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 Just wanted to say that I added an October 2016 update to the post The One Probiotic That Treats Sinusitis, which was originally posted in January 2015.  The update incorporates the latest information about treatments and products with Lactobacillus sakei  (kimchi brands, the sausage starter culture Bactoferm F-RM-52, and Lactopy Prime). According to research by Abreu et al (2012)Lactobacillus sakei is a bacteria or probiotic (beneficial bacteria) that chronic sinusitis sufferers lack and which treats chronic sinusitis. Chronic sinusitis sufferers also don't have the bacteria diversity in the sinuses that healthy people have.

Many thanks to those who have written to me about their experiences with L. sakei products and sinusitis treatment.  Please keep the updates, results, and progress reports coming. If you have had success with other kimchi brands, please let me know so that I can add it to the list. And I also want to hear if other probiotics work or don't work, or if you have found other sources of Lactobacillus sakei or new ways to use L. sakei. It all adds to the knowledge base which I will continue to update.  You can Comment after posts, the Sinus Treatment Summary page, on the CONTACT page, or write me privately (see CONTACT page).

It is now over 2 1/2 years since my family (4 people) successfully treated ourselves with Lactobacillu sakei for chronic sinusitis and acute sinusitis. We feel great! With each passing year we can tell that our sinus microbial community is bettter, and levels of inflammation are down. As a consequence, we are getting fewer colds or viruses than ever. And best of all - no antibiotics taken in over 2 1/2 years! Yes, Lactobacillus sakei absolutely works as a treatment for sinusitis.

Read the updated post: The One Probiotic That Treats Sinusitis (with October 2016 update)

It is now 104 weeks being free of chronic sinusitis and off all antibiotics! Two full years since I started my easy do-it-yourself sinusitis treatment! And my sinuses feel great! I would never ever have thought such a thing was possible several years ago. Thanks to the probiotic (beneficial bacteria) Lactobacillus sakei I got my life back. Yes, I know I'm gushing...

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 that live in healthy sinuses (the sinus microbiome), but L. sakei seems to be a key one for sinus health. As you may have guessed, the name of this web-site Lacto Bacto is in homage to the bacteria Lactobacillus sakei.

Thank you all who have written to me  - whether publicly or privately. Please keep writing because it is adding to the sinusitis treatment knowledge base. I will keep posting updates.

I will be trying to find more sources of L. sakei this year and also look for other microbes that help treat sinusitis. And the foods or products that they're in. As of today, my family (all 4 members) have successfully used live kimchi and even sausage starter culture (both containing L. sakei) to treat both acute and chronic sinusitis these past 2 years. Based on our experiences and those of others, finding live L. sakei in kimchi (not all brands have L. sakei in it) and other products can be tricky, but when the product has live L. sakei in it - the results are absolutely great! We have also learned that L.sakei products should be used sparingly - only as needed.

(NOTE: I posted a number of posts with sinusitis treatment information, with the last updated one being January 12, 2015 -  The One Probiotic That Treats Sinusitis. This post has the updated list of brands and sources of L. sakei. I wrote the story of our Sinusitis Treatment back in December 2013, and there is also a  Sinusitis Treatment Summary page. One can also click on SINUSITIS under CATEGORIES to see more posts, such as "Which Kimchi is Best for Sinusitis Treatment: Vegan or Seafood?")

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 (UPDATED AUGUST 2017) Probiotics and sinusitis treatment go hand in hand. In the last few years researchers found that one probiotic (beneficial bacteria) that chronic sinusitis sufferers lack and that treats and cures sinusitis is Lactobacillus sakei. The researchers Abreu et al found in their 2012 study that not only do 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. Of course researchers are working on a beneficial bacteria nasal spray to treat or prevent sinusitis, but that will take a while.

Luckily Lactobacillus sakei is found in some foods (such as some brands of live fermented kimchi), and in "starter cultures" (for sausages) such as Bactoferm F-RM-52 and B-2. One reason it is used in sausage starter cultures is because it dominates over and inhibits growth of pathogenic bacteria, including Staphylococcus aureus and Listeria. [Note that treating sinusitis with beneficial bacteria (rather than just antibiotics, corticosteroid nasal sprays, and surgery) is a major shift or paradigm change in sinusitis medical treatment, but it is the future in sinusitis treatment.]

More than 4 1/2 years ago I started using a very easy kimchi sinusitis treatment (basically dabbing and smearing kimchi at certain stages of fermentation into my nostrils like a very messy eater) and found that it cured my chronic sinusitis of many years within several weeks. Obviously it contained L. sakei. Then the rest of my family also tried the kimchi treatment and were also cured of chronic sinusitis! It felt miraculous, especially because it was so easy to do. (See SINUSITIS TREATMENT page for our background story, and see SINUSITIS TREATMENT SUMMARY page for different treatment methods.)

After 4 1/2 years we still feel great! Generally all 4 of us only need to treat again with a product containing Lactobacillus sakei after a virus which goes into sinusitis, or if for some other reason we feel like we're sliding into sinusitis. The last 2 years we've needed to do this far less than the first year. Because we no longer have chronic sinusitis, we have NOT taken antibiotics or any other bacteria killing spray or product (such as xylitol) for the last three and a half years. We do not use cortisone or antihistamine nasal sprays either.

