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What else can the amazing beneficial bacteria Lactobacilus sakei treat? We know it can treat sinusitis (sinus infections) - based on the original Abreu et al (2012) research, personal experiences, and feedback from hundreds of people since I started this site in 2013. Can it treat bronchitis? Earaches? How about skin infections? L. sakei dominates over and inhibits growth of pathogenic bacteria, including Staphylococcus aureus. Instead of using antibiotics - what else could L. sakei be used for?

I've been hearing interesting stories from people - a number of people have found that it (kimchi, sauerkraut with garlic, or a L. sakei product such as Lanto Sinus) works to treat coughs (bronchitis), or prevents upper respiratory infections from developing into serious sinus infections, gets rid of fungal balls in the sinuses, treats earaches, and even treats small skin infections. People have been using the various products in creative ways - all self-experimentation!

The experiences of some people contacting me, as well as family members - is that it treated bronchitis and coughs for which they would have taken antibiotics in the past - by swishing L. sakei powder (such as Lanto Sinus) in the mouth (but not in the nose). For example, one person reported that she occasionally gets bronchitis, but never sinusitis - and she successfully used Lanto Sinus to treat the bronchitis by swishing it in the mouth. The first two days she used it 2 x per day, and after that once per day until she felt better, but not totally well - and when she stopped the bronchitis (cough, phlegm) came back. So she used the L. sakei again until she felt totally healthy - and this time the cough stayed away. Since I personally know this person (we take walks together) I was able to observe her progress - cough & phlegm, then improvement, then backwards slide, and then total health when she used the product again. Hmmm... Definitely wasn't an imaginary effect or wishful thinking (placebo effect).

Not wanting to dab kimchi juice in the nostrils (the usual way to use kimchi) some gargled with kimchi juice and also swished it in the mouth and then didn't eat or drink for a while - but I don't know how the results compare to the usual kimchi method. One person dabbed kimchi juice in the ear for an earache and thought it helped (see Sinusitis Success Stories). For skin infections some individuals mixed L. sakei with a little water and applied to infection - this has been reported for both frozen Bactoferm F-RM-52 and refrigerated Lanto Sinus. But at any rate, the reports from people of various ways to use a L. sakei product are interesting. Just remember - this is all self-experimentation - which means results can be positive, negative, or no effect. And please be cautious!

For ways people use the various Lactobacillus sakei products to treat sinus infections (both chronic sinusitis and acute sinusitis) see the Sinusitis Treatment Summary page. The Best Probiotic For Sinus Infections gives an in-depth look at the different L. sakei products and results.

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Today's topic: sinusitis success stories. For those suffering from chronic sinusitis it sounds incredible, doesn't it? For more than 5 years I've posted about the probiotic Lactobacillus sakei and how it can successfully treat chronic sinusitis. Back in January 2013 I read a study by Abreu et al (2012) that the sinus microbiome (microbial community) in people with chronic sinusitis was imbalanced and that this beneficial bacteria could be a possible treatment. I had suffered from chronic sinusitis for years, so of course I went searching for Lactobacillus sakei. It wasn’t in any probiotics at the time, but I did find it in kimchi. Through experimentation I (and my family) successfully treated chronic sinusitis by dabbing and smearing a little of the kimchi juice in the nostrils once or twice a day. It felt miraculous!

By the end of 2013 I started this blog to get the word out about Lactobacillus sakei, and to also hear the experiences of others. (See results post) In the last 5 years I have heard from hundreds of people, including lots of sinusitis success stories with Lactobacillus sakei – especially using kimchi, sauerkraut made with garlic, sausage starter cultures such as Bactoferm F-RM-52, and recently with the sinusitis probiotic Lanto Sinus, which was introduced in 2018. When a Lactobacillus sakei product works as a sinusitis treatment for a person it feels absolutely wonderful and amazing. Sinus health after years of suffering! Unfortunately, it appears that Lactobacillus sakei may not work for everyone - only trying it determines if it works and how well.

The following are excerpts of some of the sinusitis success stories that people have reported - almost all are from comments after posts on this site, and a few from emails to me. Sometimes we need to hear successful treatment stories, especially if we’ve been struggling with sinusitis for a long time. Just keep in mind that these are stories of people experimenting on their own - how they used Lactobacillus sakei varies and their experiences vary. (See Sinusitis Treatment Summary for methods). Note that in Feb. 2019 the Lacto Sinus name was changed to Lanto Sinus in order to get a trademark - but the product remains exactly the same.

