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The Marshall Protocol for Treating Chronic Fatigue Syndrome and Fibromyalgia: Hopeful Results Emerging

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Note: A number of patients with CFS, FM, and other chronic illnesses such as lupus and Lyme disease are reporting success with the experimental Marshall Protocol, originally developed for relieving the symptoms of patients with the "Th1" inflammatory disease sarcoidosis. (See the Marshall Protocol message board at http://www.marshallprotocol.com, and "A Journey Towards Complete Recovery from Chronic Fatigue Syndrome" at http://www.immunesupport.com/library/showarticle.cfm/id/6569

Following is an exclusive interview conducted in July 2004 with Trevor Marshall, PhD, who devised the highly demanding and still-controversial protocol, which must be administered under the care of a physician. He explains why he believes it may work for certain CFS and FM patients, and others. (See disclaimer at end of article.)

Question: Please introduce yourself by giving some background on your medical training and practice.

Trevor Marshall, PhD: I graduated Bachelor of Engineering (w/w statistics) from the University of Adelaide in 1974. I spent a year in Papua New Guinea teaching at the University of Technology in Lae, and then spent 6 years teaching at Curtin University in Western Australia. During that tenure I received my Masters Degree and commenced my PhD Research at the University of Western Australia, in Biomedical Engineering. It was an exciting time. Another UWA student, Dr. Barry Marshall (no relation) had just discovered that the bacterium Helicobacter Pylori was the cause of stomach ulcers, and the teaching hospital where we did our clinical research ("Sir Charles Gairdner") was full of "new ideas." My mentors were convinced that we needed to develop a totally different approach to medicine.

I researched Infertility and Cryptochidism with Ted Keough and Diabetes in Tim Welborn's group. Ted found a way to treat infertility by pulsatile infusion of a hormone called GnRH, and resolved Cryptorchidism without surgery, using pulsatile infusions of the hormone LHRH. Tim's group explored the continuous infusion of insulin in Diabetes.

After moving to the USA in 1982 I took some time off to study with Mike Albisser's group at the Hospital for Sick Children in Toronto. "Sick Kids" was a world leader in diabetes research at the time, and our research team included MDs and PhDs from all over the world. It was an amazing experience, and my doctoral thesis, "Mathematical Modeling of the Insulin Glucose Homeostasis in Healthy and Diabetic Individuals", was accepted in 1985.

Soon after that, I came to the realization that sunlight was a factor in immune disease, but it took many years for all the elements of the Th1 immune reaction to gel together in my mind. Late in 1999 I noticed that a new class of drugs, "Angiotensin Receptor Blockers' (ARBs), were affecting the psyche of Sarcoidosis patients. Since I knew that ARBs should not have any such effect I commenced a full-time sabbatical in early 2001 to try and figure out exactly what was happening. The result of that research was a pathogenesis for sarcoidosis, published in 2002. Since then we have conducted an Internet-based study of ARB and antibiotic therapy in sarcoidosis, and are now exploring how our success can be generalized to all the Th1 immune diseases. The Autoimmunity Research Foundation is acting as a focus for our current efforts (http://autoimmunityresearch.org).

Question: A number of patients with Chronic Fatigue Syndrome (CFS), Fibromyalgia (FM), and other chronic illnesses report they're finding success following your sarcoidosis treatment protocol. Could you explain what CFS, FM, and sarcoidosis patients might have in common that could explain this?

Trevor Marshall, PhD: Sarcoidosis is a Th1 inflammatory disease which can damage the lungs, heart, eyes, brain, liver, kidneys and soul. Patients are still being told it has no known cause and no known cure.

Tiny "pleomorphic" bacteria have been photographed living within the cells of the immune system of sarcoidosis patients. Emil and Barbara Wirostko produced stunning electron microscope photographs of immune phagocytes each containing hundreds of tiny bacterial forms, around 0.01 to 0.025 microns in diameter, living in colonies within the very cells (phagocytes) which are supposed to kill these bacterial parasites. One of the Wirostko photographs can be found at http://www.autoimmunityresearch.org/wirostko-fig3.jpg It is important to understand that these bacteria are "coccoid" (round, and very, very small), 10 to 100 times smaller than the shapes these same pleomorphic bacteria will take when they enter the bloodstream.

We found that you can measure a hormone (in the blood) resulting from the Th1 inflammation produced by these tiny bacteria, and that it is elevated in Sarcoidosis patients. It is also often elevated in CFS patients, indicating that the inflammation of CFS is often very similar to that of Sarcoidosis.

Question: Some researchers (including Garth Nicolson, PhD at The Institute for Molecular Medicine in Huntington Beach, California) and physicians believe that multiple co-infections including bacterial and mycoplasmal infections, play a key role in the onset and pathology of CFS and FM. To what extent are bacterial and mycoplasmal infections involved in sarcoidosis, and do you believe your methods for treating those infections in sarcoidosis apply to CFS and FM patients?

Trevor Marshall, PhD: Multiple co-infections of antibiotic-resistant bacteria can act in unison because many of the species have evolved a similar technique for evading the immune system.

These bacteria live in the cytoplasm of phagocyte cells, and directly stimulate a protein called NuclearFactor-kappaB to cause the continuous release of inflammatory chemicals, a Th1 cytokine cascade. This is the source of the inflammation driving the CFS symptoms.

Where our work diverges from that of Dr. Nicolson is the manner in which we control the hormones Angiotensin II and 1,25-dihydroxyvitamin-D so as to weaken the defense mechanism of these tiny bacteria, and allow the immune system itself to start to recognize and kill them. We then use common (oral) antibiotics, at a very low dosage, to help the immune system deal with the parasites. It is the immune system which kills these tiny resistant microbes, helped along by low-dose antibiotics.

Question: What is your treatment protocol for bacterial and mycoplasmal infections?

Trevor Marshall, PhD: Our treatment protocol is split into two phases. The first phase lasts for about three months and is focused on getting the bacterial load down to a point where the endotoxins are no longer life-threatening. Then, in phase 2, we use additional (low-dose) antibiotics, making it almost impossible for the resistant bacteria to evade the immune system.

Phase 1 is available online at http://SarcInfo.com/phase1.pdf

We focus on blocking genetic protein transcription, the process whereby the tiny bacteria use the bacterial 30S and 50S Ribosomal Nucleic Acid subunits to produce the proteins they need to hide from the immune system. In phase 2 we block multiple pathways for 50S RNA synthesis, which allows the immune system to recognize (and kill) even the strains which have evolved a resistance to standard antibiotics.

