Important Note: In order to receive protocol information or coaching with a biofilm protocol, support for H. pylori eradication.., you will need to become a distance patient – Distance Client Program. I truly do want to help any and all who are interested, but it’s finally gotten to the point where far too many people want free advice, treatment plans, personalized protocols, etc. I’m a firm believer in fair exchange and I feel I have done so by providing the information in this post.
I want to help you and I can create a tailor-made protocol for your individual situation. Please fill out the distance patient application (link above). If you have a specific question about the program please call me first at 714-639-4360.
Dr. Ettinger’s Biofilm Protocol for Lyme and Gut Pathogens
Copyright © Marcus S. Ettinger, DC 2009-2018
A specific question has been asked a lot lately, as to what is my protocol for busting through bacterial biofilm. This question has mostly come from people diagnosed with or those who think they may have H. pylori bacterial infection or Lyme disease. For additional information on the link between Lyme and biofilm, please check out this 2008 presentation: Biofilms of Borrelia burgdorferi And Clinical Implications for Chronic borreliosis by Alan B. MacDonald, MD. The reason that I’ve put this “biofilm busting / disrupting protocol” post together is based on this one fact: the day I discovered how to have an effect on bacterial biofilm or it’s communication, in the human body, was the day that chronic conditions, from the sinus to the prostate, were no longer a ‘project’, so to speak, to handle. I hope the data below is helpful to you in your search for information or health restoration.
First a little background on – what is biofilm
Figure 1: The life cycle of biofilm. 1: individual bacterial cells populate a surface. 2: The extracellular polymeric substance (EPS) is produced and attachment becomes irreversible. 3 & 4: Biofilm architecture develops and matures. 5: Single planktonic cells (planktonic – meaning free floating) are released from the biofilm.
Tuned-Down Definition: A complex structure adhering to surfaces that are regularly in contact with water, consisting of colonies of bacteria and usually other microorganisms such as yeasts, fungi, and protozoa that secrete a mucilaginous protective coating in which they are encased. Biofilms can form on solid or liquid surfaces as well as on soft tissue in living organisms and are typically resistant to conventional methods of disinfection. Dental plaque, the slimy coating that fouls pipes and tanks, and algal mats on bodies of water are examples of biofilms. While biofilms are generally pathogenic in the body, causing such diseases as cystic fibrosis and otitis media, they can be used beneficially in treating sewage, industrial waste, and contaminated soil.
The American Heritage® Science Dictionary
Tuned-up Definition: Direct observations have clearly shown that biofilm bacteria predominate, numerically and metabolically, in virtually all nutrient-sufficient ecosystems. Therefore, these sessile organisms predominate in most of the environmental, industrial, and medical problems and processes of interest to microbiologists. If biofilm bacteria were simply planktonic cells that had adhered to a surface, this revelation would be unimportant, but they are demonstrably and profoundly different. We first noted that biofilm cells are at least 500 times more resistant to antibacterial agents. Now we have discovered that adhesion triggers the expression of a sigma factor that derepresses a large number of genes so that biofilm cells are clearly phenotypically distinct from their planktonic counterparts. Each biofilm bacterium lives in a customized microniche in a complex microbial community that has primitive homeostasis, a primitive circulatory system, and metabolic cooperativity, and each of these sessile cells reacts to its special environment so that it differs fundamentally from a planktonic cell of the same species. Lappin-Scott HM, et.al. Microbial biofilms. Annu Rev Microbiol. 1995;49:711-45.
Related Biofilm Posts:
- Biofilm Basics (link). This post has additional information on biofilm. The video by Dr. Bill Costerton – The “Father” of Biofilms has some great information on a variety of conditions
- Quorum Sensing and Biofilm (link)
- Biofilm, Bacterial Density, Quorum Sensing, and Autoinducers (link)
- Princeton researchers have for the first time revealed the mechanism of how bacteria, cell by cell, create protective masses, called biofilm. (link)
Pic. A simulation of the bacteria Vibrio cholerae forming a biofilm, with each slightly curved, rod-shaped unit indicating individual bacteria. The architecture shows vertically oriented bacteria at the biofilm’s center and horizontally oriented bacteria at the bottom, adhered to the surface upon which the mass is growing. Credit: Image courtesy of Bonnie Bassler, Howard Stone, Ned Wingreen and Jing Yan
Biofilm and Chronic Infection: Key Points (my additions and comments are in RED)
Excerpts from a Klaire Labs, product monograph, which is a basic primer on the topic of bacterial biofilm.) The National Institutes of Health (NIH) estimates that 60% of all human infections and 80% of refractory infections (def. unresponsive to medical treatment) are attributable to biofilm colonies. I have seen this, most commonly in cases, I’ve worked-up where the pathogen is: Chlamydia pneumoniae, Pseudomonas aeruginosa, Helicobacter pylori, [Lyme disease – Borrelia burgdorferi], and Candida albicans.
