Length 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 Olmesartan.

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 olmesartan (Benicar) alone as the drug increases expression of the body's own antimicrobial peptidesBody’s naturally produced broad-spectrum antibacterials which target pathogens.. However, it is considered ideal for patients to stay on the Protocol until they no longer experience immunopathology from any antibiotic combination.

Why the MP requires multiple years

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

When patients first begin the MP, they may optionally use low-dose, pulsed minocycline to reduce patients' bacterial load and to provide a 48-hour cycling of immunopathology symptoms.

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

Similarity of the MP to anti-tuberculosis treatments

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

Factors influencing length of treatment

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

In treating over 300 patients with the MP over 7+ years, therapeutic responses can be broken down into three categories.

Approximately 50% respond and improve solely with the MP. This is both in response to the “classical MP” where antibiotics were used more aggressively and the “new MP” where olmesartan is used solely.

25% drop out due to inability to cope with IP or the lifestyle restrictions. Recently this group has diminished in percentage as lifestyle restrictions have been moderated, antibiotics are not introduced early or at all and the dose of olmesartan are titrated according to response. However, there remains a 10% group who despite these adjustments cannot tolerate the MP effects.

Finally 25% plateau with continued disabling symptoms or even regress despite continuing with olmesartan at 40 mg q4-6h and after 4+ years of treatment.

Greg Blaney, M.D.

Charting progress

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

  • symptom severity before the MP vs. while taking antibiotics on the MP (use of low dose ABx is no longer regarded as a necessary part of the Marshall Protocol)
  • symptom severity before the MP vs. while on the MP, but having abstained from antibiotics for a couple months (giving enough time for the antibiotics, to be fully metabolized)
  • symptom severity before the MP vs. during the 4-6 hours after taking a dose of azithromycin (Zithromax) N.B. azithromycin is no longer recommended for use while on the MP.
  • symptom severity during adolescence vs. while taking antibiotics on the MP
  • blood markers before the MP vs. during the MP (although it should be noted that specialists still cannot reliably diagnose a disease with blood work)

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

Time taken to tolerate olmesartan and added minocycline

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

Ramping Minocycline

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

After completion of the Marshall Protocol

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

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


home/patients/mp_duration.txt · Last modified: 10.21.2016 by sallieq
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