bacteria (LAB) have been suggested to restore commensal microbiomes. A honeybee LAB microbiome consisting of various lactobacilli and bifidobacteria have been found potent against CRS pathogens in vitro. Recently, we examined effects of single nasal administrations of this microbiome in healthy subjects and found it inert. In this study, we examined effects of repeated such administrations in patients with CRSsNP.

The study was of a randomized, double‐blinded, crossover, and sham‐controlled design. Twenty patients received 2 weeks' treatment administered using a nasal spray‐device. The subjects were monitored with regard to symptoms (SNOT‐22 questionnaire, i.e., the primary efficacy variable), changes to their microbiome, and inflammatory products (IL‐6, IL‐8, TNF‐, IL‐8,a, and MPO) in nasal lavage fluids.

ResultsNeither symptom scores, microbiological explorations, nor levels of inflammatory products in nasal lavage fluids were affected by LAB (c.f. sham). Conclusion: Two weeks' nasal administration of a honeybee LAB microbiome to patients with CRSsNP is well tolerated but affects neither symptom severity nor the microbiological flora/local inflammatory activity.

 In this study, involving patients with well‐defined CRSsNP, we demonstrate that repeated nasal administration of a LAB microbiota composed of several species of lactobacilli and bifidobacteria over 2 weeks neither affects symptoms as assessed by SNOT‐22 questionnaire nor the bacterial composition or the inflammatory activity in the nasal cavity. The observations are of relevance to the evaluation of topical LAB treatment in the management of upper respiratory tract conditions such as CRS.

Just read a small study that compared the microbes in the sinus microbiome between 12 healthy people with no sinusitis (controls) and 14 with chronic sinusitis, their neurotransmitter levels (serotonin, dopamine, and GABA), and also looked at depression scores in the 2 groups. Well, of course they found some microbial differences between healthy people and those with chronic rhinosinusitis (CRS), but they also found that those with the most severe chronic sinusitis tended to have the most depressive symptoms, and lower amounts of the neurotransmitters studied, but they did not find significant differences overall.

I found their summary and conclusions problematic, since they discussed that "possibly" the sinus microbes influence brain neurotransmitters. And they pointed out that as certain disease associated microbes increased (especially Moraxella), the neurotransmitter concentrations tended to decrease in those with sinusitis. But since there were no significant group differences, they did not prove their hypotheses, and conclusions can not be made. So saying there is "the potential for downstream effects of the sinonasal microbiota on neural signaling and, subsequently, brain function and behavior" is misleading and overreaching. The researchers also said it was "difficult to discern disease associations from natural variation." Hah!

It should be obvious that the worse the chronic sinusitis, the more depressive symptoms, because having chronic sinusitis is DEPRESSING. One suffers with it. Some people have told me how chronic sinusitis has destroyed their life - whether their health, financially, with relationships, etc. Of course they will have higher depressive scores! And when a Lactobacillus sakei product or other probiotic successfully treats sinusitis (usually very quickly), then the mood is one of elation as symptoms go away (finally health!).

All one can say (based on studies) is: the sinus microbiomes in healthy people (normal sinus microbial community) are somewhat different from those with chronic sinusitis (out-of-whack microbial community or dysbiosis). And one would expect that those with less severe/milder sinusitis have a "better" community of sinus microbes - that is, more microbes that are associated with health, and fewer of those associated with sickness, than sicker people. Which is what this study suggested. Excerpts from the International Forum of Allergy & Rhinology:

The sinonasal microbiota, neural signaling, and depression in chronic rhinosinusitis

The complex relationships between the human microbiota, the immune system, and the brain play important roles in both health and disease, and have been of increasing interest in the study of chronic inflammatory mucosal conditions. We hypothesized that the sinonasal microbiota may act as a modifier of interkingdom neural signaling and, subsequently, mental health, in the upper respiratory inflammatory condition chronic rhinosinusitis (CRS). In this study we investigated associations between the sinonasal microbiota; local concentrations of the neurotransmitters serotonin, dopamine, and γ-aminobutyric acid (GABA); and depression severity in a cohort of 14 CRS patients and 12 healthy controls.

Several commonly “health-associated” sinonasal bacterial taxa were positively associated with higher neurotransmitter concentrations and negatively associated with depression severity. In contrast, several taxa commonly associated with an imbalanced sinonasal microbiota negatively associated with neurotransmitters and positively with depression severity. Few significant differences were identified when comparing between control and CRS subject groups, including neurotransmitter concentrations, depression scores, or sinonasal microbiota composition or abundance. Conclusion: The findings obtained lend support to the potential for downstream effects of the sinonasal microbiota on neural signaling and, subsequently, brain function and behavior.