– The protection conferred upon microorganisms (primarily gram-negative bacteria) by biofilm allows them to achieve a high level of antibiotic resistance, increased virulence, stealth, and invisibility.
– Biofilm not only provides a physical barrier to antimicrobial agents (pharmaceutical antibiotics) and host antibodies but facilitate the exchange of antibiotic-resistant genetic material between organisms and may contain antibiotic-degrading (hydrolyzing) enzymes such as b-lactamase, effectively neutralizing incoming antibiotic (b-lactam antibiotics) molecules.
– In fact, biofilm communities can be 400-1000 times more resistant to antibiotics than free-floating planktonic bacteria.
– There may be 10, 20, 30, 40, 50, 60 different types of bacteria within a biofilm, especially in infected wounds, post-surgical.
– The decreased growth rate of sessile microorganisms (def. Permanently attached to a substrate; not free to move about; “an attached oyster”) also reduces their antibiotic susceptibility as most antimicrobial agents require rapid cell growth in order to effectively kill or inhibit the microbes. Biofilm thus renders pathogenic microorganisms enormously difficult to eradicate, and can almost single-handedly contribute to localized or systemic inflammatory reactions, autoimmune reactions, and delayed wound healing.
– “…. Once established, however, biofilm infections persist. They are rarely resolved by host defense mechanisms, even in individuals with healthy innate and adaptive immune reactions. Active host responses, such as invading neutrophils (the most abundant type of white blood cell in mammals and forms an essential part of the innate (inborn; natural) immune system), can even be detrimental since those cells can cause collateral damage to neighboring healthy host tissue. Biofilm infections respond only transiently to antibiotic therapy.” From Biofilms Hypertext, Chapter 4 Biofilms in Health and Medicine contributing author James Garth, PhD
– Depending on the type of biofilm, one or more species of pathogens may be found embedded in the extracellular polymeric substance (def. Composed primarily of polysaccharides and can either stay attached to the cell’s outer surface or be secreted into its growth medium). Bacterial extracellular polymeric substance (EPS) may be a carrier of or may have heavy metals embedded in them, especially iron, thus the indication for chelation w/EDTA. EDTA, ethylenediaminetetraacetic acid, is a chelating agent used to lower one’s body burden of heavy metals). This is why Interfase Plus and lactoferrin are so useful.
Pathogenic bacteria that are known to form biofilm include, but are not limited to:
- Borrelia burgdorferi (Lyme bacteria)
- Escherichia coli (linked to colon cancer, bladder, and other infections)
- Bacteroides fragilis (linked to colon cancer)
- Candida albicans (yeast and fungal mutation)
- Clostridium difficile (the most common cause of GI infection and a growing epidemic)
- Clostridium perfringens
- Helicobacter pylori (linked to ulcers, gastritis and stomach cancer)
- Klebsiella pneumoniae
- Legionella pneumophila
- Listeria monocytogenes
- Pseudomonas aeruginosa
- Salmonella typhimurium
- Staphylococcus aureus
- Staphylococcus epidermidis
- Vibrio cholerae
Chlamydophila species such as Chlamydia pneumoniae don’t form a biofilm, as they are intercellular, but may somehow get accidentally caught up in them, before entering a host cell. Here is a good video on Chlamydia and biofilm (Video [biofilm section 7:45 min. mark] – Dr. Wilmore Webley on C. pneumoniae & Biofilms).
The number of human diseases associated with biofilm is ever expanding and includes:
- Chronic bacterial prostatitis (chronic prostate infection)
- Chronic rhinosinusitis (chronic sinus infections)
- Cystic fibrosis pneumonia
- Infective endocarditis (infection of the thin, smooth membrane that lines the inside of the chambers of the heart and forms the surface of the valves)
- Periodontitis (also known as pyorrhea, is a serious gum infection)
- Recurrent otitis media (recurrent ear infection)
- Colon cancer – Bacterial Biofilms Linked To Colon Cancer and Gut Microbes Combine to Cause Colon Cancer
- Virtually all device and surgical implant-related infections.