J. October 2017
So glad I found this site! Have been struggling with chronic sinus and gut issues go over 20 years after several rounds of antibiotics.
Immediately after reading thru this I put a dab of Kimchi juice up each nostril (had some on hand, as I eat a lot of fermented veggies). I could tell almost immediately that something was happening. Almost felt as if there was a duel going on in my sinuses between the kimchi probiotics and the nasties in my sinuses. Had some stuffiness and stiff neck but went to bed and slept great last night and woke up this morning with clearer sinuses and feeling better!

Jo. October 2015
Through the years I've tried everything for sinus infections and nothing but antibiotics helped. When I read about kimchi helping I tried that too. To my utter delight and relief, Sunja's white kimchi worked a miracle! I bought another 3 jars and keep it in the refrigerator for the next bout.

M. November 2018
I had great success in treating my chronic sinusitis with Lacto Sinus.
I’ve had sinus problems for 2 decades and tried all sorts of medicines and treatments, but nothing helped. Every single sore throat and every cold, no matter how minor, led to full-blown sinusitis and having to take antibiotics for weeks. I was always in fear of getting sick. And even when I was “healthy” I really wasn’t, I always had some symptoms. I would frequently wake up with a sore throat and with thick phlegm dripping down my throat.
I was desperate when I tried Lacto Sinus and was thrilled to see improvement within a day! I used it daily for over a week, then every other day for about 2 more weeks. And then I stopped because I didn’t need it anymore.
Getting my life and health back feels like a miracle! I don’t dread getting a cold or virus anymore – I just use some Lacto Sinus again if I get some sinus symptoms. I will always keep a bottle in my refrigerator.

T. January 2017  ...continue reading "Sinusitis Success Stories"

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Probiotics are the future of sinusitis treatment. Research found that a probiotic (beneficial bacteria) that is lacking in those with chronic sinusitis and which successfully treats sinusitis is Lactobacillus sakei. This article is the full summary of what has been learned over the past 6 years: the best L. sakei  products (such as kimchi and Lanto Sinus - which can treat even the worst recurring sinus infections), results of people trying various L. sakei products, ways to use the products, and other possible probiotics for sinusitis and sinus health.

Back in 2012, a study by Abreu et al suggested Lactobacillus sakei as a possible treatment for sinusitis. In the past 6 years those conclusions have been supported by the experiences of hundreds of people contacting me, and my family's experiences with L. sakei products. It really is the best sinusitis treatment for most people!  When Lactobacillus sakei works as a treatment - it can seem miraculous as sinusitis symptoms gradually disappear or greatly improve. Unfortunately it doesn't work for everyone - for a minority there seems to be no effect, and it is not clear why. It also doesn't treat allergies or allergy symptoms. (See Treatment Summary page for different ways to use products.)

Sinusitis research in the last decade has found 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) in chronic sinusitis -  with a depletion of some bacterial species, and an increase in "abundance" of other species.

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.

BACKGROUND STORY: Six years ago there were no probiotics containing L. sakei. None. So instead members of my family experimented using a very easy kimchi sinusitis treatment (basically dabbing and smearing kimchi at certain stages of fermentation into the nostrils like a very messy eater) and found that it cured  chronic sinusitis of many years within several weeks. Obviously it contained L. sakei. It felt miraculous, especially because it was so easy to do. (See Sinusitis Treatment Story page for our background story).

After 6 years we still feel great! Generally all 4 of us 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. 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 6 years. We do not use cortisone or antihistamine nasal sprays either.

WHEN A TREATMENT WORKS: Many 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 RESULTSThe 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 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.

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 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 (e.g. Lanto Sinus), 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 (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: Sunja's Kimchi (medium spicy cucumber kimchi and mild white kimchi), Sinto Gourmet brand kimchiMama-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), Mother-in-law's KimchiOzuke Kimchi (in Colorado), 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.

