Clearing Up Confusion on Vitamin D -- Why I Don’t Recommend the Marshall Protocol

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Clearing Up Confusion on Vitamin D -- Why I Don’t Recommend the Marshall

Protocol

 

by Dr. Mercola 

Ever since I started promoting the benefits of vitamin D there has been a small

but vocal minority of advocates of what is referred to as the “Marshall

Protocolâ€.   

As much as I would like to ignore it due to its lack of validity, I can no

longer do so, because so many people are using this information and at the very

least, they are placing their health at great risk and in many cases they are

damaging their health. 

Therefore, to remain silent would be irresponsible, so I am going to address

this issue once and then put it to rest. 

I felt it was important to share my views on what I perceive is a dangerous view

of vitamin D physiology.  It has been my common strategy for as long as I have

been in medicine to be open to new ideas and concepts and I have carefully

evaluated Dr. Marshall’s protocol and even attended one of his lectures in

Chicago nearly ten years ago.   

It was somewhat comical to attend his seminar as most of the people attending

were wearing very large, wrap around UVB blocking glasses typically worn after

cataract surgery.  I knew at that point that the operating premise was

seriously flawed. The belief that ANY exposure to the sun was dangerous and

needed to be avoided gravely concerned me. 

“Dr.†Marshall is Not a Physician and Doesn’t Even Have a Biology Degree 

For those of you who are not familiar with the protocol recommended by Trevor

Marshall, I will briefly summarize its basic tenets, as I understand them,

before going on. 

First it is important to note that Dr. Marshall is not a medical doctor but

freely uses the doctor salutation to add credibility to his questionable

theories. 

Marshall is an Australian electrical engineer who developed an interest in

biomedical engineering out of a desire to cure his own sarcoidosis, which he

developed in the 1970s. He has no medical degree. His theories come from

mathematical molecular models, not clinical studies.  

Sarcoidosis is Only Disease Where Vitamin D Levels Are an Engima 

Sarcoidosis is an inflammatory condition that produces tiny lumps of cells

called granulomas in various organs of the body. These granulomas clump

together into large or small groups, resulting in organ damage. They most

commonly occur in the lungs, lymph nodes, skin and eyes, and symptoms can wax

and wane over many years.  

Symptoms can vary from very minimal to life threatening. Some medical experts

believe sarcoidosis is an autoimmune process, and others believe some substance

or pathogen has triggered the inflammation. There is no agreement yet about the

cause of this illness. 

Marshall states the treatment he developed has cured his disease and claims that

his protocol, the Marshall Protocol (aka MP) will cure a long list of chronic

inflammatory and autoimmune diseases. According to one of his most vocal

advocates, Amy Proal[ii], the MP cures sarcoidosis, Chronic Fatigue Syndrome

(CFS), fibromyalgia, Crohn’s disease, and rheumatoid arthritis (RA), and many

others.  

Marshall proposes the following: 

All chronic diseases are the result of infection by certain bacteria that hide

out and proliferate inside the cytoplasm of the cells they infect. These cells

include macrophages, the very cells of the immune system the body uses to kill

invading pathogens. Once inside these cells, they generate the release of

inflammatory cytokines, which cause the person pain and/or fatigue.

The infected cells sustain themselves by congregating into communities called

biofilms, which produce a protective matrix that allows them to more effectively

evade the immune system and resist antibiotics.

The reason these bacteria are able to proliferate in this way is directly

related to vitamin D. Marshall argues that vitamin D is immunosuppressive—it

effectively shuts down your body’s immune system. Therefore, he states, the

lower your vitamin D is, the better, because vitamin D from any source (food,

supplements, or sunlight) in any amount drives the disease process.

The low vitamin D levels [meaning serum 25(OH)D] found in many people with

chronic diseases are a result of the disease, rather than the cause. Marshall

explains this by saying that the disease process causes 1,25-D to rise to an

unnaturally high level. This in turn causes a cascade of reactions leading to a

drop in 25(OH)D, leading to the low blood levels we observe in blood tests.