- Strong evidence is also beginning to emerge for an etiologic (causative) role of pathogenic mucosal biofilm in gastrointestinal diseases, such as Irritable Bowel Disease (IBD): Crohn’s disease, ulcerative colitis. Leaky gut and IBS may have biofilm as a contributing factor as well.
Dr. Marcus Ettinger’s Biofilm Protocol
(You can get help with any of these steps by going to my Distance Client Program).
PLEASE, PLEASE, DO NOT SELF-TREAT! —— READ MY UPDATED, UPDATE BELOW FOR MY EXPLANATION.
A. Biofilm Busting (Disrupting) Nutraceuticals
This is not an exhaustive list of the nutraceuticals that can be used as biofilm disruptors. Not all of these products will be or should be used at the same time. Additional nutraceuticals may be needed based on each individual’s unique situation, genetics, and epigenetic factors. The key to a successful outcome is two-fold. First, it’s building a comprehensive protocol of both biofilm disrupting and antimicrobial agents. Second, is to make sure that all of the protocol’s ingredients are taken at therapeutic levels. If either of these key points is out, both money and time can be wasted.
- Monolaurin or Lauricidin [AKA Glyceryl laurate or glycerol monolaurate] Read more – Antiviral and Antibacterial Actions of Monolaurin and Lauric Acid
- Nattokinase (a potent oral fibrinolytic enzyme supplement). Some prefer Boluoke Lumbrokinase.
- InterFase Plus™ (a broad-spectrum enzyme formula with EDTA)
- InterFase™ (a broad-spectrum enzyme formula without EDTA)
- NAC (N-Acetyl-Cysteine)
- Curcumin 95% Natural Turmeric Extract Powder (Curcuma longa)
- Lactoferrin (I like Nutricillin by Ecological Formulas) Dr. Anju Usman, “Our bodies make proteins, transferrin and lactoferrin, which mop up iron and block the ability of biofilm to form,” she said. “But pathogenic bacteria secrete iron chelators to snatch up iron and thus compete with the transferrin and lactoferrin for what they need to survive.”
- Xylitol (sugar alcohol)
- Nutiva Extra-Virgin Coconut Oil (42-52% Medium Chain Fatty Acids [MCFA], lauric acid, by volume)
- Serrapeptase (a potent oral fibrinolytic enzyme supplement)
- Guaifenesin (Maximum-Strength Mucinex)
- Neem oil
- Reishi Mushroom
- BFB-1™ & BFB-2™ (essential oil preparations)
- Smilax Officinalis
- Carbonized Bamboo
- Bladderwrack (an amazing, blood type O, specific nutraceutical)
- Specific Plant Tannins and/or Polyphenols based on individual need
- Specific types of Soluble Fiber and/or Insoluble Fiber, based on individual need
- Specific Plant Based Enzymes
- Transdermal Magnesium Therapy
B. Current H. pylori Protocol
December 13, 2016 – BREAKING NEWS – Help Eliminate H. pylori with Pylopass
LEARN MORE ABOUT PYLOPASS – $49 plus shipping
My current protocol consists of either the Prevpac or Pylera (see Sep. 2016 update below) and a personalized combination of biofilm busting and natural antimicrobial agents. Below are the products I’m currently pulling from to create an individualized protocol. Having the correct biofilm and H. pylori protocol is just as important as having the correct dosage of the products used. To the degree that the balance of the three is in is to the degree that the entire protocol will succeed. This is why is always best to have a qualified coach and to never self-treat.
- H-PLR and/or Bio-HPF and/or Berberine HCl and/or Berbemycin.
- Saccharomycin DF
- Bladderwrack and/or Cranberry Extract w/D-Mannose
- Black Seed Oil
- A simplified version of the personalized Biofilm Protocol.
Additional Data – Dissolve biofilms with fibrinolytic enzymes nattokinase and lumbrokinase By Dr. Peta Cohen. Effect of xylitol on an in vitro model of oral biofilm (PubMed). I have seen increased effectiveness since adding this to the protocol).