Question: How do you go about improving immune function in your patients, what is your protocol for that objective which could cross over from sarcoidosis to CFS and FM patients?

Trevor Marshall, PhD: The two hormones critical to this inflammatory process are Angiotensin II and the seco-steroid 1,25-dihydroxyvitamin-D.

Blockade of Angiotensin II weakens these bacteria to the point where they can be more easily killed, and reducing the 1,25-D makes it harder for the bacteria to slip in and out of the cells they have infected.

We use the Angiotensin Receptor Blocker "Olmesartan Medoxomil" (Benicar/Olmetec/Votum), dosed approximately every 6 hours, to blockade the Angiotensin II receptors in the inflamed tissue.

The seco-steroid 1,25-D is the active hormone resulting from sunlight on our skin, and the Vitamin D we ingest. Both these sources of 1,25-D have to be attenuated if these bacteria are to be killed.

Question: Are you currently treating any patients with CFS and/or FM, or have you in the past? If so, what is your strategy for treating these patients?

Trevor Marshall, PhD: I am a researcher with a PhD, not an MD, and I cannot treat patients directly. I help their physicians understand the disease process, so that those physicians can work with the patients to cure the disease. We are also working with several LLMDs (Lyme literate Medical Doctors).

I, and my colleagues, have published a number of papers describing all the elements of our discoveries, and, during 2002, we set up a clinical trial at the Internet site http://www.SarcInfo.com so that we could track the progress of the first patients using our protocol.

Also [a message board was created] called "MarshallProtocol" (http://www.marshallprotocol.com), and CFS and FM patients have used the information from that site to work with their physicians to implement the protocol… It seems the protocol is working just as well for these CFS and FM sufferers as it did for the sarcoidosis patients, most of whom have progressed to "cure" over the last two years.

Question: In one of your recent research articles, you discuss "Lessons from Lyme Disease." Many chronic Lyme patients experience symptoms very similar to CFS and FM, and in fact, it is not unusual for someone with Lyme disease to be mis-diagnosed with CFS or FM. Could you discuss this issue, and talk a bit about how you diagnose and treat patients with Lyme and other spirochetal diseases?

Trevor Marshall, PhD: Whether the inflammation (which gives rise to the CFS and/or FM symptoms) is caused by Borrelia, Bartonella, Chlamydia, or any other bacterium with the ability to change into these tiny pleomorphic shapes (also called "L-forms," "Cell Wall Deficient," "Cystic," "Mycoplasma"), the inflammation needs to be treated the same way. The microbes seem to be resistant to standard antibiotics, even IV antibiotics, and have to be killed by our immune system itself. We have defined what is necessary to achieve that.

Diagnosis can often be done from bloodwork assay. If the level of 1,25-dihydroxyvitamin D in the blood is elevated (above 38-45pg/ml), or the 25-hydroxyvitamin-D depressed (below 20 ng/ml) then it is pretty certain that a Th1 process is in play (note: all blood must be frozen during transit to the labs for these tests to be accurate).

Sometimes it is quicker and cheaper to apply the angiotensin blockade as a "therapeutic probe." If there are profound psychic and systemic effects from using Benicar, a drug which usually only changes the blood pressure, then that is a pretty good indication of the presence of Th1 inflammation, and an indication it is worth starting on our protocol.

Question: For those patients out there struggling with dubious diagnoses, do you recommend any specific laboratory tests to determine what infections they might have?

Trevor Marshall, PhD: Unfortunately today's laboratory tests are of little use until the immune system starts to recognize these intracellular invaders. Hundreds of these tiny bacteria can live inside a single cell. They are too small to be seen with conventional optical microscopes. The host cells live for a relatively long time. There is little apoptosis (cell death), so very few bacteria are released into the bloodstream, and they are hard to detect with lab equipment.

Because they live in stable symbiosis with our immune system, there are no antibodies created. The bacteria live within the cells in stable colonies which cannot be attacked by the body's normal defenses. Lab tests will not find antibodies to these bacteria.

PCR (polymerase chain reaction testing) is capable of sensing the occasional cell apoptosis, but the resulting low DNA concentrations would be regarded as insignificant by most labs.

The biochemical symbiosis is so delicate that it is virtually impossible to culture these bacteria outside the body. Just as the bacteria causing Leprosy (mycobacterium leprae) and the bacteria causing Syphilis (treponema pallidum) are nearly impossible to culture, I expect it is unlikely we will be able to culture these Th1 pleomorphs until we fully understand the biochemistry needed to sustain them. No lab has been able culture these bacteria up to this point in time (with the possible exception of Lida Mattman's research at Wayne State University).

So I guess the next task for us is to start working with labs to help devise tests which can produce a reliable diagnosis.

Question: Do you have any parting advice for CFS and FM patients seeking appropriate, effective treatment?

Trevor Marshall, PhD: I would just say don't take "no" for an answer. For the last 100 years sarcoidosis patients have been told that there is no known cause and no known cure for their disease (much the same prognosis being given to CFS and FM patients). The diagnosis of chronic sarcoidosis is regarded by pulmonologists as irreversible, they know their patient is dying, and that it is just a matter of time.

Yet the sarcoidosis folks who have been helping us develop our protocol, are becoming healthy again. Not just 10 percent, or 25 percent, but close to 100 percent are recovering their lives and their families. They have variously reported regaining cognitive focus, stamina, and stable gait, and resolving chronic pain, paresthesias and visual disturbances. Some have been able to discard wheelchairs, braces and supplementary oxygen.

"It is not the antibacterial therapy" that is helping these patients, say 'the experts,' "it is just spontaneous remission." Well, personally, I don't care what they call it, most of us will take this antibiotic-induced "spontaneous remission" any day, as long as it gives us back our health, our lives and our families. Don't take "no" for an answer.


Disclaimer: The content of this article reflects the views of Professor Trevor Marshall, PhD. ProHealth/ImmuneSupport.com does not endorse this or any other specific protocol as a treatment or cure for CFS or FM.

Note: This information has not been evaluated by the FDA, and is not meant to diagnose, treat, cure, or prevent any disease. It is very important that you never make any change in your health support plan without the careful review and approval of your professional healthcare team.

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24 thoughts on “The Marshall Protocol for Treating Chronic Fatigue Syndrome and Fibromyalgia: Hopeful Results Emerging”

  1. TheSephardic says:

    Every independent poll that I’ve seen on this protocol has had the same results: Disaster!

