Marshall Protocol Knowledge Base

Anemia - [Notes and comments]

joyful — 2012-02-08T20:48:17-08:00

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	A simple outpatient two minute check of your stool for blood would rule out your doctor's concerns pertaining to bleeding into the gut.[[http://www.nlm.nih.gov/medlineplus/ency/article/007008.htm\|NIH: Fecal occult blood test]]		A simple outpatient two minute check of your stool for blood would rule out your doctor's concerns pertaining to bleeding into the gut.[[http://www.nlm.nih.gov/medlineplus/ency/article/007008.htm\|NIH: Fecal occult blood test]]

-	Hi Kas, I think you are probably stuck with the anemia until your kidneys heal with the MP because those of us with bad kidneys have at least two factors leading to anemia. Below is something I have posted elsewhere.

-	<blockquote>Anemia	+	<blockquote>Hi Kas, I think you are probably stuck with the anemia until your kidneys heal with the MP because those of us with bad kidneys have at least two factors leading to anemia. Below is something I have posted elsewhere.
		+
		+	Anemia

	Several factors may contribute to the anemia observed for MPers with low kidney function. The production of new RBC is promoted by the cytokine,or hormone, erythropoetin (EPO). In adults it is synthesised by the renal peritubular cells, regulated by the level of blood oxygenation. The mechanism is a negative feedback whereby an EPO transcription factor HIF-1 (for hypoxia-inducible factor) is inactivated by oxygen. Anemia may begin to develop when around 50% of kidney function is lost.		Several factors may contribute to the anemia observed for MPers with low kidney function. The production of new RBC is promoted by the cytokine,or hormone, erythropoetin (EPO). In adults it is synthesised by the renal peritubular cells, regulated by the level of blood oxygenation. The mechanism is a negative feedback whereby an EPO transcription factor HIF-1 (for hypoxia-inducible factor) is inactivated by oxygen. Anemia may begin to develop when around 50% of kidney function is lost.

Pain medications and muscle relaxants - [Types of pain medications]

drtrevormarshall — 2012-02-07T15:30:47-08:00

The over-exuberant Stage-Five immune response

paulalbert — 2012-02-05T20:43:20-08:00

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	* recently unsuccessful at dampening intolerable immunopathology with all recommended measures		* recently unsuccessful at dampening intolerable immunopathology with all recommended measures

-	\\

	Some or all of these may be the case:		Some or all of these may be the case:
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-	===== Sunscreen =====
-
-	<mainarticle> [[home:lifestyle:light:skin_protection\|Skin protection]] </article>
-
-	In Stage Five, a 20-25% zinc oxide sunscreen will still provide some protection if the exposure is under two or three hours.

	===== Limiting the severity of an over-exuberant Stage Five response =====		===== Limiting the severity of an over-exuberant Stage Five response =====

Depression - [Depression]

joyful — 2012-02-04T15:34:40-08:00

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	<IncompleteNotice>		<IncompleteNotice>
-
-	====== Depression ======

	<note warning>If you, or someone you know, is in suicidal crisis or emotional distress please get help. In the United States you can call the Lifeline at 1-800-273-TALK (8255).		<note warning>If you, or someone you know, is in suicidal crisis or emotional distress please get help. In the United States you can call the Lifeline at 1-800-273-TALK (8255).
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	To find out more about the difference you can make in a friend or loved one's life, visit [[http://www.suicidepreventionlifeline.org/GetHelp/WhatIfSomeoneIKnowNeedsHelp.aspx\|What If Someone I Know Needs Help]].</note>		To find out more about the difference you can make in a friend or loved one's life, visit [[http://www.suicidepreventionlifeline.org/GetHelp/WhatIfSomeoneIKnowNeedsHelp.aspx\|What If Someone I Know Needs Help]].</note>
		+
		+	====== Depression ======

	<blockquote>It is my opinion that early and prominent symptoms of Th1 disease are psychological which have been interpreted as anxiety, depression, insomnia, learning disabilities etc. These symptoms like physical ones are exacerbated during effective treatment of Th1 [diseases].		<blockquote>It is my opinion that early and prominent symptoms of Th1 disease are psychological which have been interpreted as anxiety, depression, insomnia, learning disabilities etc. These symptoms like physical ones are exacerbated during effective treatment of Th1 [diseases].

Food and drink - [Food and drink]

inge — 2012-01-31T03:54:50-08:00

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-	A [[.:food:carbohydrates#Low-carb,_insulin-resistance reducing_diet\|low-carbohydrate, insulin-resistant diet]] is recommended for MP patients but not required.	+	A [[.:food:carbohydrates#Low-carb,_insulin-resistance reducing_diet\|low-carbohydrate, insulin-resistance reducing diet]] is recommended for MP patients but not required.

Cancer - [Chemotherapy and radiation]

paulalbert — 2012-01-30T14:02:53-08:00

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	====Chemotherapy and radiation====		====Chemotherapy and radiation====

-	Chemotherapy is aggressively immunosuppressive, and will allow a patient's bacterial load to return, by shutting down your immune system. For example, hepatitis infections(({{pubmed>long:21472116}})) as is pneumocystis pneumonia have been known to become reactivated during chemotherapy.(({{pubmed>long:17458875}})) chemotherapy-induced immunosuppression.	+	Chemotherapy is aggressively immunosuppressive, and will allow a patient's bacterial load to return, by shutting down your immune system. For example, hepatitis infections(({{pubmed>long:21472116}})) as is pneumocystis pneumonia have been known to become reactivated during chemotherapy.(({{pubmed>long:17458875}}))

Metabolism of vitamin D and the Vitamin D Receptor - [Effect of high 1,25-D on nuclear receptors]

inge — 2012-01-23T22:27:20-08:00

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	</blockquote>		</blockquote>

-	At normal levels, the active vitamin D metabolite, 1,25-D, serves an important role in host defense,(({{pubmed>long:19943126}})) but high levels of the hormone are immunosuppressive(({{pubmed>long:19758324}})) (({{pubmed>long:21697250}})) – if for no other reason than the fact that it is calcitriol (1,25-D) and its analogues are used widely to treat autoimmune disease. One of the mechanisms by which 1,25-D may be immunosuppressive (and contribute to symptoms of disease) is by interacting with the body's other nuclear receptors. Selvaraj //et al.// have suggested that the high levels of 1,25-D seen in patients with pulmonary tuberculosis "might lead to downregulation of VDR expression" and that "decreased VDR levels could result in defective VDR signaling."(({{pubmed>long:19219539}})) More recently, Johan Lundqvist's 2011 study showed that, consistent with the 2009 study by Proal //et al.// that "1α,25-dihydroxyvitamin D3 exerts tissue-speciﬁc effects on estrogen and androgen production and metabolism."(({{pubmed>long:21262387}}))	+	At normal levels, the active vitamin D metabolite, 1,25-D, serves an important role in host defense,(({{pubmed>long:19943126}})) but high levels of the hormone are immunosuppressive(({{pubmed>long:19758324}})) – if for no other reason than the fact that it is calcitriol (1,25-D) and its analogues are used widely to treat autoimmune disease. One of the mechanisms by which 1,25-D may be immunosuppressive (and contribute to symptoms of disease) is by interacting with the body's other nuclear receptors. Selvaraj //et al.// have suggested that the high levels of 1,25-D seen in patients with pulmonary tuberculosis "might lead to downregulation of VDR expression" and that "decreased VDR levels could result in defective VDR signaling."(({{pubmed>long:19219539}})) More recently, Johan Lundqvist's 2011 study showed that, consistent with the 2009 study by Proal //et al.// that "1α,25-dihydroxyvitamin D3 exerts tissue-speciﬁc effects on estrogen and androgen production and metabolism."(({{pubmed>long:21262387}}))

	Molecular modeling data show that at high levels, 1,25-D not only binds the VDR but also has a strong affinity for other key receptors that control the body's major hormonal systems including those that regulate the body's sex, thyroid, and adrenal hormones. As 1,25-D rises, it pushes out the molecules that are meant to control these receptors. Compromising these receptors can disrupt the body's ability to regulate temperature, libido, and any number of other functions.[table of affinities needed] Indeed, in the human brain, the VDR tends to be most common in the hypothalamus, which is responsible for these functions.(({{pubmed>long:15589699}}))		Molecular modeling data show that at high levels, 1,25-D not only binds the VDR but also has a strong affinity for other key receptors that control the body's major hormonal systems including those that regulate the body's sex, thyroid, and adrenal hormones. As 1,25-D rises, it pushes out the molecules that are meant to control these receptors. Compromising these receptors can disrupt the body's ability to regulate temperature, libido, and any number of other functions.[table of affinities needed] Indeed, in the human brain, the VDR tends to be most common in the hypothalamus, which is responsible for these functions.(({{pubmed>long:15589699}}))