A number of you have contacted me to report your own progress with various sinusitis treatments. Thank you! The following are the results from those commenting on this web-site or to me privately. People used terms such as "miraculous", "transformative", and "fabulous" when they had positive results with a product containing L. sakei. I am also starting to hear from you about other some other probiotic (beneficial) bacteria species that may treat sinusitis. When a treatment works, then all sinusitis symptoms go away, including post nasal drip, sinus headaches, "clogged ears", bad breath, and sinusitis-related coughs. Even tonsil stones! (Please note that trying such products to treat sinusitis is self-experimentation - effects can be positive or negative. One should always be very cautious.)

OVERALL RESULTS: The majority of people writing to me with results reported positive results (chronic sinusitis greatly improved or totally gone) from some form of L. sakei treatment. Most have been from the USA or Canada, but successes have also been reported to me from Europe, Australia, New Zealand, and Africa. But since it's from self-experimentation and not a clinical trial, then I don't know the actual percentage of positive results. (Please write!) Some of the people reporting success have had multiple operations, some currently have deviated septums, some with nasal polyps, and all have had long-standing chronic sinusitis, some for decades. Those same chronic sinusitis sufferers also reported that the same treatments also worked after acute sinusitis (e.g., after a cold). It seems that after colds, etc. they (including myself) develop acute sinusitis again and need re-treatment (apparently the L. sakei doesn't stay or colonize in the sinuses from earlier treatments) . But a minority of people reported that nothing has helped and there could be a variety of reasons for this (see below).

KIMCHI - A number of people reported that kimchi helped them (without naming brands), while others named brands that helped them. And one person reported a homemade kimchi worked great (he was finally symptom free after 8 years). A few have even mentioned that kimchi has helped sinusitis with fungal problems. Kimchi brands that people reported helping their chronic sinusitis: Sinto Gourmet brand kimchi, Mama-O's Premium Kimchi, the white Napa kimchi (as well as the cabbage kimchi) made by Choi's Kimchi Company (in Portland, Oregon), Farmhouse Culture Kimchi (in California), Ozuke Kimchi (in Colorado), Sunja's Kimchi  (medium spicy cucumber kimchi and mild white kimchi), in the United Kingdom the brand Mr Kimchi, and in Australia Kehoe's Kitchen white kimchi. We still use Sunja's Kimchi (the first year we used Sunja's medium spicy cabbage, but when that stopped working we switched to the medium spicy cucumber kimchi, and now also the mild white kimchi). I'm sure some other brands also contain L. sakei.

(Please note that not all kimchi brands or types of kimchi within brands contain L. sakei - finding one that has it is due to self-experimentation. We found that kimchi may contain L. sakei from about day 14 (or earlier) to about 2 to 2 1/2 months (from the day it's made). When the kimchi contained L. sakei we felt the same or started feeling better within one or 2 days. If we felt more mucusy or phlegmy over the next 2 days, or the acute sinusitis kept getting worse, than it did not contain L. sakei.)

Some people wrote in that kimchi did not help them, including various types of Sunja's kimchi. One person said that Hawthorne Valley Kim Chee had no effect, and that it was more like a sauerkraut product. (Sauerkraut had not worked for anyone until recently one person said that they improved with a homemade sauerkraut, and several people with a sauerkraut made with garlic. Some researchers feel that it's the garlic in kimchi that encourages L. sakei growth, and sauerkraut typically doesn't contain garlic.)

BACTOFERM F-RM-52 - A number of persons reported that a mixture of bottled water and the sausage starter culture Bactoferm F-RM-52  (Lactobacillus sakei and Staphylococcus carnosus), has successfully worked for them. This product is produced by the Danish manufacturer Chr. Hansen and sold by various sausage-making suppliers. It is reliable and effective, like an army that marches in to attack the sinusitis causing bacteria. (See SINUSITIS TREATMENT SUMMARY page for details). Most use it by dabbing/smearing or spooning the mixture into the nostrils, while others report using it in a neti pot (e.g., first Comment on the CONTACT page), and one person even a nasal aspirator (bulb syringe) for a large one time dose. Sometimes a side effect on the day we used the product was a dry mouth and throat (and they can be very dry when we overused it - so it's important to use only a little in a treatment). The person who used the nasal aspirator reported a temporary decrease in her sense of smell.

Bactoferm F-RM-52 contains a second bacteria besides L. sakei. Very little is known about Staphylococcus carnosus - but it is considered non-pathogenic, and also no one has reported negative effects from it. Such are the perils of self-experimentation - effects are unkown.

However, several people (one in Europe) reported that Bactoferm F-RM-52 did not work for them, but then the issue is - did the L. sakei die during shipping or did it not work for some other reason? One possibility is that  L. sakei does not work against all types of pathogenic bacteria. Even my family has had problems with Bactoferm F-RM-52  - one time it died during shipping (that batch had zero effect when we used it).