SOME OTHER EXCERPTS: Depression scores were also not significantly different between controls and CRS patients. .... The serotonin levels in CRS patients compared with control subjects tended to be lower, but not significantly so. Although median values for dopamine, GABA, and serotonin were generally lower in CRS patients than controls, all 3 neurotransmitters had a greater range among those with CRS, and no differences were significant. ... For both CRS and control individuals, bacterial communities were generally dominated by OTUs of the genera Corynebacterium and Staphylococcus.

Correlation analyses identified associations between members of the genera Staphylococcus, Finegoldia, Propionibacterium, Peptoniphilus, and Anaerococcus, as well as bacterial community diversity overall. Members of these genera have been previously identified as representative of more “health-associated” sinonasal bacterial community types, whereas their depletion has been associated with lower bacterial community diversity, increased bacterial load, increased rates of asthma, and elevated markers of inflammation. Similarly, members of the genera Burkholderia and Propionibacterium have been identified as 2 potential “gatekeepers” that help maintain bacterial community stability in the sinonasal tract. In the present study, several of these same bacterial taxa were significantly positively correlated with neurotransmitter levels and negatively with depression severity, whereas several other OTUs (including members of Streptococcus, Rothia, Enterobacteriaceae, Corynebacterium, and Moraxella) showed the opposite pattern (negatively associated with neurotransmitter levels and positively with depression severity). 

A number of people contacting me have indicated that living in a house or apartment with a mold problem led to their chronic sinusitis. And it wasn't the dreaded toxic black mold (varieties of mold which can cause serious neurological symptoms), but common molds that triggered their inflammatory reactions, respiratory symptoms, allergies, and eventually chronic sinusitis. All due to excessive mold exposure.

This summer's flooding caused by hurricanes and tropical storms will result in major mold growth in residences after the water recedes. What will be the health consequences? Article excerpts about mold (and with impressive photos) from The Atlantic:

The Looming Consequences of Breathing Mold

But the impact of hurricanes on health is not captured in the mortality and morbidity numbers in the days after the rain. This is typified by the inglorious problem of mold. Submerging a city means introducing a new ecosystem of fungal growth that will change the health of the population in ways we are only beginning to understand. The same infrastructure and geography that have kept this water from dissipating created a uniquely prolonged period for fungal overgrowth to take hold, which can mean health effects that will bear out over years and lifetimes.

The documented dangers of excessive mold exposure are many. Guidelines issued by the World Health Organization note that living or working amid mold is associated with respiratory symptoms, allergies, asthma, and immunological reactions. The document cites a wide array of “inflammatory and toxic responses after exposure to microorganisms isolated from damp buildings, including their spores, metabolites, and components,” as well as evidence that mold exposure can increase risks of rare conditions like hypersensitivity pneumonitis, allergic alveolitis, and chronic sinusitis.

Twelve years ago in New Orleans, Katrina similarly rendered most homes unlivable, and it created a breeding ground for mosquitoes and the diseases they carry, and caused a shortage of potable water and food. But long after these threats to human health were addressed, the mold exposure, in low-income neighborhoods in particular, continued. The same is true in parts of Brooklyn, where mold overgrowth has reportedly worsened in the years since Hurricane Sandy. In the Red Hook neighborhood, a community report last October found that a still-growing number of residents were living in moldy apartments.

The highly publicized “toxic mold”—meaning the varieties that send mycotoxins into the air, the inhaling of which can acutely sicken anyone—causes most concern right after a flood. In the wake of Hurricane Matthew in South Carolina last year, sludge stood feet deep in homes for days. As it receded, toxic black mold grew. In one small community, Nichols, it was more the mold than the water itself that left the town’s 261 homes uninhabitable for months.

The more insidious and ubiquitous molds, though, produce no acutely dangerous mycotoxins but can still trigger inflammatory reactions, allergies, and asthma. The degree of impact from these exposure in New Orleans after Hurricane Katrina is still being studied.

Molds also emit volatile chemicals that some experts believe could affect the human nervous system. Among them is Joan Bennett, a distinguished professor of plant biology and pathology at Rutgers University, who has devoted her career to the study of fungal toxins. She was living in New Orleans during the storm, and she recalls that while some health experts were worried about heavy-metal poisoning or cholera, she was worried about fungus.