IMPORTANT, PLEASE READ: Updated, Update – September 26, 2016, rev. August 19, 2014, original August 08, 2013
Since 2007, I have been helping patients with ulcers, gastritis, SIBO and general GI distress, caused by H. pylori, and other biofilm producing bacteria. In the beginning, getting rid of H. pylori was fairly easy, in my opinion. As time progressed, I noticed that the H. pylori-biofilm protocol, that up till now was very effective, was now becoming less and less effective, even with those receiving the H. pylori-biofilm protocol for the first time. There are now H. pylori strains that are ‘multiple drug-resistant’ even in those who have never been treated – Why? The linked article states that these mutations happen by chance. Meaning, medically, there is no real explanation for it, so they call it, “by chance.” Energetically there is a very good explanation for it, at least for me anyway, based on the research done by Rupert Sheldrake, Ph.D., “Morphic Fields and Morphic Resonance.” Please read about his theory for further clarification.
Because of this new shift, in loss of effectiveness, in some patients, I have had to incorporate more than one round of products or add more products to the protocol. The end result has always been eradication but it’s now taking more (products and/or time) to achieve this result. Also, there are many people contacting me and letting me know that they have undergone triple and quadruple therapies to no avail. This proves, in my mind, the biofilm itself and the bacteria that form it are learning to defend themselves more effectively. They are adapting and mutating, genetically and energetically, to survive. Good for them and bad for us.
My theory is that with the introduction of hundreds of blogs, chat-rooms and websites devoted to H. pylori, H. pylori treatment, and biofilm, more and more people are self-treating or getting poor treatment outcomes. This self-treating is not killing the H. pylori or breaking-up / busting through the biofilm but to the contrary, making them both stronger by building up biofilm defense. Every time a bacterial biofilm is unsuccessfully treated it becomes more resistant to the next protocol. When this is combined with the theory of Morphic Fields, it’s no wonder why H. pylori and biofilm eradication is becoming harder and harder to achieve. The point of all of this is that there is still effective treatment options available, it may just take a little more time and more products, allopathic (Prevpac or Pylera) and/or natural, may be required to get to the desired end result – H. pylori and biofilm eradication.
Personal note: don’t waste your money on Matula Herbal Formula. Many of the people that have contacted me, spent good money on the product with the hopes of it working. The Matula tea didn’t work, and they were unable to get the refund that was promised. Update: the company used to offer a 100% money back guarantee if you were retested after using Matula tea and you still had H. pylori. They do not offer that guarantee anymore. I wonder why.
Lastly, I am not against the concept of self-treating per se. The issue is that the information, out on the web, on biofilm and H. pylori eradication, is not comprehensive or clear enough for the layperson to be their own doctor or to successfully self-treat. I have always advocated and promoted that if you want to get better with or at something, you need a coach who is an expert in that field or subject. There is a time and a place where self-help is the best option, but biofilm and H. pylori treatment are not one of them. This is just my opinion.
C. Avoid or Add?
Avoid supplemental IRON during the biofilm protocol or when treating any bacterial infection. The abnormal presence of freely available iron will increase the rate of bacterial multiplication and tip the balance
in favor of the invading pathogen.
Avoid supplemental ZINC during the biofilm protocol, especially if you are taking antibiotics. Zinc is important in the break-down of life-saving antibiotics. It is widely recognized that modern medicine is on the precipice of a microbial-induced disaster. The rise of bacterial strains (and enzymes) that are resistant to (and can inactivate) commonly used and recently developed antibiotics is risking nearly 80 years of progress in successfully treating once life-threatening bacterial infections. Much of this resistance is driven by a large class of enzymes localized to the bacterial surface termed metallo-β-lactamases. These enzymes cleave the β-lactam ring of antibiotics that include the penicillins, carbapenems, cephalosporins, and monobactams.
Add? Data on Magnesium and Iron deficiency as a contributing factor to bacterial virulence and biofilm formation.
Magnesium – Studying the bacteria P. aeruginosa, a biofilm producer, researchers discovered a protein, the magnesium transporter E (MgtE). MgtE activity in P. aeruginosa appears to be influenced by the bacterium’s chemical surroundings, including the abnormal mucus in Cystic Fibrosis (CF) patients. Specifically, MgtE responds to fluctuations in magnesium levels. MgtE protein activates (increase in MgtE gene transcription) in the presence of LOW levels of magnesium increasing biofilm formation, cytotoxicity, and bacterial virulence. This study was only conducted in a laboratory setting but may translate to low human tissue levels of magnesium as well.
in an email exchange with Dr. Gregory Anderson, one of the lead researchers for the above data above.