Non-MP treatments

paulalbert — 2012-01-23T10:48:33-08:00

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	\| [[home:othertreatments:antibacterials:methotrexate\|Methotrexate]] \| methotrexate (MTX) \|{{:home:warning.png?nolink}} \| inteferes with Bactrim DS as well as production of important human metabolites \|		\| [[home:othertreatments:antibacterials:methotrexate\|Methotrexate]] \| methotrexate (MTX) \|{{:home:warning.png?nolink}} \| inteferes with Bactrim DS as well as production of important human metabolites \|
	\| [[.:othertreatments:pain_medication#muscle_relaxants\|muscle relaxants]] \|baclofen (Kemstro, Lioresal, and Gablofen), bentazepam (Thiadipone), carisoprodol (SOMA, Sanoma, Carisoma), chlormezanone (Trancopal), chlorphenesin (Maolate, Musil), chlorzoxazone (Muscol, Parafon Forte), cyclobenzaprine, diazepam (Valium), donepezil (Aricept), eperisone (Myonal), febarbamate, flopropione (Compacsul, Cospanon, Ecapron, Pellegal, Argobyl, Floveton, Saritron, Spamorin, Labrodax, Tryalon, Mirulevatin, Padeskin, Profenon), lorazepam (Ativan, Temesta), ketamine, mephenesin, mephenoxalone (Dorsiflex, Moderamin), meprobamate (Equanil, Miltown, Meprospan), metaxalone (Skelaxin), methocarbamol (Robaxin), naltrexone (Low-Dose Naltrexone (LDN)), nitrazepam (Alodorm, Arem, Insoma, Mogadon, Nitrados, Nitrazadon, Ormodon, Paxadorm, Remnos, Somnite), orphenadrine, phenprobamate (Gamaquil, Isotonil), phenyramidol, pridinol, promoxolane (Dimethylane), quinine (Qualaquin), styramate, tetrazepam (Clinoxan, Epsipam, Myolastan, Musaril, Relaxam, Spasmorelax)), thiocolchicoside (Muscoril, Myoril, Neoflax) , tizanidine (Zanaflex, Sirdalud), tolperisone (Biocalm, Mydeton, Mydocalm, Myolax, Myoxan, Viveo), trazodone (Desyrel, Oleptro, Beneficat, Deprax, Desirel, Molipaxin, Thombran, Trazorel, Trialodine, Trittico, Mesyrel), tybamate \|{{:home:warning.png?nolink}} use as necessary to modulate intolerable immunopathology \|immunomodulatory \|		\| [[.:othertreatments:pain_medication#muscle_relaxants\|muscle relaxants]] \|baclofen (Kemstro, Lioresal, and Gablofen), bentazepam (Thiadipone), carisoprodol (SOMA, Sanoma, Carisoma), chlormezanone (Trancopal), chlorphenesin (Maolate, Musil), chlorzoxazone (Muscol, Parafon Forte), cyclobenzaprine, diazepam (Valium), donepezil (Aricept), eperisone (Myonal), febarbamate, flopropione (Compacsul, Cospanon, Ecapron, Pellegal, Argobyl, Floveton, Saritron, Spamorin, Labrodax, Tryalon, Mirulevatin, Padeskin, Profenon), lorazepam (Ativan, Temesta), ketamine, mephenesin, mephenoxalone (Dorsiflex, Moderamin), meprobamate (Equanil, Miltown, Meprospan), metaxalone (Skelaxin), methocarbamol (Robaxin), naltrexone (Low-Dose Naltrexone (LDN)), nitrazepam (Alodorm, Arem, Insoma, Mogadon, Nitrados, Nitrazadon, Ormodon, Paxadorm, Remnos, Somnite), orphenadrine, phenprobamate (Gamaquil, Isotonil), phenyramidol, pridinol, promoxolane (Dimethylane), quinine (Qualaquin), styramate, tetrazepam (Clinoxan, Epsipam, Myolastan, Musaril, Relaxam, Spasmorelax)), thiocolchicoside (Muscoril, Myoril, Neoflax) , tizanidine (Zanaflex, Sirdalud), tolperisone (Biocalm, Mydeton, Mydocalm, Myolax, Myoxan, Viveo), trazodone (Desyrel, Oleptro, Beneficat, Deprax, Desirel, Molipaxin, Thombran, Trazorel, Trialodine, Trittico, Mesyrel), tybamate \|{{:home:warning.png?nolink}} use as necessary to modulate intolerable immunopathology \|immunomodulatory \|
-	\| [[.:othertreatments:pain_medication\|pain medications]] \|acetaminophen (paracetamol), aspirin, diazepam (Valium), hydrocodone-acetaminophen (Lortab, Norco, Percocet, Vicodin, Xodol), morphine, naproxen (Aleve, Anaprox, Naprelan 375, Naprosyn), oxycodone (Oxycontin), oxycodone-acetaminophen (Oxycocet, Percocet), pregabalin (Lyrica), propoxyphene-acetaminophen (Darvocet, Propox-N), tramadol (Ultracet, Ultram, Ultram ER, Zytram XL) \|{{:home:warning.png?nolink}} use as necessary to modulate intolerable immunopathology \|immunomodulatory \|	+	\| [[.:othertreatments:pain_medication\|pain medications]] \|acetaminophen (paracetamol), aspirin, diazepam (Valium), hydrocodone-acetaminophen (Lortab, Norco, Percocet, Vicodin, Xodol), morphine, naproxen (Aleve, Anaprox, Naprelan 375, Naprosyn), oxycodone (Oxycontin), oxycodone-acetaminophen (Oxycocet, Percocet), pregabalin (Lyrica), propoxyphene-acetaminophen (Darvocet, Propox-N), tramadol (Ultracet, Ultram, Ultram ER, Zytram XL) \|{{:home:warning.png?nolink}} use select medications as necessary to modulate intolerable immunopathology \|immunomodulatory \|
	\| [[.:othertreatments:sleepmeds\|sleep medications]] \|clonazepam (Klonopin, PMS-Clonazepam, Rivotril, Rivotril drops), doxylamine (Dozile, Donormyl, Dormidina, NyQuil, Restavit, Unisom-2 and Sleep Aid, Somnil), doxepin (Silenor), eszopiclone (Lunesta), melatonin, Nytol, temazepam (Restoril, Temazep), trazodone (APO-Trazodone, Desyrel, Donaren), zolpidem (Ambien, Ambien CR, Hypnogen, Stilnoct (Stilnox)) \|{{:home:warning.png?nolink}} take lowest possible dose to reduce intolerable symptoms; wean as symptoms allow \| \|		\| [[.:othertreatments:sleepmeds\|sleep medications]] \|clonazepam (Klonopin, PMS-Clonazepam, Rivotril, Rivotril drops), doxylamine (Dozile, Donormyl, Dormidina, NyQuil, Restavit, Unisom-2 and Sleep Aid, Somnil), doxepin (Silenor), eszopiclone (Lunesta), melatonin, Nytol, temazepam (Restoril, Temazep), trazodone (APO-Trazodone, Desyrel, Donaren), zolpidem (Ambien, Ambien CR, Hypnogen, Stilnoct (Stilnox)) \|{{:home:warning.png?nolink}} take lowest possible dose to reduce intolerable symptoms; wean as symptoms allow \| \|
	\| [[.:othertreatments:statins\|statins and other anti-cholesterol drugs]] \| statins – atorvastatin (Lipitor), cholestipol (Cholestid), colesevalam HCL (Welchol), ezetimibe (Zetia), ezetimibe and simvastatin (Vytorin), fenofibrate (Tricor), fluvastatin (Lescol), lovastatin (Mevacor), Omacor, pravastatin (Pravachol), rosuvastatin (Crestor), simvastatin (Zocor); gemfibrozil (Lopid, Gemcor), cholestyramine (Questran), pantethine, Red yeast rice (monascus purpureus) \|{{:home:stop.png?nolink}} wean \|immunomodulatory \|		\| [[.:othertreatments:statins\|statins and other anti-cholesterol drugs]] \| statins – atorvastatin (Lipitor), cholestipol (Cholestid), colesevalam HCL (Welchol), ezetimibe (Zetia), ezetimibe and simvastatin (Vytorin), fenofibrate (Tricor), fluvastatin (Lescol), lovastatin (Mevacor), Omacor, pravastatin (Pravachol), rosuvastatin (Crestor), simvastatin (Zocor); gemfibrozil (Lopid, Gemcor), cholestyramine (Questran), pantethine, Red yeast rice (monascus purpureus) \|{{:home:stop.png?nolink}} wean \|immunomodulatory \|

Tools for doing the Marshall Protocol - [Recording symptoms and medications] removed links to defunct phase 3 meds chart and defunct diary site

joyful — 2012-01-22T17:23:47-08:00

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	* [[http://www.carouselcharts.com/JHR_tracking2.pdf\|Phase 1 Symptom Chart - blank]]		* [[http://www.carouselcharts.com/JHR_tracking2.pdf\|Phase 1 Symptom Chart - blank]]
	* [[http://www.carouselcharts.com/JHR_trackingP2-3openZ.pdf\|Phase 2/3 Symptom Chart]]		* [[http://www.carouselcharts.com/JHR_trackingP2-3openZ.pdf\|Phase 2/3 Symptom Chart]]
-	* [[http://autoimmunityresearch.org/phase_2_chart.pdf\|Phase 2 Medication Chart]]