The smell of the fungi in her house got so strong after the flooding that it gave her headaches and made her nauseated. As she evacuated, wearing a mask and gloves, she took samples of the mold along with her valued possessions. Her lab at Rutgers went on to report that the volatile organic compounds emitted by the mold, known as mushroom alcohol, had some bizarre effects on fruit flies. For one, they affected genes involved in handling and transporting dopamine in a way that mimicked the pathology of Parkinson’s disease in humans. “More biologists ought to be looking at gas-phase compounds, because I’m quite certain we’ll find a lot of unexpected effects that we’ve been ignoring,” said Bennett.

 Mold in ceiling.  Credit: CDC

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An amazing new study is about to start in Sweden - this study will see if "snot transplants" work for the treatment for chronic sinusitis! Will this turn out to be a permanent treatment? While studies show that probiotic supplements tend not to stick around in the gut (they're gone after about a week), people receiving a fecal microbiota transplant (FMT) find that these microbial communities do stick around (colonize).  So there is something about getting an entire microbial community (bacteria, fungi, viruses) that is more effective than just a few species that are in typical probiotic supplements.

We have found the same problem in sinusitis treatment - the Lactobacillus sakei treatment works to treat sinusitis, but then doesn't stick around - as evidenced by having to treat again after a cold or sore throat.  And so we treat again - and again it's successful. And this happens again and again. Sooo.... it's important to find out if a transplant of the entire microbial community of snot (the sinonasal microbiome) works. And if works, will the treatment be a permanent one? I also wonder.... Several people have mentioned this idea to me, but has anyone with sinusitis tried a "snot transplant" at home? (And yes, this is self-experimentation.)

The description and purpose of the study refer to what this site has discussed for several years: the sinus microbiome is out of whack (dysbiosis) in chronic rhinosinusitis (CRS), whether due to antibiotics or something else (viruses, etc). The study will enroll 30 people, start May 15, 2017, and end December 31, 2018. The purpose of the study is to have patients with chronic rhinosinusits without nasal polyps (CRSsNP) receive microbiome transplants from healthy donors without any sinus problems. They would receive a snot transplant for 5 days in a row. Unfortunately we'll have to wait at least 1 1/2 years for any results. Excerpts from clinical trails.gov:

Sinonasal Microbiome Transplant as a Therapy for Chronic Rhinosinusitis Without Nasal Polyps (CRSsNP)

Purpose: Chronic rhinosinusitis (CRS) is a disease associated with impaired quality of life and substantial societal costs. Though sometimes co-appearing with other conditions, such as asthma, allergy, and nasal polyps, many cases present without co-morbidities. Micro-biological diagnostic procedures are frequently undertaken, but the results are often inconclusive. Nevertheless, antibiotics are usually prescribed, but invariably with limited and temporary success. Accordingly, there is a need for new treatments for CRS.

Recent studies indicate that the sinuses are colonized by a commensal microbiome of bacteria and that damage to this natural microbiome, by pathogens or antibiotics, may cause an imbalance that may promote CRS. Therefore, treatments that restore the commensal microbiome may offer an alternative to current protocols. Arguably, as suggested by studies on patients with intestinal infections (next paragraph), one such possibility may be to transfer a "normal microbiome" to patients with CRS.

A disrupted microbiome is linked to intestinal clostridium difficile infections. Probiotic restitution therapy may be effective even in cases recalcitrant to antibiotic treatment. However, a key to effective probiotic restitution is selecting the bacteria that facilitate regrowth of normal microbiome. As an answer to this, researchers have chosen to simply transplant the entire microbiome from a healthy donor. In the case of clostridium difficile infection in the form of faecal transplants.

In this study, we will examine the possibility to treat patients with chronic rhinosinusitis without polyps (CRSsNP) with complete sinonasal microbiomes obtained from healthy donors. Our analysis will focus on symptoms and signs of disease as well as on nasal inflammatory and microbiological indices.

Detailed DescriptionOver the last few years the theory of a damaged microbiome as a cause or promoting factor behind chronic rhinosinusitis has gained increasing interest from the scientific community. A number of studies aimed at investigating the microbiota of the nose and paranasal sinuses in health and disease has been published with very varying outcomes. Furthermore, other studies have been aimed at probiotic treatment of sinonasal disease either locally or through immunologic manipulation via the gastrointestinal microbiota.

