A specific question has been asked a lot lately, as to what is my protocol for handling Biofilms. Most of these questions have been directed to me by people diagnosed with or think they may have, Lyme disease.
First a little background on biofilms:
Fig. 1: The biofilm life cycle. 1: individual cells populate the surface. 2: extracellular polymeric substance (EPS) is produced and attachment becomes irreversible. 3 & 4: biofilm architecture develops and matures. 5: single cells are released from the biofilm. Related Post – Biofilm Basics and Quorum Sensing and Biofilm
This is an excerpt from a Klaire Labs product monograph which is a basic primer on the topic (My additions are in RED) The National Institutes of Health 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 by biofilms allows them to achieve a high level of antibiotic resistance, stealth and invisibility. Biofilms not only provide 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 enzymes such as b-lactamase, effectively neutralizing incoming antibiotic molecules. 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. Biofilms thus render pathogenic microorganisms enormously difficult to eradicate, and can almost single-handedly contribute to localized or systemic inflammatory reactions and delayed wound healing. 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) maybe a carrier of, or may have heavy metals embedded in them, thus the indication for chelation w/EDTA).
Pathogenic bacterial known to reside in biofilms include: Borrelia burgdorferi, Escherichia coli, Candida albicans, Clostridium difficile, Clostridium perfringens, Helicobacter pylori, Klebsiella pneumoniae, Legionella pneumophila, Listeria monocytogenes, Pseudomonas aeruginosa, Salmonella typhimurium, Staphylococcus aureus, Staphylococcus epidermidis, and Vibrio cholerae. The number of human diseases shown to be associated with biofilms is expanding and includes chronic bacterial prostatitis, chronic rhinosinusitis, cystic fibrosis pneumonia, infective endocarditis, periodontitis, recurrent otitis media, and virtually all device and implant related infections. Strong evidence is also beginning to emerge for an etiologic role of pathogenic mucosal biofilms in gastrointestinal diseases, such as Irritable Bowel Disorders: Crohn’s disease and ulcerative colitis.
S. aureus biofilm
Dr. Marcus Ettinger’s Biofilm Protocol – Only the eradication phase is presented here. There is a pre, post and toxin reduction step as well. I will add these soon.
A. Products (mandatory products in RED):
- Monolaurin (lauric acid) 600mg’s 2 caps 2x per day
- Nutiva Extra-Virgin Coconut Oil (almost 50% lauric acid by volume) 1-3 tablespoons per day
- Nattokinase (a potent fibrinolytic enzyme) 100mg’s 1-3 times per day
- InterFase Plus™ (broad-spectrum enzyme formula w/EDTA) 2 caps 3x/day on an empty stomach
- Serrapeptase or (Serrazimes – Now Foods) 20,000 units 2x per day
- Vitamin C (ascorbic acid – Not buffered, as most of these contain metals) 500mg’s 4x/day
B. Avoid Supplemental forms of: Magnesium, Iron and Calcium as they may feed the biofilm.
C. Take a broad spectrum probiotic and prebiotic. I like the combination of Now Foods brand Gr8, 2-3 per day and their Probiotic Defense Powder, 1/4 tsp 2-4x per day. These products will help to crowd out the bad bacteria, and also help disrupt biofilm colonies along the mucus membrane.
D. Specific Additions based on condition:
- Candida* – SF722 (10-Undecenoic Acid 50 mg) Thorne Research. I’ve used 9 up to 20 a day with clients. This is as close as you can get to a medication and still be natural. There are a few chat rooms blasting this product, based on who knows what. I’ve used it for over 15 years and it is amazing, never a problem! *Do not take if you are allergic to fish.
- Chlamydia pneumonia – Pneumotrophin PMG by Standard Process, Inc. 1 tab 3x/day. How it works. I use it because it helps direct the body’s attention to the lung where it is needed most.
- H. pylori – Complete write-up on another post.
- Chronic bacterial prostatitis – Quercitin (600mg’s) and Bromelain (200mg’s) combination by Now Foods. 3-6 capsules per day. Decreases inflammation and oxidant stress in the prostate while increasing local concentrations of beta-endorphins.
If you are interested in ordering any of these products, please contact our office/Rene at (714) 639-4360, for product and shipping costs.
Tags: Biofilm, Borrelia burgdorferi, Candida, Chlamydia pneumonia, extracellular polymeric substance, Lyme Disease, sessile microorganisms
You offer a good overview of bio films and you’ve offered a good basic explanation. Furthermore, your diagram makes them a bit easier to understand. These substances are so prevalent, our company actually creates products that are bio film resistant…
Doesn’t natto and serrap cause excessive bleeding if cut?