	==== Online diaries ====		==== Online diaries ====
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	* [[http://www.onlinediary.net\|OnlineDiary.net]]		* [[http://www.onlinediary.net\|OnlineDiary.net]]
	* [[http://www.diaryland.com\|DiaryLand.com]]		* [[http://www.diaryland.com\|DiaryLand.com]]
-	* [[http://www.mydeardiary.com\|MyDearDiary.com]]

Therapeutic probe - [Instructions]

paulalbert — 2012-01-21T14:59:14-08:00

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	The therapeutic probe consists of three elements:		The therapeutic probe consists of three elements:
-	* Restriction of vitamin D – Limit consumption of foods and supplements which contain vitamin D. Restrict skin and eye exposure to light. //The level of 25-hydroxyvitamin-D in the bloodstream should be below 20ng/ml before initiating the therapeutic probe.// If higher levels are present, please seek suggestions from the community at the MP websites.	+	* Restriction of vitamin D – Limit consumption of foods and supplements which contain vitamin D. Restrict skin and eye exposure to light. //The level of 25-hydroxyvitamin-D in the bloodstream should be below 20ng/ml before initiating the therapeutic probe.// If higher levels are present, please seek suggestions from the community at the MP websites. Note that discontinuing vitamin D may cause a patient to temporarily feel more symptomatic due to a withdrawal effect.
	* Regular doses of olmesartan medoxomil (Benicar) – Take 40mg of Benicar every six hours. If the response to treatment is especially strong, the patient and may need four hourly dosing for palliation. When Benicar is first taken, the body may rebalance hormones. This symptom often diminishes after a few days, but a period longer than two weeks may be required with some individuals. Members who decide to remain on Olmesartan because of an immunopathology response may need to quickly buy or borrow a pair of NoIR glasses, which block all infrared light, something most sunglasses do not.		* Regular doses of olmesartan medoxomil (Benicar) – Take 40mg of Benicar every six hours. If the response to treatment is especially strong, the patient and may need four hourly dosing for palliation. When Benicar is first taken, the body may rebalance hormones. This symptom often diminishes after a few days, but a period longer than two weeks may be required with some individuals. Members who decide to remain on Olmesartan because of an immunopathology response may need to quickly buy or borrow a pair of NoIR glasses, which block all infrared light, something most sunglasses do not.
	* Only if necessary to elicit a response, add pulsed low doses of minocycline - Begin with 25mg every other day and ramp by 25mg increments up to a maximum of 100mg every other day.		* Only if necessary to elicit a response, add pulsed low doses of minocycline - Begin with 25mg every other day and ramp by 25mg increments up to a maximum of 100mg every other day.

Notes on foods containing vitamin D, including substitutes

joyful — 2012-01-17T22:46:26-08:00

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		+	<blockquote>
		+	I used to use Altadena Dairy Cottage Cheese, and after calling the company and finding out that all three of the dairy ingredients they made it out of were fortified (nothing on the label about D), it turned out to be the single item that was keeping my 25D level up at about 14 ng/ml, and after dropping the cottage cheese, my 25D fell to 10 ng/ml.

		+	//Cynthia, MarshallProtocol.com// </blockquote>

	==== Milk ====		==== Milk ====

Olmesartan (Benicar)

paulalbert — 2012-01-16T08:25:14-08:00

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	===== Ordering olmesartan =====		===== Ordering olmesartan =====
-	<mainarticle> [[home:mp:olmesartan:ordering\|Ordering olmesartan]] </article>	+	<mainarticle> [[home:mp:olmesartan:buying\|Ordering olmesartan]] </article>

-	{{section>:home:mp:olmesartan:ordering#ordering_olmesartan_benicar&noheader&firstseconly}}	+	{{section>:home:mp:olmesartan:buying#ordering_olmesartan_benicar&noheader&firstseconly}}

	===== Dosing and administration of olmesartan =====		===== Dosing and administration of olmesartan =====

Cost of the Marshall Protocol - [Olmesartan (Benicar)]

paulalbert — 2012-01-16T08:23:55-08:00

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	==== Olmesartan (Benicar) ====		==== Olmesartan (Benicar) ====

-	<mainarticle> [[home:mp:olmesartan:ordering\|Obtaining olmesartan (Benicar)]] </article>	+	<mainarticle> [[home:mp:olmesartan:buying\|Obtaining olmesartan (Benicar)]] </article>

Starting the Marshall Protocol - [Starting the Marshall Protocol]

paulalbert — 2012-01-16T08:20:51-08:00

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	* [[home:starting:physician:finding\|Finding a physician]]		* [[home:starting:physician:finding\|Finding a physician]]
	* [[home:starting:therapeutic_probe\|Therapeutic probe]]		* [[home:starting:therapeutic_probe\|Therapeutic probe]]
-	* [[home:mp:Protocol guidelines]]	+	* [[home:mp\|Protocol guidelines]]
	* [[home:patients:tipsformpkb\|Tips for using the Marshall Protocol Knowledge Base]]		* [[home:patients:tipsformpkb\|Tips for using the Marshall Protocol Knowledge Base]]
	* [[home:mp\|One-article summary of the Marshall Protocol]] – links to a lot of helpful content in the Knowledge Base		* [[home:mp\|One-article summary of the Marshall Protocol]] – links to a lot of helpful content in the Knowledge Base

Resources for patients

paulalbert — 2012-01-16T08:20:08-08:00

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-
-	<relatedsection> test </section>
-
-	dfgdfgdfg

	===== References =====		===== References =====

Loss of appetite and nausea - [Management of loss of appetite and nausea] add link to NIH article outlining palliative care

joyful — 2012-01-14T14:28:27-08:00

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	In addition to more [[home:mp:managing_immunopathology\|generic methods for managing immunopathology]], the following strategies may also help:		In addition to more [[home:mp:managing_immunopathology\|generic methods for managing immunopathology]], the following strategies may also help:
	* Reduce the amount of [[home:lifestyle:exercise\|physical activity or exercise]], which will limit the number of calories burned.		* Reduce the amount of [[home:lifestyle:exercise\|physical activity or exercise]], which will limit the number of calories burned.
-	* If nausea is preventing a patient from eating, it's important to palliate the nausea. Over the counter medications such as Gravol (dramamine) might do the trick. If not, patients should ask their doctor for a prescription antiemetic.	+	* If nausea is preventing a patient from eating, it's very important to [[http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm\|palliate the nausea]]. Over the counter medications such as Gravol (dramamine) might do the trick. If not, patients should ask their doctor for a prescription antiemetic.
	* Some patients have reported that [[http://www.sea-band.com/seaband.htm\|Sea-Bands]] have helped their nausea. Sea-Bands can usually be bought in pharmacies.		* Some patients have reported that [[http://www.sea-band.com/seaband.htm\|Sea-Bands]] have helped their nausea. Sea-Bands can usually be bought in pharmacies.
	* Most medications can be taken sublingually if nausea prevents them from being taken orally.		* Most medications can be taken sublingually if nausea prevents them from being taken orally.

Diabetes, Type II

paulalbert — 2012-01-14T13:35:08-08:00

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	</blockquote>		</blockquote>
		+
		+
		+
		+
		+
		+	<blockquote>Gut microbiota and diabetes: from pathogenesis to therapeutic perspective
		+
		+	Authors:
		+	Burcelin, R; Serino, M; Chabo, C; Blasco-Baque, V; Amar, J
		+
		+	Author Full Names:
		+	Burcelin, Remy; Serino, Matteo; Chabo, Chantal; Blasco-Baque, Vincent;
		+	Amar, Jacques
		+
		+	Source:
		+	ACTA DIABETOLOGICA, 48 (4):257-273; 10.1007/s00592-011-0333-6 DEC 2011
		+
		+	Language:
		+	English
		+
		+	Document Type:
		+	Review
		+
		+	Author Keywords:
		+	Gut microbiota dysbiosis; Prebiotic and probiotic; Inflammation; Type 2 diabetes; Obesity; High throughput sequencing
		+
		+	KeyWords Plus:
		+	HIGH-FAT DIET; HUMAN INTESTINAL MICROBIOTA; CORONARY-ARTERY-DISEASE; LOW-DENSITY-LIPOPROTEIN; GLUCAGON-LIKE PEPTIDE-1; INULIN-TYPE FRUCTANS; 16S RIBOSOMAL-RNA; GERM-FREE MICE; INSULIN-RESISTANCE; METABOLIC SYNDROME
		+
		+	Abstract:
		+	More than several hundreds of millions of people will be diabetic and obese over the next decades in front of which the actual therapeutic approaches aim at treating the consequences rather than causes of the impaired metabolism. This strategy is not efficient and new paradigms should be found. The wide analysis of the genome cannot predict or explain more than 10-20% of the disease, whereas changes in feeding and social behavior have certainly a major impact. However, the molecular mechanisms linking environmental factors and genetic susceptibility were so far not envisioned until the recent discovery of a hidden source of genomic diversity, i.e., the metagenome. More than 3 million genes from several hundreds of species constitute our intestinal microbiome. First key experiments have demonstrated that this biome can by itself transfer metabolic disease. The mechanisms are unknown but could be involved in the modulation of energy harvesting capacity by the host as well as t!
		+	he low-grade inflammation and the corresponding immune response on adipose tissue plasticity, hepatic steatosis, insulin resistance and even the secondary cardiovascular events. Secreted bacterial factors reach the circulating blood, and even full bacteria from intestinal microbiota can reach tissues where inflammation is triggered. The last 5 years have demonstrated that intestinal microbiota, at its molecular level, is a causal factor early in the development of the diseases. Nonetheless, much more need to be uncovered in order to identify first, new predictive biomarkers so that preventive strategies based on pre- and probiotics, and second, new therapeutic strategies against the cause rather than the consequence of hyperglycemia and body weight gain.</blockquote>
	===== References =====		===== References =====

