Concerns about progress on the Marshall Protocol

The exact nature of a patient's progress on the Marshall ProtocolA curative medical treatment for chronic inflammatory disease. Based on the Marshall Pathogenesis. (MP) can be variable. Depending on the level of inflammationThe complex biological response of vascular tissues to harmful stimuli such as pathogens or damaged cells. It is a protective attempt by the organism to remove the injurious stimuli as well as initiate the healing process for the tissue., locations of infection, exposure to light, current stress levels, dosing and frequency of 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. or antibiotics, and any number of other variables, patients can experience minimal to a strong immunopathological reactions that wax and wane.

There is no evidence that the MP worsens a patient's health. If anything, the strong exacerbation of symptoms as the immune response recovers, is an indication that the MP is working all too well. For patients who are experiencing intolerable immunopathologyAn unbearable or unsafe severity of bacterial die-off reaction., there are a number of strategies available.

In the interests of safety, it is important that patients proceed on the MP at a conservative pace, leaving themselves a margin due to the highly variable nature of immunopathologyA temporary increase in disease symptoms experienced by Marshall Protocol patients that results from the release of cytokines and endotoxins as disease-causing bacteria are killed..

“My disease is getting worse”

Frequent administration of olmesartan (Benicar)Medication taken regularly by patients on the Marshall Protocol for its ability to activate the Vitamin D Receptor. actives the immune response against intraphagocytic and other pathogenic forms of bacteria. When bacteria die, endotoxins and inflammatory cytokinesAny of various protein molecules secreted by cells of the immune system that serve to regulate the immune system. are released at the site of infection, causing an increase in symptoms such as pain and fatigue. For example, patients with the lung disease sarcoidosis may notice that their coughing spells get worse. Those with psoriasis may notice a flare in their skin symptoms. In laymen's terms, one is likely to feel worse before getting better.

Early on the protocol MP patients' symptoms tend to wax and wane in a semi-predictable fashion and occur in expected locations. This is particularly true if a regular schedule of dosing is followed. However, as a patient's own immune response begins to take hold, predictability become more elusive. Patients may even notice new symptoms occurring in organs previously not known to be infected. The MP does not and cannot create new inflammation.

Later on in the protocol, Biofilm A structured community of microorganisms encapsulated within a self-developed protective matrix and living together. is likely to break up, leading to unpredictable surges in immuno-pathology.

In cases where people have trouble grasping this concept, the biggest hurdle is to get them through the first phase of the treatment when the immunopathology is often strongest. If I have any dropouts, they come from this group – the people who can’t intellectually grasp the idea that they need to feel worse before they get better.

Greg Blaney, MD

The 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. (sometimes referred to as the Jarisch-Herxheimer reaction) is widely accepted as an indication of progress and, according to the literature, has been observed in at least ten different diseases and conditions.

It is noteworthy that anxiety often is a symptom of the disease process. Given that the MP is, after all, a multi-year treatment, succeeding on the MP requires a conviction that the cause of one's inflammation is intracellular, pleomorphic bacteria, and that the elimination of these bacteria will eventually result in resolution of the inflammation and recovery from disease.

Patients tend to become more sensitive to antibiotics as their immune system heals

Please note that use of antibiotics to modulate response on the MP is now considered optional, and the use of Azithromycin is discouraged.

At some point in the Protocol, many patients find their immune system becomes much more active and immunopathology symptoms may increase. At this point, for those who still use antibiotics, there may be a need to reduce or stop, staying on Benicar alone. This is completely expected and is consistent with the stages of illness and recovery. Rather than being a sign of “treatment failure,” the need to reduce antibiotics is actually a result of improved immune function.