SAUERKRAUT - Sauerkraut has worked for some people if it is 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 high-quality refrigerated L. sakei product specifically meant for the sinuses and treatment of sinusitis is sold by Lanto Health. The kimchi derived Lactobacillus sakei product called Lanto Sinus is meant to be used when needed. Lanto 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 (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 2 years (self-experimentation!).    ...continue reading "The Best Probiotic For Sinus Infections"

People ask me: what's going on with research in the treatment of sinusitis with probiotics? Well, the answer is that things are moving along slowly - very slowly, but there are good signs. Earlier this year an interesting article by researcher Anders U. Cervin at the University of Queensland (Australia) was published that specifically talked about "topical probiotics" as a potential treatment for chronic sinusitis. By this he means that probiotics (beneficial bacteria) could be directly applied to the nasal passages in the nose, such as a nasal spray. And he discussed how the prevailing view nowadays, based on scientific evidence, is that in sinusitis there is an "imbalance of the sinus microbiome" - the community of microbes living in the sinuses. Yes!!!

Cervin mentioned all sorts of research showing beneficial effects of using different strains of probiotics for various illnesses, mentioned the Abreu et al study (which is the reason I focused on Lactobacillus sakei as a sinusitis treatment, and which works successfully for many people), but.... nowhere did he mention Lactobacillus sakei by name. What??? There are already excellent L. sakei probiotics out there for chronic sinusitis treatment such as Lanto Sinus.

Cervin discusses how studies are needed to test nasal sprays for the treatment of sinusitis, and made a lot of good points. He looked at studies already done, wondered what bacterial strains might be beneficial, but obviously didn't read the Abreu et al study carefully to see that L. sakei might be a good candidate to test. And he didn't do an internet search to see what probiotics people are using already as a successful treatment for sinusitis (see Sinusitis Treatment Summary page). He did mention that the only good trial using nasal spray probiotics in humans with sinusitis found no effect - because they tested the wrong Lactobacillus strains - they were honeybee strains, and not ones found in humans.

Eh... So once again I'm heartened by the focus on the microbial community in sinusitis, and heartened that he said there it was time to get out of the laboratory and start testing probiotics as treatments on people. But I'm dismayed that the focus is so narrow that he's missing what is in front of him - what is already out there. He also missed that a "snot transplant" study is now going on in Europe, which is sure to have interesting results.

By the way, some of the questions the article raises are ones which, based on the experiences of myself and others over the past 5 years, we can already answer: living bacteria as a treatment are better than dead bacteria (using dead bacteria doesn't work), nasal treatments work but just swallowing a probiotic pill doesn't, Lactobacillus sakei works as a treatment for many, the L. sakei bacteria reduces inflammation in the nasal passages, the probiotic can be used in place of an antibiotic, and only treat when needed and not continuously (continuously treating can also result in an imbalance in the sinus microbiome). [See post The Best Probiotic For Sinus Infections where these issues are discussed and the best L. sakei products.] ...continue reading "Researcher Sees Potential for Sinusitis Nasal Probiotics"

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Big announcement today! The high quality product Lanto Sinus, which contains the probiotic Lactobacillus sakei specifically for sinus health, is now available. This product contains an excellent strain of Lactobacillus sakei that is kimchi derived. Lactobacillus sakei is the one probiotic (beneficial bacteria) that has successfully treated the chronic sinusitis of many people, including all members of my family. It has been an amazing journey - and since using Lactobacillus sakei our sinuses feel great, and we have not had to use antibiotics in 6+ years! A win-win.

More than 6 years ago I read research about the sinus microbiome (microbial community), and how chronic sinusitis sufferers lack the keystone bacteria Lactobacillus sakei that successfully treats sinusitis. There were no probiotics with L. sakei available back then. None. But we (my family) were able to successfully treat chronic sinusitis with live kimchi, which can contain Lactobacillus sakei (see Sinusitis Treatment Story). Kimchi is a wonderful product, but... with kimchi you never know if you're getting L. sakei, and even then it dies off rapidly. We went on to experiment with other products for years, with none of them ideal. So it is great that finally, after all these years, a product like Lanto Sinus is now available.

Nice things about Lanto Sinus are that the Lactobacillus sakei strain is kimchi derived (an excellent strain!), the product holds up well, it is in powder form, easy to use, and it only needs to be refrigerated. (That's right, it's meant to be refrigerated, and not frozen.) Since it also holds up well for a time without refrigeration, it also ships well. (After all, L. sakei lives and multiplies in our body at about 98.6 degrees Fahrenheit.) Lanto Sinus is sold by Lanto Health, and shipped from the NJ/NY metro area. Lanto Sinus is a high quality product that is produced with Good Manufacturing Practices, and is lab tested and verified.