Osteoporosis and osteopenia - [Evidence of infectious cause]

paulalbert — 2012-01-14T13:33:06-08:00

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	* certain antibiotics help strengthen bones – NIH animal studies have shown that minocycline, an [[home:mp\|MP antibiotic]], increased bone density, "stimulated bone formation substantially" and slowed bone resorption. (({{pubmed>long:9972125}}))		* certain antibiotics help strengthen bones – NIH animal studies have shown that minocycline, an [[home:mp\|MP antibiotic]], increased bone density, "stimulated bone formation substantially" and slowed bone resorption. (({{pubmed>long:9972125}}))
	* connection with disparate diseases – the NIH connects several Th1 diseases with higher risk of osteoporosis, including rheumatoid arthritis, celiac disease, anorexia nervosa, inflammatory bowel disease and lupus [cite needed]		* connection with disparate diseases – the NIH connects several Th1 diseases with higher risk of osteoporosis, including rheumatoid arthritis, celiac disease, anorexia nervosa, inflammatory bowel disease and lupus [cite needed]
		+
		+
		+	===== Patients experiences =====
		+
		+	<blockquote>Bone news: the bone in my injured leg healed quickly except for the region at the knee (it was not quite dense enough). But a new xray in December showed the knee region now is also very good (and I can have the metal out if I need to). Yay! And that's after avoiding "vitamin D" like the plague for seven years! So much for "vitamin D" and bone health....
		+
		+	//Dogster, MarshallProtocol.com//</blockquote>

People

paulalbert — 2012-01-12T07:48:45-08:00

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	{{:home:arf:keith80.jpg?nolink }}Keith Waterhouse (Australia) - Keith is a retired career electrician with a speciality in repair and renovation which he now applies to people since encountering his own health challenges with acute and chronic illness. He says that being married to a retired career nurse with both practice nurse and pathology management qualifications helps too. \\		{{:home:arf:keith80.jpg?nolink }}Keith Waterhouse (Australia) - Keith is a retired career electrician with a speciality in repair and renovation which he now applies to people since encountering his own health challenges with acute and chronic illness. He says that being married to a retired career nurse with both practice nurse and pathology management qualifications helps too. \\
		+	\\
	\\		\\
	\\		\\

Marshall Protocol - [Starting a patient on the Marshall Protocol]

drtrevormarshall — 2012-01-12T01:23:08-08:00

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	- Wait for patient to stabilize on olmesartan – It usually takes a month or two to stabilize symptoms on olmesartan alone. Some patients may need more time. Depending on the patient's bacterial load and a host of other factors, some patients initially feel better on olmesartan, some worse, and some don't experience any change. All three reactions are normal. A partial list of typical immunopathology symptoms includes: depression, irritability, mania, paranoia, fatigue, muscle weakness, rash, headache, photosensitivity, pain anywhere, numbness, nausea, diarrhea, constipation, ringing in the ears, toothache, sinus congestion, nasal stuffiness, fever/chills, flu-like body ache, cough, sleep disturbances and "brain fog."		- Wait for patient to stabilize on olmesartan – It usually takes a month or two to stabilize symptoms on olmesartan alone. Some patients may need more time. Depending on the patient's bacterial load and a host of other factors, some patients initially feel better on olmesartan, some worse, and some don't experience any change. All three reactions are normal. A partial list of typical immunopathology symptoms includes: depression, irritability, mania, paranoia, fatigue, muscle weakness, rash, headache, photosensitivity, pain anywhere, numbness, nausea, diarrhea, constipation, ringing in the ears, toothache, sinus congestion, nasal stuffiness, fever/chills, flu-like body ache, cough, sleep disturbances and "brain fog."
	- Ramp olmesartan to six times per day - the immunostimulative and palliative effects of olmesartan are believed to be maximal at four-hourly dosing. Once the patient has stabilized, the frequency should be gradually increased to every four hours, over several weeks, or in accordance with the patient's ability to tolerate any increases in immunopathology that may result. (Some patients will actually feel better at the higher frequency.)		- Ramp olmesartan to six times per day - the immunostimulative and palliative effects of olmesartan are believed to be maximal at four-hourly dosing. Once the patient has stabilized, the frequency should be gradually increased to every four hours, over several weeks, or in accordance with the patient's ability to tolerate any increases in immunopathology that may result. (Some patients will actually feel better at the higher frequency.)
-	- Optionally Begin minocycline – Once the patient has become fully stable on olmesartan, too low a level of immunopathology optionally may be remedied by prescribing the first MP antibiotic, brand name or generic minocycline, at 25 mg every 48 hours. Do not use less or any substitute such as doxycycline. As with the other MP antibiotics, patients may need to [[home:mp:dividingmeds\|divide the contents]] by opening a capsule or using a pill cutter. While using minocycline and olmesartan, patients should begin to learn the nature of their immunopathology, and how, in conjunction with their physician, they can adjust their olmesartan and/or antibiotic dosing to elicit tolerable immunopathology. //Sudden increases in immunopathological reactions may occur at any time as the immune response strengthens.// Patients should familiarize themselves with the [[home:mp:managing_immunopathology\|managing immunopathology]] article to manage symptoms. The response may even necessitate reducing or temporarily stopping some or all of the antibiotics for an extended period of time This is not uncommon and should not be regarded as a setback, but rather as a sign of progress as it usually signals a more robust immune response. Note that olmesartan alone may generate adequate immunopathology in some patients: there is no requirement to use antibiotics during the MP, although many patients find them helpful at some stages.	+	- Optionally begin minocycline – Once the patient has become fully stable on olmesartan, too low a level of immunopathology optionally may be remedied by prescribing the first MP antibiotic, brand name or generic minocycline, at 25 mg every 48 hours. Do not use less or any substitute such as doxycycline. As with the other MP antibiotics, patients may need to [[home:mp:dividingmeds\|divide the contents]] by opening a capsule or using a pill cutter. While using minocycline and olmesartan, patients should begin to learn the nature of their immunopathology, and how, in conjunction with their physician, they can adjust their olmesartan and/or antibiotic dosing to elicit tolerable immunopathology. //Sudden increases in immunopathological reactions may occur at any time as the immune response strengthens.// Patients should familiarize themselves with the [[home:mp:managing_immunopathology\|managing immunopathology]] article to manage symptoms. The response may even necessitate reducing or temporarily stopping some or all of the antibiotics for an extended period of time This is not uncommon and should not be regarded as a setback, but rather as a sign of progress as it usually signals a more robust immune response. Note that olmesartan alone may generate adequate immunopathology in some patients: there is no requirement to use antibiotics during the MP, although many patients find them helpful at some stages.
-	- Optionally Increase dosage of minocycline – When patients using minocycline feel able to increase the strength of their immunopathological reaction, they typically increase their dosage of minocycline, in increments of 25 mg (q48h), until they reach 100mg. It is strongly recommended that patients should stay at each dosage for at least a week and should not increase the antibiotic until their immunopathology at a particular dosage has declined to a low level.	+	- Optionally increase dosage of minocycline – When patients using minocycline feel able to increase the strength of their immunopathological reaction, they typically increase their dosage of minocycline, in increments of 25 mg (q48h), until they reach 100mg. It is strongly recommended that patients should stay at each dosage for at least a week and should not increase the antibiotic until their immunopathology at a particular dosage has declined to a low level.
-	- Optionally Add a second or third antibiotic – There is no requirement for patients to take more or higher doses of antibiotics if symptoms become uncomfortable. Nor should patients feel reluctant to reduce their doses of antibiotics if they find immunopathology at their current doses excessively troublesome. //Olmesartan plays the most critical role in the recovery process.//	+	- Optionally add a second or third antibiotic – There is no requirement for patients to take more or higher doses of antibiotics if symptoms become uncomfortable. Nor should patients feel reluctant to reduce their doses of antibiotics if they find immunopathology at their current doses excessively troublesome. //Olmesartan plays the most critical role in the recovery process.//