Given these premises, his treatment plan consists of the following:

Avoid sunlight and vitamin D as if they were the plague. He restricts people

from eating foods high in vitamin D, as well as having them hole-up inside for

months on end. If they go outside, they cover up completely, including wearing

special sunglasses.

Patients take a medication called Benicar (olmesartan), which is an angiotensin

II receptor blocker (ARB). This is supposed to reactivate the immune system by

opening up the VDRs (vitamin D receptors), allowing the body to once again

manage the infections.

Patients concurrently take pulsed, low-dose antibiotics to further combat the

infection.

The protocol is continued for 3-5 years. Before patients begin to feel better,

they can expect to feel much worse due to the “Herx†reaction

(Jarisch-Herxheimer reaction). Herx is the effect of bacterial dye-off,

releasing toxins into the bloodstream, stimulating the production of

inflammatory cytokines, which make the patient feel bad.

So, Marshall believes, if you don’t feel bad, it’s not working.

Why One Size Doesn’t Fit All 

Probably because Marshall is an engineer and not a physician, his approach

reveals a lack of appreciation of the complexity and variation of the human

system. Your body is not a piece of electronics that can be predicted to act a

certain way every time. A radio is a radio is a radio, but not so with the human

body. It is more than a sum of its parts, making medical science as much an art

as it is a science. 

This is precisely why clinical trials are necessary before conclusions about

causation can be drawn. There are simply too many variables. 

What Marshall has done is take conclusions from his research for a cure for his

own condition (sarcoidosis), and then applying it to everything from soapsuds to

unicorns. The error in logic would not be so disturbing were it not for the fact

that he is doing a lot of harm to people who desperately seek help for their

pain.

We Evolved in the Sun 

First, let me address the most basic premise here—that vitamin D and sunshine

promote disease. Besides being contrary to current research, this goes against

our evolutionary history.  

We evolved in the sun. We’ve spent thousands of years hunting and gathering

outdoors, particularly in equatorial regions, and most of that time we certainly

wore far less clothing than we wear today. It makes no sense that we would have

developed the need to avoid sunlight altogether. 

Nature has designed a system in which humans go into the sun, make thousands of

units of cholecalciferol, which the liver then converts to 25(OH)D. Our organs

then make a steroid hormone, 1,25-D, which helps to regulate genes in every

organ of the body[iii].  

As Dr. Cannell, Executive Director of the Vitamin D Council, says, “We

assume nature created this for a good reason.â€

Inflammation Requires Holistic Approach 

I can agree with Marshall on the idea that inflammation is a major underlying

factor in many chronic diseases. However, ,inflammation must be addressed with a

holistic approach that includes diet and nutritional type, exercise, sleep,

stress, psychological factors, environmental toxins, and many other things. None

of these is mentioned, that I can find, in the Marshall Protocol. 

And it is my firm belief that medication should rarely if ever be the first

avenue of treatment for anything. Most healing can be achieved by supporting

your body’s own ability to heal itself by strengthening your immune system.

The Antibiotic Issue 

Taking antibiotics for years, as directed by the MP, is just ludicrous and is an

invitation for disaster.  

There are certainly times when antibiotics are necessary, but they are widely

overused. For every time they are used appropriately in traditional medicine,

there are at least 10 to 20 times when they are inappropriately used, and this

is what has resulted in antibiotic-resistant bacteria. 

Marshall claims that, by “pulsing†several different antibiotics, antibiotic

resistance is avoided. However, there is evidence to the contrary in the

literature.  

A researcher at MIT by the name of Mark London has written a very detailed,

comprehensive analysis of the MP[iv]. He states that overuse of macrolides

(Zithromax, clindomycin, and others) is known to result in resistant bacteria,

and the risk is even higher when macrolides are combined. There is also

cross-resistance between macrolides. Therefore, Marshall’s claim that his

protocol prevents antibiotic resistance is false. 

In the past I have used antibiotics for rheumatoid arthritis when I was applying

Dr. Brown’s protocol.  Even though Dr. Brown clearly helped many

thousands of patients with this, after using it for many years I realized that

even better results could be achieved without the use of antibiotics. 

