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Tag: chronic sinusitis

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Published on 4 Comments on Three Years of Sinusitis Treatment Success

It's now 3 years being free of chronic sinusitis and off all antibiotics! Three amazing years since I 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 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, as well as information about some other promising bacteria. Thank you so much! [For latest see: The Best Probiotic For Sinus Infections]

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. One can also click on SINUSITIS under CATEGORIES to see more posts, such as "Probiotics and Sinusitis" - a discussion by one of the original sinusitis researchers about what she thinks is going on in sinus microbiomes and what is needed.)  

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Published on 6 Comments on Update on Sinusitis Treatment

[UPDATE:  I added an Oct. 2018 update to the post The One Probiotic That Treats Sinusitis, which was originally posted in January 2015.]  Updates incorporate the latest information about treatments and products with Lactobacillus sakei  (kimchi brands, the probiotic Lacto Sinus , the sausage starter culture Bactoferm F-RM-52, etc.). 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 Oct. 2018 update]

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Published on 2 Comments on Two Years (and Counting) Without Sinusitis

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: Since then I've posted a number of posts with sinusitis treatment information. The updated (November 2018) The Best Probiotic For Sinus Infections has products and sources of L. sakei. The Sinusitis Treatment Summary page has treatment methods. And news about a Lactobacillus sakei product which I really like - Lacto Sinus. 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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Published on 252 Comments on The One Probiotic That Treats Sinusitis

[Please go to updated June 2022 version of this post.]

(Oct. 2018) 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.  And for many, major improvement may take only days!

The researchers Abreu et al found in their 2012 study that not only do sinusitis sufferers lack L. sakei, they have too much of some other 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 since then also found that there is a depletion of some bacterial species, and an increase in "abundance" of other species in those with chronic sinusitis.

Luckily Lactobacillus sakei is found in some foods (such as some brands of live fermented kimchi), some sausage starter cultures (such as B-2), and recently in some probiotic supplements (e.g. Lanto Sinus). One reason it is used in sausage starter cultures is because L. sakei dominates over and inhibits growth of pathogenic bacteria, including Staphylococcus aureus. This post discusses these L. sakei products and other possible probiotic treatments for sinusitis.

Treating sinusitis with beneficial bacteria (rather than with antibiotics, corticosteroid nasal sprays, and surgery) is the future in sinusitis treatment.

BACKGROUND STORY: More than 5 years ago there were no probiotics containing L. sakei. None. So I experimented 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 two weeks. Obviously it contained L. sakei. Then the rest of my family also tried the kimchi treatment and were also quickly cured of chronic sinusitis! It felt miraculous, especially because it was so easy to do.

After 5 years we still feel great! Generally we only need to treat again with a product containing Lactobacillus sakei (we've been using refrigerated Lanto Sinus) after a virus which goes into sinusitis, or if for some other reason we feel like we're sliding into sinusitis. We've improved every year so need to do it less and more minimally.

Because we no longer have chronic sinusitis and can easily treat sinusitis if it occurs with L. sakei, we have NOT taken antibiotics or any other bacteria killing spray or product (such as xylitol) for over 5 years. We do not use cortisone or antihistamine nasal sprays either.

WHEN A TREATMENT WORKS: A number of you have contacted me to report your own progress with various sinusitis treatments. People used terms such as "miraculous", "transformative", and "fabulous" when they had positive results with a product containing L. sakei  -  and many with major improvement happening within a few days. I’ve also heard from a few people of some other beneficial bacteria species that may treat sinusitis.

When a treatment works, then all sinusitis symptoms go away  --sometimes within days, sometimes longer. This includes 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 cautious.)

OVERALL RESULTS: The majority of people contacting me with results reported positive results (chronic sinusitis greatly improved or totally gone) from some form of L. sakei treatment. Successes have been reported to me from the USA, Canada, 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.

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. Interestingly,  Lactobacillus sakei works best when it is used only when needed, when there are sinus symptoms. Don't use when feeling healthy.

Those same chronic sinusitis sufferers also reported that the same treatments also worked to treat acute sinusitis or sinus infections. It seems that after colds or viruses may develop acute sinusitis again and need re-treatment (apparently the L. sakei frequently doesn't stay in the sinuses from earlier treatments). However, the sinuses do continue improving over time so fewer and more minimal treatments are needed over the years.

Another very small group reported that other probiotic strains helped, and a minority of people reported that nothing has helped and there could be a variety of reasons for this (see below). Some people reported that one product helped, but not another - whether kimchi or a L. sakei product. It also became clear that L. sakei does not treat seasonal allergies or allergy symptoms.