    Has 50% of people getting worst on it versus 28% getting better. Oddly, most of those reporting getting claimed that they went to FULL REMISSION, yet I cannot find a single post on that group saying that – this cause me to suspect that those results were salted. If you look at the Marshall Board, you will find Aussie Barb — whose been on the protocol for a long long time (likely the longest of any CFIDS patient) and her posts indicate that she is not in remission, and quite frankly, continues year after year in religious-like hope that it will.

    What is odd is the total absence of any articles in recognized medical journals after many years? There seem to be many MD’s trying it on their patients — surely, at least one of them would want to share such a wonderful breakthru! Or, are these MD’s prescribing to just get quiet from demanding patients and they are not seeing the results with their patients?

  2. dafo says:

    I agree with TheSephardic whose comment was written here on 11-22-06. I have sarcoidosis and when I was first diagnosed, I initially got into the Marshall Protocol (MP), reading everything and trying like crazy to find a doctor. They continued to send me lists of doctors whom, I discovered, would NOT use the MP. One doctor’s office requested to be taken off the list because they were tired of the calls, and although I told them about it, the name remained. When the list of doctors to contact is long, it makes this treatment look more impressive, doesn’t it? Another doctor I actually went to twice, and paid $125 out-of-pocket for each visit, told me he had used the protocol in the past although he could not tell me the names of the drugs used in the later phases! When I questioned him about it, he said his “patients got better on Phase I alone.” He clearly had no clue about the MP, but he remains on the MP list of doctors.

    Consider this: Why in the world would anybody want to start this program without knowing what drugs it entails?? Why do they keep them “secret?” People should not blindly take ANY drugs without looking up the side effects first, but the folks at the MP won’t tell you what they are. It’s not as if you can self-medicate because they are prescription drugs.

    I, too, have not found any independent validation of the protocol and, in fact, found it is listed as one of the worst.

    I also agree with TheSephardic about Aussie Barb, and others. On the site she admits to not following the protocol 100% (she eats forbidden foods like bacon), and then backpeddles when called on it. She is good at admonishing others in her tone, but why isn’t she cured by now if she’s been following the plan?

    Some of the administrators and Trevor Marshall himself occasionally appear to be hostile, angry, or condescending to members.

    Look up info on their site about why there have been no clinical trials if this protocol really works, and you won’t get a straight answer. Really. Think about it: why wouldn’t someone who really believes in this MP want scientific PROOF via clinical trials?

    1. norris2 says:

      I mostly agree with this post, but disagree with a few things.

      I agree that Marshall et al. have overstated the protocol, and I do not know why immunesupport is republishing an interview with him two years ago, where he is clearly overestimating results. Shouldn’t there be new info by now?

      Also, I agree that Marshall and his ‘staff’ are insulting; they act as if you are a moron if you question anything in their protocol or any of their results. They are consistently contradicting themselves, as do many of the patients on the protocol. There is no give and take on the discussion boards. It is so frustrating that I never even check in anymore.

      The parts of this post I think I disagree with regard the use of drugs in the protocol. Maybe the protocol has changed, but when I was checking in, it was outlined pretty well, and the only drugs I saw were minocin, zithromax and benicar. The side effects of these drugs are known and not generally serious or widespread and can easily be researched. While doctor supervision is necessary, this is not what bothers me about the protocol….it is the results, how the results are presented and Marshall himself that are the problem.

      Every once in a while you read about someone who really improves on the protocol. I’ve tried benicar myself, and it definitly affected me (not side effects) but I could never be sure what was happening because the only advice I got was to push on. This is why it is so unfortunate that someone more helpful and unbiased could do a real study of this protocol, in part or in whole. I think it is worth a study if there was any $$$, but with Marshall as a consultant, not the one doing the trials or publishing results.

    2. marystuff says:

      The report is from November 2006 and the interview from 2004. Anything currently available? My wife was on the MP, and it was working wonders, until she had to get off it last December for some unrelated complications. We are eager to get back on the protocol and would like to hear from others about their experieces. The Marshall protocol site is wealthy with comments and experiences.

    3. goggy says:

      As you say, the MP site is “wealthy with comments and experiences.” That’s because if anyone disagrees with the MP or has anything negative to say, they are thrown off the site. So you are only seeing comments from people who agree 100%, and who won’t say anything bad, because they are afraid of being “told off.”

      I was on the MP for 3 years, and during that time I also wrote on that website and shared what I thought were positive experiences. Until I realised that the MP wasn’t working, and was in fact making me sicker. But I didn’t feel I could share anything of my “negative” realisations on the site, so I stopped going on to the website altogether. Since stopping the MP, I have also realised that a lot of things I thought were improving because of the MP actually weren’t (i.e. I was using less of one of my medications, but instead of it being because the MP made me better, it turns out it was because of an interaction with a different medicine I was taking, and it had nothing to do with the MP!) I am much better now than when I was on the MP, but it took me some time to get back to the level of health I was at before I started the MP.

    4. fabwheelie says:

      Dr Marshall and protocol could be dangerous!

      Hello, sorry to disappoint anyone who thinks the Marshall protocol has any proper scientific basis but I’m educated with BSc Biological Sciences and MSc Biomedical Sciences and have looked at the Marshall protocol web site as I was researching if it may help my lupus(SLE).
      My scientific education included studies in pathology and immunology and for people out there who think I’m just a critic of TG Marshall all I can say is I’ve looked into his arguements and the most current “peer reviewed published research” and I am open minded enough to have sufficient vision to consider any valid arguement for “treatment” which may help my lupus

      I actually think that this site (http://www.marshallprotocol.com/) is dangerous and misleading.

      Dr TG Marshall is not a medical doctor and his theories regarding Vitamin D are misinformed (eg what he says about Vitamin D contridicts numerous research which shows that vitamin D supplements can actually help lupus)

      If he really believes his theories to be true why does he not publish his findings in “proper peer reviewed reputable scientific journals”. It is relatively easy to get scientific articles published even if you are contridicting what other people say

      The MP site says
      “In order to receive counseling on this study site and be included in the cohort of study subjects, members (or their caregivers) must meet the following criteria….” “Failure to meet these criteria will exclude members from the study at any time and mandate they rely on their doctor alone for information and support.”

