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Introduction to the Marshall Protocol

The Marshall Protocol, sometimes referred to as the MP, was developed by a team led by Trevor Marshall, PhD, as an antimicrobial treatment for chronic inflammatory diseases. Most diseases of unknown cause are chronic inflammatory diseases, and almost 100% of patients with these diseases have responded to the treatment. On this site and others, chronic inflammatory diseases are sometimes referred to as the Th1 diseases.

At its essence, the MP involves four key elements, each of which is supported by the latest insights in molecular science. MP patients must:

Many MP patients also take varying combinations of pulsed, low doses of specific bacteriostatic antibiotics.

The objective of the MP is to safely activate a highly versatile defense, the innate immune response. By strengthening the innate immune response, the MP targets the mix of microbes including bacteria, fungi, and viruses that play a role in chronic disease. As pathogens and infected human cells die, they generate inflammation (sometimes called a “cytokine storm”) and release endotoxins into the body, resulting in a temporary increase in patients' original symptoms. This is known as immunopathology (generally abbreviated to IP).

Treatment on the MP requires a number of years to complete, but the exact duration is determined by the rate of a patient's progress.

The MP is to be administered only by a licensed physician competent in use of the Marshall Protocol. The available evidence for the treatment's effectiveness is described here.

Medications used

Important: The Autoimmunity Research Foundation does not support or license the public use of this therapy for patients not actively participating on the Marshall Protocol study site at

This document is a one-article summary of key issues related to the Marshall Protocol, especially those relevant to physicians. Many of the topics covered here are reviewed in greater depth throughout the Knowledge Base.

Avoidance of vitamin D

Main article: Vitamin D in food

The vitamin D derived from food and supplements is converted into 25-hydroxyvitamin D (25-D), the form of vitamin D which dysregulates the Vitamin D Receptor (VDR), preventing the innate immune system from functioning properly. Olmesartan (Benicar) can only restore the function of the innate immune system when it does not have to compete with 25-D at the VDR binding sites. A 25-D level of under 12 ng/ml provides the opportunity for olmesartan to work, and allows the immune system to return to proper function.

Patients on the Marshall Protocol (MP) are required to avoid all ingested forms of vitamin D. When the innate immune system returns to proper function, symptoms (immunopathy, or IP) may increase, but without this return to function, there cannot be cure.

A number of foods contain vitamin D, either naturally or because it has been added during processing. It is important to read labels. However, sometimes a label will not state that a food is supplemented with vitamin D. In such cases, the only real way for a MP patient to determine if they have been successful at avoiding vitamin D is to test his/her 25-D level. The target for 25-D level is 12 ng/ml or less.


Main article: Immunopathology

Immunopathology (often abbreviated to IP) is what patients experience when they fight an infection. In the context of the Marshall Protocol, immunopathology refers to an increase in one's present symptoms of inflammation, or a return of previous inflammatory symptoms. This is caused by cytokines and endotoxins being released from dying bacteria. Occasionally, immunopathology will consist of a new symptom or abnormal lab value due to the occurrence of subclinical inflammation that has been revealed by the Marshall Protocol (MP). Immunopathology is a necessary part of recovery for most patients. The amount of immunopathology a patient experiences on the Marshall Protocol (MP) is correlated with disease severity. Patients who are less sick will have comparatively less strong immunopathology.

Immunopathology is sometimes used synonymously with “herx” or the “Jarisch-Herxheimer reaction.”

Note that three forms of immunopathology are particularly life-threatening and should be handled with an abundance of caution: cardiac immunopathology, neurological immunopathology, and respiratory immunopathology.

Duration of the Marshall Protocol

The exact duration of the Marshall Protocol (MP) depends on any number of factors, including degree of illness, amount of fibrosis, subclinical inflammation, the health of the kidneys, and personal preference to remain on the MP.

While someone who is very ill might expect the MP to take five or more 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 olmesartan or olmesartan plus 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 as the drug increases expression of the body's own antimicrobial peptides. However, it is considered ideal for patients to stay on the Protocol until they no longer experience immunopathology from any antibiotic combination.

Cost of the Marshall Protocol

Related article: Insurance coverage

One of the prerequisites for starting on the Marshall Protocol (MP), a treatment that generally lasts for many years, is the money and/or insurance necessary to pay for certain basic expenses. These expenses include clinic visits, laboratory tests, medications, and special protective sunglasses. Some of these costs are fully or partially covered by insurance. Patients can check their coverage before agreeing to a visit, test or medication so that they are aware of the potential cost. In the United States, insurance coverage varies widely. Patients usually obtain full insurance coverage for the Protocol. The support given on the MP study site is free.

Diseases and conditions treated by the Marshall Protocol

Main article: Diseases
Related article: Symptoms

According to the Marshall Pathogenesis, chronic inflammatory disease is caused by a microbiota of bacteria, including L-form bacteria, biofilm bacteria, and intracellular bacterial forms. These bacterial forms are collectively known as the Th1 pathogens, and they collectively cause the Th1 diseases. Although the exact species and forms of bacteria, as well as the location and extent of the infection, vary between one patient suffering from chronic disease and the next, the disease process is common: bacterial pathogens persist and reproduce by disabling the innate immune response.

As counterintuitive as the theory of a Th1 Spectrum Disorder may seem to some medical specialists, it has been the experience of Autoimmunity Research Foundation that nearly all MP patients with inflammatory disease eventually respond with immunopathology–the predictable rise and fall of symptoms, which is taken to be a sign of progress.

Some diseases are represented by more patients trying the therapy than others. As more patients join the MP cohort, the Autoimmunity Research Foundation will gather more data about the efficacy of the treatment with respect to individual diseases. In the meantime, the MP may be an appropriate treatment option for some of the diseases listed below.

Approximately twenty patients have shared their stories of recovery on

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Last modified: 01.02.2012
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