Managing intolerable immunopathology

Main article: Managing immunopathology

Patients whose immunopathology is intolerable have a number of options, including the following:

  • Lower one's dose of antibiotics. Typically, the most effective way to manage immunopathology.
  • Take a break from taking antibiotics. Breaks tend to be more effective in the earlier stages of treatment before the immune response becomes more self-sustaining.
  • Discontinue minocycline for a period of time and prove to yourself that it is the antibiotic which is making you feel worse.
  • Dose minocycline more frequently, 50mg every day. This may “turn off” immunopathology and may be a better option than discontinuing antibiotics altogether, which can actually exacerbate immunopathology.
  • Ensure olmesartan (Benicar) dosing frequency is every four hours. Typically, if a patient's symptoms are a result of immunopathology, the increase in olmesartan (Benicar) will help alleviate them.
  • Assess light exposure to determine whether any relief might be derived from decreased exposure. Sometimes, MP patients are extremely light sensitive in the beginning of the MP and any excess light exposure makes them feel considerably worse than they would feel without the excess light.
  • Change nothing and just “ride it out” to see if or when there is a window of feeling some improvement. Sometimes it take several weeks before a patient feels any better.

Concerns about progress with a life-threatening disease

The expected increase in symptoms that MP patients experience can be alarming, especially when those symptoms are potentially life-threatening. A patient with severe cardiac inflammation may have to endure frightening arrhythmias or chest pain before the heart muscle is free of inflammation. A patient with shortness of breath and coughing may experience a worsening of those symptoms before pulmonary function improves. Symptoms of severe depression are no less scary.

One common mistake MP patients make is to underestimate how much exposure to light can drive immunopathology. As a general rule, the more life-threatening a patient's symptoms, the more judicious he or she should be when it comes to regulating light exposure.

Of course, patients experiencing any kind of symptoms that appear life-threatening are advised to promptly consult with their physicians.

“The MP is not having an effect”

MP patients do not always recognize immunopathology. Mental or neurological immunopathologyA temporary exacerbation of neurological symptoms due to bacterial death. Requires careful management by physicians. may be particularly hard to notice given that life events can color the perception of the MP's effect on one's mind. Many patients have benefited by recording their progress in a log or journal or by asking a friend or family member to offer feedback on progress.

"I do everything by the MP book, and I am still ill"

Environmental immune suppressants can be powerful enough to delay or impair recovery.

The emf from a microwave oven is one example. Air pollution of various kinds is another, like the fuel drop we guessed was affec6ting one MPeer who lived under the approach path of a major airport.

Electrosmog suppresses immunity

This past year we have identified and begun to document the impairment of immune function caused by the massive global build-out of wireless technologies.

Something as simple as a wireless home telephone can cause all the symptoms of CFS/ME in people. Symptoms that often resolved when the wireless home phone was removed. Unfortunately, there are also wireless signal sources that are coming into many homes that can't be removed by us (cell towers, neighbor's wi-fi, etc.)

Joyful 2015

Citizens oppose 5G technology over multiple risks to health including heart arrhythmias and 50% reduction in neutrophil (immune) activity in vertebrate research

Women until past childbearing and boys not yet fully grown are particularly at risk. Aware parents are learning how to improve their children's lives, right from the start Safe Baby Monitor

Troubleshooting a seemingly unresponsive immune system

The following checklist should help identify any reasons why patients fail to generate the expected immunopathological reaction.

Reports of MP treatment failures

Every so often, reports of “treatment failure” surface. The MP has a number of requirements, which are non-negotiable, and, if violated, can result in failure. For example, one cannot make progress on the MP while consuming significant levels of vitamin D or taking immunosuppressants. Continuing to take supplements with unknown effects can be problematic as well.

Another issue relates to the fact that the MP is a curative therapy. For many of the sickest patients – people who have five, six or more co-morbidities – this may mean five or more years of treatment.

So long as symptoms of immunopathology continue and elevated blood markers of bacterial die-off (such as BUN), there are bacteria being killed and to be killed.

The range of time it takes seriously ill patients to recover on the Marshall Protocol is not entirely without precedent in medicine. The first-line treatment for for tuberculosis infection takes six months1) – and that's only a single genus as opposed to a metagenomic microbiota. It's also worth noting that recovery from tuberculosis also involves an immunopathological-type reaction.2)

Patients should try to consider their responses to the MP medications logically. The safety profile of olmesartan (Benicar) as well as the safety profile of the MP antibiotics are excellent. The single best explanation for why a patient symptoms are worse is that the immune system is becoming stronger and microbes are being killed.