A problem common to all these studies is that studies examining the normal nasal microbiota have identified a great amount of different bacterial species. It is as of today not known which individual species or combinations of species that promotes health

In this study the investigators aim at recruiting patients suffering from chronic rhinosinusitis without polyps (CRSsNP) and healthy participants without any history sinonasal disease. The patients and the healthy participants will be examined for infectious diseases in a manner similar to other medical transplant procedures to minimize the risk for the recipients. The patients will then be treated with antibiotics to reduce the bacterial load of the nose and the paranasal sinuses. After the patient has finished the antibiotic treatment a microbiome transplant will be harvested from the healthy participant as a nasal lavage. The raw lavage fluid will then be used to transplant the microbiome to the patient. The procedure will be repeated for five consecutive daysThe outcome measures analysed will focus on subjective sinonasal health and symptoms of the patients but also include nasal inflammatory and microbiological indices.

Once again a study looked at biofilms in sinuses - but this time in the sinuses of healthy people and not those with sinusitis. Various different species of bacteria and small size "microcolonies" or biofilms were found in the healthy maxillary sinuses of all 30 people - so yes, it appears that the presence of biofilms in the sinuses is normal in healthy people. And yes, the presence of bacteria (even some low levels of species which are typically associated with sinusitis) are normally found in the sinuses of healthy people.  (Earlier research also found this last finding.)

The researchers state that it is normal for people to have "small size bacterial microcolonies" (of different kinds of bacteria) in the sinuses. The researchers theorized that the biofilms are probably "in equilibrium" under the influence of  "inhibiting defensive factors of the body", but they can become a source of infection if there are favorable conditions (such as illness). In other words, the researchers said that these biofilms are more like "bacteria films" in that they contain bacteria, but they live in small colonies that don't cause an inflammatory response with sinusitis symptoms.

One negative of this study was that advanced genetic sequencing was not done on the samples. Instead all samples taken from the people were cultured, which we now know misses a lot of bacterial and other microbial species (fungi, viruses). They looked at the microcolonies (biofilms) with scanning microscopes. Thus, while they found an assortment of bacteria on the sinuses of each person - they only found a total of 41 bacterial species among 30 persons. This is in contrast to studies using modern genetic sequencing that found hundreds of microbial species in healthy sinus microbiomes (microbial communities).

The other issue is that it is not clear to me if there were biofilms or  microcolonies that contained "beneficial" species in any of the samples. Other research suggests that biofilms of beneficial bacteria are also found in humans, and that this is one way beneficial bacteria that normally can't survive with exposure to oxygen can survive oxygen (the slime coating on the colony protects the bacteria within).

Other studies also stress that in healthy people there is "homeostasis" or "equilibrium" among all the microbes living in the sinuses, - a microbial community (which includes biofilms), and which helps maintain sinus health. See post with discussion of Mackenzie et al 2017 study: "A stable network of microbial interactions, established through processes such as niche competition, nutrient cycling, immune evasion, and biofilm formation help maintain homeostasis during health." But, as has been usual in recent sinus research, the current study also stated that much is unknown, that there are theories which are not yet proven one way or another, and more research needs to be done. Of course.... From  PLoS ONE:

The presence of bacterial microcolonies on the maxillary sinus ciliary epithelium in healthy young individuals

The aim of this cross-sectional in vitro study was to evaluate the mucosal surfaces of healthy maxillary sinuses, explore different forms of bacterial microorganism colonies present on the mucous membrane, and determine a mucosal surface area they occupy. Samples of the maxillary sinus mucosa were collected from 30 healthy patients (M = 11; F = 19). The material was obtained during the Le Fort I osteotomy performed during corrective jaw surgery. The morphological and morphometric analysis of sinus mucosa and bacterial film that was grown on it was performed using scanning electron microscopy (SEM) as well as imaging software.

Scanning electron microscopy analysis showed the presence of different bacterium and bacteria-like structures in all the analyzed samples. In most cases, the bacterial film was mostly composed of diplococci-like and streptococci-like structures on the mucosa of the paranasal sinus. In any case, the mucous layer did not cover the whole lining of the evaluated sample. Each colony consists of more than 20 single bacterial cells, which has grown in aggregates.

Under the conditions of normal homeostasis of the body, the maxillary sinuses present diverse bacterial colonization. The bacteria are dispersed or concentrated in single microcolonies of the biofilm on the border of the mucous covering the ciliary epithelium. There is no uniform layer of the biofilm covering the mucosa of the maxillary sinuses. Because the biofilm is detected on healthy individuals sinus mucosa, the clinical question if it may become pathogenic is unclear and require an explanation.