      One of these criteria is “-Acceptance of the validity of the Marshall pathogenesis.”
      From the research I’ve done no one could accept the validity of his pathogenesis because his immuno-pathological explaination has not been scientifically validated, and his theories on vitamin D are actually contridicted by the majority of scientific resarch and “peer reviewed” medical opinion

      Please do research outside the MP site

      Please discuss with you GP (and any consultant treating your disorder) before stopping any medication that you are on

      Please be aware of the risks and symptoms associated with low vitamin D levels

    5. dafo says:


      I saw your other post after I sent my reply to you, not realizing you live in the Czech Republic. Sorry! Sending information on where to get unfortified milk in the USA won’t help you! Maybe it will help others, though.

      I should have included this link to a site in my reply because it is full of great comments. It is fascinating information about the MP from Mark London, and offers a LOT of things to consider and question. Kudos to him for doing this.


    6. renata says:

      thanks a lot for the link, it is something I have been looking for,although it will take me weeks to go through it. My English is sometimes not sufficient for such a sophisticated vocabulary! Thanks though!

    7. nat12 says:

      While the Marshall Protocol is not yet mainstream clinical practice it is based on some very innovative and rigorous molecular modeling. Yes, the role of Vit D is conceived of differently than in clinical medicine but that is because Prof. Marshall has drilled down and investigated the structure and function of the various forms of Vit D (there are several) rather than just blindly plying people with one form of Vit D and make subjective judgments about what is going on inside the body- that’s what clinical medicine does and it’s akin to playing pin the tail on the donkey. No scientist outside the medical field takes that sort of ‘research’ methodology seriously. Vit D will make CFS and other autoimmune patients feel better in the short term (as will steroids) as it is immunosuppressive. But try then going off it, even for a moment, and watch the spectacular relapse!

      As an analytical chemist, I am delighted to finally see proper molecular modeling and analysis entering into clinical medicine and challenging misguided assumptions that have dominated the clinical field for so long leaving patients with few answers on chronic illness except pain killers, steroids and more illness. I’m pleased that Prof. Marshall is getting more airtime and readers should note that he recently attended a conference at Karolinska institute, presented a seminar on his work at the US FDA and has managed to get published in peer review journals including BioEssays and Theoretical Biology and Medical Modelling, (see http://www.trevormarshall.com/papers.htm). So yes it’s new and different but it’s legit. Times are finally a changin’.

    8. Pro-MP says:

      If you carefully study the molecular science behind the Marshall Protocol,you find that it points out that it is not low vitamin D that is dangerous,but high 1,25D that IS.Also that vitamin D is usually low in patients with “auto-immune disease” because of the elevated 1,25D…which again is the REAL risk.Have you ever had your 1,25D level checked?
      Research outside of bio-medical engineering should be more rigorously challenged because it is not based on anything than theories. …. blind theories like “molecular mimicry”{from my poor mis-informed neurologist}Or the THEORY that my “reputable” endrinologst holds-that if I take 100,000 IU of vitamin D for a few weeks and continue with 50,000 iu…that I’ll be MUCH BETTER?

      Don’t you get it? Vitamin D is immunosuppessive…..and 1,25D, one of it’s metabolites and a secosteroid, blinds the immune system to the culprits that are driving things like lupus…l-form bacteria{I hope we can all at least agree with that}

      For my illnesses…which include CFS,Neuropathy,”Bi-Polar Disorder”[really a spectrum disorder] it is amazing how these things are agitated when exposed to sunlight…which for people infected with mycoplasma causes an abrupt rise in 1,25D….this is one of the things that always produces an immediate flair in symptoms, confirming to me that Marshall is correct in his belief that the VDR is the heart of inate immunity….and taking “vitamin” D would be pallitive and maybe even protective in the short term….but disastrous for somebody infected with bacteria that would love nothing more than a break from your immune system. For the record…The Marshall Protocol has already helped me tremendously just by lowering my 1,25D and giving me a fighting chance.{My 1,25D was 58 mg/pl….far exceeding the Merck maximum}

    9. Pro-MP says:

      How long will it take for all of the “experts” finally understand that it is not low vitamin D that is so dangerous as is high 1,25D?

      Elevated 1,25D supresses the production of vitamin D{25-D},
      resulting in low test levels.
      More importantly high 1,25D is whats causing all of the other immune problems people with Th-1 pathogens experience…..then the “experts” come in and say
      “It must be because your 25-D is so low that these problems are occuring,”
      Then they tell them to bring their 25-D levels up….then you end up worse thn before….with high 1.25D and high 25-D.
      Here is the problem with high 1,25D: it blinds the immune system to the culprits causing the current manifestation of their illness….whether it is chronic fatigue,fibromyalgia,neuropathy etc.. High 1,25 D allows these bacteria,called l-form or cell wall deficienr bacteria to infect and proliferate in the T-cells of the host,resulting in destructive “auto-immune” disease.
      25-D is immunosupressive….so taking it shuts down what’s left of your immune system….which reduces the symptoms of the disease while giving the bacteria even more freedom to reproduce.This is why the Marshall Protocol is so effective in spite of the side effects people are critical about,because it lowers your 1,25 D so the immune system begans to kill the funk causing the illness.So because l-forms are slow growing and have probably been in the body for decades in chronically ill folk…it will take time to kill them and yes you will experience side effects as a result of them dying.
      But the healing that results is undeniable.I know this also first hand from experience in treatment with the MP.
      I don’t know Aussie Barb at the Marshall Protocol…but I know she has only been on the MP since 2007, and is definately seeing tangible results.In my opinion,people who embark on the MP are intelligent and brave.Intelligent because they have made a decision based on real science,brave because they perservering through the killing of the pathogens with the reward of being cured in plain site.

    10. fabwheelie says:

      Hi good for you that you are feeling helped by the MP but I hope you are also being monitored by a medically qualified person who is aware of all the things you are doing to try to help yourself get better.
      I personally think that it is potentially going to make your symptoms worse if you have lupus or similar illness and also are avoiding vitamin D
      Also I think Dr Marshall is a “quack” and I can not take him seriously as he is not medically qualified and he appears to be claiming he can cure a number of diseases including lupus (there is no cure for lupus at this moment in time and I would always be sceptical of anyone who thinks they have the cure for more than one disease).

      I do not agree with the MP theories about l-form bacteria driving lupus (where is the scientific evidence that this is the case?)