If infectious agents do underlie disease, which is certainly possible but

remains to be proven, antibiotics are not the answer. There are many natural

choices for anti-infectives that are much safer and have fewer side effects than

antibiotics.  

For example, for thousands of years, Chinese medicine has been curing infections

with herbs, mushrooms, bark, and other natural agents.  

If you have an infection, your best strategy is to get your immune system into

shape by addressing the things I mentioned above, none of which are addressed by

the Marshall Protocol.

“Herx†Reactions, or Something More Ominous? 

Jarisch-Herxheimer reactions are a major part of what patients are told to

expect once they begin the MP.  

The MP teaches that, in order to know that you have one of these infections, you

go onto the MP, and if you have a Herx reaction (which they basically define as

feeling bad in any number of ways), you can conclude you’re on the right path.

By the same token, they say, if you don’t “Herx,†then you don’t have an

infection.  

However, Herx reactions are known to occur only with certain types of infections

such as Lyme and syphilis. They normally occur only early in treatment and

typically last a few days or weeks, not months or years, and only in some

people—not in all people3[v][vi]. 

Therefore, any test that is based on whether or not a Herx reaction occurs is

meaningless, since the lack of a reaction doesn’t rule out the presence of an

infection. Similarly, an increase in your symptoms doesn’t necessarily mean

you’re having a Herx reaction.  

So-called Herx reactions can be explained by well-documented medication side

effects. For example, Minocycline has been known to cause dizziness and nausea

in some people. Benicar has many documented side effects at much smaller doses

than what the MP calls for, including headaches, chest pain, muscle pain, and

coughing.  

How do you know that your “Herxing†isn’t just a reaction to the

Benicar? 

Also, the MP can cause an elevated PTH level (Parathyroid Hormone), which in

itself can cause symptoms of fatigue, poor concentration, irritability,

depression, insomnia, headaches, and palpitations[vii].  

To say that everyone who has any increase in symptoms while on the MP is just

having a “Herx reaction†is simply ignorant and foolhardy, as well as

negligent as it causes the patient to ignore potentially dangerous signals that

something else could be wrong! 

This is just what happened to a man by the name of Steve Carroll. Mr. Carroll

is  someone who tried the MP and nearly died of ’s disease, as a

direct result of the Marshall Protocol.  His symptoms were of a growing adrenal

crisis. However, the MP advisors told him that he was simply “herxing.â€Â 

When he consulted his own physician, who took him off the protocol and saved his

life, Mr. Carroll contacted the MP “forum†advisors[viii]. He was met with

nothing but resistance and denial, and told that his own physician was wrong.

The Marshall forum advisors refused to even consider the possibility they might

be wrong, and that using Benicar with people who have weak adrenal function

(namely low cortisol and aldosterone production) is very dangerous and can lead

to an adrenal crisis. 

A documentation of the dialog between Mr. Carroll and the MP folks is quite

telling and has been posted verbatim online[ix]. 

As Mr. London writes: 

“Giving a medicine to see if a person will get better from it, and then

continuing that medicine due to the fact that a positive benefit occurred, is of

course extremely common.  However, giving a medicine specifically to see if a

person will get worse from it, and then continuing that medicine because this

occurred, is quite rare.   

While it’s true that many medicines will first cause side effects before the

positive benefits occur from it, these side effects are almost never considered

to be a sign that the medicine is the proper medicine to use to treat a

person.â€

Measuring 1,25-D is Like Herding Cats 

Marshall states that 1,25-D levels are elevated in people with chronic

infectious diseases. [Remember, 1,25-D is the active form of vitamin D, once

it’s been converted from 25(OH)D.]  

He relies on 1,25-D levels as indicators of the disease process. However, 1,25-D

values can fluctuate tremendously up and down for many reasons, other than

disease processes. 1,25-D is influenced by calcium, phosphate, and PTH, just to

name a few, which makes it meaningless to use it as a marker for dysfunctional

vitamin D production or regulation.  

In fact, some studies show little to no correlation between 1,25-D and 25(OH)D

levels[x][xi]. Many body tissues have the ability to generate 1,25-D themselves,

as a way to self-regulate, rather than solely relying on serum 25(OH)D. 

