(UPDATED May 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. 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 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. Lacto 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 a major shift or paradigm change in sinusitis medical treatment, but it is the future in sinusitis treatment.]
BACKGROUND STORY: More than 5 years ago there were no probiotics containing L. sakei. None. So instead 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 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 method details.)
After 5 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 few years we've needed to do this far less (and more minimally) than the first year because every year we have improved – fewer colds and viruses, and an improved sinus microbiome. 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. Thank you! People used terms such as "miraculous", "transformative", and "fabulous" when they had positive results with a product containing L. sakei. 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, 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 contacting 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 to treat acute sinusitis. It seems that after colds, etc. they (including myself) may develop acute sinusitis again and need re-treatment (apparently the L. sakei frequently doesn't stay or colonize in the sinuses from earlier treatments). However, the sinuses do continue improving over time so our experience has been that fewer and more minimal treatments are needed over the years. Another very small group reported that other probiotic strains helped (but it is not always clear whether they also tried a L. sakei product), 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.
THREE MAIN PRODUCT CATEGORIES: Currently there are 3 main categories of products containing live Lactobacillus sakei, and which people have reported success in treating sinusitis: 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 details.)
KIMCHI - Many people report 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 and 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. I'm sure some (many?) other brands also contain L. sakei.
(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 or phlegmy 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.
[NOTE: SAUERKRAUT had not worked for anyone until recently - one person 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.]
REFRIGERATED LACTOBACILLUS SAKEI PRODUCTS – A refrigerated L. sakei product specifically meant for the sinuses is now available in the United States. The company Lacto Health has introduced a kimchi derived Lactobacillus sakei product called Lacto Sinus - to be used when needed. Lacto Sinus is sold as a dietary supplement, holds up well in the refrigerator, is effective, reliable, and easy to use. This product ships well because it holds up for a while 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 Lacto Health on this product and have been testing and using this product successfully for over a year (self-experimentation!).
FROZEN LACTOBACILLUS SAKEI PRODUCTS – While other frozen L. sakei products are now appearing, 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). Note that 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 Bulgaria (but may ship elsewhere). 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). One study says it secretes toxins capable of killing other yeasts.
Most use a frozen product by dabbing/smearing or spooning a little of the mixture (L. sakei and bottled water) into the nostrils, while a few others report using it in a neti pot, and one person even a nasal aspirator (bulb syringe) for a large one time dose. 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.]
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. The culture Bactoferm F-RM-52 package says that it dies off in less than 2 weeks at room temperature (therefore store in freezer). Please note that the L. sakei in any product can also die off during shipping if it takes too long, it’s too hot, or some other reason. Thus we order 2 or 3 day shipping (if possible) and hope for the best. Also note that there can be some variability in how strong the L. sakei is in a batch – especially in kimchi. After all, it’s alive!
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 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 while. We think this might be an issue of "too much of certain microbes" - and 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 multi-strain probiotics (the dry powder) or refrigerated L.sakei 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. 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). And over time we’ve noticed that using less is better than more – probably due to our 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 PROMISING PROBIOTICS - 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 have been mentioned - but note that all were refrigerated probiotics. The following bacteria were mentioned frequently: Lactobacillus acidophilus, L. rhamnosus, L. plantarum, L. reuteri, L. casei, Bifidobacterium longum, and B. lactis, B. bifidum, and B.breve. I have concerns with products also containing 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!
Some researchers are focusing on Lactobacillus sakei, L. rhamnosus, L. plantarum, L. 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, 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 phlegmy – then swishing the dry powder from one capsule in the mouth and then swallowing it - frequently results in some improvement (perhaps with a cough). 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: 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?").
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 casei, and 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 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).
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 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 ? - On a side note, two family members, plus several people contacting me, 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, is good for oral health, 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. 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).