Dr. Ettinger – “I’m assuming that the signaling is in response to “low” tissue magnesium levels. Is this correct?”
Dr. Anderson – “Yes, MgtE responds to low magnesium levels. Specifically, Mg limitation leads to an increase in mgtE gene transcription.”
Dr. Ettinger – “Did this mechanism reverse or stop when magnesium was increased or did biofilm continue to form?”
Dr. Anderson – “We are now testing the effects of magnesium on biofilm formation. Don’t have conclusive results yet.”
Dr. Ettinger – “Have you studied any other minerals that may have a similar effect like zinc or iron?”
Dr. Anderson – “We haven’t looked at zinc or iron, or other metals. MgtE only seems to be magnesium-responsive, though. It is known that iron limitation inhibits P. aeruginosa biofilm formation, as iron is important for biofilms.”
Magnesium is one of the most important minerals/chemicals in the body and at the same time, magnesium deficiency is one of the most common nutrient deficiencies in the world. Almost every RBC magnesium test I perform is at the lowest end of normal or more common, below normal. Low levels of magnesium can lead to cardiovascular disease, weakened immunity, nerve and muscle conditions, migraine headaches, diabetes, chronic fatigue, fibromyalgia and a myriad of other health maladies. So, it makes sense that in the presence of low magnesium levels a biofilm-forming bacteria would become cocky and more aggressive. “when the cats away the mice will play.” Magnesium repletion therapy is one of the most common protocol recommendations I give to my patients. The magnesium bath below is the best way to rebuild tissue magnesium levels.
Iron – In addition, many bacterial pathogens have used the low concentration of iron present in the host as an important signal to enhance the expression of a wide variety of bacterial toxins and other virulence determinants. It’s a double-edged sword. On the one side, iron may increase the growth rate of pathogenic bacteria and on the other side, low levels of iron may contribute to bacterial virulence and biofilm formation (as a protective mechanism). I guess the moral of the story is to stay healthy and don’t get put into a situation where a pathogenic bacteria can take up residence. Easier said than done, right! This think may help to some degree – Epigenetics – Why Am I Sick, Why Am I Healthy
Take a broad-spectrum, patented strain, probiotic and abundant amounts of prebiotics (polyphenols like clove, cinnamon, turmeric, raw cacao, and ginger; IAG [larch arabinogalactans]; flaxseed meal; onion, garlic and fibrous fruits and vegetables. Probiotics, prebiotics and high FODMAP foods may not be suitable for those with SIBO. This will need to be determined on a case by case basis. I like Xymogen brand ProbioMax 350DF, Xymogen ProbioMax Daily, and Progurt. VSL-3 can also be used (for a short period only) as well as Elaine Gotschall’s SCD™ yoghurt. These products will help to crowd out the bad bacteria, and also help disrupt and replace biofilm colonies along the mucous membrane.
E. Beneficial Yeast
Saccharomyces boulardii (S. boulardii) is another addition that will have positive benefits in any H. pylori, SIBO, or Candida eradication protocol.
A recent meta-analysis involving 14 RCTs (1671 patients) evaluated the role of probiotics in H. pylori eradication [Tong et al. 2007]. In patients with H. pylori infection, probiotic supplementation improved eradication rates and reduced treatment-related side effects and individual symptoms [Tong et al. 2007]. In this meta-analysis, only one RCT evaluated S. boulardii and found that it decreased the risk of diarrhea when given concomitantly to patients receiving triple eradication therapy for H. pylori [Duman et al. 2005]. S. boulardii induces morphologic changes in H. pylori cells consistent with cellular damage [Vandenplas et al. 2009] and was shown to cause a reduction in H. pylori colonization in infected children by 12% [Gotteland et al. 2005]. Of four RCTs testing S. boulardii in H. pylori infections, two were in children [Gotteland et al. 2005; Hurduc et al. 2009] and two in adults [Cindoruk et al. 2007; Cremonini et al. 2002]. Although there was no significant difference in H. pylori eradication between the S. boulardii and placebo groups, a significantly lower relative rate of AAD (16.1–25%) was observed. In a recent meta-analysis, the H. pylori eradication rate in the triple therapy group was 71% and increased significantly to 80% with S. boulardii supplementation [Szajewska et al. 2010]. Thus, S. boulardii may not be effective in eradicating H. pylori itself, but it is effective in reducing the side effects of the standard triple therapy (Prevpac).