Kidney (renal) function tests - [Increases in kidney metabolites on the Marshall Protocol]

paulalbert — 2012-01-09T14:58:39-08:00

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	* BUN – One study found that hemodialysis patients who had high serum values of urea nitrogen (BUN) were less likely to have the acute infection, //Helicobacter pylori//.(({{pubmed>long:14696511}})) This suggests that temporary markers of kidney stress such as BUN may correlate with a robust and successful immune response.		* BUN – One study found that hemodialysis patients who had high serum values of urea nitrogen (BUN) were less likely to have the acute infection, //Helicobacter pylori//.(({{pubmed>long:14696511}})) This suggests that temporary markers of kidney stress such as BUN may correlate with a robust and successful immune response.
-	* **Creatinine** – In a 2011 study appearing in //Kidney International//, Agarwal //et al.// gave 16 patients with chronic kidney disease daily doses of paricalcitol, an orally active vitamin D receptor (VDR) activator.(({{pubmed>long:21716260}})) (Note that the VDR plays a key role in innate immunity.) The vitamin D analog was stopped after four days, and measurements were continued for three. During therapy, researchers found that subjects' serum creatinine significantly increased at a rate of 0.010 mg/dl/day and urine creatinine at a rate of 17.6 mg/day. Researchers also found a small increase in blood levels of BUN.	+	* **creatinine** – According to Goldstein, clinicians caring for patients with acute kidney injury (AKI) have been hindered by the reliance on serum creatinine or decreased urine output, both kidney function markers, to make the AKI diagnosis. Even more vexing is the fact that similar serum creatinine changes can occur without kidney damage, for example in the context of dehydration, nephrotic syndrome or hepatorenal syndrome.(({{pubmed>long:22189039}}))
		+
		+	In a 2011 study appearing in //Kidney International//, Agarwal //et al.// gave 16 patients with chronic kidney disease daily doses of paricalcitol, an orally active vitamin D receptor (VDR) activator.(({{pubmed>long:21716260}})) (Note that the VDR plays a key role in innate immunity.) The vitamin D analog was stopped after four days, and measurements were continued for three. During therapy, researchers found that subjects' serum creatinine significantly increased at a rate of 0.010 mg/dl/day and urine creatinine at a rate of 17.6 mg/day. Researchers also found a small increase in blood levels of BUN.


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	This work emphasizes the need for MP doctors to rely upon the 24-hour creatinine clearance test rather than eGFR to get the most accurate picture of real kidney function. Also, it validates the strategy of waiting-out abnormal creatinine values, rather than trying to intervene.		This work emphasizes the need for MP doctors to rely upon the 24-hour creatinine clearance test rather than eGFR to get the most accurate picture of real kidney function. Also, it validates the strategy of waiting-out abnormal creatinine values, rather than trying to intervene.
-
-	<blockquote>
-	However, clinicians caring for patients with acute kidney injury (AKI) have been hindered by the reliance on serum creatinine or decreased urine output, both kidney function markers, to make the AKI diagnosis. ... Even more vexing is the fact that similar serum creatinine changes can occur without kidney damage, for example in the context of dehydration, nephrotic syndrome or hepatorenal syndrome.
-
-	//SL Goldstein//(({{pubmed>long:22189039}}))
-	</blockquote>

	===== Patients experiences =====		===== Patients experiences =====

Test: C-Reactive Protein (CRP) - [Notes and comments]

paulalbert — 2012-01-09T14:56:08-08:00

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	//July 13, 2011// -- [[http://labtestsonline.org/news/crp-may-have-role-in-predicting-breast-cancer-outcomes/\|CRP May Have Role in Predicting Breast Cancer Outcomes]]		//July 13, 2011// -- [[http://labtestsonline.org/news/crp-may-have-role-in-predicting-breast-cancer-outcomes/\|CRP May Have Role in Predicting Breast Cancer Outcomes]]
		+
		+
		+	<blockquote>Am J Cardiol. 2011 Oct 12. [Epub ahead of print]
		+	Relation Between Serum 25-Hydroxyvitamin D and C-Reactive Protein in Asymptomatic Adults (From the Continuous National Health and Nutrition Examination Survey 2001 to 2006).
		+	Amer M, Qayyum R.
		+	Source
		+	Johns Hopkins University School of Medicine, Baltimore, Maryland.
		+	Abstract
		+	The inverse relation between vitamin D supplementation and inflammatory biomarkers among asymptomatic adults is not settled. We hypothesized that the inverse relation is present only at lower levels and disappears at higher serum levels of vitamin D. We examined the relation between 25-hydroxyvitamin D [25(OH)D] and C-reactive protein (CRP) using the continuous National Health and Nutrition Examination Survey data from 2001 to 2006. Linear spline [single knot at median serum levels of 25(OH)D] regression models were used. The median serum 25(OH)D and CRP level was 21 ng/ml (interquartile range 15 to 27) and 0.21 mg/dl (interquartile range 0.08 to 0.5), respectively. On univariate linear regression analysis, CRP decreased [geometric mean CRP change 0.285 mg/dl for each 10-ng/ml change in 25(OH)D, 95% confidence interval [CI] -0.33 to -0.23] as 25(OH)D increased ≤21 ng/ml. However, an increase in 25(OH)D to >21 ng/ml was not associated with any significant decrease [geometric mean CRP change 0.05 mg/dl for each 10-ng/ml change in 25(OH)D, 95% CI -0.11 to 0.005) in CRP. The inverse relation between 25(OH)D below its median and CRP remained significant [geometric mean CRP change 0.11 mg/dl for each 10-ng/ml change in 25(OH)D, 95% CI 0.16 to -0.04] on multivariate linear regression analysis. Additionally, we observed a positive relation between 25(OH)D above its median and CRP [geometric mean CRP change 0.06 mg/dl for each 10-ng/ml change in 25(OH)D, 95% CI 0.02 to 0.11) after adjusting for traditional cardiovascular risk factors. In conclusion, from this cohort of asymptomatic adults, independent of traditional cardiovascular risk factors, we observed a statistically significant inverse relation between 25(OH)D at levels <21 ng/ml and CRP. We found that 25(OH)D at a level ≥21 ng/ml is associated with an increase in serum CRP. It is possible that the role of vitamin D supplementation to reduce inflammation is beneficial only among those with a lower serum 25(OH)D.
		+	Copyright © 2011 Elsevier Inc. All rights reserved.
		+
		+	PMID: 21996139
		+	</blockquote>
	===== References =====		===== References =====

Hormone and pro-hormone therapy - [Patients experiences] added pt experience with Wiley Protocol

joyful — 2012-01-08T13:09:42-08:00

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	They will return to normal balance even faster if we don't interfere.		They will return to normal balance even faster if we don't interfere.

-	//CousinTC//</blockquote>	+	//CousinTC, MarshallProtocol.com//</blockquote>

	{{tag>non-MP_therapies}}		{{tag>non-MP_therapies}}

Test: Angiotensin-Converting Enzyme (ACE)

paulalbert — 2012-01-05T06:45:19-08:00

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	You will need Adobe Acrobat Reader on your computer to view the full text. opening PDF files		You will need Adobe Acrobat Reader on your computer to view the full text. opening PDF files
		+
		+
		+	<blockquote>Olmesartan Medoxomil 40mg q6hrs
		+
		+	It was seven years ago today I discovered http://www.sarcinfo.com and I now share wonderful news.
		+
		+	I had laboratory work done on 11/19/11 and my Angiotensin Converting Enzyme or ACE is now normal. It has been out of range since being diagnosed with sarcoidosis in December 2004.
		+
		+	I have no doubt in my mind or spirit that the MP works. It is a slow path, to be sure, but that's an advantage: you can't make too drastic of a mistake all at once (except stopping the Olmesartan Medoxomil IMO). And it also the constant attention to diet, keeping stress down, and moderate exercise (if you can).
		+
		+	Hooray for all of us.
		+
		+	Sherry
		+	</blockquote>
		+
		+

	===== References =====		===== References =====

Beta-lactam antibiotics - [Notes and comments]

paulalbert — 2012-01-04T11:40:02-08:00

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	===== Notes and comments =====		===== Notes and comments =====

		+	FDA restricts use of cephalosporin antibiotics in livestock saying it contributes to drug-resistant bacteria in humans. http://nyti.ms/yhomPV
	===== References =====		===== References =====

Microbes in the human body - external edit

2012-01-02T20:22:32-08:00

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	* creation of virulence factors which suppress MAMPs (Microbial Associated Molecular Patterns)(({{pubmed>long:18639458}}))		* creation of virulence factors which suppress MAMPs (Microbial Associated Molecular Patterns)(({{pubmed>long:18639458}}))
	* Ehrlichia/anaplasma (EA) are an obscure group of obligate parasitic intracellular pathogens that intracellularly excrete a substance called host transcriptional protein, which can alter transcription in cell division. Infection with EA may lead to changes in transcription in proliferating cells, and contribute to illnesses such as leukemia, systemic lupus erythematosus, myelodysplastic disease, multiple sclerosis, amyotrophic lateral sclerosis, and rheumatoid arthritis.(({{pubmed>long:21669495}}))		* Ehrlichia/anaplasma (EA) are an obscure group of obligate parasitic intracellular pathogens that intracellularly excrete a substance called host transcriptional protein, which can alter transcription in cell division. Infection with EA may lead to changes in transcription in proliferating cells, and contribute to illnesses such as leukemia, systemic lupus erythematosus, myelodysplastic disease, multiple sclerosis, amyotrophic lateral sclerosis, and rheumatoid arthritis.(({{pubmed>long:21669495}}))
-
-
-
-
	* [[home:pathogenesis:vitamind:metabolism#bacteria_disable_the_vdr\|creation of ligands]] such as Capnine which bind, block, and downregulate the Vitamin D Receptor;(({{pubmed>long:18200565}})) Alzheimer's may be a case where bacteria stimulate the body's production of the antimicrobial peptide amyloid-beta to dramatically suppress VDR activity(({{pubmed>long:20966550}}))		* [[home:pathogenesis:vitamind:metabolism#bacteria_disable_the_vdr\|creation of ligands]] such as Capnine which bind, block, and downregulate the Vitamin D Receptor;(({{pubmed>long:18200565}})) Alzheimer's may be a case where bacteria stimulate the body's production of the antimicrobial peptide amyloid-beta to dramatically suppress VDR activity(({{pubmed>long:20966550}}))

Guaifenesin - external edit

2012-01-02T20:22:09-08:00

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	Many drug and health food store sells guaifensin. It is also available at a number of online retailers.		Many drug and health food store sells guaifensin. It is also available at a number of online retailers.