Gentle, yet strong. It is being sold as a probiotic dietary supplement for sinus health. It comes in powder form with directions stating to mix with a little bottled water or take it dry, and swallow - after all, it is a dietary supplement. Lanto Sinus comes with a little spoon for ease of use. The product is meant to be used when needed for sinus support (when there are some sinusitis symptoms).

I want to mention that I have been a consultant to the company, and have been testing and using the product for over 2 years. As usual, I self-experimented various ways to see what works best for me - but of course, only using it when needed (for example, if I start to slide into sinusitis after a cold). After 6 years of self-experimentation in various ways my sinus microbiome has improved, so at this point I only need to use a little bit for successful results. What has worked for me is swishing a little of the dry powder in the mouth, and then swallow it, and not drink or eat for a least 30 minutes after that (to let it travel to the sinuses). Yes, I like the product a lot!

By the way, the advice to use only when needed - should be applied to any probiotic  supplement that is used as a sinusitis treatment or for sinus support. And as I describe in The One Probiotic That Treats Sinusitis - based on my family's experiences and many people contacting me - most people are helped by Lactobacillus sakei, but not all. Unfortunately there is no way to know if L. sakei will treat a person's sinusitis unless it is tried. This is because everyone's sinus microbiome (microbial community) is different - and so how one reacts to different probiotics can vary. By the way, L. sakei does not appear to treat allergies or allergy symptoms.

Finally, I want to point out that currently all probiotics in the United States are sold as dietary supplements and not as treatments. The FDA (Food and Drug Administration) at this time does not allow any medical treatment claims for any probiotic sold. Using a probiotic dietary supplement in ways other than label directions is SELF-EXPERIMENTATION. [See Sinusitis Treatment Summary page for self-experimentation details - the different ways people use L. sakei products.]

[FEB. 2019 UPDATE: Lanto Sinus was originally called Lacto Sinus. On February 3, 2019 the company changed the name to Lanto Sinus in order to get a trademark. It is the exact same product - the only change is the name. This post has been updated to reflect the name change.

Read the The Best Probiotic For Sinus Infections - results from many people using Lactobacillus sakei and other probiotic sinusitis treatments.]

And on a final note, some other news about L. sakei: According to several studies, when taken orally (swallowed) Lactobacillus sakei appears to be beneficial in certain skin conditions such as atopic eczema-dermatitis syndrome and atopic dermatitis. Another study found that patients with ischemic strokes had decreased numbers of Lactobacillus sakei in the gut (as compared to healthy individuals).  It's an interesting microbe!

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

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

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

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

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

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

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

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

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

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

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

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

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As you may have noticed, I write about the beneficial bacteria Lactobacillus sakei a lot. This is because it has turned out to be a great treatment for both chronic and acute sinusitis for my family and others (see post The One Probiotic That Treats Sinusitis). We originally found it in kimchi (it occurs in the kimchi during normal fermentation), but not all kimchi brands. Kimchi is a mix of vegetables (including typically cabbage) and seasonings, which is then fermented for days or weeks before it is eaten.

Why is L. sakei found in some kimchi, but not all? Which vegetable or spice is needed or important for encouraging L. sakei growth? It turns out it is not the cabbage - which is why L. sakei is not found in sauerkraut. A recent study looking at several kimchi samples found that garlic seems to be important for the development of various Lactobacillus bacteria, of which L. sakei is one. The results mean that raw garlic has very low levels of L. sakei, and it multiplies during kimchi fermentation. Note that as fermentation progresses, the bacterial species composition in the kimchi changes (this is called ecological succession). Korean studies (here and here) have consistently found L. sakei in many brands of kimchi (especially from about day 14 to about 2 or 2 1/2 months of fermentation), but not all kimchi brands or recipes. L.sakei, of which there are many strains, is so beneficial because it "outcompetes other spoilage- or disease-causing microorganisms" and so prevents them from growing (see post).

Excerpts are from the blog site Microbial Menagerie: MICROBES AT WORK IN YOUR KIMCHI

Cabbage is chopped up into large pieces and soaked in salt water allowing the water to draw out from the cabbage. Other seasonings such as spices, herbs and aromatics are prepared. Ginger, onion, garlic, and chili pepper are commonly used. The seasonings and cabbage are mixed together. Now the kimchi is ready to ferment. The mixture is packed down in a glass container and covered with the brining liquid if needed. The kimchi sits at room temperature for 1-2 days for fermentation to take place....Kimchi does not use a starter culture, but is still able to ferment. Then where do the fermentation microbes come from?