      Also I think that the Marshall Protocol is ignoring the majority of scientific evidence about the role of vitamin D in autoimmune diseases, for example:-(1) Patients with SLE have multiple risk factors for vitamin D deficiency (symptoms of this e.g. musculoskeletal pain, cramps may be overlooked as SLE symptoms). In addition the disease severity in SLE seems to be correlated with lower 25-OH vitamin D serum levels. Also scientific opinion suggests that it is mandatory to consider (and treat if necessary) vitamin D deficiency in SLE patients (ref Cutolo M, Otsa K. Vitamin D,immunity and lupus. Lupus 2008;17:9-16)

      (2)In animal models vitamin D has been shown to be an effective treatment for SLE (this treatment is limited by the effects of hypercalcaemia).Similar animal models show that vitamin D deficiency worsens other autoimmune diseases ( ref Deluca HF, Cantorna MT. Vitamin D:its role and uses in immunology FASEB J 2001;15;2579-2585 ) -by the way FASEB is The Federation of American Societies for Experimental Biology

      (3)Vitamin D status has been linked to autoimmune diseases that have T-Cells that target self and drive the immune system such as multiple sclerosis(MS), rheumatoid arthritis(RA) and inflammatory bowel disease (IBS). For example (a) those with high vitamin D intake have a reduced incidence of developing MS -ref Munger KL, Zhang SM, O’Reilly E et al Vitamin D intake and incidence of multiple sclerosis. Neurology 2004;62 60-65.
      (b)Vitamin D intake is inversely associated with rheumatoid arthritis -ref Merlino LA, Curtis J, Mikuls TR et al Vitamin D intake is inversely associated with rheumatoid arthritis: results from thr Iowa Women’s health study. Arthritis Rheum 2004;50 72-77
      (c)Vitamin D serum concentrations are correlated with the severity with rheumatoid arthritis -ref Cutolo M, Otsa K, Laas K et al Circannual vitamin D levels and disease activity in rheumatoid arthritis Clin Exp Rheumatolo 2006; 24:702-704

      I’m not well enough to spend my energy on fully explaining things about vitamin D, it’s biologically active form 1,25(OH)2D3 which has immunoregulatory activities, and the vitamin D receptor, and it would take too long. However if you are interested in the science behind where my point of view is coming from please try to get hold of scientific books and research papers on the role of Vitamin D in immunity

      I’m not sure if you would understand the science (if you don’t perhaps your consultant or GP who sees you would and they can possibly access a copy of any references for you) but there is an excellent Review of vitamin D and Lupus in the scientific journal called Lupus.
      This review explains things quite clearly and has sources of other references about vitamin D and the immune system.

      The review is called Vitamin D,immunity and lupus (Review) by the authors M Cutolo and K Otsa and is in the journal Lupus (2008)volume 17 pgs 6-10 (scientific people/librarys will understand the reference Cutolo M, Otsa K. Vitamin D,immunity and lupus. Lupus 2008;17:9-16)

      As I understand things I think you have got mixed up re the immunological role of vitamin D. As I understand it the physiologically active form of vitamin D (1,25 dihyroxyvitamin D also referred to as 1,25(OH)2D3) has immunomodulatory effects which tend to down-regulate the immune response, for example it inhibits T-cell proliferation (particularly on the Th1 arm) and inhibits cytokine production as well as inhibiting antibody secretion and auto antibody production, thus INCREASED 1,25(OH)2D3 would INCREASE IMMUNOSUPPRESSION (hence less auto-antibodies and less immune response in the autoimmune diseased person which is what medical personnel are aiming for to prevent organ damage , flare ups etc in Lupus)
      Also In vitro 1,25(OH)2D3 stimulates phagocytosis and killing of bacteria by macrophages so even if the theories about bacteria driving lupus were true lowering 1,25D would give less bacterial killing and would make the disease worse

    11. Pro-MP says:

      Actually my doctor who is 40 years into research decided to do the MP herself because everything about the science made great sense to her.I think that Marshall sees things through a dfferent paradigm that most of the medical field are not famiiar with,so I understand how it can be hard to accept as a legitimate treatment, especially since it tends to confuse people concerning 1,25D and 25D levels and how many things are affected by these metabolites

      I think you would have to believe that low levels of 25-D cause more pronounced T-cell activity,resulting in greater immunopathology and being interpeted as some one not having “enough” vitamin D, when in fact the increased activity results in excessive cytokines being released due to pathogenic loads in the T-cells themselves. It’s hard not to “buy” this when you see the slides.
      1,25 D is immunosuppressive as it is a seco-steroid, resulting in proliferation of the l-forms and enabling them to slip in and out of the t-cells without detection.Constantly elevated 1,25 D gives a pallitive effect,as does high 25-D.Both have to come down for the battle to begin.

      I will check out your references to be fair, I am one who has “auto immune” disease and don’t pretend to know as much as a doctor, but I did convince a doctor to get on the therapy as I was racing to get on it myself.

    12. rotomill1 says:

      I have had the circuit with the so called experts.I also think capital punishnment should be used on the
      snake oil pushers that promise the world and give you squat.
      I do know I have something, when it flares up I can’t get out of bed,my hands swell up so I can’t even pick up my socks, My feet swell up so I can’t walk, the small bones on the top of my feet feel like they are going flat. My right elbow and both of my shoulders and hips give me trouble also.’
      Is there any one here with symptions like these.
      About 10 years ago I worked in Indiana and I was exposed to ticks and I do remeber the rash also.
      I am 62 and not ready to give up yet/ But I am sick of being taken. Is any one useing this on Lymes or Rheumatoid Arthritis please let me know.

    13. dkrolls says:

      3 topics: F&F Centers scam, MP, Guai Protocol
      Sorry I cannot name names in this post, since TM who developed the M Protocol for all Th1 inflammatory illnesses will sue me for libel.

      I know this is years late, but I do hope you were not taken in by the
      F & F Centers. They are a horrible scam perpetuated by a “Dr. T.”
      He is on the staff at the Dr. Oz. show as of 2010. His bio can be found there and you will know him by his specialties including Fibro. He has never healed a single fibro as announced long ago by the doctor that bought his practice. He is simply a supplement seller and gets kickbacks from everything he agrees to mention in his speeches and he is making himself rich and is now rich enough to pay a doctor’s malpractice insurance for those who agree to work in one of his clinics and push the supplements. So it’s a great opportunity for a doctor to get rich quick at the expense of the fibros.