-	* United States – [[http://www.amazon.com/s/ref=nb_ss_gw_0_9?url=search-alias%3Daps&field-keywords=guaifenesin&x=0&y=0&sprefix=guaifenes\|Amazon.com]]	+	* United States – [[http://www.amazon.com/s/ref=nb_ss_gw_0_9?url=search-alias%3Daps&field-keywords=guaifenesin+capsules&x=0&y=0&sprefix=guaifenesin\|Amazon.com]]
	* Australia – [[http://www.pharmacyonline.com.au/robitussin-chesty-cough-p-11637.html\|Pharmacy Online]]		* Australia – [[http://www.pharmacyonline.com.au/robitussin-chesty-cough-p-11637.html\|Pharmacy Online]]

	{{tag>supplements }}		{{tag>supplements }}
-

	===== Notes and comments =====		===== Notes and comments =====

Zithromax (azithromycin)

paulalbert — 2012-01-01T05:19:36-08:00

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	===== Can I take generic azithromycin? =====		===== Can I take generic azithromycin? =====

-	Azithromycin is the generic name for the antibiotic Zithromax. Generics are less expensive than a name brand. It is fine to use the brand name or generic form of azithromycin.	+	Azithromycin is the generic name for the antibiotic Zithromax. Generics are less expensive than a name brand. MP patients have reported no problems from using the generic form of azithromycin.

Clindamycin

drtrevormarshall — 2011-12-31T05:17:25-08:00

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	As specified in greater detail in the Protocol Guidelines, patients on the Marshall Protocol begin by taking regular doses of olmesartan (Benicar) and then, later on, increasing doses of minocycline. When ready to experience additional immunopathology, patients begin to take a second antibiotic.		As specified in greater detail in the Protocol Guidelines, patients on the Marshall Protocol begin by taking regular doses of olmesartan (Benicar) and then, later on, increasing doses of minocycline. When ready to experience additional immunopathology, patients begin to take a second antibiotic.

-	Typically, that second antibiotic is azithromycin (Zithromax). Under certain circumstances, patients and their physicians may wish to use clindamycin.	+	That second antibiotic has historically been azithromycin (Zithromax) or clindamycin. Under certain circumstances, patients and their physicians may wish to use Sulfamethoxazole/Trimethoprim (Bactrim/Septra).

-	* When to use Zithromax as a second antibiotic (Phase Two) – Patients with significant psychological symptoms such as depression, anxiety, intrusive thoughts, or obsessive-compulsive behavior should use azithromycin, because clindamycin often exacerbates these symptoms to intolerable levels. For these patients, clindamycin is usually tolerated better at later stages of the treatment.	+	* When to use clindamycin as a second antibiotic – Clindamycin doesn't linger in the tissues like Zithromax, so it is easier to control the immune system reactions. Clindamycin is helpful for patients who are very sick and may not be able to tolerate the relatively prolonged effect of Zithromax. Clindamycin can be quickly discontinued if necessary, and give a physician more options when treating acute trauma (after a car accident, for example) or other situations where surgery may be imminently required.
-	* When to use clindamycin as a second antibiotic (Modified Phase Two) – Clindamycin doesn't linger in the tissues like Zithromax, so it is easier to control the immune system reactions. Clindamycin is helpful for patients who are very sick and may not be able to tolerate the relatively prolonged effect of Zithromax.	+	* When to use Zithromax as a second antibiotic – Patients with difficult-to-control psychological symptoms such as depression, anxiety, intrusive thoughts, or obsessive-compulsive behavior should use azithromycin, because clindamycin often exacerbates these symptoms to intolerable levels. For these patients, clindamycin is usually tolerated better at later stages of the treatment. Some members have reported that these conditions resolve more quickly with clindamycin, however.

-	Patients who are still experiencing significant immunopathology from 100mg of minocycline alone are not yet ready to add a second antibiotic because the two antibiotic combination, especially when Zithromax is used, is much stronger than minocycline alone.	+	Patients who are still experiencing significant immunopathology from the Olmesartan / 100mg minocycline combination are not yet ready to add a second antibiotic because the two antibiotic combination, especially when Zithromax is used, is very much stronger than minocycline alone.

Reactive arthritis (Reiter's syndrome)

paulalbert — 2011-12-31T03:18:31-08:00

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	<IncompleteNotice>		<IncompleteNotice>
		+
		+
		+	<blockquote>Nat Rev Rheumatol. 2011 Nov 22;8(1):55-9. doi: 10.1038/nrrheum.2011.173.
		+	Chlamydia-induced ReA: immune imbalances and persistent pathogens.
		+	Gracey E, Inman RD.
		+	Source
		+	Toronto Western Hospital, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada.
		+	Abstract
		+	Reactive arthritis (ReA), an inflammatory arthritic condition that is commonly associated with Chlamydia infections, represents a significant health burden, yet is poorly understood. The enigma of this disease is reflected in its problematic name and in its ill-defined pathogenesis. The existence of persistent pathogens in the arthritic joint is acknowledged, but their relevance remains elusive. Progress is being made in understanding the underlying mechanisms of ReA, whereby an imbalance between type 1 and type 2 immune responses seems to be critical in determining susceptibility to disease. Such an imbalance occurs prior to the initiation of an adaptive immune response, suggesting that innate cellular and molecular mechanisms in ReA should be prioritized as fruitful areas for investigation.
		+	PMID: 22105240</blockquote>
		+