Phylogenetic analysis based on 16S rRNA sequencing indicates that the kimchi microbiome is dominated by lactic acid bacteria (LAB) of the genus Leuconostoc, Lactobacillus, and Weissella. Kimchi relies on the native microbes of the ingredients. That is, the microbes naturally found on the ingredients. Because of this, there may be wide variations in the taste and texture of the final kimchi product depending on the source of the ingredients. In fact, a research group from Chung-Ang University acquired the same ingredients from different markets and sampled the bacterial communities within each of the ingredients. The group found a wide variability in the same ingredient when it was bought from different markets. Surprisingly, the cabbage was not the primary source of LAB. Instead, Lactic acid bacteria was found in high abundance in the garlic samples

Note that Lactobacillus sakei is an example of a lactic acid bacteria. More study details from  the Journal of Food Science: Source Tracking and Succession of Kimchi Lactic Acid Bacteria during Fermentation.

This study aimed at evaluating raw materials as potential lactic acid bacteria (LAB) sources for kimchi fermentation and investigating LAB successions during fermentation. The bacterial abundances and communities of five different sets of raw materials were investigated using plate-counting and pyrosequencing. LAB were found to be highly abundant in all garlic samples, suggesting that garlic may be a major LAB source for kimchi fermentation. LAB were observed in three and two out of five ginger and leek samples, respectively, indicating that they can also be potential important LAB sources. LAB were identified in only one cabbage sample with low abundance, suggesting that cabbage may not be an important LAB source.

Bacterial successions during fermentation in the five kimchi samples were investigated by community analysis using pyrosequencing. LAB communities in initial kimchi were similar to the combined LAB communities of individual raw materials, suggesting that kimchi LAB were derived from their raw materials. LAB community analyses showed that species in the genera Leuconostoc, Lactobacillus, and Weissella were key players in kimchi fermentation, but their successions during fermentation varied with the species, indicating that members of the key genera may have different acid tolerance or growth competitiveness depending on their respective species.

Although W. koreensis, Leu. mesenteroides, and Lb. sakei were not detected in the raw materials of kimchi samples D and E (indicating their very low abundances in raw materials), they were found to be predominant during the late fermentation period. Several previous studies have also reported that W. koreensis, Leu. mesenteroides, and L. sakei are the predominant kimchi LAB during fermentation (Jeong and others 2013a, 2013b; Jung and others 2011, 2012, 2013a, 2014). 

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Image result for antibiotics Yes, of course this makes sense!.... Many rounds of antibiotics have an effect not just in one area of the body, but kill off both good and bad bacteria in many areas of the human body. The researchers in this study found that taking antibiotics for a reason OTHER THAN SINUSITIS was associated with an increased risk of developing chronic sinusitis (as compared to those people not receiving antibiotics). Use of antibiotics more than doubles the odds of developing chronic sinusitis without nasal polyps. And this effect lasted for at least 2 years. Other research has already associated antibiotic use with "decreased microbial diversity" in our microbiome  and with "opportunistic infections" such as Candida albicans and Clostridium difficile. Diseases such as Crohn's disease and diabetes are also linked to antibiotic use. In other words, when there is a disturbance in the microbiome (e.g.from antibiotics) and the community of microbes becomes "out of whack", then pathogenic bacteria are "enriched" (increase) and can dominate.

This study lumped together chronic sinusitis without nasal polyps (CRSsNP) and chronic sinusitis with nasal polyps (CRSwNP), but when the 2 groups are separated out, then antibiotic use was mainly associated with chronic sinusitis without polyps. It appeared that antibiotic exposure did not significantly impact the odds of developing chronic sinusitis with nasal polyps. The researchers write: "This effect was primarily driven by the CRSsNP subgroup, which also supports the evolving concept of CRSwNP (chronic sinusitis with nasal polyps) as a disease of primary inflammation rather than infection. Despite this, we elected to analyze the CRS (chronic rhinosinusitis) group as a whole because the precise relationship between CRS with and without nasal polyps remains incompletely understood, and it is possible that a proportion of the CRSsNP patients could go on to develop nasal polyps over time."