F. Specific additions based on condition (Not a complete list)
- Candida albicans – SF722* (10-Undecenoic Acid) Thorne Research. This is as close as you can get to a medication and still be a natural substance. There are a few chat rooms blasting this product, based on who knows what – can’t make everyone happy. I’ve used SF722 for over 15 years and it is amazing – never a problem! *Do not take SF722 if you are allergic to fish. ADP by Biotics Research is also a dynamite product. There are many other amazing products that can be added to complement the SF722 and ADP. It’s really a matter of how many pills someone wants/doesn’t want to take per day or the severity of one’s condition, that will determine, if or which, additional products will be added. If the Candida albicans overgrowth is severe, has not responded to holistic methods or has mutated into its more virulent hyphal form/fungal infection (nails, underarms, groin or skin); Diflucan (fluconazole), a prescription medication, is my personal preference, but Nizoral (ketoconazole) can also be used. In Azole-resistant Candida albicans, lactoferrin must be added to either medication in order to increase their effectiveness. There are specific B-complex vitamins, minerals, and amino acids that possess synergistic properties and I find them indispensable when taking Diflucan (fluconazole), Nizoral (ketoconazole), and for supporting candida (yeast/fungal) treatment, and die-off symptoms.
- Chlamydia pneumonia, Klebsiella pneumoniae or Pseudomonas aeruginosa – One product I like is Pneumotrophin PMG by Standard Process, Inc. I use this because it helps direct the body’s attention to the affected area and assists the body’s healing efforts to the lung, where it’s needed most. Apex Energetics’ H-PLR and serrapeptase are also a mandatory addition. I also like to use OOrganik-15™ and Pneuma-Zyme™ by Biotics Research with some of my patients who manifest asthma, a chronic cough and/or emphysema-like symptoms. IgG 2000 and Ig 26 by Xymogen, Restore, and Progurt may also be utilized.
- H. pylori Protocol – Heartburn/gastritis/GERD or achlorhydria or H. pylori?
- Chronic bacterial prostatitis – Quercitin and Bromelain combination by Now Foods decreases inflammation and oxidant stress in the prostate while increasing local concentrations of beta-endorphins. Apex Energetics’ H-PLR and iodine is also a mandatory addition.
Specific dietary restrictions or addition will most likely be implemented. These will be determined on a case by case basis, based on many factors. After the desired result is achieved, there will need to be a rebuilding and regeneration protocol. This is as important as eliminating the biofilm.
Biofilm testing is available, through Fry Laboratories. Fry Laboratories, L.L.C. is an independent clinical diagnostic and research laboratory located in Scottsdale, Arizona. We are committed to understanding chronic diseases and contributing to their cure through advancements in diagnostics and basic science research with emphasis on chronic inflammatory diseases, vector-borne diseases, and their intersection. Our clinical diagnostic laboratory offers general and targeted immunology services in conjunction with standard and cutting edge infectious disease detection and identification technologies. Our signature services include microscopy for visual identification and quantification of a wide range of blood-borne pathogens, co-infection serology, biofilm detection, and genus-wide molecular detection technology with sequencing for individualized species and/or strain identification. We participate in both CAP and API quality control programs and provide worldwide testing service.
Diseases of Interest: Chronic Fatigue Syndrome, Fibromyalgia, Gulf War Veterans Illness, Chronic Lyme Disease, ALS (Lou Gehrig’s Disease), Parkinson’s Disease, Multiple Sclerosis, Autism, Lupus, Ulcerative Colitis, Scleroderma, Rheumatoid Arthritis, Osteoarthritis, Crohn’s Disease.
Infections of Interest: Borrelia (Lyme), Babesia, Bartonella, Anaplasma, Ehrlichia, Q-Fever (Coxiella), Toxoplasma, Rickettsia, Plasmodium, XMRV
Important: This post is not a substitute for medical advice or treatment and is for informational purposes only. Please consult with a physician before starting any nutritional or biofilm protocol on your own.
Effect of ciprofloxacin and N-acetylcysteine on bacterial adherence and biofilm formation on ureteral stent surfaces (PubMed)
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