Length of the Marshall Protocol

The exact length of time the Marshall Protocol (MP) takes depends on any number of factors, including degree of illness, amount of fibrosis, subclinical inflammation, the functionality of the kidney, and personal preference to remain on the MP.

While someone who is very ill can expect the MP to take in the range of 3-5 years, there is no way to know for sure how long the treatment will take. Due to the nature of immunopathology, feelings of well-being and blood markers of disease tend to be variable in the short-term and improve over the long-term. Also owing to the nature of infection, different symptoms will improve at different rates.

So long as one is responding to antibiotics with symptoms that wax and wane, there are still bacteria to be killed.

Note that there is no requirement that patients reach the maximum dosages for all antibiotics or do all antibiotic combinations in order to complete the Protocol. In many cases, patients can make considerable progress on olmesatan (Benicar) alone due to production of the body's own antimicrobial peptidesBody’s naturally produced broad-spectrum antibacterials which target pathogens.. However, it is considered ideal to stay on the Protocol until one has tried all the combinations and no longer experiences immunopathological reactions from the antibiotics.

The goal of the MP is to eradicate the bacteria that cause inflammatory disease. Many of these bacteria live deep in tissues that may be hard to penetrate with antibiotics. Others are intraphagocytic, living in the very cells meant to kill them. While it's not known how many species of bacteria or how many bacteria cause inflammatory disease, one recent estimate has it that nine out of ten cells in the human body are bacterial; so it may prove to be a lot indeed.

When patients first begin the MP, they use low-dose, pulsed minocycline to reduce patients' bacterial load. But not all those bacteria will be susceptible to minocyline alone. Patients who move to Phase Two, where a second low-dose, pulsed antibiotic is added, probably still have many varieties of bacteria to eliminate. Minocycline potentiates the second antibiotic to weaken different bacteria. This combination is continued until one no longer has much of an immune system reaction and that may take 3-18 months or more. At this point, there may still be some remaining bacteria that aren't susceptible to this combination, even if one no longer has any disease symptoms.

Later on, additional low-dose, pulsed antibiotics are used in various combinations to make sure that there are no remaining bacteria as evidenced by no immunopathology, no disease symptoms, and blood work returns to normal.

Many of the patients on the MP, especially the early adopters, were very sick indeed. Some may have even been too sick to complete the MP. However, as the MP has been shown to induce recovery in serious forms of chronic disease, a number of patients have begun to use the treatment to treat a couple minor symptoms or as a prophylactic. These patients have reported a shorter and considerably less arduous trajectory of recovery.

The range of time it takes seriously ill patients to recover on the MP is not entirely without precedent in medicine. The preferred regimen for the treatment of latent tuberculosis infection is 9 months of isoniazid.¹⁾– and that's only a single genus as opposed to a metagenomic microbiota. Note that both treatments are intended to kill intracellular pathogens. It's also worth noting that recovery from tuberculosis also involves an immunopathological-type reaction.²⁾

• Degree of illness – If the disease process has advanced to the point where symptoms are extremely debilitating or vital organs are severely compromised, it may be very difficult or even impossible to tolerate the immunopathology involved in the healing process. MP patients must improve with all due caution. It is ultimately up to individuals to decide what level of symptoms they are willing or able to tolerate and up to the doctor to monitor biological processes to make sure they stay within acceptable limits.
• Degree of health desired – Different patients have different tolerances for what level of symptom reduction is acceptable.
• Prior use of immunosuppressants and immunomodulatory medications –
• Fibrosis – When the immune system fails to kill a pathogen, it encases the diseased tissue in collagen. This process is known as fibrosis. MP patients with fibrosis can expect to be killing pockets of these for a long time, extending the length of the treatment, as the fibrosis remodels.

There are different ways to chart one's progress on the MP. Patients can compare:

• symptom severity before the MP vs. while taking antibiotics on the MP
• symptom severity before the MP vs. while on the MP, but having abstained from antibiotics for a couple months (giving enough time for the antibiotics, especially azithromycinBacteriostatic antibiotic used by Marshall Protocol patients. Has relatively long half-life., to be fully metabolized)
• symptom severity before the MP vs. during the 4-6 hours after taking a dose of azithromycin (Zithromax)Bacteriostatic antibiotic used by Marshall Protocol patients. Has relatively long half-life.
• symptom severity during adolescence vs. while taking antibiotics on the MP
• blood markers before the MP vs. during the MP (although it should be noted that specialists still cannot reliably diagnose a disease with blood work)

Patients can also keep track of changes in activities of daily living and ability to take on additional work and home responsibilities.

The following curves were assembled with patient data. What they show is the range of times to complete Phase One and Phase Two among approximately 100 survey respondents. While the charts are from actual patients, there is a myriad of factors which can affect the progress and length of time for each individual; thus the charts should only be used as a general guideline. Patients are strongly advised to proceed to the next phase only if their immunopathology is tolerable.

The Phase One chart shows that the short-end was around 40 days, and the long was about 350 days. The average was around 120 days, with the bulk of patients between 70 and 150 days.

The Phase Two chart shows that the short end was around 80 days, and the long was about 500 days. The average was around 250 days, with the bulk of patients between 200 and 300 days.

To a large extent, patients who have completed the Marshall Protocol can return to a normal life with the following modifications:

• consumption of vitamin D – MP patients are free to enjoy foods such as fish that naturally contain vitamin D. Even so, patients are encouraged not to consume any food products that are fortified with extra vitamin D.
• light – Although suntanning is not an option, veterans of the MP may choose to expose their eyes and skin to increasing amounts of light. A word of caution: some patients in later stages of treatment may experience a Stage Five reaction when exposed to too much light. To limit the possibility of a severe immunopathological reactionA temporary increase in disease symptoms experiences by Marshall Protocol patients that results from the release of cytokines and endotoxins as disease-causing bacteria are killed., always increase light exposure (and exercise) gradually. Also, be aware that sometimes an increase in symptoms from light may begin one or two days after exposure and last for several days or even longer.
• antibiotics – In later stages of the MP, the immune system is self-sustaining and can eradicate bacteria without antibiotics. However, there is no harm in using a couple weeks' worth of MP antibiotics as an annual checkup.
• olmesartan (Benicar) – In later stages of the MP, the Vitamin D ReceptorA nuclear receptor located throughout the body that plays a key role in the innate immune response., which controls innate immunityThe body's first line of defense against intracellular and other pathogens. According to the Marshall Pathogenesis the innate immune system becomes disabled as patients develop chronic disease., is properly working again and can be activated without olmesartanMedication taken regularly by patients on the Marshall Protocol for its ability to activate the Vitamin D Receptor. Also known by the trade name Benicar. . Under these circumstances, olmesartan only serves to palliate symptoms.
• laboratory tests – Various tests are expected to come in range:
  • return of ACE, CRP, triglycerides, ALP to low end of normal
  • increase in % lymphocytes, back into the normal range
  • 1,25-D at 25-35pg/ml measured over a six-month interval
  • signs of inflammation resolution on CT and MRI imaging