It should also be noted that pathogenic organisms, such as Pseudomonas aeruginosa, Haemophilus influenzae, Streptococcus pneumoniae, or Staphylococcus aureus can be found in patients without active symptoms of the disease. Usually, colonization is defined as the presence of bacteria on the mucous membrane, and the lack of the inflammatory response distinguishes it from an infection.

However, the bacteria film in contrast to typical biofilm might be defined by the presence of bacteria, that growth in colonies without inducing the inflammatory response. Thus, the aim of the study was to evaluate the mucosal surfaces of the healthy maxillary sinuses (without any history of recent acute sinus inflammations or chronic inflammation in the past), to identify different forms of bacterial microorganisms which could, under certain conditions, become opportunistic or pathogenic and determine a mucosal surface of the area they occupy.

Scanning electron microscope investigations revealed the presence of bacterial film on the surface of maxillary sinus mucosa in 30 patients. Moreover, microbiological examinations of specimens taken from study participants revealed the presence of various types of aerobic and anaerobic bacteria in 28 cases (93.34%) out of 30 studied samples. All samples had mixed flora. In total, 41 different microorganisms were isolated. The most frequently found microorganism was Streptococcus spp. in over 90% of all samples, while Propionibacterium acnes were present in 29,2% of samples, and Staphylococcus spp. was present in 17% of the samples.

Scanning electron microscopy analysis showed that the mucous layer has a thickness of 200 nm (± 40), which is covered up to 5% of the surface of each sample. The analysis showed the presence of bacteria-like microcolony structures in all analyzed samples.....Each colony consisted of more than 20 single bacterial cells, that had grown in aggregates. These clearly indicate the existence of a bacterial-like microcolony on maxillary sinus mucosa.

Bacterial microcolonies on the maxillary sinus ciliary epithelium in healthy young individuals. Credit: Morawska-Kochman et al.

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Last week a person told an amazing story in the comments section after a post on this site. After suffering from a "constant runny nose and a bad smell" in the nose for 2 years - which was diagnosed as "fungi and staph" in the sinuses - the person started doing "kimchi treatments" (as discussed in the Sinusitis Treatment Summary page). After 2 weeks a fungal ball was loosened, which came out of the sinuses and into the mouth, and was then spit out. About an inch in size - a smelly, grey/green, round fungal ball. Wow. Which leads to the question: Are any of the microbes in live kimchi anti-fungal?

Kimchi is an amazing live fermented food, typically made with cabbage and other vegetables and a variety of seasonings. Kimchi is the national dish of Korea and so there is tremendous interest in Korea in studying kimchi to learn about the many different microbial species in kimchi, including how they change over the course of fermentation. It turns out that kimchi contains many species of bacteria, including various species of Lactobacillus - which are considered beneficial. Of course one of the species found in kimchi over the course of fermentation is Lactobacillus sakei - the bacteria that successfully treats sinusitis, and which I have written about extensively. L. sakei predominates over pathogenic bacteria (antibacterial) - which is why it is also used as a sausage starter culture (to kill off bacteria such as Listeria). One study found that the garlic, ginger, and leek used in making kimchi were the sources of L. sakei bacteria found in fermented kimchi.

Studies show that a number of the Lactobacillus species found in kimchi are antifungal against a number of different kinds of fungi.  Some of these antifungal bacteria are: Lactobacillus plantarum, L. cruvatus, L. lactis, L. casei, L. pentosus, L. acidophilus, and L. sakei (here, here.

A study from 2005 found that some Lactobacillus species found in kimchi are predominant over a fungi known to cause health problems in humans - Aspergillus fumigatus, a mold (fungi) which is the most common cause of Aspergillus infections. Aspergillus (of which there are many species) is very common both indoors and outdoors (on plants, soil, rotting plants, household dust, etc.), so people typically breathe in these fungal spores daily and without any negative effects. However, sometimes Aspergillus can cause allergic reactions, infections in the lungs and sinuses (including fungal balls), and other infections. (more information at CDC site). The study found that 5 bacterial species in kimchi were also antifungal against other species of fungi (Aspergillus flavus, Fusarium moniliforme, Penicillium commune, and Rhizopus oryzae). The 5 bacterial species in kimchi that they found to be antifungal were: Lactobacillus cruvatus, L. lactis subsp. lactis, L. casei, L. pentosus, and L. sakei.

