CISRA’s Synergy Health Newsletter

Issue 8. 2005 Update — Marshall Protocol: Conference, Update, Corrections

by J. C. Waterhouse, Ph.D. 
Note: Experience indicates that the Marshall Protocol (MP) must be studied and followed carefully in order to be effective and avoid possibly serious consequences due to enhanced antibiotic effectiveness even at very low doses (for free assistance, and conference DVDs go to

Conference on Chronic Disease and Anti-Bacterial Therapy (Chicago, IL, March 12-13, 2005)

A conference for physicians, patients and policymakers is being sponsored by the Autoimmunity Research Foundation and is scheduled for March 12-13, 2005 in Chicago, Illinois. The conference is entitled “Recovering from Chronic Disease.” The focus will be on: Sarcoidosis (Reggie White’s Disease), Chronic Fatigue Syndrome, Chronic Lyme Disease, Rheumatoid Arthritis and Fibromyalgia. At the conference, there will be speakers from the NIH and FDA: James Kiley, PhD, Director of Division of Lung Diseases, NHLBI/NIH, and Commander Sarah Linde-Feucht, MD, of the FDA OOPD (Office of Orphan Product Development). Other speakers will include: Lida Mattman, PhD, a Nobel prize nominee, famous for her groundbreaking textbook Cell Wall Deficient Forms: Stealth Pathogens; Leonard Jason, PhD, a prolific CFS/CFIDS/ME researcher and author of an important epidemiological study on CFIDS; Millie Coker-Vann, PhD, Arthritis Research Center; and Andrew Wright, MD, a researcher in bacterial causes of CFS/ME and FMS in the UK, who has also done innovative work in techniques to photograph pathogens in patients’ blood. In addition, tutorials and panel sessions will be held with the assistance of a number of medical professionals and support personnel.

Trevor Marshall, PhD, will also be a presenter at the conference. He has been a researcher in diverse fields, such as cryptorchidism, male and female infertility, and subcutaneous insulin infusion (in diabetes). Most recently he has deduced and published a bacterial pathogenesis for Th1 diseases, including Chronic Lyme Disease, CFS and Sarcoidosis. He has also developed a treatment called the ‘Marshall Protocol’ (MP), which is being implemented by physicians around the world. Although Chronic Lyme Disease, CFS, and Fibromyalgia are not currently widely accepted as TH1 diseases, Dr. Marshall has found that a more accurate view of what the TH1/TH2 dichotomy means, as well as new vitamin D data, indicate that these diseases really are diseases of TH1 inflammation.

Effects of Vitamin D Should Not Be Judged by Subjective Experience Alone

There has been a lot of confusion in recent years as to how much vitamin D should be taken, particularly since many studies have based their recommendations on measuring levels of the inactive precursor form of vitamin D (25 D). This may be seriously misleading, because recent data shows that one may have a low inactive vitamin D and still have elevated levels of the active vitamin D hormone (1,25 D; for example, see Issue 7 article on vitamin D at CISRA’s Synergy Health Newsletter).

There are also differences in the subjective experience of the effect of vitamin D level increase or decrease. According to Dr. Trevor Marshall’s work on TH1 diseases, some people may feel temporarily better with higher levels of vitamin D and sunlight, despite it doing them harm in the long run. In this view, those with sarcoidosis and certain other inflammatory diseases may feel temporarily better with higher vitamin D from sun exposure or supplements because an elevated level of active vitamin D may inhibit the immune system from killing cell wall deficient (CWD) bacteria. In a sense, the high vitamin D may be acting in an immune suppressing manner somewhat analogous to steroid drugs. In other words, the elevated active vitamin D hormone serves to inhibit the symptom-provoking Herxheimer reactions that occurs when antibiotics or the immune system kill bacteria. Dr. Marshall finds that some people even report being on vitamin D for months or even a year or two and they may think they are improving from taking the vitamin D. But, in the long run, the experience with sarcoidosis patients is that this elevated vitamin D will allow the bacteria to continue to increase and eventually the patient will relapse. According to Dr. Marshall, evidence suggests that this is likely to be the case with other TH1 diseases with similar vitamin D patterns, like CFS and Chronic Lyme Disease.

