Probiotics For Sinus Issues - A New Solution | Chris Kresser

Chronic Sinus Problems: Another Role for Probiotics?

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Almost 40 million Americans suffer from chronic sinusitis. Unfortunately, most conventional treatments are not effective and don’t address the underlying cause. Find out why probiotics may represent the future of treating chronic sinus problems.

probiotics for sinuses
Sinus pressure and pain can be debilitating. b-d-s/iStock/Thinkstock

Chronic sinusitis (also known as chronic rhinosinusitis, or CRS) is one of the most common human diseases, affecting 1 in 7 American adults. And like many other modern, chronic conditions, its prevalence appears to be increasing.

CRS is a debilitating and often intractable disease. Over 20 percent of patients are unresponsive to drug therapy, and up to 40 percent of patients do not respond to surgery.

The conventional viewpoint is that CRS is caused by the presence of certain harmful species of bacteria, such as Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. (1) In other cases, CRS may result from an immunologic reaction to fungi that colonize the sinuses. (2) Fungal species associated with this syndrome include Bipolaris specifera and Aspergillus, Curvularia, and Fusarium.

However, in a recent paper out of the University of California, San Francisco, Dr. Susan Lynch demonstrated that the primary difference between patients with CRS and control subjects was not the presence of any particular pathogenic species (which both groups had in similar amounts), but the overall diversity of the sinus microbiome. (3)

This discovery has important implications for how we can successfully treat CRS, and I will come back to it later in the article. But first, let’s take a step back and discuss the sinus microbiome—since this may be the first time you’ve heard about it.

The Microbiome: It’s Not Just about the Gut!

If you’ve been following this blog, listening to my podcast, or have read my book, you’ll know that the gut microbiome is one of my favorite topics.

But I’m not alone. Even mainstream media outlets like The New York Times, Time, The Wall Street Journal, and FOX News have done major stories on the gut microbiome and its importance in health and disease. It’s no longer an exotic concept that only scientists and health care professionals discuss; it’s now a household term.

Could probiotics be the answer to chronic sinusitis and nasal congestion?

Yet while it’s true that the majority of microbes that comprise our microbiome live in the gut, it’s also true that we have microbes in other areas of our bodies that play similarly important roles in maintaining health and preventing disease. These areas include the skin, vagina, penis, mouth, respiratory tract, and—you guessed it—the sinus cavity.

Prior to the development of DNA/PCR technology, our ability to determine the composition of microorganisms in these various areas was extremely limited. But thanks to recent advances in technology, we now have a much better idea of what “normal” and “abnormal” microbiomes look like—not only in the gut, but also on the skin and the penis and in the mouth, respiratory tract, and sinuses.

This understanding has profound implications for how we view the pathogenesis of diseases like CRS, and in turn, what treatment options might be available to patients in the future.

It’s the Forest That’s Important, Not the Trees

As I was reading Dr. Lynch’s seminal paper, I came across the following quote, which summarizes the importance of these recent discoveries and how they will change our approach to treating conditions that are microbial in their origin:

Because of extensive use of conventional laboratory culture approaches to detect microbial species, we have been conditioned to view chronic or acute infections as exclusively due to a single pathogenic species. However, recent studies have demonstrated that the composition of the resident microbiota in a given niche can strongly influence the behavior of specific species, particularly pathogens, and, as such, represents an important contributory factor to disease etiology.

The idea here is that it isn’t the presence of a particular pathogen that matters most, but rather the environment in which the pathogen is present. If you extend this idea to thinking about treatment approaches, it follows that focusing on eradicating a particular pathogen or species may be misguided, and that a better approach is restoring microbial diversity.

This has already become evident with the gut microbiome. Clostridium difficile is a virulent infection that still kills almost 30,000 people in the U.S. each year. We’ve thrown every antibiotic we have at it, but they are often ineffective in the most severe cases.

Yet fecal microbiota transplants—which are essentially massive infusions of human probiotics—are over 90 percent effective, even in cases where patients have failed multiple courses of antibiotics. (4)

If we apply this same reasoning to the treatment of CRS, it suggests that probiotics—rather than antibiotics—may be a better solution. Antibiotics may kill harmful species of bacteria, but they are likely to further reduce microbial diversity, which would be expected to worsen CRS over time if Dr. Lynch’s theory is correct.