Which makes me wonder, will giving beneficial bacteria (such as Lactobacillus sakei) to those who have chronic sinusitis with nasal polyps show the same improvement in symptoms as those people without nasal polyps? Or do 2 treatments have to occur at once: something to lower the inflammation (which may be the reason for the nasal polyps) and also beneficial microbes to treat the bacterial imbalance of sinusitis? We just don't know yet. Note that CRS = chronic rhinosinusitis (commonly called chronic sinusitis). Research by A.Z. Maxfield et al from The Laryngoscope :

General antibiotic exposure is associated with increased risk of developing chronic rhinosinusitis 

Antibiotic use and chronic rhinosinusitis (CRS) have been independently associated with microbiome diversity depletion and opportunistic infections. This study was undertaken to investigate whether antibiotic use may be an unrecognized risk factor for developing CRS. Case-control study of 1,162 patients referred to a tertiary sinus center for a range of sinonasal disorders.

Patients diagnosed with CRS according to established consensus criteria (n = 410) were assigned to the case group (273 without nasal polyps [CRSsNP], 137 with nasal polyps [CRSwNP]). Patients with all other diagnoses (n = 752) were assigned to the control group. Chronic rhinosinusitis disease severity was determined using a validated quality of life (QOL) instrument. The class, diagnosis, and timing of previous nonsinusitis-related antibiotic exposures were recorded.

Antibiotic use significantly increased the odds of developing CRSsNP  as compared to nonusers. Antibiotic exposure was significantly associated with worse CRS QOL {Quality of Life} scores over at least the subsequent 2 years. These findings were confirmed by the administrative data review. Use of antibiotics more than doubles the odds of developing CRSsNP and is associated with a worse QOL for at least 2 years following exposure. These findings expose an unrecognized and concerning consequence of general antibiotic use.

Antibiotic use and chronic rhinosinusitis (CRS) have been independently associated with microbiome diversity depletion and opportunistic infections. This study was undertaken to investigate whether antibiotic use may be an unrecognized risk factor for developing CRS.....Antibiotics have also been associated with significant adverse side effects. It has long been recognized that antibiotic use may lead to increased susceptibility to secondary mucosal infections from pathogens including Candida albicans and Clostridium difficile.  Recent studies on the concept of mucosal microbial dysbiosis have suggested that these infections arise as a result of antibiotic induced depletion of the diverse commensal microbial assemblage, which enables the proliferation of pathogenic species.

Chronic rhinosinusitis (CRS) is defined....as having greater than 12 weeks of sinonasal symptoms, along with at least one objective measure of infection or inflammation by nasal endoscopy or radiographic imaging....However the distinct lack of long-term disease resolution following antimicrobial therapy and in some cases surgery, suggests that additional factors are likely involved. Through these studies, CRS with nasal polyps (CRSwNP) has been recognized as an inflammatory subtype characterized by eosinophilic inflammation and a T-helper cell type 2 immunologic profile. Although CRSwNP lacks the features of a classic infectious process, the precise role of bacteria and their byproducts in the promotion of nasal polyp-related inflammation remains unclear.

Recent findings from culture independent investigations of the sinonasal microbiome have offered new insights into the pathogenesis of CRS. These studies have suggested that a decreased microbial diversity exists in CRS patients as compared to healthy controls with a selective enrichment of pathogenic species. Furthermore, some studies have shown that antibiotic exposure may be a risk factor associated with this loss of biodiversity,  echoing the findings seen in postantibiotic C. difficile infections.  Although systemic antibiotics have long been a mainstay of therapy for CRS, these findings lead inexorably to the paradoxical hypothesis that antibiotic exposure may, in fact, promote its onset.

We performed a....case control study of 1,574 patients referred to the Massachusetts Eye and Ear Infirmary Sinus Center in 2014 with symptoms of presumed sinonasal disease.... Inclusion criteria included all antibotic naive patients, and all antibiotic exposed patients for whom antibiotic use was for nonsinonasal-related infections. Among the antibiotic exposed group, only patients who used antibiotics for nonsinonasal-related infections prior to the onset of symptoms of CRS (within the case group) were enrolled in the study.....The case group was further substratified into CRS patients without nasal polyps (CRSsNP, n =273) and with nasal polyps (CRSwNP, n =137) based on the presence of nasal polyps on sinonasal endoscopy.