Is xylitol effective against biofilm?
What if you’re controlling blood pressure with magnesium?
Thank you for having this online for people!
Doesn’t natto and serrap cause excessive bleeding if cut? – No
Is xylitol effective against biofilm? – No
What if you’re controlling blood pressure with magnesium? – It may help by itself, but is better when combined with a low glycemic diet and exercise.
Hi Dr. Ettinger,
Thanks so much for this informative post. I have babesia and lyme and am a strict vegan. I have a few questions:
1) Are there vegan alternatives to Klaire Labs’ Interfase, which is made from egg whites?
2) I have heard that Bromelain breaks down biofilm. Is this correct? If so, what dosage would be good to take?
3) I have been told that you need to get rid of the babesia because it blocks the body’s ability to detoxify and it must be gotten rid of before working on lyme and its co-infections. Does babesia also have biofilm? Is this a good way to get rid of babesia?
Thanks very much for your assistance!
Susan
Hi Dr. Ettinger,
Thanks so much for this informative post. I have babesia and lyme and am a strict vegan. I have a few questions:
1) Are there vegan alternatives to Klaire Labs’ Interfase, which is made from egg whites? The only one I can think of is Digest Platinumâ„¢ by Now foods. It doesn’t have the EDTA, but should work just fine. Make sure you utilize the other components of the protocol.
2) I have heard that Bromelain breaks down biofilm. Is this correct? If so, what dosage would be good to take? Stick to the protocol and then if you want to add to it, that’s okay.
3) I have been told that you need to get rid of the babesia because it blocks the body’s ability to detoxify and it must be gotten rid of before working on lyme and its co-infections. Does babesia also have biofilm? Is this a good way to get rid of babesia? I can’t say w/100% certainty but I would hedge my bets in that direction. Olive leaf extract is my product of choice for babesia. NAC by Now Foods will help with phase II liver detoxification.
Thanks very much for your assistance! Your are welcome. Dr. E
Susan
I have been looking on your site for the “pre, post and toxin reduction steps for biofilms which you stated would be added. Have I missed it?
P.S. I have been on LT ABX combination therapy for C.Pneumoniae [developed/patented by Vanderbuilt U.'s microbiologist Dr. Charles Stratton] http://www.cpnhelp.org …. took me down big time from (disabled, wheel chair, lots of fun stuff) now, after 3 years am getting my life back, only to discover I probably have serious biofilm issues. One Capsule of InterFase Plus caused MAJOR Herx reactions… My tests still show low mag/low ferritin and high CPN, EBV and HHV6 titers… makes sense to me! Found your site doing a query on biofilms…. great stuff.
Thanks.
I’m in the process of completing that write-up. In the mean time it would be wise to get of a phase II detoxification product. I like Tyler Encapsulations Detoxification Factors – 120 Caps. Herx reactions are primarily caused because the body lacks sufficient phase I and II nutrients. My recommendation would be to get on an ISO100 whey protein, Biotics liquid vitamin D forte – 8,000IU’s per day and the Detoxication Factors.
Also, Molecularly Distilled Fish Oil and Magnesium Glycinate would be helpful
Dr. Ettinger,
Thank you very much for such a prompt response and information! I’m intentionally not supplementing Magnesium (it’s at the lowest end of the normal range) or Iron as I do not want to feed the biofilms (plus CPN uses and “eats” iron –don’t want to feed the beasties!)
I will definitely check out the methylation supp’s (am debating whether to spend the $’s for Dr. Yasko’s Methlylation pathway testing). I already take 10,000 units of Vit D/day (my level was 18 when I became ill and is now only 50 after 3 yrs of supplementation of Vit D)
I prefer natural vs allopathic treatment (I had a WONDERFUL DABCI back in my home state) but because of the life cycle of CPN have chosen the route of ABX (with tons of supplements and probiotics, of course) If I didn’t live on the opposite side of the U.S. I would schedule an appt. with you
Again, thank you very much, you site has great information. I will watch for your additional posts.
When is the protocol done and for how long?
Taken every day? And for how long?
I’m using chelex for metals and I want to throw in an enzyme for biofilm dissolving.
But I only chelate on weekends so I’m trying to find the right protocol for me.
When is the protocol done and for how long? – “Hard to say w/o you here. Best guess w/o knowing anything about you is 2-4 months. Biofilms don’t just vanish forever, never to appear again. The protocol is designed to knock them down enough so that your own immune system and the nutraceuticals can work more effectively.”