THREE MAIN PRODUCT CATEGORIES: The main categories of products containing live Lactobacillus sakei are:: kimchi (and some sauerkraut), refrigerated products, and frozen products. Note that at this time the FDA does not allow any probiotics to be sold as a medical treatment – they can only be sold as a supplement.

Using the following products to treat sinusitis is self-experimentation (results are unknown and can vary). Always be cautious when testing a new product. (See Sinusitis Treament Summary page for treatment methods.)

KIMCHI - Many people report that kimchi helped them. 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: Sunja's Kimchi (mild white kimchi and medium spicy cucumber kimchi), Sinto Gourmet brand kimchi, Mama-O's Premium Kimchi, the white Napa kimchi and cabbage kimchi made by Choi's Kimchi Company (in Portland, Oregon), Farmhouse Culture Kimchi (in California), Ozuke Kimchi (in Colorado), Mother-in-law's Kimchi, in the United Kingdom the brand Mr Kimchi, and in Australia Kehoe's Kitchen white kimchi.

(Not all kimchi brands or types of kimchi within brands contain L. sakei - finding one that has it is due to self-experimentation. The kimchi must be live, and not pasteurized. 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 over the next 2 days, or the acute sinusitis kept getting worse, than it did not contain L. sakei.) Some researchers feel that it's the garlic in kimchi that encourages L. sakei growth.

SAUERKRAUT - Some people improved with 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.

REFRIGERATED LACTOBACILLUS SAKEI PRODUCTS  – A refrigerated L. sakei product specifically meant for the sinuses is now available. The company Lanto Health has introduced a kimchi derived Lactobacillus sakei product called Lanto Sinus - to be used when needed (when there are symptoms). Lanto Sinus  is sold as a dietary supplement, holds up well in the refrigerator, is effective, quick-acting, and easy to use. This high-quality product ships well because it holds up for a while (days) without refrigeration.

People have reported success using it mixed with bottled water (dabbing, smearing, spooning a little in nostrils), or swishing it dry in the mouth. I’ve been a consultant with Lanto Health on this product and have been testing and using this product successfully for over a year (self-experimentation!).

FROZEN LACTOBACILLUS SAKEI PRODUCTS  – The main L. sakei products available in many countries throughout the world are various frozen sausage starter cultures. All L. sakei products needing to be kept frozen are generally reliable and effective for sinusitis treatment. They should only be used when needed. But negatives with all frozen L. sakei products are that they must be kept frozen, they don’t hold up well once the package is opened, and they can easily die off during shipping.

Sausage starter cultures include BACTOFERM F-RM-52 (many countries, made by Chr. Hansen), PRIMAL SK NATUR 50 (Europe, made by Van Hees), and BITEC LS-25 (Europe, made by Frusarum). These starter cultures contain 2 types of bacteria (L. sakei and Staphylococcus carnosus) – little is known about S. carnosus, but it is considered non-pathogenic, and no one has reported negative effects from it. B-2, which is only L. sakei (made by Chr Hansen), is available in New Zealand and some EU countries. The starter culture BACTOFERM  SM 160 (L. sakei, Staphylococcus carnosus and Debaryomyces hansenii) has also been used successfully for chronic sinusitis. But one should be very cautious because while the third bacteria is considered non-pathogenic, is common in food products, is used commercially to make B12 - it is a yeast species (fungi).

Most use a frozen product by dabbing/smearing or spooning a little of the mixture (L. sakei and bottled water) into the nostrils. Sometimes a side effect on the day the product is used is a dry mouth and throat (and they can be very dry when overused - 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.

[NOTE: I personally have overuse concerns (too strong a dose) with using L. sakei in a neti pot or nasal syringe, and so have never used any L. sakei product that way. My personal view: let the little suckers travel up to the sinuses on their own. And they do. And I always start first with the most cautious way to see if that works.]

SOME L.SAKEI ISSUES: I still think of L. sakei as fairly fragile – for example, it is killed off by antibiotics, by oxygen, and it only lives a limited amount of time at room temperature. [For ex.: the culture Bactoferm F-RM-52 package says that it dies off in less than 2 weeks at room temperature - therefore store in freezer.] On the other hand, many different Lactobacillus strains live and multiply in our bodies at 98.6 degrees Fahrenheit - so L. sakei can handle warm temperatures just fine for a while.

Note that the L. sakei in any product can also die off during shipping if it takes too long, it’s too hot (e.g. inside hot postal vehicles in extreme heat), or some other reason. Thus we order 2 day shipping (if possible) and hope for the best. (Note: Consider overnight shipping during 100+degree Fahrenheit heat waves. Also, USPS delivers to mailboxes, while UPS typically delivers to the door.)