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	\| [[home:othertreatments:antibacterials:methotrexate\|Methotrexate]] \| methotrexate (MTX) \|{{:home:warning.png?nolink}} \| inteferes with Bactrim DS as well as production of important human metabolites \|		\| [[home:othertreatments:antibacterials:methotrexate\|Methotrexate]] \| methotrexate (MTX) \|{{:home:warning.png?nolink}} \| inteferes with Bactrim DS as well as production of important human metabolites \|
	\| [[.:othertreatments:pain_medication#muscle_relaxants\|muscle relaxants]] \|baclofen (Kemstro, Lioresal, and Gablofen), bentazepam (Thiadipone), carisoprodol (SOMA, Sanoma, Carisoma), chlormezanone (Trancopal), chlorphenesin (Maolate, Musil), chlorzoxazone (Muscol, Parafon Forte), cyclobenzaprine, diazepam (Valium), donepezil (Aricept), eperisone (Myonal), febarbamate, flopropione (Compacsul, Cospanon, Ecapron, Pellegal, Argobyl, Floveton, Saritron, Spamorin, Labrodax, Tryalon, Mirulevatin, Padeskin, Profenon), lorazepam (Ativan, Temesta), ketamine, mephenesin, mephenoxalone (Dorsiflex, Moderamin), meprobamate (Equanil, Miltown, Meprospan), metaxalone (Skelaxin), methocarbamol (Robaxin), naltrexone (Low-Dose Naltrexone (LDN)), nitrazepam (Alodorm, Arem, Insoma, Mogadon, Nitrados, Nitrazadon, Ormodon, Paxadorm, Remnos, Somnite), orphenadrine, phenprobamate (Gamaquil, Isotonil), phenyramidol, pridinol, promoxolane (Dimethylane), quinine (Qualaquin), styramate, tetrazepam (Clinoxan, Epsipam, Myolastan, Musaril, Relaxam, Spasmorelax)), thiocolchicoside (Muscoril, Myoril, Neoflax) , tizanidine (Zanaflex, Sirdalud), tolperisone (Biocalm, Mydeton, Mydocalm, Myolax, Myoxan, Viveo), trazodone (Desyrel, Oleptro, Beneficat, Deprax, Desirel, Molipaxin, Thombran, Trazorel, Trialodine, Trittico, Mesyrel), tybamate \|{{:home:warning.png?nolink}} use as necessary to modulate intolerable immunopathology \|immunomodulatory \|		\| [[.:othertreatments:pain_medication#muscle_relaxants\|muscle relaxants]] \|baclofen (Kemstro, Lioresal, and Gablofen), bentazepam (Thiadipone), carisoprodol (SOMA, Sanoma, Carisoma), chlormezanone (Trancopal), chlorphenesin (Maolate, Musil), chlorzoxazone (Muscol, Parafon Forte), cyclobenzaprine, diazepam (Valium), donepezil (Aricept), eperisone (Myonal), febarbamate, flopropione (Compacsul, Cospanon, Ecapron, Pellegal, Argobyl, Floveton, Saritron, Spamorin, Labrodax, Tryalon, Mirulevatin, Padeskin, Profenon), lorazepam (Ativan, Temesta), ketamine, mephenesin, mephenoxalone (Dorsiflex, Moderamin), meprobamate (Equanil, Miltown, Meprospan), metaxalone (Skelaxin), methocarbamol (Robaxin), naltrexone (Low-Dose Naltrexone (LDN)), nitrazepam (Alodorm, Arem, Insoma, Mogadon, Nitrados, Nitrazadon, Ormodon, Paxadorm, Remnos, Somnite), orphenadrine, phenprobamate (Gamaquil, Isotonil), phenyramidol, pridinol, promoxolane (Dimethylane), quinine (Qualaquin), styramate, tetrazepam (Clinoxan, Epsipam, Myolastan, Musaril, Relaxam, Spasmorelax)), thiocolchicoside (Muscoril, Myoril, Neoflax) , tizanidine (Zanaflex, Sirdalud), tolperisone (Biocalm, Mydeton, Mydocalm, Myolax, Myoxan, Viveo), trazodone (Desyrel, Oleptro, Beneficat, Deprax, Desirel, Molipaxin, Thombran, Trazorel, Trialodine, Trittico, Mesyrel), tybamate \|{{:home:warning.png?nolink}} use as necessary to modulate intolerable immunopathology \|immunomodulatory \|
-	\| [[.:othertreatments:pain_medication\|pain medications]] \|acetaminophen (paracetamol), aspirin, diazepam (Valium), hydrocodone-acetaminophen (Lortab, Norco, Percocet, Vicodin, Xodol), morphine, naproxen (Aleve, Anaprox, Naprelan 375, Naprosyn), oxycodone (Oxycontin), oxycodone-acetaminophen (Oxycocet, Percocet), pregabalin (Lyrica), propoxyphene-acetaminophen (Darvocet, Propox-N), tramadol (Ultracet, Ultram, Ultram ER, Zytram XL) \|{{:home:warning.png?nolink}} use as necessary to modulate intolerable immunopathology \|immunomodulatory \|	+	\| [[.:othertreatments:pain_medication\|pain medications]] \|acetaminophen (paracetamol), aspirin, diazepam (Valium), hydrocodone-acetaminophen (Lortab, Norco, Percocet, Vicodin, Xodol), morphine, naproxen (Aleve, Anaprox, Naprelan 375, Naprosyn), oxycodone (Oxycontin), oxycodone-acetaminophen (Oxycocet, Percocet), pregabalin (Lyrica), propoxyphene-acetaminophen (Darvocet, Propox-N), tramadol (Ultracet, Ultram, Ultram ER, Zytram XL) \|{{:home:warning.png?nolink}} use select medications as necessary to modulate intolerable immunopathology \|immunomodulatory \|
	\| [[.:othertreatments:sleepmeds\|sleep medications]] \|clonazepam (Klonopin, PMS-Clonazepam, Rivotril, Rivotril drops), doxylamine (Dozile, Donormyl, Dormidina, NyQuil, Restavit, Unisom-2 and Sleep Aid, Somnil), doxepin (Silenor), eszopiclone (Lunesta), melatonin, Nytol, temazepam (Restoril, Temazep), trazodone (APO-Trazodone, Desyrel, Donaren), zolpidem (Ambien, Ambien CR, Hypnogen, Stilnoct (Stilnox)) \|{{:home:warning.png?nolink}} take lowest possible dose to reduce intolerable symptoms; wean as symptoms allow \| \|		\| [[.:othertreatments:sleepmeds\|sleep medications]] \|clonazepam (Klonopin, PMS-Clonazepam, Rivotril, Rivotril drops), doxylamine (Dozile, Donormyl, Dormidina, NyQuil, Restavit, Unisom-2 and Sleep Aid, Somnil), doxepin (Silenor), eszopiclone (Lunesta), melatonin, Nytol, temazepam (Restoril, Temazep), trazodone (APO-Trazodone, Desyrel, Donaren), zolpidem (Ambien, Ambien CR, Hypnogen, Stilnoct (Stilnox)) \|{{:home:warning.png?nolink}} take lowest possible dose to reduce intolerable symptoms; wean as symptoms allow \| \|
	\| [[.:othertreatments:statins\|statins and other anti-cholesterol drugs]] \| statins – atorvastatin (Lipitor), cholestipol (Cholestid), colesevalam HCL (Welchol), ezetimibe (Zetia), ezetimibe and simvastatin (Vytorin), fenofibrate (Tricor), fluvastatin (Lescol), lovastatin (Mevacor), Omacor, pravastatin (Pravachol), rosuvastatin (Crestor), simvastatin (Zocor); gemfibrozil (Lopid, Gemcor), cholestyramine (Questran), pantethine, Red yeast rice (monascus purpureus) \|{{:home:stop.png?nolink}} wean \|immunomodulatory \|		\| [[.:othertreatments:statins\|statins and other anti-cholesterol drugs]] \| statins – atorvastatin (Lipitor), cholestipol (Cholestid), colesevalam HCL (Welchol), ezetimibe (Zetia), ezetimibe and simvastatin (Vytorin), fenofibrate (Tricor), fluvastatin (Lescol), lovastatin (Mevacor), Omacor, pravastatin (Pravachol), rosuvastatin (Crestor), simvastatin (Zocor); gemfibrozil (Lopid, Gemcor), cholestyramine (Questran), pantethine, Red yeast rice (monascus purpureus) \|{{:home:stop.png?nolink}} wean \|immunomodulatory \|

1325564502		current
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	* [[http://www.carouselcharts.com/JHR_tracking2.pdf\|Phase 1 Symptom Chart - blank]]		* [[http://www.carouselcharts.com/JHR_tracking2.pdf\|Phase 1 Symptom Chart - blank]]
	* [[http://www.carouselcharts.com/JHR_trackingP2-3openZ.pdf\|Phase 2/3 Symptom Chart]]		* [[http://www.carouselcharts.com/JHR_trackingP2-3openZ.pdf\|Phase 2/3 Symptom Chart]]
-	* [[http://autoimmunityresearch.org/phase_2_chart.pdf\|Phase 2 Medication Chart]]

	==== Online diaries ====		==== Online diaries ====
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	* [[http://www.onlinediary.net\|OnlineDiary.net]]		* [[http://www.onlinediary.net\|OnlineDiary.net]]
	* [[http://www.diaryland.com\|DiaryLand.com]]		* [[http://www.diaryland.com\|DiaryLand.com]]
-	* [[http://www.mydeardiary.com\|MyDearDiary.com]]

1325564611		current
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	* [[home:starting:physician:finding\|Finding a physician]]		* [[home:starting:physician:finding\|Finding a physician]]
	* [[home:starting:therapeutic_probe\|Therapeutic probe]]		* [[home:starting:therapeutic_probe\|Therapeutic probe]]
-	* [[home:mp:Protocol guidelines]]	+	* [[home:mp\|Protocol guidelines]]
	* [[home:patients:tipsformpkb\|Tips for using the Marshall Protocol Knowledge Base]]		* [[home:patients:tipsformpkb\|Tips for using the Marshall Protocol Knowledge Base]]
	* [[home:mp\|One-article summary of the Marshall Protocol]] – links to a lot of helpful content in the Knowledge Base		* [[home:mp\|One-article summary of the Marshall Protocol]] – links to a lot of helpful content in the Knowledge Base

