Resources for physicians

The Marshall Protocol (MP) is the name given to a therapy devised by Professor Trevor Marshall. Based on the pathogenesis Marshall has proposed for chronic inflammatory disease, the MP is aimed at targeting bacteria, fungi, viruses, and other microbes that appear to interact to cause chronic inflammatory diseases.

Marshall and colleagues have hypothesized that chronic inflammatory diseases, including many autoimmune diseases, are caused by dysbiosis of a metagenomic microbiotaThe community of bacterial pathogens including those in an intracellular and biofilm state which cause chronic disease.: communities of microbial pathogens, many of which persist intracellularly. A recent (2009) peer-reviewed paper describes this Pathogenesis in more detail.1)

Supported by Autoimmunity Research Foundation, the MP has been available since 2002 and has been used in a wide range of chronic inflammatory illnesses.

A significant number of patients diagnosed with sarcoidosis, post-treatment chronic Lyme syndrome, chronic fatigue syndrome, uveitis, Hashimoto’s thyroiditis, rheumatoid arthritis, fibromyalgia, diabetes type II, psoriasis, lupus (SLE), multiple sclerosis, and a number of other diagnoses are showing a promising response from being treated with the Protocol.

In determining whether a patient can be successfully treated with the MP, a specific chronic disease diagnosis is not as important as the clinical assessment by an interested health care provider, the results of a therapeutic probe, and outcome of the vitamin D metabolites blood test.2)

According to the Marshall PathogenesisA description for how chronic inflammatory diseases originate and develop., chronic inflammatory disease is characterized by dysregulation of the nuclear receptorIntracellular receptor proteins that bind to hydrophobic signal molecules (such as steroid and thyroid hormones) or intracellular metabolites and are thus activated to bind to specific DNA sequences which affects transcription. pathways which control the innate immune response. For example, the Vitamin D nuclear receptorA nuclear receptor located throughout the body that plays a key role in the innate immune response. (VDR) expresses many of the body's antimicrobial peptidesBody’s naturally produced broad-spectrum antibacterials which target pathogens. (along with TLR2A receptor which is expressed on the surface of certain cells and recognizes native or foreign substances and passes on appropriate signals to the cell and/or the nervous system.). In addition to down-regulation of expression of the VDR itself by many common bacteria and viruses, antagonistic microbial metabolites incrementally block ligands from activating it. Ingested vitamin D slows activity of the receptor in this same manner, preventing the body from killing the pathogens at the heart of the disease state. That is why avoidance of ingested vitamin D (in food and supplements) is essential for the innate immune system to recover. 3) 4)

The MP uses multiple daily dosing of olmesartan medoxomil (Benicar, Olmecip, Olmetec) to re-activate the Vitamin D Nuclear Receptor, dislodging bacterial ligands in the process. This drug was developed as an Angiotensin II Receptor Blocker (ARB) but it has multiple actions in the human body when dosed as defined by Marshall. In addition to immunostimulation via the VDR, Olmesartan also reduces inflammatory cytokine production by inhibiting the NF kappa-B transcription pathway. This inhibits, among other things, the release of TNF-alpha, helping to protect the organs from effects of excessive inflammation.

Additionally, several pulsed, low-dose, bacteriostatic oral antibiotics may optionally be used, in a minority of patients it may reduce IP, but is more likely to provoke it when after some months, it has declined to insignificance. Four bacteriostatic antibiotics: minocycline, clindamycin, sulfamethoxazole-trimethoprim (Bactrim DS), and demeclocycline (Declomycin) have been found useful for these outcomes. Minocycline directly acts in an immunosuppressive manner on the PXR nuclear receptor, and this biochemical action may be useful in pulsing immunopathology to (for example) a 48 hour cycle. Bactrim, however, may be better avoided by anyone with a tendency to high potassium MedPage which is not under control by sodium bicarbonate (see baking soda)

N.B. azithromycin is no longer recommended for use while on the MP.

Seriously ill patients may develop photosensitivity during the healing process, so avoidance of direct and indirect sunlight may be necessary. Patients may need to protect their eyes from bright lights to prevent further retinal damage and reduce neurological symptoms due to inter alia, the effect of ocular 1,25-D production on the brain.

Patients may also develop sensitivity to skin exposure to sunlight, and/or find that they need to avoid skin exposure to sunlight in order to maintain the naturally low blood levels of vitamin D required by the Protocol. However, some patients do not experience significant photosensitivity during recovery. Those who do often find it more manageable several years into the therapy.

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 MarshallProtocol.com.