With this in mind, let’s see what the research has to say about probiotics and sinus problems.

Probiotics for Chronic Sinus Problems

As it turns out, there are several published studies suggesting that probiotics may be an effective treatment for chronic sinus problems.

One review in the Journal of Allergy found that “an emerging number of publications demonstrate beneficial effects using probiotics in clinical double-blind placebo-controlled trials in allergic rhinitis (AR).” (5) Although data on probiotics and non-allergic CRS are lacking, there are several lines of evidence to suggest that probiotics may be effective in these cases.

First, probiotics have been shown to disrupt biofilms, which are present in CRS and difficult to eradicate through other means. (6)

Second, both human and animal studies have shown that oral probiotics reduce colonization of the nose and upper respiratory tract by pathogenic bacteria (e.g., Staphylococcus aureus, Streptococcus pneumoniae, and β-hemolytic streptococci). (7, 8)

Third, upper respiratory tract infections often precede the development of CRS, and probiotics have been shown to be effective in preventing them. (9)

Finally, although this is certainly not peer-reviewed evidence, I can tell you anecdotally from my work with patients that many CRS sufferers do seem to improve with strategies aimed at restoring the microbiome—such as eating more fermentable fiber and fermented foods, and/or taking prebiotics and probiotics.

Future Directions: Nasal Probiotic Sprays for Repopulating the Sinus Microbiome?

So far we’ve been talking about the role of oral probiotics in treating CRS. But if a disruption of the sinus microbiome is the true underlying cause of CRS, wouldn’t it make more sense to address that more directly?

Dr. Lynch found that most patients with CRS are lacking in a particular species of bacteria called Lactobacillus sakei. This bacteria is a natural, protective species in our nose, but (as the name implies) it is also used to make certain fermented beverages and foods like sake and kimchi.

One might suspect that Dr. Lynch and her peers are developing a nasal spray that contains Lactobacillus sakei to be used in the treatment of CRS. Of course such a treatment will have to be developed and tested for safety and effectiveness in human clinical trials.

Given that this may take several years, some folks have decided to take matters into their own hands, er, noses.

A blog called Lacto Bacto, which is written by CRS sufferer Mara Silgailis, describes a DIY approach that appears to have helped many people with CRS. It involves putting small amounts of kimchi juice directly into the nostrils. According to Mara, she has essentially cured herself and her family of their long-term CRS, and they have been antibiotic-free for more than two years.

Along the same lines, I’ve heard anecdotal reports from patients and people online who have created DIY nasal probiotic sprays and even crushed up probiotic tablets and sniffed them, achieving somewhat miraculous results.

Of course I can’t recommend or endorse these procedures, because they haven’t been tested for safety or efficacy. It would seem that the risk is relatively low, but it’s at least possible that some of the other microbes in kimchi or other oral probiotics may not be beneficial for the sinus microbiome. We’re really just starting to scratch the surface in this area of research, and there’s still a lot that we don’t understand. So if you decide to perform these experiments at home, proceed at your own risk!

Okay, now I’d like to hear from you. Do you suffer from CRS? Have you tried oral probiotics? If so, with what result? What other treatments have you found to be effective? Please let us know in the comments section.

254 Comments

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  1. Hey there everyone! So I was diagnosed with Marcons about a year ago. Been doing the standard BEG and silver/edta sprays without much success. Since Marcons ruins everything from VEGF to ADH, androgens to thyroid…….whatever you can do to get rid of it you want to try. So after reading this and going on to Lactobacto and then to Lacto Sinus I tried the nasal L. Sakei. On three different occasions of trying it I woke up in almost a static shock state barely being able to move, being very dizzy, etc. As I assumed my BP was in the toilet. This morning it was down to 96/48…..hence feeling horrible. As lots of Marcons die off can lower VEGF I am assuming the L Sakei is working so well it is doing the same thing. So just proceed with caution. Low BP can be a bit scarey. Not sure if I will continue it but it is stirring the pot!