      Please just read the new 7th. Ed. of
      “What You Doctor May Not Tell You About Fibromyalgia”
      by R. Paul St. Amand M.D. & Claudia Mareck.
      This doc has a fibro protocol which is seldom taken seriously. My father was a drug chemist for WarnerLambert/Parke Davis and we had a good laugh at it too. It’s that the pill you take is guaifenisen, i.e. Mucinex!
      Hilarious! So I decided to prove it all a scam and did it perfectly and even video-journaled a bit every day or so, so that I could go out and warn everyone about it.
      Then in month 4 my foot had to be surgically removed from my mouth as I got my first great day! It was a miracle!
      Then by month 8 I could jog 8 miles and I thought this is as good as it gets. Nope. My anxiety I’d had since birth vanished in month 9.

      WOW, I never knew how awesome life could be when you are not afraid anymore. They just all called me a very shy child.
      Nope I had anxiety my entire life and thought everyone did. Just like my Mom did.
      Dr. Amand has been practicing in Marina Del Rey, CA for over 40 years. As of 2012 he is still accepting new patients. He charges $400 but many insurances cover the expense now.
      The doc is now in his 70’s and still works a full schedule.
      You do not need to meet him, but if you CAN swing it, they all say it is worth the trip him. I did not meet him. I did it with a little help from a doc that was trained by Dr. Amand and is right here in Chicago, where I live. So I’m very lucky.
      Just read the book, which you can read for free from your library. Be sure to get the latest one. It has a red band across the top.

      As of this post [Jan 2012] it can now be pre-ordered for a May delivery on Amazon.
      If it is way past 2012 then try Ebay, for a used one.
      As per MP. I’m very happy for those with Sarc who say they feel much better, but I’ve yet to hear of anyone being cured and off the meds. But that’s still a lot for a Sarc. I’d be happy with that…not dying part!

      But as per fibro: well, there is not anyone yet who has reached anything close to a cure. TM is a salesman and an inventor and has applied his love of invention from Computer programming and mathematics and Electrical Engineering into this leap over into medicine.

      Hey, I’m open to all inventions. I like to invent stuff and I was darn good at it. So it’s possible that he learned about a few areas of medicine and then learned by drilling deeper and deeper and deeper and not wider and wider, like a regular internist. Like some fibros know more about fibro and what works and why than a doc would.
      Yes, I got to stage III and yes it was the worst hell on earth for years. And eventually due to a simple misunderstanding on what my benicar dosage should be, my potassium spiked and my heart almost stopped, and I easily could’ve died on the floor in my kitchen. Well that was enough excitement for me and it took me 2 years to get back to a place where I could go through the Guaifenisen Protocol and reach remission again.

      As per the after effects from MP, yes I am damaged: the after images are retained on my retina for waaaay too long now, and the sun is not yet my friend. Plasma TV’s are too bright for me.
      I have to have other lights on in the room or the after images become very distracting.
      None of these things are of much importance thus far, but who knows the possible long term damage I’ve done to myself.

      TM is an odd bird and his resume and list of credentials can be found on the web, as is a short paper of his life history and how far away from medicine it really is. He is an Electrical Engineer [not a Biological Engineer as he states in interviews] who was good at statistical analysis, and got onto a diabetes project to use his math skills to assist in insulin homeostasis something er other.
      TM is an inventor. A good one, perhaps. He did work with Macs for a time!

      I’m sure he searches the web monthly for the link to all negative items and then my post will be removed as he will claim liable, however nothing in the info is incorrect, so he can’t do much but yell at Yahoo to take negative items down, and boy does he spend waaaay too much time going after anyone writing anything negative about him, his theories or the instructions for phases II, and III. He has to personally find out how you are doing and sends a long questionnaire before you can be approved to get the next set of instructions

      I was in it around (2008-ish ) and every month he “made a new breakthrough” And we all cheered him on!

      Here is the latest place for the info, if Mr. TM has not found it again:


      There are no cured fibros. You will be on benicar for the rest of your life and they sure don’t tell you THAT up front, [hence the secrecy at each phase].

      How on earth could you get an Rx for this blood pressure med for the remainder of your life? Docs move, die and quit administering MP every day.

      We had only 1 doc in all of Chicago. He dropped all his MPer’s cold turkey!
      I cannot even imagine what they went through getting cut off.
      There was 1 more doc an hour away who was on MP and had Sarc, but he too stopped administering it, so all of those in Chicago got dumped into one helova deep pit, with no meds to even help them get off the Benicar or to help slow the herxing. You just cannot stop MP whenever you want, like the Guaifenisen Protocol. MP withdrawals are so hellish and mine lasted for 2 years after I decided to try to get off of it.
      Sarcoidosis patients who are dying might as well try this as it seems to be the only thing out there for them. And they are much happier than the fibros on the group and often have good stories to tell. Not so with the fibros.
      As per you fibros, please wait until there is at least one proven case of remission where the patient was actually cured AND OFF OF the Benicar….always ask about the Benicar when you speak to his fans with fibro.

      The only info you will get from the website is positive. It will seduce you with all these wonderful sounding theories. All negative posts are deleted.
      ———————–As per the logistics:
      There are not enough doctors to fall back on in the US if you DO find one and you get dropped you are gonna be in a world of hurt. The number of doctors administering MP is not growing. It is actually shrinking, as docs don’t make enough money they tell me to make it worth all the work, and it’s such a massive responsibility to monitor your Potassium levels so your heart does not stop.
      And since none of this is approved, the doctor is thus prescribing all your meds “off label” which the FDA is cracking down on. So it’s only getting worse for those wanting to try it.
      JC Waterhouse is a fibro and says she did not have success on the Guai Protocol, and dedicated her life to Marshall’s work.

      She [Joyce] always says she is getting better…but it’s been since 2005ish for her, and I could’ve reached remission 3x over using the Guai Protocol in the time she’s spent on MP.

      You can only imagine the costs. They are staggering. So many checkups: often twice a month and they charge a ton. And all the Rx’s that have to be called in so often, which the doc can’t charge for. So when one of my Doctors said he wanted to drop me since he was doing more work than it was worth to him, I had to make an agreement to come in every 2 weeks for a full hour’s worth of time and sit and pick my nose, since I was simply there to help pay for all the little things a Doc has to do that he cannot charge for.