In contrast, Dr. Marshall finds that other patients will feel significantly better when they lower vitamin D and sunlight due to lower symptoms of hypervitaminosis D. So, the overall message is that it appears to be better to base one’s judgments on the vitamin D test results, done and interpreted properly (frozen for transport), and including both inactive (25 D) and active (1,25 D).

It also should be noted that in some cases, the vitamin D levels in the serum may not adequately reflect the levels in the local tissues, if the most inflamed areas do not get as much blood flow (e.g., the skin, the nervous system and the joints). In these cases, the total clinical picture can be used to determine whether the Marshall Protocol (MP), which includes temporarily minimizing vitamin D, is appropriate. In some circumstances, it may also be useful to measure other inflammatory markers or use a therapeutic probe of Benicar or low dose minocycline as described on the web sites. It is recommended that help be obtained in interpreting vitamin D and other results at the MP web sites interactive forums ( or

Some Supplements and Medications May Be Taken on the Marshall Protocol (MP)–But Check First

Unnecessary dietary supplements are discouraged for those on the MP for two main reasons: the need to avoid vitamin D and the potential for supplements to have unknown immune modulation effects or interactions with the MP. With regard to vitamin D, it has been found that even when supplements do not include vitamin D on the label, they still may contain it. This is because vitamin D is naturally found in some plant and animal products and the FDA does not require labeling of naturally occurring vitamin D found in foods, herbs or supplements.

Even when a product label indicates vitamin D is present, the label may not reveal the actual amount of vitamin D. A study by Adams and Lee (Gains in bone mineral density with resolution of vitamin D intoxication, Annals of Internal Medicine, Aug 1997, 127(3):203-6) showed excessive levels of vitamin D in several patients who were taking large amounts of vitamin D from nonprescription supplements. The vitamin D intake in these patients was high enough to cause them to have bone loss. Some of the supplements they were taking were analyzed and found to contain added vitamin D that was not included on the label. When all supplements other than calcium were stopped, their bone density gradually returned toward normal.

For those on the Marshall Protocol or with certain inflammatory diseases, Dr. Marshall finds that the problem is much more difficult due to the dysregulation of vitamin D, which causes many of the patients to have very high levels of active vitamin D, even in cases where their intake of vitamin D and sun exposure is moderate. Avoiding too much vitamin D in supplements is especially difficult for these patients because very small amounts of vitamin D in supplements are hard to detect by commonly used laboratory methods and very small amounts can still be a problem for MP patients, particularly during the first 12-18 months of the MP.

The second reason the MP recommends avoiding unnecessary dietary supplements is that they may have effects on the immune system that might interact with the MP in unknown and detrimental ways. They may be O.K. when not on the MP, but might be a problem when on the MP through stimulation or suppression of the immune system, among other things. The decision about taking a supplement is further complicated by the possibility that a supplement which seems to be relieving a severe or difficult to tolerate symptom may be doing so by blocking the Herxheimer reaction and thus blocking the killing of bacteria. Thus, in some cases, a supplement’s effect may be symptom-relieving, but it may be interfering with the progress of the patient on the MP, which requires bacterial killing and the accompanying Herxheimer reaction symptoms. The fact that the effects of most supplements on the underlying processes thought to be involved in the effectiveness of the MP is not yet known gives added weight to the argument for avoiding unnecessary supplements.

Despite the above warnings, one need not assume beforehand that taking a supplement or medication will prohibit a patient from using the MP, but one should consult the web sites “Frequently Asked Questions” section (, use the search function on the web sites, or directly ask the moderators in the Internet discussion group to find out what the views on various supplements currently are. Over time, there have been a number of patients who have used various supplements that the patient or their doctor felt was essential and still succeeded with the MP. One can ask others in the two MP web site forums to find out what supplements they have found did not seem to interfere with the MP. In particular, one should regard the judgment of the group moderators as reflecting the Marshall Protocol’s view and distinguish these judgments from other members’ opinions.

One can also check in the above ways through the MP web sites regarding medications that may be used with the MP. Medications/supplements that are part of another protocol being taken for the purpose of treating the disease process are generally discouraged due to potential negative interactions with the MP. However, one might check for the most current views on the above-mentioned MP web sites regarding the use of a particular medication or supplement in a particular situation.