---[Please note: One sausage culture seller (sausagemaker) has been so upset (afraid of lawsuits?) that the Bactoferm F-RM-52 they sell has been used "off label" to treat sinusitis that they now have applied their own warnings to the back of the product package. The warnings state that the product also contains manganese sulfate monohydrate, which is used in tiny amounts as a food additive (a food grade nutritional supplement). However, the warnings listed are from the Safety Data Sheet for people handling large batches of manganese sulfate monohydrate (for "science education applications" or "laboratory and manufacturing use"). It's as if they are warning that the package contains nothing but the powdered form of manganese sulfate monohydrate, in case people might stick their heads in the package and inhale for prolonged periods.]

B-2  - Several persons from Australia and New Zealand have reported good results with B-2. The manufacturers of Bactoferm F-RM-52 also make a Lactobacillus sakei only product called B-2. It is part of their SafePro product line of bio-protective cultures for meat. It is used exactly like the Bactoferm F-RM-52, but a person who has used both products liked the effects of B-2 more than Bactoferm F-RM-52 ("less irritating and more effective").  I have not seen this culture available anywhere in the U.S., but I know B-2 is available in New Zealand and can be (and is) shipped  to Australia.

BACTOFERM  SM 160 - One person (outside of North America) tried Bactoferm SM 160, which contains Lactobacillus sakei, Staphylococcus carnosus and Debaryomyces hansenii, and is finding very good results in treating chronic sinusitis that he had for years. The third microbe Debaryomyces hansenii is considered "non-pathogenic", and is common in food products (cheeses, processed meat, and early stages of soy fermentation). One study said D. hansenii secretes toxins capable of killing other yeasts, and it is used on an industrial scale to produce vitamin B2. However, it is a yeast species (a fungi) so it is unknown if it can cause problems (and so he's being cautious in its use, and so far all is good).

PRIMAL SK NATUR 50 - The European company VAN HEES makes a starter culture PRIMAL SK natur 50 with the same ingredients as Bactoferm F-RM-52. The ingredients are: Lactobacillus sakei and Staphylococcus carnosus, with a carrier base of dextrose (to feed the bacteria when used as a starter culture). They ship to various European countries.

BITEC STARTER LS 25 (also called BITEC LS-25) - The product BITEC LS-25 (which contains the same 2 bacteria as Bactoferm F-RM-52) is available in Europe, but the ingredients listed are Staphylococcus carnosus first and Lactobacillus sakei second. This product is also sold as a sausage starter and is made by Frutarum (a global "flavor, fragrances, and fine ingredients" company) that is based in Israel and Europe.

SOME L.SAKEI ISSUES: I still think of L. sakei as fairly fragile - it is killed off by antibiotics, by oxygen within a week of opening a kimchi jar, and even the culture Bactoferm F-RM-52 package says that it dies off within 2 weeks at room temperature (therefore store in freezer). Please note that the L. sakei in the product can also die off during shipping if it takes too long or some other reason. Thus we order 2 day shipping (if possible) and hope for the best.

WHY DOESN'T L. SAKEI WORK FOR SOME PEOPLE? Some other possibilities to explain why some people trying L. sakei products has not resulted in their sinusitis improving is that perhaps some other "keystone species" (a very important microbial species for a normal healthy community) besides L. sakei is  missing in their sinus microbiomes. Or perhaps they have microbes or biofilms that the Lactobacillus bacteria cannot overcome, even though it is viewed that some Lactobacillus species are anti-biofilm and anti-pathogenic. It is unclear whether the results are different if there are also nasal polyps. [Researchers now suspect that those with nasal polyps also have a problem with "primary inflammation".] We (modern medicine) know so little about the normal healthy sinus microbiome that there are many unanswered questions. (NOTE: click on the Category SINUSITIS for more posts on recent sinusitis research.)

PROBLEM WITH A PRODUCT SUDDENLY NOT WORKING, OR OVERUSE - Several people reported that a kimchi brand or L. sakei product that originally worked for them suddenly stopped working or not as well, but usually it had been the only product used for a long time. We think this might be an issue of "too much of certain microbes" - and we (family members) have found that switching to another product (e.g., from one brand or type of kimchi to another), or from a L. sakei product to kimchi, or swishing multi-strain probiotics (the powder) in the mouth has corrected the situation for us. (Finding what works is self-experimentation, and varies from time to time). And months later, we can use the original product once again.

BOTTOM LINE: When feeling good or healthy, stop using the L. sakei product. Use L.sakei products sparingly - only as needed (e.g. after developing sinusitis). L. sakei seems to be necessary for sinusitis treatment for most people, but there are also other important microbes in the sinuses - a whole community.