This is why the standard used by the medical community for assessing health is

serum 25(OH)D, which is not subject to these variables and fluctuations.. This

test has been standardized, recognized and used by every vitamin D expert in the

world.  I have talked to many of the leading vitamin D researchers and not one

of them had anything favorable to say about the misinformation Marshall is

promoting.

What about the Cancer Studies Cited by MP Advocates? 

On her website called Bacteriality, Amy Proal mentions a number of cancer

studies that reportedly demonstrate that vitamin D does not decrease cancer

risk. Upon close inspection, however, several of those studies involve people

supplementing with very low doses of vitamin D, lower than what is considered

effective by most vitamin D experts. The supplementation levels are 600-800 IU

per day, which is too little to prevent much of anything. 

Dr. Cannell, one of the foremost experts on vitamin D today, scripted a

response to the MP, which he sent out in his newsletter[xii].  He makes the

point: 

If Marshall’s hypothesis is correct, that low vitamin D levels are the result

of disease, then he is saying that cancer causes low vitamin D levels, not the

other way around. The problem is that Professor Joanne Lappe directly disproved

that theory in a randomized controlled trial[xiii] when she found that baseline

vitamin D levels were strong and independent predictors of who would get cancer

in the future.  

The lower your levels, the higher your risk. Furthermore, increasing baseline

levels from 31 to 38 ng/ml reduced incident cancers by more than 60% over a

four-year period. Therefore, advising patients to become vitamin D deficient as

the MP clearly does, could cause some patients to die from cancer. 

It is worth noting that the amount of vitamin D subjects in the Lappe study

received was 1,100 IU per day, higher than any of studies cited as negative

toward vitamin D, and this study was of longer duration.

Can Any Value Be Found in Marshall’s Work? 

Marshall arrived at most of his theories from his personal battle with

sarcoidosis, and he certainly can’t be faulted for taking an aggressive

approach to finding a solution for what is traditionally viewed as an incurable

disease. After all, many serendipitous discoveries in history came about in

unusual ways.  

I strongly believe his efforts have gone astray, however, in assuming all those

other chronic diseases fit the same model.  

Sarcoidosis is a condition marked by abnormal immune responses, one of the many

unique features of that condition. For example, according to Dr. Cannell, in

sarcoidosis, the body can’t regulate activated vitamin D production, resulting

in hypercalcemia12. But these immune responses are not found in all of the other

inflammatory conditions, so any treatment effective against sarcoidosis is thus

treating a rather unique condition and may not necessarily be as effective for

other conditions.  

If the MP does indeed help some people with sarcoidosis and various other

conditions as it seems to, based on some people’s reported experiences on the

web, there is no guarantee it is working in the way Marshall assumes it is. 

For example, Benicar and the various antibiotics all have various effects, both

positive and negative, on various conditions, which could be one explanation for

why some folks feel better. Benicar has been shown to have some

anti-inflammatory properties, among others. Some antibiotics have

anti-inflammatory and analgesic effects themselves (minocycline, for

example).  

It could be this effect that makes patients feel as if they are getting better.

If so, patients might experience a recurrence of symptoms once the meds are

discontinued. 

What About Melatonin?  

Since light suppresses melatonin, it would be expected that melatonin levels

would rise when you avoid light. Melatonin has significant effects on your

immune system. In fact, in 2006, a study showed that melatonin was a safe and

effective treatment for sarcoidosis![xiv] Melatonin has also been shown to help

other conditions, including CFS, fibromyalgia and colitis.  

How does anyone know it isn’t the melatonin that is causing some people to

feel better? If so, there are much better ways to increase your melatonin level

than by sacrificing sunlight and valuable vitamin D! 

The point is, there are many other factors that could explain why the MP could

seem to help sufferers of sarcoidosis, besides the one he claims. To really

determine what is causing what, a series of controlled studies would have to be

done. He has drawn a lot of conclusions without the clinical studies to separate

out the variables.  

I believe that Marshall is placing people’s health at risk by having them

participate in a clinical trial via the Internet--and a badly designed one at

that—with inadequate details and precautions about what the health

consequences might be.  