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	- Wait for patient to stabilize on olmesartan – It usually takes a month or two to stabilize symptoms on olmesartan alone. Some patients may need more time. Depending on the patient's bacterial load and a host of other factors, some patients initially feel better on olmesartan, some worse, and some don't experience any change. All three reactions are normal. A partial list of typical immunopathology symptoms includes: depression, irritability, mania, paranoia, fatigue, muscle weakness, rash, headache, photosensitivity, pain anywhere, numbness, nausea, diarrhea, constipation, ringing in the ears, toothache, sinus congestion, nasal stuffiness, fever/chills, flu-like body ache, cough, sleep disturbances and "brain fog."		- Wait for patient to stabilize on olmesartan – It usually takes a month or two to stabilize symptoms on olmesartan alone. Some patients may need more time. Depending on the patient's bacterial load and a host of other factors, some patients initially feel better on olmesartan, some worse, and some don't experience any change. All three reactions are normal. A partial list of typical immunopathology symptoms includes: depression, irritability, mania, paranoia, fatigue, muscle weakness, rash, headache, photosensitivity, pain anywhere, numbness, nausea, diarrhea, constipation, ringing in the ears, toothache, sinus congestion, nasal stuffiness, fever/chills, flu-like body ache, cough, sleep disturbances and "brain fog."
	- Ramp olmesartan to six times per day - the immunostimulative and palliative effects of olmesartan are believed to be maximal at four-hourly dosing. Once the patient has stabilized, the frequency should be gradually increased to every four hours, over several weeks, or in accordance with the patient's ability to tolerate any increases in immunopathology that may result. (Some patients will actually feel better at the higher frequency.)		- Ramp olmesartan to six times per day - the immunostimulative and palliative effects of olmesartan are believed to be maximal at four-hourly dosing. Once the patient has stabilized, the frequency should be gradually increased to every four hours, over several weeks, or in accordance with the patient's ability to tolerate any increases in immunopathology that may result. (Some patients will actually feel better at the higher frequency.)
-	- Optionally Begin minocycline – Once the patient has become fully stable on olmesartan, too low a level of immunopathology optionally may be remedied by prescribing the first MP antibiotic, brand name or generic minocycline, at 25 mg every 48 hours. Do not use less or any substitute such as doxycycline. As with the other MP antibiotics, patients may need to [[home:mp:dividingmeds\|divide the contents]] by opening a capsule or using a pill cutter. While using minocycline and olmesartan, patients should begin to learn the nature of their immunopathology, and how, in conjunction with their physician, they can adjust their olmesartan and/or antibiotic dosing to elicit tolerable immunopathology. //Sudden increases in immunopathological reactions may occur at any time as the immune response strengthens.// Patients should familiarize themselves with the [[home:mp:managing_immunopathology\|managing immunopathology]] article to manage symptoms. The response may even necessitate reducing or temporarily stopping some or all of the antibiotics for an extended period of time This is not uncommon and should not be regarded as a setback, but rather as a sign of progress as it usually signals a more robust immune response. Note that olmesartan alone may generate adequate immunopathology in some patients: there is no requirement to use antibiotics during the MP, although many patients find them helpful at some stages.	+	- Optionally begin minocycline – Once the patient has become fully stable on olmesartan, too low a level of immunopathology optionally may be remedied by prescribing the first MP antibiotic, brand name or generic minocycline, at 25 mg every 48 hours. Do not use less or any substitute such as doxycycline. As with the other MP antibiotics, patients may need to [[home:mp:dividingmeds\|divide the contents]] by opening a capsule or using a pill cutter. While using minocycline and olmesartan, patients should begin to learn the nature of their immunopathology, and how, in conjunction with their physician, they can adjust their olmesartan and/or antibiotic dosing to elicit tolerable immunopathology. //Sudden increases in immunopathological reactions may occur at any time as the immune response strengthens.// Patients should familiarize themselves with the [[home:mp:managing_immunopathology\|managing immunopathology]] article to manage symptoms. The response may even necessitate reducing or temporarily stopping some or all of the antibiotics for an extended period of time This is not uncommon and should not be regarded as a setback, but rather as a sign of progress as it usually signals a more robust immune response. Note that olmesartan alone may generate adequate immunopathology in some patients: there is no requirement to use antibiotics during the MP, although many patients find them helpful at some stages.
-	- Optionally Increase dosage of minocycline – When patients using minocycline feel able to increase the strength of their immunopathological reaction, they typically increase their dosage of minocycline, in increments of 25 mg (q48h), until they reach 100mg. It is strongly recommended that patients should stay at each dosage for at least a week and should not increase the antibiotic until their immunopathology at a particular dosage has declined to a low level.	+	- Optionally increase dosage of minocycline – When patients using minocycline feel able to increase the strength of their immunopathological reaction, they typically increase their dosage of minocycline, in increments of 25 mg (q48h), until they reach 100mg. It is strongly recommended that patients should stay at each dosage for at least a week and should not increase the antibiotic until their immunopathology at a particular dosage has declined to a low level.
-	- Optionally Add a second or third antibiotic – There is no requirement for patients to take more or higher doses of antibiotics if symptoms become uncomfortable. Nor should patients feel reluctant to reduce their doses of antibiotics if they find immunopathology at their current doses excessively troublesome. //Olmesartan plays the most critical role in the recovery process.//	+	- Optionally add a second or third antibiotic – There is no requirement for patients to take more or higher doses of antibiotics if symptoms become uncomfortable. Nor should patients feel reluctant to reduce their doses of antibiotics if they find immunopathology at their current doses excessively troublesome. //Olmesartan plays the most critical role in the recovery process.//

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-	* acetaminophen (Tylenol) – Tylenol dosage should be limited to a total of 4 grams (4,000mg) in a 24 hour period for patients with healthy livers.	+	* acetaminophen (Tylenol) – Tylenol dosage should be limited to a total of 3 grams (3,000mg, six 500mg tablets) in each 24 hour period for patients with healthy livers.
	* aspirin – not recommend in the routine use of aspirin for its touted preventative characteristics; //see NSAIDs//		* aspirin – not recommend in the routine use of aspirin for its touted preventative characteristics; //see NSAIDs//
	* celecoxib (Celebrex) – a COX-2 inhibitor; //not recommended//		* celecoxib (Celebrex) – a COX-2 inhibitor; //not recommended//
-	* [[home:othertreatments:corticosteroids\|corticosteroids]] – //contraindicated//	+	* [[home:othertreatments:corticosteroids\|corticosteroids]] – //contraindicated// - may cause IP instablity
	* diazepam (Valium) – okay for patients to take; only the brand name, Valium, has seemed to work for patients with Th1 inflammation; half the 2mg (white tablet, the one with the V cut from the center) seems to often be enough to reduce anxiety and calm restless muscles; stay away from the generic diazepam and the higher strengths; make sure your doctor orders Valium 2mg to use “as directed” and writes “no substitutions” on the prescription; Valium is usually taken 1-4 times per day.		* diazepam (Valium) – okay for patients to take; only the brand name, Valium, has seemed to work for patients with Th1 inflammation; half the 2mg (white tablet, the one with the V cut from the center) seems to often be enough to reduce anxiety and calm restless muscles; stay away from the generic diazepam and the higher strengths; make sure your doctor orders Valium 2mg to use “as directed” and writes “no substitutions” on the prescription; Valium is usually taken 1-4 times per day.
-	* hydrocodone-acetaminophen (Lortab, Norco, Percocet, Vicodin, Xodol)	+	* hydrocodone-acetaminophen (Lortab, Norco, Percocet, Vicodin, Xodol) - Generally reported OK
	* ibuprofen (Motrin, Advil) – of Motrin and Advil, Advil is preferred: Motrin has two times the additives a Motrin – 18 versus 9 – and the additives are some very difficult substances for the body to break down; //see NSAIDs//		* ibuprofen (Motrin, Advil) – of Motrin and Advil, Advil is preferred: Motrin has two times the additives a Motrin – 18 versus 9 – and the additives are some very difficult substances for the body to break down; //see NSAIDs//
	* ketamine – An anesthetic drug commonly used in Lyme disease and chronic fatigue syndrome. Reports suggested that Ketamine doesn't work very well at palliation, and it loses efficacy quickly as the months go by. Also, Ketamine may damage bladder function.(({{pubmed>long:21684556}}))		* ketamine – An anesthetic drug commonly used in Lyme disease and chronic fatigue syndrome. Reports suggested that Ketamine doesn't work very well at palliation, and it loses efficacy quickly as the months go by. Also, Ketamine may damage bladder function.(({{pubmed>long:21684556}}))
-	* morphine – shown to be immunosuppressive in a study(({{pubmed>long:9208156}}))	+	* morphine – avoid if possible - shown to be immunosuppressive in a study(({{pubmed>long:9208156}}))
	* naltrexone – an opioid receptor antagonist used primarily in the management of alcohol dependence and opioid dependence. Naltrexone would certainly appear to affect the ability of the MP to return the human immune system to full function again. Lymphocytes express opioid receptors, probably for a good reason. Even though that reason is not fully understood, it is not a good idea to block those opioid receptors (with naltrexone) if one expects to be able to return your immune system to normal.		* naltrexone – an opioid receptor antagonist used primarily in the management of alcohol dependence and opioid dependence. Naltrexone would certainly appear to affect the ability of the MP to return the human immune system to full function again. Lymphocytes express opioid receptors, probably for a good reason. Even though that reason is not fully understood, it is not a good idea to block those opioid receptors (with naltrexone) if one expects to be able to return your immune system to normal.

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	* naproxen (Aleve, Anaprox, Miranax, Naprogesic, Naprosyn, Naprelan, Synflex)		* naproxen (Aleve, Anaprox, Miranax, Naprogesic, Naprosyn, Naprelan, Synflex)
-	* oxycodone (Oxycontin)	+	* oxycodone (Oxycontin) - Generally reported OK
-	* oxycodone-acetaminophen (Oxycocet, Percocet)	+	* oxycodone-acetaminophen (Oxycocet, Percocet) - Generally reported OK
	* pregabalin (Lyrica) – a "small" molecule, one which is very non-specific in what it targets in the body; there are tens, probably hundreds of potential targets for a molecule that small; //not recommended//		* pregabalin (Lyrica) – a "small" molecule, one which is very non-specific in what it targets in the body; there are tens, probably hundreds of potential targets for a molecule that small; //not recommended//
	* propoxyphene-acetaminophen (Darvocet, Propox-N)		* propoxyphene-acetaminophen (Darvocet, Propox-N)