OTHER PROMISING PROBIOTICS - Seven people have  reported that multi-strain probiotics  (but they did not contain L. sakei) treated their sinusitis. One woman tried Pure Encapsulations Probiotic 50B in her nose (I assume similarly to how we use Bactoferm F-RM-52) and reported major improvement. This product (which must be refrigerated) contains the following bacteria:  Lactobacillus acidophilus, L. rhamnosus, L. plantarum, Bifidobacterium longum and B. lactis. Another person successfully treated his sinusitis by mixing a saline solution with a probiotic containing: Lactobacillus acidophilus, L. plantarum, L. rhamnosus, Bifidobacterium lactisL. casei, B. bifidum, B.breve, and Streptococcus thermophilus. Note that the first 4 bacteria listed here are the same as in the first person's probiotic. (Scroll down to the Comment written by Martin for more details).

Some researchers are focusing on Lactobacillus sakei, L. rhamnosus, L. plantarumL. casei, and L. Johnsonii in the treatment of sinusitis and sinus health (see below Promising Probiotic Nasal Sprays and also the June 29, 2016 post).

OTHER PROBIOTICS MAY OR MAY NOT HAVE BENEFICIAL EFFECTS - On the other hand, a few people (including my family members) reported trying various multi-strain probiotics containing various Lactobacillus and Bifidobacterium species in the nostrils or swishing the powder in the mouth, but it did not treat the sinusitis, even though it resulted in some improvement usually (but not always). Since sinusitis sufferers don't have the bacteria diversity of healthy people, and the sinus microbial community is different in each person, then adding what are viewed as beneficial bacteria to the sinus microbial community might help some people.

The possibility remains that perhaps one or more bacteria species, or a combination of species, has effects similar to L. sakei. But which ones or which combinations of bacteria? (Just remember, trying L. sakei products or multi-strain probiotics is self-experimentation, and results are unknown and can vary - can be positive, negative, or no effect.)

STILL UNKNOWN: People have written in about 3 products that contain L. sakei, but no one has reported results. (1) From a person in Australia: Danisco's CHOOZIT® FNR 1 - a cheese starter culture that contains L. sakei and Staphylococcus vitulinus. The bacteria S. vitulinus is considered benign, but I could find almost nothing about it. So self-experimentation results are totally unknown - could be negative or positive. (2) Multi-strain Probiotic by Innovix Labs - tablets containing 26 probiotics, including L. sakei. However, I have 2 concerns with this product: A) This product does not require refrigeration, but all other L. sakei products require refrigeration (even the freezer), because at room temperature L. sakei dies within a few weeks. B) L. sakei is considered anaerobic  - doesn't live when exposed to oxygen. So...while the L. sakei may be alive when the product is produced, is it alive weeks or months later at room temperature?  (3) Pro-Kids ENT by Hyperbiotics are chewable tablets containing 5 strains of bacteria, including L. sakei and S. salivarius K12. I have the same concerns with this product as with product #2. In addition, the S. salivarius K12 has caused problems for some people (scroll down to "Problems With BLIS K12?") If purchasing product #2 or #3 I would consider refrigerating them to slow down the decline of bacteria numbers (which always happens over time), and add a desiccant to deal with the moisture from refrigeration (if it's not already included).

PROMISING PROBIOTIC NASAL SPRAYS - The original sinusitis researchers (Susan Lynch, A. Goldberg) are still working on a probiotic nasal spray containing L. sakei. Another research group (at the Univ. of Antwerp in Belgium) is developing a nasal spray with Lactobacillus rhamnosus, Lactobacillus plantarum, Lactobacillus caseiand other Lactobacillus species, including L. sakei. They are calling the nasal spray "Oronasopharyngeal probiotics", and say that these Lactobacillus  species (especially L. rhamnosus) are "anti-pathogenic and antibiofilm agents". 

NO EVIDENCE FOR JUST SWALLOWING PROBIOTIC SUPPLEMENTS: Evidence (my family, people writing in, research) so far has been that only directly dabbing/smearing/spraying probiotics in the nose, or even swishing a paste of probiotics in the mouth may help treat sinusitis. I have not found any studies finding that ingesting/swallowing a probiotic pill has helped sinusitis (including a 2009 study looking at swallowing L. rhamnosus tablets 2 times daily for 4 weeks).

PROBIOTICS TO AVOID - The product NatureWise Maximum Care Time-Release Probiotics: 30 Strains, 30 Billion CFU contains a number of probiotic bacteria, including L. sakei. Lactobacillus and Bifidobacterium bacteria are generally viewed as beneficial. However, it also contains E. faecium (Enterococcus faecium) which is considered very controversial. This is because strains of this specific bacteria show multi-drug resistance (including to antibiotics). (See my Sept 2, 2016 Comment after the August 30, 2016 post for more information.)

PROMISING PHAGE THERAPY - Some researchers in the USA and Australia are currently testing phage therapy to see if it could be used as a treatment for various conditions, including chronic sinusitis. A bacteriophage is a virus that infects bacteria, and the name literally means "bacteria eater". Phage therapy is the therapeutic use of bacteriophages to treat bacterial infections. See the June 3, 2016 post Phage Therapy May Help Sinusitis Sufferers for more information. The authors of one study I posted there said that they had found evidence for people having "virus-like particles" in their sinuses, which they thought were bacteriophages.