Physicians' concerns about the Marshall Protocol

Over the years, physicians have voiced various concerns about the Marshall ProtocolA curative medical treatment for chronic inflammatory disease. Based on the Marshall Pathogenesis., concerns ranging from the safety of higher doses of olmesartan (Benicar)Medication taken regularly by patients on the Marshall Protocol for its ability to activate the Vitamin D Receptor. to concerns about long-term antibiotic use. The Autoimmunity Research FoundationNon-profit foundation dedicated to exploring a pathogenesis and therapy for chronic disease. has assembled articles, well-grounded in scientific research, which address these concerns. Physicians who choose to use and administer the MP do so on the basis of the available evidence.

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Support for physicians

Online forum

Access to the Marshall Protocol study site is available for health professionals upon request. Health Professionals are welcome, and will be manually joined into the database after sending an email to Moderators@MarshallProtocol.com listing their desired username and password. Health professionals are granted access to the Private Section for Health Professionals.

If you need one of our staff members to verify your account status and username, please send an email to our Admin Staff and let us know so we can help you get the problem resolved.

Contact Trevor Marshall directly

In addition to the Private Section for Health Professionals, health professionals have the option to contact Dr. Marshall at TM@AutoimmunityResearch.org or (818) 584-1201.

To ensure success, physicians are asked to encourage their patients to carefully study this Knowledge Base. This site provides additional instructions, helpful hints, and support that will greatly ease a practitioner’s emotional support workload and smooth the patient’s path to recovery.

Representative presentations

Trevor Marshall and the rest of the Autoimmunity Research Foundation research team have been active in publishing papers and making presentations before learned bodies.

This material is provided in order to give a more detailed description of the Marshall Pathogenesis and Protocol.

Presenter(s) Date Conference Title Location
Marshall TG 2016 SeptemberPredictive, Preventive and Personalized Medicine Immune Disease and the Microbiome: Healthcare in response to New Knowledge Moscow, Russia
Marshall TG 2016 April 10th Congress on Autoimmunity What More is there to Discover about Vitamin-D Leipzig, Germany
Marshall TG 2015 September EPMA World Congress Is there a role for a Tin-Foil hat in PPPM? University of Bonn
Marshall TG 2015 May Preventive Medicine 2015 Innovative methods of diagnosis, treatment and rehabilitation Moscow, Russia
Marshall TG 2012 June Molecular Basis of Clinical Medicine What can microbial genomes tell us about human health? Saint Petersburg, Russia
Lindseth IA 2012 May 8th International Congress on Autoimmunity Treatment of chronic fatigue syndrome as an immunological disorder Granada, Spain
Marshall TG 2012 May 8th International Congress on Autoimmunity The microbiome, which feeds a myriad of autoimmune diseases Granada, Spain
Goetze-Pelka R 2011 November Autoimmunity Congress Asia Psychiatric and neurologic comorbidities as systemic dysfunctions Singapore
Marshall TG 2011 May NeuroTalk 2011 The human microbiome is the mechanism fueling neurodegenerative disorders Dalian, China

Read more

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

Sallie Q 08.19.2017 added to list of presentations 2015 Sept, 2016 April, 2016 Sept

Trevor also mentioned that we probably do need to develop a “cover letter” which may take more time.

===== References =====

Proal AD, Albert PJ, Marshall T. Autoimmune disease in the era of the metagenome. Autoimmun Rev. 2009 Jul;8(8):677-81. doi: 10.1016/j.autrev.2009.02.016. Epub 2009 Feb 13.
[PMID: 19393196] [DOI: 10.1016/j.autrev.2009.02.016]
Blaney GP, Albert PJ, Proal AD. Vitamin D metabolites as clinical markers in autoimmune and chronic disease. Ann N Y Acad Sci. 2009 Sep;1173:384-90. doi: 10.1111/j.1749-6632.2009.04875.x.
[PMID: 19758177] [DOI: 10.1111/j.1749-6632.2009.04875.x]
Albert PJ, Proal AD, Marshall TG. Vitamin D: the alternative hypothesis. Autoimmun Rev. 2009 Jul;8(8):639-44. doi: 10.1016/j.autrev.2009.02.011. Epub 2009 Feb 12.
[PMID: 19393200] [DOI: 10.1016/j.autrev.2009.02.011]
Waterhouse JC, Marshall TG, Fenter B, Mangin M, Blaney G. High levels of active 1,25-dihydroxyvitamin D despite low levels of the 25-hydroxyvitamin D precursor — Implications of dysregulated vitamin D for diagnosis and treatment of Chronic Disease. In Vitamin D: New Research. Volume 1. Edited by: Stoltz VD. New York: Nova Science Publishers; 2006. ISBN: 1-60021-000-7.
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