Just keep in mind that fungi are everywhere around us, and even part of the microbes that live in and on us - this is our mycobiome (here and here). We also breathe in a variety of fungi (mold spores) every day. In healthy individuals (even babies) all the microbes (bacteria, viruses, fungi, etc) live in balanced microbial communities, but the communities can become "out of whack" (dysbiosis) for various reasons, and microbes that formerly co-existed peacefully can multiply and become problematic.  If the populations get too unbalanced (e.g., antibiotics can kill off bacteria, and then an increase in fungi populations take their place) then ordinarily non-harmful fungi can become pathogenic. Or other pathogenic microbes can enter the community (e.g., through infection), and the person becomes ill.

IN SUMMARY: Kimchi has beneficial bacteria in it that are effective not just against bacteria (antibacterial), but also against some kinds of fungi (antifungal). One 2016 review study went so far as to say: "Kimchi possesses anti-inflammatory, antibacterial, antioxidant, anticancer, antiobesity, probiotic properties, cholesterol reduction, and antiaging properties." Experiences of my family and people writing suggest that the L. sakei in kimchi (and other products) is also antibiofilm. Hopefully, there will be some research on this in the future. But in the meantime, please keep writing to me about fungal complications of sinusitis, and especially if kimchi, L. sakei products, or other probiotics helped.

It's now 4 years being free of chronic sinusitis and off all antibiotics! Four amazing years since I (and then the rest of my family) started using easy do-it-yourself sinusitis treatments containing the probiotic (beneficial bacteria) Lactobacillus sakei. My sinuses feel great! And yes, it still feels miraculous.

After reading the original ground-breaking research on sinusitis done by Abreu et al (2012), it led to finding and trying L. sakei as a sinusitis treatment. Of course, there is an entire community of microbes (bacteria, fungi, viruses) that live in healthy sinuses - the sinus microbiome - but L. sakei seems to be a key one for sinus health.

I just updated the post The One Probiotic That Treats Sinusitis (originally posted January 2015) using my family's experiences (lots of self-experimentation!) and all the information that people have sent me. The post has a list of brands and products with L. sakei, treatment results, as well as information about some other promising probiotics (beneficial bacteria). Thank you so much!

Thank you all who have written to me  - whether publicly or privately. Please keep writing and tell me what has worked or hasn't worked for you as a sinusitis treatment. If you find another bacteria or microbe or product that works for you - please let me know. It all adds to the sinusitis treatment knowledge base. I will keep posting updates. 

(NOTE: I wrote our background story - Sinusitis Treatment Story back in December 2013, and there is also a  Sinusitis Treatment Summary page with the various treatment methods quickly discussed. One can also click on SINUSITIS under CATEGORIES to see more posts about what is going on in the world of sinusitis research.)

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People assume that taking probiotics results in the beneficial probiotic bacteria colonizing and living in the gut (or sinuses when using L. sakei). It is common to hear the phrase "take probiotics to repopulate the gut" or "improve the gut microbes". The human gut microbiota (human gut microbiome) refers to all the microbes that reside inside the gut (hundreds of species). Probiotics are live bacteria, that when taken or administered, result in a health benefit. But what does the evidence say?

First, it is important to realize that currently supplements and foods contain only a small variety of probiotic species, with some Lactobacillus and Bifidobacterium species among the most common. But they are not the most common bacteria found in the gut. And very important bacteria such as Faecalibacterium prausnitzii (a reduction of which is associated with a number of diseases) are not available at all in supplements. One problem is the F. prausnitzii are "oxygen sensitive" and they die within minutes upon exposure to air, a big problem when trying to produce supplements.

The evidence from the last 4 years  of L. sakei use for sinusitis treatment is that for some reason, the L. sakei is not sticking around and colonizing in the sinuses. My family's experiences and the experience of other people contacting me is that every time a person becomes sick with a cold or sore throat, it once again results in sinusitis, and then another treatment with a L. sakei product is needed to treat the sinusitis. And of course this has been a surprise and a big disappointment.

The same appears to be true for probiotics (whether added to a food or in a supplement) that are taken for other reasons, including intestinal health. Study after study, and a review article, finds that the beneficial bacteria do not colonize in the gut even if there are health benefits from the probiotics. That is, there may be definite health benefits from the bacteria, but within days of stopping the probiotic (whether in a food or a supplement) it is no longer found in the gut. Researchers know this because they can see what bacteria are in the gut by analyzing (using modern genetic sequencing tests) what is in the fecal matter (the stool).

However, the one exception to all of the above is a fecal microbiota transplant (FMT) - which is transfer of fecal matter from one person to another. There the transplanted microbes of the donor do colonize the recipient's gut, referred to as "engraftment of microbes". Some researchers found that viruses in the fecal matter helped with the engraftment. So it looks like more than just some bacterial strains are involved. Another thing to remember is that study after study finds that dietary changes result in microbial changes in the gut, and these changes can occur very quickly.