Taken every day? And for how long? - “See above”
I’m using chelex for metals and I want to throw in an enzyme for biofilm dissolving. – “See my protocol.”
But I only chelate on weekends so I’m trying to find the right protocol for me. – “My protocol may be for you it may not. I can tell you that it won’t hurt to try it and see what get’s better.”
I have started to use your protocol with some very promising results.
Thank You.
As you well know Biofilms are a dastardly resilient bacteria.
In my long search for a real treatment for a biofilm infection I ran across some thing called Phage Therapy. I was just wondering you opinion on the possibilities of this treatment for biofilm.Thanks
Forest,
I am glad you are seeing favorable results.
I have been following Page Therapy off and on over the last 3-4 years. It is promising, but we will not see it an a convenient therapy for quite some time. My recommendation is to stick with what you are doing.
Prevention is the key. Vitamin D, magnesium, A probiotic and omega 3 fatty acids should be taken by all. These are the most common nutritional deficiency there are and because of this, predispose the population to every named condition there is. This is just my opinion though.
Dr. Ettinger….
I like what you have written up in your biofilm protocol….
I was wondering what you thought about adding Manuka Honey to this biofilm regimen as it is known to kill MRSA when externally applied….MRSA is extremely difficult to treat even with antibiotics….Also, I am under the impression that when Manuka Honey is taken internally that it is converted by the body to hydrogen peroxide in a stable form that I believe would help….Google “hydrogen peroxide” and “manuka honey”….and please let me know what you think….
Thank you for your time and consideration….Julie
Julie,
Thank you for the question. I have been using Manuka honey, as a food, since the Synergy Company first introduced, Healing Honey, in the US. Mitchel May and the Synergy Company are a one of a kind producer of specialty nutritional products and I highly endorse them.
Manuka Honey is a wonderful product and would be a great synergist to any nutritional protocol, but on it’s own, lacks the potency to be a stand-alone product. Personally, I feel it is a wonderful, medicinal food and should be consumed as such. This comment comes from almost seven years of using and testing the product at home and in my practice.
External use of Manuka Honey is totally different than what will occur if taken internally. Yes, it is an amazing external product for MRSA.
Hi, I take a powdered Mag Calm to help severe twitching from Lyme disease. Your info suggests not taking any Mineral supplement. What do you suggest in place of mag for the twitching?
I appreciate your site and info. You appear to have an understanding in treating the disease and not the symptom; thank you.
Lyme is not a fun disease to have.
Blessings
Belva
Belva,
If you are not following Lyme biofilm protcol, than taking a mineral supplement will be perfectly okay. I prefer magnesium malate (600mg’s) for what you are describing.
Dr. E
I am a patient of Dr. Brownsteins in Michigan. I am using the interfase product and everything marked in red in your protocol. I am having herz reaction everyday and pushing through. My inflammation in my joints is unbearable. I am going to start pushing a phase 2 detox product which is a huge issue for me. Any other suggestions?? Should I slow it down a little? Do biofilms regenerate like candida or not as quickly?? Should I tackle antibiotics next? I have had Lymes approx 12 years. I feel like I am in good hands but no one seems to be one the same page with Lymes.
Stacy,
First and very important is to eliminate gluten (wheat, rye, oat and barley) and dairy from your diet. This is a MUST and will help the inflammation in the joints. Deficiency of “phase II” nutrients is a common finding with most chronic conditions. Adding those nutrients back in should also help a lot. Additionally, I like adding 6,000IU’s vitamin D to the daily program (Liquid Vitamin D Forte by Biotics Research). Let me know how this works out.
Dr. Ettinger,
Any thoughts about these relatively recent papers?
http://www.sciencemag.org/cgi/content/abstract/328/5978/627
D-Amino Acids Trigger Biofilm Disassembly
Ilana Kolodkin-Gal,1 Diego Romero,2 Shugeng Cao,3 Jon Clardy,3 Roberto Kolter,2 Richard Losick1,*
Also:
http://stke.sciencemag.org/cgi/content/abstract/sigtrans;3/120/ec134
Microbiology
Biofilm Today, Gone Tomorrow Stella M. Hurtley
Keep up the good work!
Nick
Nick,
I read both abstract when it first came out and even did my own follow-up investigation on the issue. Here is the problem: there aren’t any D-amino acid (combination) supplements on the market to assist in the breakdown of the biofilm. I still feel that the biofilm protocol I have come-up with is a pretty good one. I use it daily in my practice and get very favorable/predictable results, at around the 66 day mark of treatment.
Thank you for taking the time to send me the data and I will post new research as comes down the pike.