  2. I have suffered from cronic sinus infections for years. I usually end up in the doctors office 1-2 times a year and prescribed antibiotics. I also have constant drainage. I started using probiotics about 3 weeks ago for a completely different issue and I noticed my nasal issues have stopped (which is why I googled if probiotics can benefit the sinuses and ended up here). I will continue to use them, but the changes I have already noticed are great!

  3. I’d be careful with snorting probiotics. I read a study published by NPR about probiotics to clear up nasal infection, and proceeded to try it DIY. I made it a lot worse. I think the bacteria that are beneficial to your gut are not the same as the ones beneficial to your nose. 🙂 Inhaling steamed vapors of essential oils like tea tree and oregano are very helpful to me in controlling nasal infections. I even cleared up the self-inflicted probiotic infection with oils!

  4. After eating fermented veg I made, I can breath though my nose for the first time in my like !!!

    • Hey Gregor,

      How often are you ingesting your fermented veg and for how long until you saw results? Very interested in trying it out!

  5. I find it interesting that an article whose main point that it’s not so much the presence of individual pathogenic microbial strains which causes problems in the sinus cavities (but rather the overall lack of a diversity of microbial species in the sinuses), should end with the following warning:

    “Of course I can’t recommend or endorse these procedures, because they haven’t been tested for safety or efficacy [….] it’s at least possible that some of the other microbes in kimchi or other oral probiotics may not be beneficial for the sinus microbiome.”

    Hello! Didn’t we just learn the profound lesson that the presence of “un-beneficial” strains DOSEN’T MATTER like this?
    So why are we then advised to be complacent for fear of unknown “un-beneficial” strains being placed into the sinus cavities? We are being warned against creating a diversity of unknown microbial strains in our sinus cavities, right after being told that the greater the diversity of microbial strains leads to increased health. I guess we really *are* conditioned to the old ways of scientific thinking!

    • Because many of the old ways of scientific thinking are still extremely useful and relevant. The human body is so amazingly complex — you can’t apply general principles and expect them to hold across the board, since there are too many variables. It’s not enough that arguments ring true. Everything must be tested against . Otherwise we might as well be just dealing with truthiness, post-truth, or “alternative facts.” The internet is full of unsubstantiated nutritional and health advice.

  6. I’ve read quite a bit of different research on this over the past few years and I think that our gut bacteria is the key to all problems to be honest, so I think it is 100% plausible that our sinuses and everything else are the same way.
    I am 25 F, I am physically very healthy, I exercise and I eat as healthy as I can. I live in FL. I have PMDD, Gastroparisis, GERD, ADHD, some anxiety and panic attacks, I have had to take Allegra D since I was a teen, had to stop because it was making me crazier, switched to Allegra and was fine for a while and then it just stopped working and I could even function, I cannot take any corticosteroids, they also make me crazier. I tried every drug on the market, as of now I take Allegra everyday and singular as it helps a little with post nasal drip. Without regular Allegra I get very itchy all over and that’s one reson why I was started on it in the first place. I had a test done, I’m allergic to Bioparis sorokiniani and Bermuda grass pollen. I feel best being outside. I lost my job because of all this and I can now only work outside. I found that many of my problems are slightly better when we have raw milk to drink, it also helps with my BF’s bi polar. I take the strongest prescription on the market for my stomach problems (Dexilant), which I believe they don’t full know what I have and just gave me two conditions that for the most part sum up what’s wrong. I still struggle with my stomach everyday and my sinus problems make it worse and my stomach makes my sinus problems worse, it’s never ending. I love to drink kombucha and kefir too, I do feel they help, but of course everything that I need is expensive, and we can barely pay our bills. I am so miserable all the time, it can really wear on me and get me down, especially because of my other problems. I feel like I need to be studied or something, I want to be cured and I feel like at least if I have to suffer like this it should help science and possibly my condition someday. I am going to try to add more probiotics and probiotics to my massive regiment, just have to find the money.

    • Hi, me too. Seriously.