PROBLEMS WITH BLIS K12 ? - On a side note, two of us, plus several people contacting me, tried the probiotic BLIS K12 bacteria (also known as Streptococcus salivarius BLIS K12) for several weeks because scientific research had found it to be an immune booster, that it is good for oral health, and it lowers the incidence of upper respiratory infections. However, from the first tablet (ate it by slowly dissolving it in the  mouth) there were problems - feeling phlegmy and yellow mucus. After several weeks, we stopped the experiment and had to do kimchi treatments to recover. Two persons reported similar negative effects with PRO-dental tablets, which also contains BLIS K12. The message here is clear: these specific bacteria did not react well with our sinus and oral bacterial communities. Remember, whenever one introduces new bacteria into the human organism, there can be positive or negative effects.

PLEASE WRITE!  I would really like to hear how you are treating and curing your sinusitis, especially chronic sinusitis. Or even what hasn't worked. It all adds to the knowledge base. And let me also know if you've had additional problems or complications such as sinus operations, nasal polyps, a fungal problem, diagnosed with antibiotic resistant bacteria (for example: Pseudomonas aeruginosa), etc. Has L. sakei or another probiotic helped? Write to me privately, or can comment after any post.  (Note that most comments are after this post, the SINUSITIS TREATMENT SUMMARY page, the CONTACT page, and  other sinusitis posts - see category SINUSITIS).

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[PLEASE NOTE THAT AN UPDATED VERSION OF THIS POST WITH NEW INFORMATION, INCLUDING NEW PRODUCTS, WAS PUBLISHED IN OCTOBER 2016: The One Probiotic That Treats SinusitisComments can be posted there.]

We now know that antibiotics, especially repeated courses of antibiotics, kills off bacteria and alters the microbial community in the sinuses (sinus biome). Research by Abreu et al (in 2012) showed that it is Lactobacillus sakei that is missing in chronic sinusitis sufferers, and that Lactobacillus sakei successfully treats sinusitis. From this research it is clear that Lactobacillus sakei is a  beneficial bacteria that can be used as a probiotic to cure sinustis.

It turns out that many brands of live fermented kimchi contain Lactobacillus sakei, and this is what my family used to treat and cure ourselves of chronic sinusitis (and acute sinusitis). So yes, kimchi can be probiotics for sinusitis. It is now over 85 weeks since I've been off all antibiotics and feeling great!

Until now I avoided naming the kimchi brand we used on this site because I believe that many brands of fermented kimchi (with cabbage) contain Lactobacillus sakei, and should be effective in curing sinusitis (this is by dabbing or smearing it in the nostrils - see Sinusitis Treatment Summary link for the METHOD and details).

WHAT BRANDS OR PRODUCTS WITH Lactobacillus sakei WORK?

The brand I use is Sunja's Kimchi (from Vermont). We originally were successful with the Medium Spicy Cabbage Kimchi and when that stopped being fully effective last winter (from overuse? recipe change?), we switched to Sunja's Medium Spicy Cucumber Kimchi (fermented at least 14 days and the jar opened less than 1 week).

Recently I heard from a woman in Nevada who wrote me stating that smearing/dabbing Sinto Gourmet Mild White Napa Cabbage Kimchi into her nostrils was successfully treating her chronic sinusitis (using the method described in the Sinusitis Treatment page)

One person wrote that he successfully cured chronic and acute sinusitis with a fermented sausage starter from Chr. Hansen containing L. sakei and another bacteria. He used it after mixing very small amounts in his  Neti pot - initially used it 1 x per day until cured, and then sparingly only as needed (after a cold) or as a maintenance booster once every 3 or 4 months (see his comment in the Contact page for more details). (UPDATE: one name for this product is Bactoferm F-RM-52, which contains Lactobacillus sakei and Staphylococcus carnosus  . See 1/12/15 post for more, including my experience with it.)

The Korean product Lactopy shows definite promise because they advertise it as L. sakei from kimchi. However, everything on the package is written in Korean, it needs to be refrigerated, and it is shipped from Korea.

Eating kimchi does not seem to treat sinusitis, even though it may be good for the gut. Only smearing or dabbing it in the nostrils works.

Several people have reported that using sauerkraut has not helped their sinusitis, and scientific studies report that sauerkraut contains minimal L.sakei, if at all.

Others have also mentioned thinking about using lactic acid starter cultures containing L. sakei , whether using it alone or making kimchi with it, but I don't know how it went.

Finally, I would like feedback from you: 1) What brands of kimchi have worked for you in treating or curing sinusitis?     2) What other products containing Lactobacillus sakei have worked successfully for you? And how did you use it?   3) What other bacteria have worked for you in curing sinusitis?

Please let me know by commenting in the comments section or writing me an email. This way I can update this list.  The goal is to find ways to improve the beneficial bacteria in the sinuses and so treat, cure, and eventually prevent sinusitis.   Thanks!

[PLEASE NOTE THAT AN UPDATED VERSION OF THIS POST WITH NEW INFORMATION WAS PUBLISHED IN OCTOBER 2016: The One Probiotic That Treats SinusitisComments can be posted there.]