WHY DOESN'T L. SAKEI WORK FOR SOME PEOPLE? Some possibilities to explain why some people trying various 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 that the L.sakei bacteria cannot overcome.

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.

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 while. There may be a feeling of "imbalance" or on rare occasion some symptoms (e.g. more mucus, sore throat). We think this might be an issue of "too much of certain microbes".

Then we (family members) have found that immediately 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 an opened capsule (the dry powder) of multi-strain probiotics, or refrigerated L.sakei in the mouth (this last if switching from kimchi)  has corrected the situation for us. (Finding what works is self-experimentation, and varies from time to time.). And weeks later, we can use the original product once again. This is also why we only use a product when needed.

BOTTOM LINE: When feeling good or healthy, stop using the L. sakei product. Use L. sakei products sparingly - only as needed (e.g. when developing sinusitis). Using less is better than more over time – probably due to sinus microbial communities improving over the years. L. sakei seems to be necessary for sinusitis treatment for most people (a keystone bacteria), but there are also other important microbes in the sinuses - a whole community.

OTHER PROBIOTICS MAY OR MAY NOT HAVE BENEFICIAL EFFECTS - Rarely some people have reported that multi- strain probiotics (but they did not contain L. sakei) treated their sinusitis. They mixed the powder in the capsules with water and smeared or dabbed the mixture in the nose, or even used it in a saline rinse (this last was rare). Different brands containing different mixtures of bacteria (Lactobacillus and Bifidobacterium) have been mentioned - but all were refrigerated probiotics - so nothing stands out.

On the other hand, other people (including my family members) reported trying various multi-strain probiotics containing various Lactobacillus and Bifidobacterium species in the nostrils and found it did not help sinusitis. However, we found that when we feel a little “imbalanced” – perhaps a cough or mucusy – then swishing the dry powder from one capsule in the mouth and then swallowing it - frequently results in some improvement (perhaps with a cough).

I have concerns with products that also contain titanium dioxide – this is because it may be in nanoparticle form, and recent studies have raised concerns that the nanoparticles can travel to other organs in the body, and are also inflammatory. So read the ingredients!

STILL UNKNOWN: Some multi-strain probiotics now contain L. sakei, but may be problematic if they don’t need refrigeration (e.g. Multi-strain Probiotic by Innovix Labs). L. sakei products typically die after a few weeks without refrigeration, and die when exposed to oxygen (anaerobic).  So...while the L. sakei may be alive when the product is produced, is it alive weeks or months later at room temperature?

Also, will a multi-strain probiotic containing both L. sakei and S. salivarius K12 (such as Pro-Kids ENT by Hyperbiotics) help or make things worse for those with sinusitis?  S. salivarius K12 has caused problems for some people (scroll down to "Problems With BLIS K12?").

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

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 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 said that they had found evidence for people having "virus-like particles" in their sinuses, which they thought were bacteriophages.

SNOT TRANSPLANTS IN THE FUTURE? – Currently a “snot transplant” study from healthy persons to sinusitis sufferers is going on in Europe to see if it works as a sinusitis treatment. This possibility may work great, but researchers have the same concerns as with fecal microbial transplants (stool transplant) for the gut. For example, are diseases also being transplanted?

PROBLEMS WITH BLIS K12 ? - Some people (and family members) tried the probiotic BLIS K12 bacteria (also known as Streptococcus salivarius BLIS K12), but found it brought on sinusitis-type symptoms. Scientific research finds it to be an immune booster and it lowers the incidence of upper respiratory infections. But not for us - from the first tablet (ate it by slowly dissolving it in the mouth) there were problems - feeling phlegmy and yellow mucus.

Several 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. 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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Published on 4 Comments on Which Probiotic Treatment is Best For Sinusitis?

[PLEASE NOTE THAT AN UPDATED VERSION OF THIS POST WITH NEW INFORMATION, INCLUDING NEW PRODUCTS, WAS PUBLISHED IN MAY 2018: The One Probiotic That Treats Sinusitis. Comments 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.)

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 MAY 2018: The One Probiotic That Treats Sinusitis. Comments can be posted there.]

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

Link between antibiotics, bacterial biofilms and chronic infections found

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

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

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

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

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

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

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

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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.... 

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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.

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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 Best Probiotic For Sinus Infections for more information, more products one can use, and more L. sakei treatment information. We are using the high quality refrigerated product Lacto Sinus these days.)

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SUMMARY OF TREATMENT METHOD USING KIMCHI

The following is a quick summary of the method we use (see Sinusitis Treatment Summary page).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.

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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).