      4 things that really help me with the worst of it – Finding out I have silent reflux! Literally can not eat acidic foods anymore or I get throat, ear, sinus and stomach problems. Also, Neti sinus rinse every day, Dr. D’Adamo’s blood type diet and Acupuncture every other week during allergy season. The neti and the acupuncture can be quite cheap. I get community acupuncture. Blood type diet is also cheap to get started and it’s not that expensive to remove highly suspect food stuffs from your diet.

      We do really need personalized medicine through genetic typing. It’s coming, but not fast enough. In the meantime, I try everything that seems to help people and keep only what works for me. Haven’t tried sinus or oral pro-biotics but am looking into it.

      Also, some people are just more sensitive to environmental pollution and have a harder time metabolizing/not absorbing all the junk that is being thrown into the air and water. Also can not take any prescribed or otc for severe allergies that keep me hiding inside and/or wearing face mask outdoors for all of spring/summer in the Pacific Northwest. (And it’s only here that I have the worst allergies!) My reactions to the doctor meds are worse than the allergies sometimes.

      Good look and keep at it!

    • Have you heard of MCAS? It may explain some of your prproblems. I agree, many of our issues stem from gut dysbiosis, but there may be some other issues at play. Hope you find some answers or relief soon. I may try FMT.

      • Ms. Owen please look into getting on a probiotic immediately ( I use renew life 30 billion) . Im also a believer that healthy gut bacteria is the key to healthy sinuses. I moved to FL when i was 18 and developed horrible nasal allergies out of nowhere and even visiting my home state of RI I had terrible sinus congestion. Had surgery for a deviated septum which helped aleviate the allergies some more then I became immune to Claratin D from taking it for so long, years down the road. All of the sudden NO drugs worked and it was hell. Was turned on to oregano oil as an antibacerial and anti fungal and probiotics. It takes a month or two for the probiotics to build up in your gut but once they do its amazing and have cured my horrible nasal congestion due to sinus allergies.

    • Ms. Owen,
      I suffered from sinus infections for many years until 2015 when I started taking an approach to heal my gut. I believe that the key to optimal health stems from your gut. I can honestly say that I have not had a sinus infection in over 2 years. If you would like more info let me know I would love to share what has helped me.
      Jean

      • I would love to know how you did it. I am dealing with dry inflamed nasal passages due to over use of zycam spray and am miserable. I get this it seems after a bout of stress and not eating healthy.

  7. I just got diagnosed with AERD after two years of the generic “chronic sinusitis” diagnosis from multiple doctors, and recommend that anyone with nasal polyps take a look at this website to see if this could be your problem: http://aerd.partners.org/. Brigham Women’s Hospital seems to be the foremost expert on this area and this website is fabulous. I’d love to have Chris bring a researcher on AERD onto the show (and I’d love to hear if they think there could be any link between the microbiome and AERD, since all research seems to be looking at diet but not explicitly calling out the potential role of microbes in this).

    • I also have Samters Triad (AERD) and believe the unbalanced microbe in the nasal cavities and respiratory system (including lungs) is the problem. If anyone can let me know if some probiotic products which I can try to sniff, I’d be grateful. I’m happy to experiment. Surely though, probiotics for the intestines contain different bacteria than those for the nasal and lungs?

    • Please look at the post The One Probiotic That Treats Sinusitis at the site Lacto Bacto.
      It has brands and products that my family and people have written in as working – as well as some other probiotics (besides L. sakei) that may (or may not) work.
      It’s like an experiment in progress to get reader feedback over what works and doesn’t…

  8. I was a chronic sinus infection sufferer, on the other hand my wife never gets anything when she gets a cold, no sinus infections, no strep throat, no bronchitis. So one day when she was taking a hot shower I had her swab the inside of her nose with a q tip. I then put that in my nose. That was five years ago and I haven’t had a sinus infection since, after having horrible ones for forty years.

    • I was thinking about doing that but was a bit freaked out. It makes sense that a healthy sinus must have all the correct bacteria for good sinus health. Have to get my head round it.