From Gut Microbiota News Watch: Learning what happens between a probiotic input and a health output

What scientists know is that probiotics in healthy individuals are associated with a number of benefits. Meta-analyses of randomized, controlled trials show that probiotics help prevent upper respiratory tract infections, urinary tract infections, allergy, and cardiovascular disease risk in adults. But between the input and the output, what happens? A common assumption is that probiotics work by influencing the gut microbe community, leading to an increase in the diversity of bacterial species in the gut ecosystem and measurable excretion in the stool.

But this theory doesn’t seem to be true, according to a recently published systematic review by Kristensen and colleagues in Genome Medicine. Authors of the review analyzed seven studies and found no evidence that probiotics have the ability to change fecal microbiota composition. So even though individuals in the different studies were ingesting live bacterial species, the bacteria didn’t stick around to increase the diversity of the gut fecal microbiota.

Do probiotics alter the fecal composition of healthy adults? The answer seems to be no,” says Dr. Mary Ellen Sanders, Executive Science Officer for the International Scientific Association for Probiotics and Prebiotics (ISAPP)....Dr. Dan Merenstein, Research Division Director and Associate Professor of Family Medicine at Georgetown University Medical Center in Washington, DC (USA), agrees. “Initially when probiotics were studied, some people expected to see permanent colonization. We now realize that is unlikely to occur,” he says. “This study shows that the probiotics tested to date do not result in overarching bacterial community structure changes in healthy subjects. But clinical effects are clearly demonstrated for probiotics, and likely some are mediated by microbiome changes.

At issue, then, is not what probiotics do for healthy individuals, but exactly how they work: the so-called ‘mechanism’. Sanders, who described some alternative mechanisms in her BMC Medicine commentary about the Kristensen review, points out a logical error in news stories worldwide that covered the article: the assumption that if probiotics fail to change the microbiota composition, they fail to have any health effects. Sanders emphasizes that probiotics might work in many possible ways. “Probiotics may act through changing the function of the resident microbes, not their composition. They may interact with host immune cells,” she says. “They may inhibit opportunistic pathogens that are not dominant members of the microbiota. They may promote microbiota stability… .” 

What exactly are the differences between people with chronic sinusitis and those who are healthy and don't get sinusitis? I've written many times about the Abreu et al 2012 study that found that not only do chronic sinusitis sufferers lack L. sakei, they have too much of Corynebacterium tuberculostearicum (normally a harmless skin bacteria), and they also don't have the bacteria diversity in their sinuses that healthy people without sinusitis have. In other words, the sinus microbiome (microbial community) is out of whack (dysbiosis). A number of studies found that there is a depletion of some bacterial species, and an increase in "abundance" of other species in those with chronic sinusitis.

Now a new analysis of 11 recent studies comparing people with chronic sinusitis to healthy people adds some additional information. Once again a conclusion was that those with sinusitis had "dysbiosis" (microbial communities out of whack) in their sinus microbiomes when compared to healthy people. And that an increased "abundance" of members of the genus Corynebacterium in the sinuses was associated with chronic sinusitis (studies so far point to C. tuberculostearicum and C. accolens). Nothing new there... But what was new was that they found that bacteria of the genus Burkholderia and Propionibacterium seem to be "gatekeepers", whose presence may be important in maintaining a stable and healthy bacterial community in the sinuses. And that in chronic sinusitis the bacterial network of healthy communities is "fragmented". In other words, when a person is healthy, the community of microbes in the sinuses may provide a protective effect, and if the gatekeepers are removed (e.g., during illnesses or after taking antibiotics), then a "cycle of dysbiosis and inflammation" may begin.

PLEASE NOTE: Genus is a taxonomic category ranking used in biological classification that is below a family and above a species level. For example, Lactobacillus is the genus and sakei is the species. Also, the researchers discussed "gatekeepers" as being important for sinus health, while Susan Lynch discusses the importance of "keystone species" for sinus health.

OK... so which species of Burkholderia and Propionibacterium bacteria are found in the healthy microbiome? Unfortunately that was not answered in this study. And of course this needs to be tested further to see if the addition of the missing species of Burkholderia and Propionibacterium bacteria to the sinus microbiome will treat chronic sinusitis. Or perhaps other bacteria such as L. sakei and someother still unknown bacteria also need to be added to the mix.

