The Marshall Protocol (MP) is based on the Marshall Pathogenesis, which posits that chronic diseases (termed Th1 illnesses), are the result of infection by an intraphagocytic, metagenomic microbiota of chronic microbial forms that we often refer to as the Th1 pathogens.
Patients on the MP take higher than typical doses of a medication called olmesartan (called Benicar in the United States), which is able to bind and activate the Vitamin D Receptor (VDR) by pushing 25-D and bacterial proteins out of the receptor.
Patients also lower levels of 25-D in the body by avoiding the kinds of vitamin D present in various foods. These measures renew the body’s ability to turn on the innate immune response and produce antimicrobial peptides. The immune system is then able to kill the Th1 pathogens and is once again able to manage viral and other co-infections.
Main article: Science behind immunopathology
Related articles: Managing immunopathology, Immunopathology
When patients on the MP kill bacterial pathogens they experience a reaction called immunopathology. Immunopathology is an increase in one's present symptoms of Th1 inflammation, or a return of previous Th1 inflammatory symptoms, that is caused largely by cytokines generated by the immune response and endotoxins released from dying bacteria. Occasionally, immunopathology will result in a new symptom or abnormal laboratory value (e.g., elevated creatinine, elevated liver enzymes, low white blood count, etc.). The occurrence of subclinical bacterial inflammation is due to olmesartan's activation of the immune system. Immunopathology appears to be a necessary part of recovery. The amount of immunopathology a patient experiences on the Marshall Protocol (MP) tends to correlate with disease severity and bacterial load. Patients who are less sick will have comparatively less-strong immunopathology.
Immunopathology is sometimes used synonymously with the “Jarisch-Herxheimer reaction” or “herx.”
Many MP patients who have experienced prolonged periods of immunopathology have reached stages of significant improvement or remission. This supports the conclusion that immunopathology is a necessary result of chronic bacterial death, and a precursor to disease reversal. The MP is not unique in this regard. A number of other diseases and/or therapies generate immunopathological or immunopathological-like reactions.1) 2) 3)
Lab work and patient reports can be used to track clinical signs of immunopathology.
NOTE: Antibiotics are no longer considered a necessary part of the Marshall protocol.
Main article: Science behind olmesartan
Related article: Health maintenance and Olmesartan
Patients on the Marshall Protocol (MP) take olmesartan (Benicar), a drug whose actions are well known, every six hours. In general, olmesartan tends to be prescribed for its antihypertensive properties due to the fact that is an angiotensin receptor blocker. A growing body of research supports the use of olmesartan as a part of a curative therapy for chronic disease.
For the purposes of the MP, olmesartan has two primary actions: it reduces inflammation by blocking the Nuclear Factor-kappaB cytokine pathway and it is an agonist of the Vitamin D Receptor (VDR). As a VDR agonist, olmesartan uniquely activates the innate immune response. Research supports the safety of the doses used by MP patients.
Olmesartan has minimal interactions with other drugs and is one of the safest drugs on the market.
Main article: Safety of olmesartan
Related article: Recent research into Celiac disease
Some patients and healthcare providers have expressed concerns about the safety of higher than typical doses of olmesartan (Benicar).
Ample research supports the fact that olmesartan is one of the safest and has the most gentle side effects profiles of almost any drug on the market – as opposed to Benicar HCT, which contains a thiazide and is harmful.
I feel there are simply no adverse reactions or negative side effects that I need to worry about while taking the Marshall Protocol medications. It is an extremely safe approach. Personally, I believe overtreating this condition is preferable than undertreating as the side effects of both antibiotics and Benicar are so minimal compared to the risk of [disease] recurrence.
Greg Blaney, M.D.
For those with gastric issues, it is recommended that the pill be crushed and mixed with applesauce or similar to reduce impact on gastric lining.
Main article: Olmesartan and kidney disease
As a matter of course, markers of kidney function including blood urea nitrogen (BUN) and creatinine will fluctuate while a patient is on the Marshall Protocol (MP).
There is a tendency for some physicians to become alarmed by these fluctuations, particularly if a patient has kidney disease. However, for the vast majority of patients these test results are an expected part of the healing process. In fact, a wide range of research shows that olmesartan is therapeutic for kidney disease.