Sincerely,
Dr. E
Dr. Marcus Ettinger says: December 31, 2009 at 8:41 am
Is xylitol effective against biofilm? – No
http://iadr.confex.com/iadr/2007orleans/techprogram/abstract_88048.htm
Culture of harvested biofilm showed an inhibition of the growth of the different species included in the biofilm. Conclusions: There is a clear inhibiting effect of xylitol on the formation of the experimental biofilm.
I stand corrected. Thank you for the link.
Sarah,
Please remember this is just in an experimental model. There is a lot going on in the human mouth and we need live (in vivo) studies to show whether it’s going to be effective there. If you have found something on that or if you do in the future, please share it with me.
Sincerely,
Dr. E
Hi!
I am very excited about discovering biofilms and your site. I have been trying to get rid of my candida for 5 years and have come to the conclusion that it is because of biofilms. I live in the UK, so it’s a little harder for me to get hold of some of the supplements. I have a few questions.
Would ‘Now Foods, Liver Detoxifier & Regenerator’, be suitable for phase 1 & 2 detox, in place of the Tyler Encapsulations Detoxification Factors?
Lots of the enzyme formulas has Apergillus in them, is it best to avoid Aspergillus if possible? I hear some people can be allergic to it. Is that why you suggest Interfase? It doesn’t appear to contain Aspergillus.
Is it safe for someone with low blood pressure to take Nakkotinase and serrapeptidase?
Can I use ‘Thorne Research, Vitamin D (D3), 1 fl oz (30 ml) ‘ instead of Biotics Vitamin D forte?
Do you recommend Kefir as a source of probiotics?
Thank you in advance!
Victoria.
Hi Dr Ettinger, I work as a research associate in a Lyme and related diseases clinic in Washington DC. I have been in discussion with the ID but he needs convincing evidence of the efficacy of monolaurin before he can add it to his protocol. We currently use only nattokinase and I can’t convince him to add monolaurin because I wasn’t able to find any testimonials to its specific benefits with regards biofilm destruction. Also, do you think monolaurin works synergistically or additively with nattokinase? Thank you and please do keep up the good work.
Sincerely,
Zoba
Zoba,
Monolaurin at 2,400mg’s/day works synergistically with Natto and the other enzymes I use. There is no one product that works alone at eradicating biofilm. I have used my protocol over 100x on various conditions where biofilm has been the reason for the chronic condition not responding to conventional treatment. 40-60 (sometimes a little longer) days on the protocol and retests are coming back negative.
Your doc will do what he/she wants and for THEIR own reasons. I write my posts just to get it out of my head. If someone wants to investigate my findings then they will have to try it for themselves and not just take my word for it. Good luck.
Dr. E
Victoria,
I would use Now Foods NAC instead. It also has molybdenum and selenium in it. All three of these nutrients are exactly what a person with candida needs.
Plant derived enzymes from Apergillus are perfectly safe and I have never had a patient have a problem with them. I really like the Interfase Plus and use it exclusively.
Thorne vitamin D is okay.
Nakkotinase and serrapeptidase should have no effect on BP but if it’s a concern monitor it daily while on the products.
I would use Probiotic 10 from Now Foods or something similar instead of kefir, which would feed the yeast/candida.
I hope this helps.
Dr. E
I didn’t actually buy any of the susbtitutes I asked you about because I was too impatient to wait to order them before I got your reply.
For detoxification I bought Thorne Basic Detox Nutrients which contains the molybdenum, selenium, vitamin D, vitamin C and NAC + a million other things.
Instead of ‘Interfase’ (I can’t get any shipped to the UK), I bought ‘Braggzyme superior systemic enzymes’, which contains the required serrapeptidase, nattokinase, as well as Bromelain,Papain, Protease, Lipase. It was the closest to Interfase I could find and seems good quality.
Now a couple more questions if you don’t mind:
I read this about dissolving biofilms:
”The other theoretical issue is that the biofilm may be holding on to toxic metals such as aluminum and lead. As this toxic biofilm degrades, heavy metals may be released into the gastrointestinal tract for excretion”
Will Jarrow Formula ‘ToxGuard, heavy metal detox’ help incase of sudden toxicity?
Are the other supplements ineffective without monolaurin? Or do they just work less effectively? I haven’t aquired any monolaurin yet, but I did buy lactoferrin.
You say there are ‘pre’ ‘post’ and ‘toxin reduction’ steps as well as the actual ‘eradication’. Now, since you haven’t yet put up the other stages, is it safe for me to embark on the ‘eradication’ stage as long as I take the detox supplements and drink plenty of water and do FIR saunas at the same time? Is there anything important I should do before I the eradication?