  9. I was looking for information to support my own findings and found this article. My nine year old son and I have been using a homemade yogurt based sinus spray for over two years now with amazing results. Before this the doctors were talking about surgery for my son’s chronic sinus issues. Now he has little to know sinus problems. As an added benefit the sinus spray has reduced my own asthma issues by about 90%.

    • Wow. Do you have the recipe or where I can get this?
      The Ent doctor said I need sinus surgery. But my gut feeling is saying probiotics will work. Plz share where you buy this or the recipe. I am desperate to try this. ?

  10. I can report on my n=1 trial I did last year in which I filled an empty nasal spray bottle with kimchi juice and squirted it up my nose each night for a week. After I tilted my head to the side so the juice would drip into the sinus.

    Amazingly this cleared up a chronic sinus infection that had been bothering me for months before.

    I can only caution against the risks associated with such crazy experiments, which Chris mentioned in the article, but I was certainly pleased with the results. I would recommend finding a variety of kimchi made without chilli though, as I was unable to, and the chilli hurt like hell….hah! Still pleased though. A couple of months ago I got a nasty cold which has left me with a blockage and constant drip from my left sinus long afterward, so I’m going to be trying it again soon!

    • I’m glad the kimchi spray worked, but it is not necessary to spray it up the nostrils – just try dabbing or smearing a little (no more than 1/2″ in) into the nostrils like a really “messy eater”. The L. sakei, if the kimchi has it, travels up to the sinuses on its own.
      My family has been doing this successfully (when needed) for 4 years now – I described the method and various L. sakei sources at my site Lacto Bacto (especially see the post “The One Probiotic That Treats Sinusitis”). This post also has information on what people have told me about L. sakei products.

      • I read all your articles. They gave me hope. I have had chronic sinus infection for over a year. I just did the kimch this morning and night ….rubbed the juice 2 inches up nostril and then sniffed in gently. How many days did it take to cure it?
        What did your Ent say when you found this miracle cure ?

        • We only smear/dab it about 1/2″ into the nostrils. (see Sinusitis Treatment Summary page for details).
          If the kimchi has Lactobacillus sakei in it, then we start feeling better within a day. If we’re really sick (acute sinusitis) then first it stops getting worse, then drains, then improves (just like with antibiotics).
          We were 100% normal/healthy in less than 3 weeks initially.
          If using a stronger Lactobacillus sakei product, the initial response may be quicker.

          Whether or not a kimchi jar has L. sakei in it varies – trying it out is the only way to know. There are other beneficial microbes in kimchi also – some of which are antifungal and antibiofilm. I suspect L. sakei is not only anti-bacterial, but also anti-fungal and anti-biofilm.
          Unfortunately the L. sakei does not stick around in the sinuses (doesn’t colonize) so we have do do another treatment when we get sick. Getting back to normal is a much faster process now., so there probably have been sinus microbial changes over the last few years.

          By the way, none of us has seen an ENT in 4 years – why would we go if we’re fine?

          • Thank you Mara ! You are a God send to me.
            I asked you about the ENT reaction because I’ve heard many other comments that the medical establishment gets mad at the natural cure ect..
            Sooo glad to hear that you and your family don’t need them anymore !
            My family and I have juiced vegetables for 20 years and never see doctors, except for physicals. I consult many times with our natural doctor who has been right about everything! This Cronic sinus infection came because of a failed tooth bone graft for a tooth implant. I have been suffering for 2 years with it. I was forced to go to ENT and devastated when he said I need surgery.
            Need so badly for this natural cure to work.
            I’m using Micro mamma kimchi 2x a day. Several applications 1/2 inch into nostril like you said. Using for 4 days now. Can’t tell if it’s working.
            May I ask you what is the kimchi you use?
            I’m in Massachusetts.
            My husband is so tired of this he said he wants
            The natural healing first but if I don’t get healed by April he wants me to do surgery.
            I am praying to God that he will heal me through this by then and save me from surgery.
            Thank you to you and Lacto baco and Susan lynch for the study in science translational medicine !