If a supplement is taken by a patient to correct a known deficiency, it is usually considered allowable, but care must still be taken regarding hidden vitamin D. It also should be recognized that the views on various supplements may change as more is known. Uncertainty in these matters is regrettable, but this lack of certain knowledge is not limited to the MP. The way in which most supplements act and interact with other illnesses and protocols is also still far from complete.

At this point in time, there is a supplement that has recently been suggested as being helpful for the MP, and that supplement is Quercitin. It has a known molecular mechanism that Dr. Marshall has determined is helpful and does not interfere with the MP. However, it must be pure quercitin, without other ingredients, such as bromelain. There is also a non-citrus Quercitin from Solaray that some have found to be more tolerable than other types. Quercitin is generally found to be more useful later in the protocol, and may even increase symptoms near the beginning of the protocol.

Regardless of all the views expressed above, the ultimate responsibility for what is done in a particular case lies with the patient and the treating physician. However, the view of Dr. Marshall is that the experience of most patients who have succeeded on the MP suggests that supplements are unnecessary if one eats a healthy diet, and the use of supplements may have serious drawbacks, as has been described.

(Note: Although a healthy diet is preferred over supplements in the MP, if a multivitamin is used, the only one currently known to the MP staff to be labeled as not containing vitamin D is Nature’s Life Vegetarian Mega Vita Min. Another option is to take individual pure nutrients to make up what is usually found in a multivitamin, but without vitamin D. Folic-acid containing B vitamins are generally not recommended in the MP if they cause the person to exceed the 400 mcg RDA of folic acid, which can usually be obtained from a healthy diet. This is because excess folic acid is thought to promote bacterial growth).

Light Avoidance

Some feel that they can not do the MP due to the requirement for strict avoidance of sun and bright light for about the first 12 of the MP. It now appears that there is some help that can be obtained with this problem through the use of a 2% ketoconazole cream. Research has shown that this prescription cream blocks vitamin D production by the skin and some patients on the MP have verified that it works for them. Experience so far indicates that it may be applied to exposed areas like the face, when it is really necessary for daily activities or work, and that it does seem to effectively block the vitamin D reaction. The Physicians Desk Reference (2004) describes studies that show that negligible amounts of ketoconazole are absorbed by the body and that it is generally well-tolerated (2008 note:  now many find zinc oxide containing sunscreen to be more effective). The rest of the body not covered by the unscented ketoconazole cream needs to be well covered with clothing when outdoors, including gloves and NoIR sunglasses, as recommended in the web site sections on “What Is The Marshall Protocol” ( and in the FAQ section ( There is also information on the web sites on alternatives to the relatively low-cost NoIR sunglasses, such as specially-coated Zeiss lenses, for those who desire something more stylish for the workplace.

Correction on Pulsing Minocycline Prior to Marshall Protocol

In a note at the end of Issue 7’s overview article on the Marshall Protocol, it was mentioned that for those who for some reason could not start the MP, they might simply try alternate day doses of minocycline, beginning at a low dose, like 12.5 to 25 mg minocycline.

Recently, Dr. Trevor Marshall has written that he does not recommend this pulsing with minocycline before beginning the MP to try to reduce the bacterial load. There are several reasons for this and they are described on the MP web site (see FAQ at In his view, if the minocycline is used for more than a few months, there is a risk of clearing tissues of bacteria sensitive to minocycline alone and allowing resistant bacteria to take over in those tissues. Also, without the Benicar, the patient doesn’t have the protection from inflammation for the organs provided by Benicar’s angiotensin blockade. Another problem he sees in the use of minocycline without Benicar occurs in cases where the patient is diligently avoiding vitamin D and light exposure. This situation may be dangerous in some patients because the bacterial die-off or Herxheimer reaction becomes stronger with the lower vitamin D and may reach an intolerable level without the protective effects of the Benicar taken at the dosing levels required in the MP (

Further Links:

For a 2007 overview see A Short Introduction to the Marshall Protocol by Amy Proal

For an up-to-date, two-part article on the Marshall Protocol from the Townsend Letter for Doctors and Patients see:

Part One: and

Part Two:

***For newer information on sun avoidance and the use of zinc oxide-containing sunscreens by Marshall Protocol patients see Sunscreen Overview — Updated Feb. 24, 2008

Written by synergyhn

October 29, 2008 at 3:53 pm

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