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 non-typeable Haemophilus influenzae are a common cause of infection in the upper respiratory tract. By attaching to surfaces in the body the bacteria form a biofilm. Wu et al. have reported that 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

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.... 

Yesterday I read and reread a very interesting journal review paper from Sept. 2013 that discussed recent studies about probiotics and treatment of respiratory ailments, including sinusitis. Two of the authors are those from the Abreu et al sinusitis study from 2012 (that I've frequently mentioned and that guided our own Sinusitis Treatment) that found that Lactobacillus sakei protects against sinusitis and treats sinusitis. Some of the things this paper discussed are: microbial communities in the airways and sinuses vary between healthy and non-healthy individuals (and each area or niche seems to have distinct communities), that lactic acid bacteria (including Lactobacillus sakei) are generally considered the "good guys" in our sinus microbiomes (the communities of microbes living in our sinuses), and that treatments of the future could consist of "direct localized administration of microbial species" (for example, getting the bacteria directly into the sinuses through the nasal passages with a nasal spray, or dabbing fermented kimchi juice like I did). They also mentioned that maybe one could also get probiotics to the GI tract (e.g., by eating probiotics) and maybe this would have some benefits. So far it seems that administering something containing L.sakei directly (by nasal spray or dabbing kimchi juice - as I did) seems to work best for treating sinusistis.

They also discussed that lactic acid bacteria are found in healthy mucosal surfaces in the respiratory, GI, and vaginal tract. They then proposed that lactic acid bacteria (including L.sakei) act as pioneer, or keystone species, and that they act to shape mucosal ecosystems (the microbiomes), and permit other species to live there that share similar attributes, and so promote "mucosal homeostasis". It appears that having a healthy sinus microbiome protects against pathogenic species.

So yeah - the bottom line is that microbial supplementation of beneficial bacteria seems very promising in the treatment of respiratory ailments. And for long-term successful sinusitis treatment, one would need to improve the entire sinus microbial community (with a "mixed species supplement"), not just one bacteria species. (By the way, maybe that is also why using kimchi in our successful Sinusitis Treatment works - it is an entire microbial community with several lactic acid species, including the all important Lactobacillus sakei. (NOTE: See Sinusitis Treatment Summary page and The One Probiotic That Treats Sinusitis for some easy methods  using various probiotics to treat chronic sinusitis. These articles get updated frequently.) From Trends in Microbiology:

Probiotic strategies for treatment of respiratory diseases.

More recently, Abreu et al. profiled the sinus microbiome of CRS (chronic rhinosinusitis) patients and healthy controls at high resolution [2]. Microbial burden was not significantly different between healthy subject and CRS patient sinuses. Moreover, known bacterial pathogens such as H. influenza, P. aeruginosa, and S. aureus were detected in both healthy and CRS sinuses; however, the sinus microbiome of CRS patients exhibited characteristics of community collapse, in other words many microbial species associated with healthy individuals, in particular lactic acid bacteria, were significantly reduced in relative abundance in CRS patients. In this state of microbiome depletion, the species C. tuberculostearicum was significantly enriched. This indicates that composition of the microbiome is associated with disease status and appears to influence the activity of pathogens within these assemblages.

Although sinusitis patients in the Abreu study exhibited hallmark characteristics of community collapse, the comparator group – healthy individuals – represented an opportunity to mine microbiome data and identify those bacterial species specific to the sinus niche that putatively protect this site. The authors demonstrated that a relatively diverse group of phylogenetically distinct lactic acid bacteria were enriched in the healthy sinus microbiota [2]. As proof of principle that the sinonasal microbiome itself or indeed specific members of these consortia protect the mucosal surface from pathogenic effects, a series of murine studies were undertaken. These demonstrated that a replete, unperturbed sinus microbiome prevented C. tuberculostearicum pathogenesis. Moreover, even in the context of an antimicrobial-depleted microbiome, Lactobacillus sakei when co-instilled with C. tuberculostearicum into the nares of mice afforded complete mucosal protection against the pathogenic species. Although this is encouraging, it is unlikely that a single species can confer long-term protection in a system that is inherently multi-species and constantly exposed to the environment. Indeed, previous studies and ecological theory supports the hypothesis that multi-species consortia represent more robust assemblages, and tend to afford improved efficacy with respect to disease or infection outcomes [44,45]. This study therefore provides a basis for the identification of what may be termed a minimal microbial population (MMP) composed of multiple phylogenetically distinct lactic acid bacteria, including L. sakei. Such a mixed species assemblage would form the foundation of a rationally designed, sinus-specific bacterial supplement to combat established chronic diseases or, indeed, be used prophylactically to protect mucosal surfaces against acute infection.

Therefore, although site-specific diseases such as chronic sinusitis may well be confined to the sinus niche and be resolved simply by localized microbe-restoration approaches, it is also entirely plausible that an adjuvant oral microbe-supplementation strategy and dietary intervention (to sustain colonization by the introduced species) may increase efficacy and ultimately improve long-term patient outcomes. This two-pronged approach may be particularly efficacious for patients who have lost protective GI microbial species due to
administration of multiple courses of oral antimicrobials to manage their sinus disease.