Among the case patients, 56.34% reported a previous nonsinus-related antibiotic exposure as compared to 42.02% of control patients. Antibiotic use significantly increased the odds of developing both CRSsNP and any form of CRS as compared to nonusers. This odds ratio was similar even when excluding patients who were treated for upper aerodigestive infections. In contrast, antibiotic exposure did not significantly impact the odds of developing CRSwNP. The percent of patients with any form of CRS and CRSsNP only, which was attributable to a previous exposure to antibiotics, was 24.69%  and 33.70%, respectively. In both the case and control groups, the most common class of antibiotic patients received was a penicillin (52.63% vs. 45.77%), and the most common reported reason for antibiotic prescription was the diagnosis of pharyngitis(18.06% vs. 16.67%).

Among the CRS patients (i.e., case group), the use of antibiotics was significantly associated with worse QOL scores as compared to antibiotic-naıve CRS patients. The effect on QOL was enduring because patients who used antibiotics at least 2 years prior to the development of CRS (36.81%) had similar disease severity scores as compared to those with more recent exposures. There was no significant difference in QOL score among patients using different antibiotic classes and among patients with different underlying reasons for antibiotic use.

The human microbiome project has provided new insights into the distribution and abundance of bacterial species in both health and disease. Opportunistic pathogens, as defined by the pathosystems resource integration center, were found nearly ubiquitously in the nares of healthy subjects, albeit at relatively low abundance. Additional studies of the normal nasal cavity found an inverse correlation between the prevalence of Firmicutes such as S. aureus and benign commensal organisms, suggesting a homestatic antagonism between potential pathogens and the remainder of the healthy microbial assemblage. Extrapolation of this concept would therefore predict that events resulting in a perturbation or loss of the commensal microbial community would enable proliferation of pathogenic species, resulting in the disease phenotype. This prediction has borne out in several studies of the sinonasal microbiome in patients with CRS. Feazel et al. found a decreased number of bacterial types and an overabundance of S. aureus among CRS patients as compared to controls. Antibiotic exposure was one of the most significant clinical factors driving this effect. Similar findings were published by Choi et al. and Abreu et al.... Although literature regarding the sinonasal microbiome in health and disease remains nascent, it has provided some limited clues that antibiotics may lead to a reduction of sinonasal microbial biodiversity, which in turn may be a significant feature of CRS.

Our results demonstrate that exposure to antibiotics is a significant risk factor for the development of CRS and accounts for approximately 25% of the disease burden in our study population. These findings harmonize with the predictions of the nascent literature on the sinonasal microbiome. This effect was primarily driven by the CRSsNP subgroup, which also supports the evolving concept of CRSwNP as a disease of primary inflammation rather than infection. Despite this, we elected to analyze the CRS group as a whole because the precise relationship between CRS with and without nasal polyps remains incompletely understood, and it is possible that a proportion of the CRSsNP patients could go on to develop nasal polyps over time.....

One unexpected outcome of our study was that a large percentage of exposures preceeded the onset of the diagnosis of sinusitis by more than 2 years. This indicates that, regardless of the mechanism, the sequelae of antibiotic use may endure much longer then previously thought....The impact of antibiotics on promoting bacterial resistance, and the development of mucosal infections from pathogens such as C. difficile and C. albicans, has been well established. This study demonstrates that antibiotics also significantly increase the risk of developing CRS, an effect that is driven primarily by CRS patients who do not have nasal polyps. Furthermore, premorbid antibiotic use could account for approximately 25% of our patients who developed CRS, and exposure conferred a worse disease-specific quality of life.

An interesting study (published in September 2015) looked at how prevalent biofilms are in the sinuses of people with chronic sinusitis (with or without nasal polyps) as compared to healthy people (without chronic sinusitis). Biofilms are communities of bacteria sticking to one another and coated with a protective slime. The researchers found that the most biofilms were found in people with chronic sinusitis who also had nasal polyps (97.1%) , followed by those with chronic sinusitis without nasal polyps (81.5%), and the least in the control group of healthy patients (56%). They felt that the biofilms contributed to or had a role in chronic sinusitis. But note that the majority of people in all groups had biofilms.

Unfortunately nowhere in the study was there an analysis of the bacteria making up the biofilms. Are the bacteria in the biofilms different in the healthy people versus those with chronic sinusitis? The general assumption is that biofilms are formed from pathogenic (bad) bacteria such as Staphylococcus aureus, but it is known that beneficial bacteria such as Lactobaccillus plantarum and Lactobacillus reuteri can also form biofilms. One study concluded that: "L. reuteri biofilms secreted factors that confer specific health benefits such as immunomodulation and pathogen inhibition." So what was in the biofilms of healthy people (without chronic sinusitis)? Were the biofilms in healthy sinuses made up of protective beneficial bacteria or pathogenic bacteria that were kept in check by other "beneficial" microbes (which can be bacteria, fungi, viruses, etc) in the sinus microbiome?