My Recommendation  

Stick to what you know works, and if there is merit to any of Marshall’s

theories, studies will bear that out in time.  It would seem that the only

indication for MP would be sarcoidosis. I believe it would be unwise to use it

for other conditions, but even for sarcoidosis there are a number of effective

non-drug approaches to address it. 

I would have to agree with Dr. Cannell that you would be hard-pressed to find

any reputable person in the vitamin D field who takes Marshall’s theories

seriously. They are poorly substantiated and lack corroborating evidence.  

Go with what you know. Health comes from getting back to the basics…nutrition,

exercise, restorative sleep--and yes, appropriate exposure to sufficient

sunshine to normalize your vitamin D levels. 

Wikipedia, http://en.wikipedia.org/wiki/Trevor_Marshall

[ii] Amy Proal’s website, Bacteriality: Exploring Chronic Disease

http://bacteriality.com/about-the-mp/ (accessed February 11, 2009)

[iii] Cannell JJ, “Vitamin D and mental illness,†the Vitamin D Council

website, http://www.vitamindcouncil.org/mentalIllness.shtml (Accessed February

12, 2009)

[iv] London M, Is the treatment for sarcoidosis helpful for other chronic

diseases? MP’s theories are not supported by lab studies. July 2, 2008

http://stuff.mit.edu/people/london/universe.htm (accessed February 11, 2009)

[v] Herrell D, “What is a Herxheimer reaction?â€

http://www.angelfire.com/biz/romarkaraoke/Herx.html (Accessed February 12, 2009)

[vi] Silver Colloids, “The Herxheimer reaction—feeling worse before feeling

better†http://www.silver-colloids.com/Pubs/herxheimer.html (Accessed February

12, 2009)

[vii] http://www.parathyroid.com/parathyroid-symptoms.htm

[viii] Marshall Protocol Study Site, http://www.marshallprotocol.com/

[ix] http://www.lassesen.com/cfids/advised_reading.htm

[x] Breslau NA, Preminger GM, BV, Otey J, Pak CY. “Use of ketoconazole

to probe the pathogenetic importance of 1,25-dihydroxyvitamin D in absorptive

hypercalciuria,†J Clin Endocrinol Metab. 1992 Dec;75(6):1446-52 PubMed

http://www.ncbi.nlm.nih.gov/pubmed/1464646?dopt=Abstract (Accessed February 11,

2009)

[xi] Abreu MT, Kantorovich V, Vasiliauskas EA, Gruntmanis U, Matuk R, Daigle K,

Chen S, Zehnder D, Lin YC, Yang H, Hewison M, JS. “Measurement of

vitamin D levels in inflammatory bowel disease patients reveals a subset of

Crohn’s patients with elevated 1,25-D and low bone mineral density,â€

Gut.2004 Aug;53(8):1129-36 PubMed http://www.ncbi.nlm.nih.gov/pubmed/15247180

(Accessed February 11, 2009)

[xii] Cannell J, April 2008 newsletter. “Cholecalciferol is cholecalciferolâ€

http://www.vitamindcouncil.org/newsletter/2008-april.shtml

[xiii] Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP.

“Vitamin and calcium supplementation reduces cancer risk: results of a

randomized trial.†Am J Clin Nutr 2007 Jun;85(6):1586-91. PubMed

http://www.ncbi.nlm.nih.gov/pubmed/17556697?ordinalpos=1 & itool=EntrezSystem2.PEn\

trez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum (Accessed February 11, 2009)

[xiv] Pignone AM, Rosso AD,, Fiori G, Matucci-Cerinic M, Becucci A, Tempestini

A, Livi R, Generini S, Gramigna L, Benvenuti C, Carossino AM, Conforti ML,

Perfetto F. “Melatonin is a safe and effective treatment for chronic pulmonary

and extrapulmonary sarcoidosis,†J Pineal Res. 2006 Sep;41(2):95-100 PubMed

http://www.ncbi.nlm.nih.gov/pubmed/16879313?dopt=AbstractPlus (Accessed February

11, 2009)

 

Love, Gabby. :0)

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