Although it is impossible to define the precise strains or species that will be used in future microbial supplementation strategies to treat chronic inflammatory diseases, there is a convergence of evidence indicating that healthy mucosal surfaces in the respiratory, GI, and vaginal tract are colonized by lactic acid bacteria. We would venture that members of this group act as pioneer, keystone species that, through their multitude of functions (including bacteriocin production, competitive colonization, lactate and fatty acid production), can shape mucosal ecosystems, thereby permitting co-colonization by phylogenetically distinct
species that share functionally similar attributes. Together, these subcommunities promote mucosal homeostasis and represent the most promising species for future microbe-supplementation strategies.

It is now more than 69 weeks since I first successfully started using kimchi to treat the chronic sinusitis that had plagued me (and my family) for so many years. I originally reported on the Sinusitis Treatment on Dec. 6, 2013 (the method is described there) and followed up on Feb. 21, 2014.

Based on the sinus microbiome research of N. Abreu et al (from Sept. 2012 in Sci.Transl.Med.) that discussed Lactobacillus sakei as a sinusitis treatment, I had looked for a natural source of L.sakei and found it in kimchi. Since dabbing the kimchi juice in our nostrils as needed, all 4 of us are still free of chronic sinusitis and off all antibiotics at close to a year and a half (I'm optimistic). So how is year two shaping up?

Well, it is different and even better than year one. Much of the first year seemed to be about needing to build up our beneficial bacteria sinus community (sinus microbiome) through kimchi treatments, eating fermented foods (such as kimchi, kefir, yogurt), whole grains, vegetables, and fruits. And of course not having to take antibiotics helped our sinus microbial community.

But now in year two we notice that we absolutely don't need or want frequent kimchi treatments - even when sick. Daily kimchi treatments, even during acute sinusitis (after a cold), actually seems to be too much and makes us feel worse (for ex., the throat becomes so dry, almost like a sore throat). But one treatment every 2 or 3 days while sick is good. In fact, this year we have done so few treatments, that even when ill, each time the sick person stopped doing kimchi treatments before he/she was fully recovered, and any sinusitis symptoms kept improving on their own until full recovery! Amazing!

To us, this is a sign that all of us have much improved sinus microbiomes from a year ago. And interestingly, we are getting fewer colds/viruses than ever.  Our guiding principle this year is: "Less is more." In other words, at this point only do a kimchi sinus treatment when absolutely needed, and then only do it sparingly. Looking back, we think we should have adopted the "less is more" last year after the first 6 months of kimchi treatments.

The other thing we've done is cut back on daily saline nasal irrigation, especially when ill and doing kimchi treatments. We've started thinking that the saline irrigation also flushes out beneficial bacteria.

The conclusion is: YES, a person's microbiome can improve, even after years or decades of chronic sinusitis. It is truly amazing and wonderful to not struggle with it, and to feel normal.

(UPDATE: See Sinusitis Treatment Summary page and The One Probiotic That Treats Sinusitis for more information, more probiotics one can use, and more L. sakei treatment information.)

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SUMMARY OF TREATMENT METHOD

The following is a quick summary of the method we use (from the Dec.6, 2013 post - Sinus Treatment page).   Please read the original post for complete descriptions and explanations. We use live (fermented and not pasteurized) vegan (no seafood added) kimchi. Choosing vegan (no seafood added) kimchi is a personal preference. Lactobacillus sakei is found in meat, seafood, and some vegetables.

Treatment Method: 1) Wash hands, and then use a clean teaspoon to put a little juice from the kimchi jar into a small clean bowl. 2) Dip finger in the kimchi juice and dab it or smear it along the insides of one nostril (about 1/2" into the nostril). 3) Dip finger in kimchi juice again and repeat in other nostril. 4) Do this several times. If I needed to blow my nose at this point I would, and afterwards I would put more kimchi juice up each nostril (again repeating the procedure) and then not blow my nose for at least an hour (or more). 5) Afterwards, any unused kimchi in the little bowl was thrown out and not replaced in the main kimchi jar. (Note: Put the main kimchi jar back in the refrigerator. Also, once opened, take kimchi juice from it for no more than 6 days.)

My rationale was that I was inhaling the bacteria this way and that it would travel up the nasal passages on their own to my sinuses. I did this regimen once or twice a day initially until I started feeling better, then started doing it less frequently, and eventually only as needed.

I spent time this past week searching the medical literature (US National Library of Medicine - Medline/PubMed) for the latest in sinusitis research. I wish I could tell you that amazing research has been happening recently, especially with the sinus microbiome (which could mean treating sinusitis with microbes), but I was disappointed. Really disappointed.

I did four searches: one for "sinusitis" (looked at 600+ studies dating back to summer 2013), then "chronic sinusitis" (going back to fall 2012), then "sinusitis, probiotics", and finally "sinusitis, microbiome". The "sinusitis, probiotics" search turned up 10 studies dating back to 2002. The "sinusitis, microbiome" search turned up a grand total of 13 studies, with the oldest dating back to 2004. Of course the sinus microbiome research by Abreu et al from September 2012  discussing Lactobacillus sakei and which I based my personal (and successful) kimchi sinusitis treatment was on the list (see my Dec. 5 post for a discussion of their research). But none of the other studies looked at Lactobacillus sakei (which is in kimchi).