Biofilms are very hard to eradicate, even with antibiotics. The researchers mentioned that "To date many different modalities have been tested, from Manuka honey to ultrasound and surfactant, but none have been shown to be very efficient." However, they did not mention other bacteria (probiotics) as a treatment possibilty in eradicating biofilms in the sinuses. There has been research looking at using probiotics against biofilms elsewhere in the body (such as dental plaque on teeth).

If biofilms from pathogenic bacteria are so pervasive in chronic sinusitis (81.5% to 97.1%), then it appears that some bacteria such as Lactobacillus sakei somehow predominate over them. I am saying this based on the majority of people writing to me saying that L. sakei treated their chronic sinusitis, as well as the experiences of my own 4 family members (at least 3, perhaps all 4 of us probably had biofilms in our sinuses based on the 81.5% to 97.1% numbers in this research). Something to contemplate. From the journal Acta Oto-Laryngologica:

Bacterial biofilms in chronic rhinosinusitis; distribution and prevalence.

Biofilms were more prevalent in patients with CRSwNP [chronic rhinosinusitis with nasal polyps] compared to both CRSsNP [chronic rhinosinusitis without nasal polyps] and controls [healthy people], and also on the ethmoid bulla compared to the middle turbinate, supporting a biofilm-related pathogenesis of CRSwNP....This study comprised 27 patients with CRSsNP, 34 patients with CRSwNP, and 25 controls.

Chronic rhinosinusitis (CRS) is today understood as a multifaceted group of diseases. The most established differentiation is between CRS with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP)....Patients with CRSwNP have the worst quality-of-life scores, and they have frequent recurrences of their symptoms after surgery.

The pathophysiology of nasal polyps is poorly understood. Bacterial infection, in the form of biofilms, is proposed as a major drive behind the inflammation in CRS. Bacterial biofilms is identified as the agent behind an ever increasing number of chronic infectious diseases, ranging from endocarditis to dental caries. Bacterial biofilms are communities of bacteria in their sessile form, and can be extremely difficult to eradicate with conventional antibiotic therapy.

The total number of patients in the CRS group was 61, 23 females and 38 males, and median age was 40 years....Bacterial biofilms were detected in 97.1% of patients with CRSwNP, 81.5% of patients with CRSsNP, and 56% of controls. Patients with CRSwNP had highly significantly increased prevalence of biofilms compared to controls....The prevalence of biofilms in different anatomical locations within the nasal cavity differed....Biofilms were detected in 79.6% of the samples from the ethmoid bulla, 70.9% of the samples from the uncinated process, and 62.0% of the samples from the middle turbinate.

In this study a significantly increased prevalence of biofilms were found in patients with CRSwNP compared to controls, but also compared to CRSsNP. Indeed only one of the patients with CRSwNP was biofilm negative. This indicates a role for biofilms in the pathogenesis of CRS, but specifically in CRSwNP.

The pathophysiological mechanisms underlying nasal polyps are still poorly understood. Biofilms are shown to be heterogeneous and can be composed of both bacteria and fungi. Staphylococcus Aureus feature prominently in most biofilms found in the sinonasal cavity, being isolated in 50% of the samples. and can possibly facilitate co-colonization with fungi....Bacteria in a biofilm are shown to have up to a 1000-fold increased resistance to antibiotics compared to planktonic bacteria. These features of biofilms make them notoriously hard to eradicate.... In the setting of CRS we have the opportunity of direct local treatment which gives us a greater range of potential treatment options. To date many different modalities have been tested, from Manuka honey to ultrasound and surfactant, but none have been shown to be very efficient....In regards to nasal polyps, further studies are needed to investigate why some patients with biofilms develop nasal polyps while others do not.

Biofilms thrive in moist areas without too much turbulence, conditions found deep in the middle meatus. This may also explain why there were a higher number of biofilm positive CRSwNP patients, as regular nasal polyps originate in the ethmoid....In the opinion of the authors the findings in this article suggest a role for biofilms in CRSwNP.

Bacterial biofilm in a person with chronic sinusitis Credit: Thiago Freire Pinto Bezerra et al,  Braz. j. otorhinolaryngol. (Impr.) vol.75 no.6 São Paulo Nov./Dec. 2009