            • Right now we’re using Sunja’s white kimchi (at Whole Foods or Fairway Market) or Sunja’s medium cucumber kimchi. Whether the kimchi works or doesn’t work depends on if there is Lactobacillus sakei in that batch.
              There should be some improvement within a few days if the jar contains L. sakei.

              • Thank you for all your support.
                I would love to do a probiotic net pot. Is that what you use the Bactoform F- RM-52 for ? Also where to you get this ?
                On your website Lacto baco, Sima said she got great results from this.

                • We use Bactoferm F-RM-52 in a similar way as kimchi by dabbing/smearing a little in each nostril, or can spoon in a little bit into each nostril (but first mix a little with bottled water). I have never used a neti pot with any product.
                  Many people have reported positive results with Bactoferm F-RM-52.
                  It has to be ordered from a sausage making supplier- because it’s used as a sausage starter (the L. sakei in it are anti-pathogenic).
                  Only use when needed.

                • I have any ther question with regard to Bactoferm F-RM-52 . Do you buy he freeze dried? How do you mix it to apply to nostril? Thank you

                • If research by Dr. Lynch has shown that most patients with CRS are lacking L. Sakei. Yet above Mara Silgailis says:
                  “Unfortunately the L. sakei does not stick around in the sinuses (doesn’t colonize) so we have do do another treatment when we get sick”.
                  Does it not then stand to reason that the lack of L. Sakei should be characteristic to everybody and not just CRS sufferers?
                  I am confused. What am I missing here?

      • I have read all your articles. I have had chronic sinus infection for over a year and desperate. I put the kimchi in this morn and night 2 inches up nostril and sniffed.
        How many days did it take to cure ?
        What was your ENTs reaction ?

      • Plz answer the 7:41 (time)comment …. The later comment i put i forgot to check to give me email.

  11. Found a sausage starter culture with the same bacterial cultures as f-rm-52. It’ll probably arrive tomorrow. I’m on pretty heavy anti inflammatory drugs now, but I guess this is not going to cure me. Fingers crossed, and I’ll keep you folks posted.

  12. Love it! Properly researched and lots of great info for us lay people.

    “First, probiotics have been shown to disrupt biofilms, which are present in CRS and difficult to eradicate through other means.”

    I’m on the hunt for more info regarding biofilms – do you have any tips as to where I can find more info on them, Chris?

    • Regarding biofilms they certainly can protect harmful cultures from being eradicated through conventional and holistic medicines. I have read to help probiotics in breaking down biofilms it can be helpful to use enzymes such as serrapeptase.

      • I have found the Neti-Pot with J&J baby shampoo has done wonders to interrupt the bio-film as well. Look it up. There was a great study out of Baylor I believe. (Yes, sounds crazy, I know.)

  13. Hi there!
    Finding your website has changed my life!!!
    Really! I am in my late fifties, Irish and working in the Middle East where dust is constantly in the atmosphere. Over the past two years I have been suffering from chronic sinusitis. I began thinking that feeling low in energy and basically no enthusiasm for anything was because I was pushing sixty! I had taken several courses of antibiotics which cleared the symptoms sometimes for a week or so only to return yet again. I was at the end of my tether…. Then while researching on the net I came across this website.
    I bought Ultimate Flora, crushed a tablet in my saline solution on two occasions and then took one a day orally. After one week the infection cleared up and i am anew woman. Full of energy with no wish to retire which was a daily thought before.
    Thanks so much!
    Touch wood!
    Geraldine

    • Thank you for sharing this Geraldine! I am an American 40 yr old woman of Irish descent and have had three major sinus surgeries. I am tired of taking antibiotics and steroids all the time and refuse to have another surgery. I’m on day two of opening a probiotic capsule and putting it into my NeilMed Sinus Rinse. I’m so happy to have read people are having good results with this. I have reached the point of desperation and am praying this works

      • Hi, can you let us have an update on how this is working for you? I’d be surprised if it works, as the flora in the nasal passages is different to the flora in the gut. However, I’d be so happy to be proved wrong!

    • Do you remember which ultimate flora you broke up to put in neti pot ?and did your sinus take it ok or were you sore ?
      Thank you !
      And yes finding this website has also changed my life !
      Thank you Chris.