Some of the findings among the many chronic sinusitis studies: microbial diversity is lower in antibiotic treated chronic sinusitis sufferers (than in healthy controls) and the microbial communities more uneven (meaning some microbes dominated over others), and greater Staphylococcus aureus populations among those with chronic sinusitis. After antibiotic treatment patients typically became colonized by microbes that are less susceptible to the prescribed antibiotics. One study found that Staphylococcus epidermidis (SE) may have some effectiveness against Staphylococcus aureus (SA) in the sinusitis microbiome in mice. Lactobacillus rhamnosus was not found to be effective against sinusitis. A number of studies reported biofilms in the sinuses which are highly resistant to medicines. Some studies found that smoking or exposure to second-hand smoke is linked to chronic sinusitis. (June 2016 UPDATE: I should have said that Lactobacillus rhamnosus (R0011 strain) was not effective against sinusitis when taken orally (a tablet) twice a day for 4 weeks in the study. There have been no further studies since then looking at L. rhamnosus for sinusitis treatment. It is unknown whether spraying or smearing/dabbing L. rhamnosus directly into the nostrils would have a positive effect)

Everyone agreed that state of the art genetic analyses found many more microbial species than older methods (the least effective was the traditional culture method). Several studies suggested that perhaps chronic sinusitis is due to immunological defects and one suggested that it was due to "immune hyperresponsiveness" to organisms in the sinuses. Surprisingly, some studies reported that there are more microbes or microbial species in chronic sinusitis patients than in control patients and that Staphylococcus aureus may be dominant (NOTE: These results may be due to not having been done with state of the art genetic analyses which would have picked up more microbial diversity. Another issue is where in the respiratory tract the samples were taken from, because it seems that the different areas have different microbial communities).

There was frequent mention that chronic sinusitis affects millions of people each year in the US, that little is known about its exact cause, and that there is controversy over appropriate treatment. Originally doctors thought that healthy sinuses were sterile, and it has taken a while to realize that is untrue. It is clear that researchers are only now trying to discover what microbial communities live in healthy individuals compared to those with chronic sinusitis.

But it appeared to me that the majority of the studies from the last 2 years indicated that treatment of chronic sinusitis is still: first try antibiotics, then antibiotics plus inhaled corticosteroids and perhaps nasal saline irrigation, then followed by endoscopic sinus surgery (or sometimes balloon dilation), then perhaps steroid drip implants (steroid-eluting sinus implants), and then there may be revision surgeries.

So I'm sticking with my easy-to-do, inexpensive, and fantastically successful kimchi (Lactobacillus sakei) sinusitis treatment. Of course! (see my Dec. 6, 2013 and Feb. 21, 2014 posts or click on the Sinusitis Treatment link for further information).

It is now over a year since I successfully started treating chronic sinusitis with kimchi, and almost a year for the other 3 family members. The kimchi treatment continues to be amazingly effective. We all continue to feel great and we have not taken any antibiotics in all this time. (See my December 6, 2013 post or the Sinusitis Treatment Summary page for details on how we do various easy Sinusitis Treatments.)

No more symptoms of acute or chronic sinusitis! We have made some recent changes though. We decided to stop doing frequent kimchi "booster" or "maintenance" treatments. Instead, we decided to only use kimchi when there is a definite need, for example after a cold or other virus when we have gone into acute sinusitis, or when our sinuses don't feel right for several days. Since adopting this policy we haven't done a kimchi treatment in over a month and continue to feel great. (Our new motto: If it ain't broke, don't fix it.)

We came to this decision because in December two of us noticed we were only getting a partial response to the brand of kimchi we had been using for almost a year, but when we switched to a new kind of kimchi (but again vegan) we once again felt fantastic. Why did this occur? I have two possible hypotheses: 1) Since kimchi contains so many types of bacteria, perhaps frequent "booster applications" also increased other bacteria in the sinuses that competed with the Lactobacillus sakei, and switching to a new kind of kimchi corrected this problem. OR 2) Perhaps the kimchi company changed their kimchi recipe or ingredients, and thus the Lactobacillus sakei numbers went way down.

We think that since we still get acute sinusitis after a cold or flu-type virus means that our sinus bacterial communities (sinus microbiome) are still not quite right, even thought they must be better than they've been in years (after all, we feel great and not ill, and have not taken antibiotics in over a year). Thus we are making every effort to eat fermented and pickled foods, fruits, vegetables, whole grains, yogurt, raw cheeses, and kefir to naturally increase our beneficial bacteria numbers. We are not taking probiotics because no brand of probiotics currently available contains Lactobacillus sakei. We are also planning to test other brands of kimchi to see what brands are effective. And, of course, I'm always looking for new sources of Lactobacillus sakei and other effective natural sinusitis treatments.