      It’s just not worth risking your life if you have fibro. There were 2 known deaths when I was on MP. I can only imagine there must be many more, as it is way too easy to make a mistake with the Benicar, and your potassium can easily spike if you make one mistake and your heart will simply stop. And the autopsy would just show a potassium problem that lead to heart stoppage. It’s not as though the words “M Protocol”-related death would ever find there way onto the report. So we will never know the real death toll.
      Try Dr. Amand’s approach. It has worked for 40 years and is 100x easier than MP, it’s infinitely safer, and tons cheaper.
      But do NOT go out and buy some guai and start taking it. YOU HAVE TO READ THE BOOK or you will buy the wrong guai, won’t know how the titration process works, you will not know to avoid all Salicylates [“sals” block the guai for 12-24 hours and are to be eliminated in your body products. As are some foods, like anything with mint]
      When you see the word ‘protocol,’ you should know it is a program of multiple things you have to do and not do.
      It’s NOT just going out and getting some plain old guai from a bin in the drugstore and taking it.
      This happens all to often:
      Dentists are now telling their fibro patients to “start using guaifenisen” since it removes tarter or considerably slows it’s progression and you can avoid gum disease which is a very common symptom of fibro.
      So the patient goes out and gets the cheap, wrong guai, and takes it as the bottle states, and then gets so ill they toss the bottle out never knowing that had they just read the book they would know how to do the protocol properly and watch their fibro blow away forever.
      You need to know which “sals” to avoid and then there is a serious diet portion where all real sugar has to go bye-bye until you are VERY healthy, then you can cheat if you must.
      Yes it is a difficult protocol: imagine your fibro going backwards in time very fast. That is what it feels like and that is what it is actually doing.
      For every year you had fibro super bad you will have 2 months of discomfort prior to reaching remission. But what most of us say about it is
      “It never gets worse than your personal worst day sick with Fibro.” Assuming you are doing it right with the proper guai at your proper dosage.

      Proper dosage is very tricky too, so you HAVE to join the GUAIGROUP [instructions in the book on how to join] This is where we all meet to ask all the questions we still have after reading the book. And you can track your progress against others with your similar background dates. You make tons of friends here, and they are the only ones who have been through all that you have been through and know you to your core. It is a very positive group in general, since everyone is getting better and better. As opposed to the fibro sites where it’s just a list of how sick you are now and getting sicker every year which is just depressing. We are a group dedicated to actually reversing the effects of our condition, not just “what’s the best heating pad?” Or have you tried Lyrica [Ha!] Lyrica. An anti-seizure “gaba” med that’s been around forever and has 2 sister drugs made by other companies that do the same thing and have already been prescribed for Fibro for years. I’m glad for the ads since the general population will at least stop telling us it’s all in our heads. But even today, doctors are still either taught nothing about Fibro or told to treat it as a waste-basket condition if you can’t find anything wrong with the person.

      Most fibros are at least aware that they should be eating a low carb diet, as that is almost always the the first item on most websites about Fibro. But Dr. Amand takes an even stricter approach. In the book, there is a diet with lists of specific foods which are legal and not legal as many of us have: food sensitivities we never knew we had, or just a general carbohydrate intolerance, or even hypoglycemic symptoms that are so bad they actually mimmic fibro perfectly. So if you do not follow the diet and only take the pills properly, your fibro will be gone eventually, but you won’t ever know it, since you did not take control over what you shoved in your pie hole! As time passes your diet is expanded one item at a time to be sure you can tolerate it. Many foods do not show their negative effects for hours, so you must limit it to one new food at a time until you are sure it is not making you sick. This is a non-profit clinic, they do not sell anything except the book, which you can get at your library. They run on donations and the Dr. dose charge $400 for a very long visit. They also get donations from companies like Cleure.com, who service Fibros on Guai exclusively. But you can get everything you need just as cheap as you are getting it today. You simply have to learn how to read the labels and what to look for to avoid.

    14. renata says:

      Hi I am Renata. Did you find anything that would help you with sarcoidosis? My friend has been suffering from it for more than two years and MP seems her only chance since standard treatment/ prednisone/ failed. Any suggestions?

    15. dafo says:

      Hi Renata,

      Sorry to hear about your friend. No, I haven’t found anything that works, but I am lucky that my case is not as severe as others. How bad is your friend? What are his/her worst symptoms? Do they have any other conditions going on at the same time (like MS, psoraisis, fibromyalgia, lupus, etc)? What part of the country do they live in?

      I do think there are certain things that will help. The first thing really is avoidance of Vitamin D. I was exposed to a LOT of sunshine a couple of years ago and that is when I felt the worst. When I stopped (or greatly reduced) the sunshine and foods high in vitamin D (mushrooms, fish, fortified cereals & milk), I believe it helped. I personally believe that the “fortified Vitamin D” food items are much worse than “natural Vitamin D” foods. In other words, fresh fish is not as bad as fortified milk or fortified cereal. Maybe you can find a local source for unfortified milk at this website. http://www.realmilk.com/where.html

      Without trying to sound like a nature-nut, I think fresher foods and plenty of water are important, as well as fasting a little every once in a while. I say this as a person who loves to cook, and eat, so don’t misconstrue the suggestion.

      I think prednisone is probably the very last resort. There are reports on how poor the quality of life is for people on them (or, when they get off of them), and the benefits would have to significantly outweigh the risks. How long was your friend on it, and how long have they been off?

      I believe there is merit to some parts of the MP, but I am still wondering after all these years why there hasn’t been a documented clinical trial. I think too much of it is just ‘trial and error’ without the clinical trial constraints. If you read through some of the information, they have changed some of what they have said a couple of years ago. Also, I think there are contradictions and too much confusion with the information. I have read a lot of it and still cannot effectively explain to my primary care physician why he should ignore the reference ranges that his lab have adopted and use the ones on the MP instead. I also believe there is a lot of “lab blaming” if the blood work doesn’t conform to the MP theories.

      I checked for new doctors on the Marshall Protocol (MP) site and still found the old ones on there. That is, the one who told me they have nothing to do with the MP and would like to be removed from the list the MP is sending to people, as well as the one I went to. As I said in my last post, the one I saw (and suggested by the MP folks) clearly was not familiar with the protocol, but since I saw him I know he has treated others, so perhaps he has educated himself.

      I wish I could be of more help. I am sending my records this week to try to get an appointment to see a “conventional” sarcoidosis specialist. If I learn anything new, or come across something else, I will email you again.

      Is there a way to reach you by email, or only from this site? Or, is that forbidden??

      Take care, sweetie. Good luck.


