Blumberg HM, Leonard MK Jr, Jasmer RM
JAMA293p2776-84(2005 Jun 8)
Related article: Spontaneous remission is a myth
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.
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.
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)
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.
There are different ways to chart one's progress on the MP. Patients can compare:
Patients can also keep track of changes in activities of daily living and ability to take on additional work and home responsibilities.
The following curves were assembled with patient data. What they show is the range of times to 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.
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.
To a large extent, patients who have completed the Marshall Protocol can return to a normal life with the following modifications:
— Sallie Q 01.13.2016 edited mentions of Azithromycin in Charting progress.
addition to list of Factors influencing length of treatment — Sallie Q 08.18.2015