Both Burkholderia and Propionibacterium have many species, but I have not seen any in probiotics. Species of Propionibacteria can be found all over the body and are generally nonpathogenic. However, P. acnes can cause the common skin condition acne as well as other infections. One species - Propionibacterium freudenreichii (or P. shermanii)  - is found in Swiss type cheeses such as Emmental, Jarlsberg, and Leerdammer. Propionibacteria species are commonly found in milk and dairy products, though they have also been extracted from soil. There are many Burkholderia species, with a number of them causing illness (e.g., B. mallei and B. pseudomallei), but also beneficial species, such as those involved with plant growth and healthBurkholderia species are found all over, in the soil, in plants, soil, water (including marine water), rhizosphere, animals and humans. At this point it is unclear to me which are the species found in healthy sinuses.

But it is clear that while L. sakei works to treat chronic sinusitis in many people, the fact that L. sakei typically has to be used after each illness (cold, sore throat, etc,) means that the sinus microbiome may still be missing microbial species or that there is still some sort of "imbalance" (even though the person may feel totally healthy). The researchers noted that a variety of fungi and viruses are also part of a normal sinus microbiome, but they weren't discussed in the article. As you can see, much is still unknown. Stay tuned..,..

This was a very technical article - thus not easy to read. Keep in mind that the information about the conclusions about the bacteria species in the sinuses was from studies that used modern genetic sequencing data (16S rRNA sequence data) to determine what bacteria are in the sinuses. (These are called "culture independent technologies" and much, much better than using cultures in determining species of bacteria.) This way they could analyze differences in "sinonasal bacterial community composition" and see differences between healthy people and persons with CRS (chronic rhinosinusitis).

Excerpts from Environmental Microbiology: Bacterial community collapse: a meta-analysis of the sinonasal microbiota in chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is a common, debilitating condition characterized by long-term inflammation of the nasal cavity and paranasal sinuses. The role of the sinonasal bacteria in CRS is unclear. We conducted a meta-analysis combining and reanalysing published bacterial 16S rRNA sequence data to explore differences in sinonasal bacterial community composition and predicted function between healthy and CRS affected subjects. The results identify the most abundant bacteria across all subjects as Staphylococcus, Propionibacterium, Corynebacterium, Streptococcus and an unclassified lineage of Actinobacteria.

The meta-analysis results suggest that the bacterial community associated with CRS patients is dysbiotic and ecological networks fostering healthy communities are fragmented. Increased dispersion of bacterial communities, significantly lower bacterial diversity, and increased abundance of members of the genus Corynebacterium are associated with CRS. Increased relative abundance and diversity of other members belonging to the phylum Actinobacteria and members from the genera Propionibacterium differentiated healthy sinuses from those that were chronically inflamed. Removal of Burkholderia and Propionibacterium phylotypes from the healthy community dataset was correlated with a significant increase in network fragmentation. This meta-analysis highlights the potential importance of the genera Burkholderia and Propionibacterium as gatekeepers, whose presence may be important in maintaining a stable sinonasal bacterial community.

The high density and diversity of host-associated microbial communities present in different body sites supports a near infinite number of potential host to microbe, and microbe to microbe interactions. A stable network of microbial interactions, established through processes such as niche competition, nutrient cycling, immune evasion, and biofilm formation help maintain homeostasis during health (Walter and Ley, 2011; Grice et al., 2009). Taxa that hold together the bacterial community by interacting with different parts of the network can be considered “gatekeepers” (sensu Freeman, 1980; Widder et al., 2014). During health, a consortium of microbes may provide a protective effect, and a breakdown in these networks due to the removal of gatekeepers may begin a self-perpetuating cycle of dysbiosis and inflammation (Vujkovic-Cvijin et al., 2013; Widder et al., 2014; Byrd and Segre, 2016).

The genus-level phylotype Corynebacterium was again associated with CRS bacterial communities, and Burkholderia was associated with healthy subjects.

In contrast to the variety of Actinobacteria and Betaproteobacteria phylotypes differentiating the healthy sinonasal bacterial communities, only one phylotype (Corynebacterium) was consistently associated with those individuals that were chronically inflamed. The significance of specific members of the genus Corynebacterium in CRS microbial communities is supported by findings in two previous studies (Abreu et al., 2012; Aurora et al., 2013). The relative abundance of C. tuberculostearicum and C. accolens was significantly higher in subjects with CRS in two recent 16S rRNA studies (Abreu et al., 2012 and Aurora et al., 2013, respectively).