    16. renata says:

      Hi Dafo,
      thanks for your reply.
      My friend was diagnosed 2 years ago and has multi organ sarcoidosis. It effects her eyes, lungs, liver, pancreas, skin, joins, heart, almost everywhere you can see those granulomas. She has been treated with prednison for the entire time. Now she take only 4 mg and all symptoms have returned. They want to raise her doses of corticosteroids again but she wants something that can cure not just maintain. She doesn’t speak English so I do research for her on internet.I contacted some people on MP sites and they are encouraging her to start MP, but her doctor is skeptical for the very reasons you mentioned. If you get some new ideas from your sarc. specialist, please let me know. I appreciate it. my e-mail is:rbejckova@centrum.cz

    17. pinevalley says:

      I refute the snake oil comment concerning the Marshall protocol. Anyone can stand back and say that the Marshall protocol does not work touting a little medical knowledge, but I suggest that you go a little deeper in researching this protocol and listening to those who have tried it. I have spent years trying many protocols, but for me, the Marshall Protocol is one that works. You ask why it is not widely accepted by the medical community: it is because the MP concept is 180 degrees out from the common belief that we cannot get enough vitamin D. It is supplemented in our milk, cereal, yogurt, etc.
      I have chronic Lyme disease. My career was going down the drain fast while suffering from the effects of Lyme disease (muscle pain, fatigue, brain fog, etc.). I was desperate to find a cure for this debilitating disease. I tried Dr. Shoemaker’s cholestyramine treatment and experienced a little temporary improvement (I think the small improvement resulted from removal of Lyme toxins). I tried expensive mega vitamins and immune enhancing supplements recommended by Dr. Teitelbaum and prescribed by associated Fibro & Fatigue centers. My symptoms became so much worst that it was scary (probably due to the high doses of vitamin D included in the treatment). I became so weak that I could not walk 50 feet without my legs giving out from under me. I was definitely headed for a wheel chair to vegetate in pain.
      In desperation, I tried fibro and fatigue center recommended Burrascano protocol for a year. Essentially, this protocol involves throwing every powerful antibiotic in triple combinations at this disease for at least a year with the hope that if it does not kill the patient, it might cure the disease. It helped for a while, but within weeks of stopping the protocol, I fell into relapse.
      My last attempt was the Marshall Protocol. I am now completing phase two and going on to the third and last phase). I made the mistake of dropping out of the protocol for several months when I had shoulder surgery. I felt fine for awhile, but the symptoms started coming back. I was unable to go back to phase three protocol (too much herx at that level) and I have had to work my way back from phase 2 again. I am not fully cured yet, but I have improved hundreds of percent from where I was. I can walk long distance again. The proof is in the pudding. I have tried pushing the protocol to get done faster, but killing off the bacteria too fast creates a great deal of herx pain. It is best to take it easy at a tolerable pain level. The Marshall Protocol staff (at marshallprotocol.com) are a great help in getting through the treatment and answering your questions. The protocol takes 1-3 years, it is painful with lots of herx pain from killing off bacteria, but worth the journey. From my personal experience, this protocol works like no other – and I have tried many of them. I hope that my experience helps someone out there….
      Best to you in healing

  3. renata says:

    I am Renata from the Czech Republic.My friend was diagnosed with sarcoidosis two years ago and has been on Prednison since. It seemed to work at first but now all symptoms have returned after being on very low doses. Since she doesn’t speak English I am trying to google all info and I found MP quite interesting with testimonies of people who are claiming to get better. She is desperate.Standard treatment has failed and she is now trying to convince her doctor to start MP. You seemed skeptical.Is there anything better worth trying? This is the first site with negative comments. Do you know about reliable source that would comment on MP? I am not educated in the area so I would like to make up my mind….Thanks a lot. Renata

  4. brawa says:

    I have yet to see any criticism of the marshall protocol that doesnt rely on all the glorifying vitamin-d studies. The way I see it, studies show a certain consensus regarding a correlation, but its a long way from correlation to scientific proof of benefit. As a patient i see nothing but explanations for a million questions in the theory behind the MP, which in my opinion are far more plausable than any vitamin-d gloryfication, which never did me any good. I can only speak for myself, but i feel many people tend to jump to conclutions based on medical-community consensus, which is sad since this has on several occations turned out to be wrong.

    As for self-proclaimed experts stating the lack of scientific basis, i cant say i care. since the scientific basis of today’s practice, which is far from conclusive though it may seem so, it does not appear to be helping anyone in the long term.. some say the MP is dangerous, well so is disease, cortison, interferon and narrow-minded doctors and researchers. A bacterial link to autoimmune disease may not be scientificly proven but it sure does seem reasonable, and has plenty of studies stating that it MAY be. The fact that few people are looking at l-forms should not make us ignore them.

    To me its good enough to risk a cure based on assumtions, as long as I personally believe in it, the consensus will NOT make me any better. what seems to me like a good reason to belive in the MP, is the patient stories, which are far too many of the positive kind to ignore. There will always be fall-offs and they may participate in yahoo polls, but they seem to be an exeption rather than a rule. IMO:D

  5. 24cristina says:

    My Name is Cris.

    Can anyone tell me more about this therapy, I been sick for 2 years now and just now found out about this.
    I have cfs, Had eb bar, and lyme, not counting the thyroid disese.

    I need to know more about this, can someone please help me.

  6. goggy says:

    I agree about Vit D being important. To the person who posted as “Pro-MP”, have you considered that perhaps the body uses 1,25D as a tool to fight infection? That the levels are raised not because it’s causing a problem but because it’s the way the body responds to a problem?

    I was on the MP for 3 years but I was getting worse rather than better. Now that I’ve stopped I am getting proper nutrition (including taking Vitamin D) and I’m slowly getting back the health that the MP made worse.

    People advocating the MP will always say that we should ignore the current research on Vit D, but then they get annoyed when anyone ignores the MP research. They can’t pick and choose which research is legitimate according to their own agenda. When I started the MP I wanted to belive it would work, but now that I’ve been through it and am out on the other side I know that it doesn’t work.

  7. docma1 says:

    I have tried Olmesartan for about two and half years. I believe the drug mainly works by reducing the over activity of sympathetic system. I found for me it was impossible to take 40 mgs four times daily, there were cramps in the muscles, retrosternal pain, gastric acidity and asthma. initially I continued with full dose but then gradually I reduced it to 40mgs twice daily which I managed to take for two years. when I tried to taper it off I found my symptoms that were caused by overactive sympathetic system will get worse. I take 40mgs once a day to keep my sympathetic system under check and therefore reduced symptoms. basically this drug does not work in CFS

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