Finding the optimal pace

Patients who are sick with Th1 diseaseAny of the chronic inflammatory diseases caused by bacterial pathogens. are understandably eager to become well. But, especially for patients who are very ill, achieving desired results from the MP can take several years or more. Over that length of time, there is strong evidence that the MP is effective. On the other hand, there is no current evidence that one can speed up progress on the MP beyond a certain pace.

In fact, trying to excessively hasten the pace of the MP has a number of disadvantages:

  • Especially when patients have cardiac, respiratory or neurological symptoms, patients could be putting their lives in danger.
  • Patients could have an episode of intolerable immunopathology, which could require a visit to the emergency room and set back one's progress even further.
  • Killing too many bacteria in a short period of time could result in tissue damage.
  • Patients could become discouraged, both physically or mentally.
  • In Phase One, going too fast could result in a failure to kill all the bacteria susceptible to minocycline alone.

Finding the optimal and safest pace to succeed with the MP is ultimately a matter of trial and error. Patients are advised to work closely with their physician to find the right combinations of antibiotics at the right time.

Leave a margin

MP patients are advised to dose their antibiotics such that they leave themselves a margin between the level of their current symptoms and “intolerable.” The variable nature of immunopathology necessitates this approach.

Here are some suggestions for getting well in the safest and smoothest manner, without getting side-tracked or delayed:

  • Give new antibiotics two weeks to “kick in” before increasing a dose.
  • Stay at each dose level for at least three doses before increasing. A dose may kick in suddenly and unexpectedly after several doses at the same dose level.
  • If you are experiencing intolerable symptoms at any given dose level, stay at the dose level longer.
  • Make changes cautiously, especially when other factors and life events could result in debilitating symptoms. These symptoms include: extra stress, added activity, an infection, difficult menses, etc.
  • Try a break from the MP to help determine what symptoms are disease baseline (pre-MP) and what are immunopathology. Note that some patients do not feel better with a short break and need the antibiotic(s) to keep symptoms manageable.
  • If in doubt, always choose the more cautious action.

It is hard for some of us to pace ourselves and go slowly. Many of us are used to pushing ourselves to the limit and have learned to be tough and almost obsessive in order to make it in our lives. We have had to overcome punishing levels of symptoms in order to make it under the burden of these illnesses. However, for the Marshall Protocol, remember, discretion is the better part of valor. Don’t treat your body too harshly. The illness has done that too much already. The fable of the tortoise and the hare really does apply here: the slow and steady ones are better able to make it to the finish line.

Joyce Waterhouse, PhD

An exception: ALS may require being less conservative

Patients with ALS, unlike those who have any other chronic Th1 disease, have a fast-progressing illness and need to be more aggressive in progressing on the MP to kill bacteria as quickly as possible.

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

===== References =====

Cek M, Lenk S, Naber KG, Bishop MC, Johansen TEB, Botto H, Grabe M, Lobel B, Redorta JP, Tenke P, Members of the Urinary Tract Infection (UTI) Working Group of the European Association of Urology (EAU) Guidelines Office. EAU guidelines for the management of genitourinary tuberculosis. Eur Urol. 2005 Sep;48(3):353-62. doi: 10.1016/j.eururo.2005.03.008. Epub 2005 Mar 16.
[PMID: 15982799] [DOI: 10.1016/j.eururo.2005.03.008]
Cheung CMG, Chee SP. Jarisch-Herxheimer reaction: paradoxical worsening of tuberculosis chorioretinitis following initiation of antituberculous therapy. Eye (Lond). 2009 Jun;23(6):1472-3. doi: 10.1038/eye.2008.204. Epub 2008 Jul 4.
[PMID: 18600241] [DOI: 10.1038/eye.2008.204]
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