Thank you again. Victoria.
Victoria,
The amount of metals released will be negligible; I would get too concerned over that. The Thorne product you purchased will help with metals as well as liver detoxification.
As far as monolaurin goes, it really helps to have it but you still may get benefit without it. Try extra virgin coconut oil if you can get it. 1/2 tbsp 2x/day will give you a good dose of lauric acid which will be converted to monolaurin in the body.
Additional steps that you can take is to consume plenty of soluble and insoluble fiber, along with a potent, multi-strain probiotic.
How many Braggzymes capsules should I take per day? It doesn’t seem to contain enough serrapeptidase but I’m not sure how the ‘units’ system works.
Here is a link to the list of ingredients:
http://www.iherb.com/Bragg-Braggzyme-Superior-Systemic-Enzymes-120-Capsules/23196?at=0
thanks again.
Hi Dr. Ettinger
Do you think one should add iodine to help with bacteria and parasites?
I have halides attached to my mitochondrial membranes and i know iodine is used for this but i am worried about losing lithium and detoxing.
cheers
I just came on your site recommended by someone in regards to treating candida. For years I have felt unwell (Fatigue, adrenal issues, thyroid issues, depression on and off, migraines (for 20 years), hives at times etc etc). After two major surgeries in June and November of 2009 things just plummeted. I have felt worse than ever and basically unable to function most days. Over the years I have seen several doctors, had numerous tests and have tried countless treatments. Sometimes there was relief from symptoms but I never really felt the cause was addressed. Last month a doctor did a stool test from Metametrix and it came back +3 out of 4 for fungi/yeast, and it said I had no parasites. He put me on Diflucan 200mg 2x day for two weeks but really gave no other instructions. I continued the treatment and I am now in my 3rd week. After reading so much research on yeast/candida I continue to get more and more confused on what protocol to do. This has lead me to you. I would appreciate any thoughts of help you could give me.
Currently I am taking Diflucan, a Probiotic, Vit C, B complex, and Magnesium. I have always eaten pretty healthy (no sugar, white flour, processed foods etc). I have also been eating Gluten Free (100% for a few weeks previously about 75%) and Dairy Free (for years I use almond, rice or hemp milk). In the past week I have tried the Candida Diet where I eliminate fruit, brown rice etc.
I read your information above that states “Only the eradication phase is presented here. There is a pre, post and toxin reduction step as well. I will add these soon.” I am curious to know your thoughts on what I might do. I am feeling lost and overwhelmed and what to do and where to go since there is so much information out there.
Sorry for the long post I would greatly appreciate your thoughts and help
Jacalyn
Victoria,
I don’t use that product but after looking at it you can do up to 2 per day; more is not advised. It will not replace Interfase Plus, as it is just a fibrinolytic enzyme. Interfase Plus helps to breakdown the mucopolysaccharides as well as supplying the metal chelating (binding) agent, EDTA.
Dr. E
Paul,
With the limited data provided I feel uncomfortable making a recommendation one way or another. As a general recommendation, I feel safe to recommend NAC. It supports detoxification in the liver and is a precursor to glutathione (GSH), a very potent antioxidant. NAC also helps the body detoxify heavy metals.
I hope this is of some help.
Dr. E
Jacalyn,
First off, this is my personal thought on Diflucan and not a recommendation for you to change your protocol, unless agreed to by your prescribing doctor. Diflucan works better if given over a long period, rather than a huge dose over a short period. The best protocol I have found, and this is after trying different variations – one being the one you are on now, is: 200mg’s once per week for 12 weeks, followed by 4 week off, followed-up with another 6 weeks on. This protocol is a total of eighteen 200mg tablets.
Yeast, especially when it mutates into a more virulent fungal form, is incredibly difficult to treat but not impossible. When you have millions of years to learn how to only do three things, you learn them very well. Feed, breed and defend – that’s it! So, a slow and steady approach is more successful that to bomb them all at once. One way to help with you eradication is to add Monolaurin (1200mg’s 2x/day) and Biotin (5,000mg’s/day). Biotin helps to stop the conversion of the yeast into the fungal form. NAC form Now Foods, which has molybdenum in it, is key to mental clarity and detoxification of acetylaldehyde. Acetylaldehyde is a nasty byproduct of chronic yeast/fungal infections and is the main cause of fatigue and the foggy feeling in the head in those with chronic candida.
If you need any of these products, please call our office – 714-639-4360. I hope this will be of some help to you.
Dr. E