Marshall Protocol

Dr Gary Deed interviewed by Judy Williams

Judy writes: Recently I spent some time with Dr Gary Deed - a general practitioner in Brisbane who specialises in nutritional and environmental medicine. He graduated from The University of Queensland and has completed post-graduate training in the use of medicinal herbs (Southern Cross Herbal School) plus a Fellowship through the Australasian College of Nutritional and Environmental Medicine.

He has spent a great deal of time in the education of other health professionals to improve services in the area of Integrative Medicine and works closely with diverse patient groups within Women’s Health, Fatigue Spectrum Disorder, Autistic Spectrum Disorder and Diabetes to name a few. He is a current Adjunct Lecturer at the University of New England in Nutrition. He has practiced Integrative Medicine for the past 15 years.

Dr Deed is supervising several patients on the Marshall Protocol, myself included, and I felt it was important to get some accurate information out to fellow CFS people in Australia. Being a 24 year veteran of CFS, I believe hope is the single most important element to maintain in this disease and hopefully, reading about Trevor Marshall’s new science and new medicine will deliver this……

JUDY: Thank you very much for sharing some time with me today. I know how hard it is to get a hold of you but I really appreciate your generosity, thank you very much. I wanted to catch up with you a little bit on some updates on Chronic Fatigue Syndrome. One of the reasons for this is that I recently heard about the Marshall Protocol and I wondered if you would be willing to speak with me about that?

DR GARY DEED: Yes, Judy. This is part of the holistic management of persons with Chronic Fatigue Syndrome in the fact that, in the unifying theory which we might talk about shortly, certain infectious agents may need to be addressed, including bacterial infections and certain viral infections. The Marshall Protocol fits very solidly into that holistic management programme; it’s a very sensible and structured way of addressing chronic infections of the type that we currently know about supported by research into Chronic Fatigue, Sarcoidosis and maybe some other emerging conditions. So it allows us a well structured (as I explained) logical approach that minimises a patient’s risk.

JUDY: So it is interesting for you to talk about chronic infection with CFS patients because so many people haven’t come to understand that yet.

DR GARY DEED: The problem with Chronic Fatigue Syndrome is that it is a spectrum disorder, and the spectrum of symptoms is what I believe epiphenomena from core problems. That is yes, you can have sleep disorders, you can have low blood pressure, you can have gut disturbance ... but these are manifestations of sometimes dysfunctional control symptoms within the human body, disordered by some more core, underlying problems including - as I will explain hopefully this afternoon - infections in certain areas of the brain and controlling areas of the hypothalamus for instance, and even chronic infections in the gut itself, which then lead the body’s immune system and other regulatory systems to respond by releasing certain chemicals which create symptoms.

The patients have all these symptoms, both the core symptoms of Chronic Fatigue Syndrome and each person’s individual symptoms across that spectrum. And the nature of the symptoms reflect the degree of infection or disorder of those systems within them. And so, do you treat the symptoms or do you treat the cause? That’s the question. I believe the Marshall Protocol is probably addressing in many patients - not in everyone, but in many patients - a core problem with infection and inflammation creating the symptoms which are the epiphenomena.

JUDY: This is so interesting. One of the questions I was going to ask you was that, in particular, I understand the Newcastle Researchers in the past defined, I think, about five sub-groups of people with CFS - but you are saying that the Marshall Protocol really covers all those sub-groups, or they are not exactly important.?

DR GARY DEED: : The sub-groups identified by the University Newcastle research and other research, basically again reflect the grouping of people with symptomatology and pathology creating those symptoms. But when you identify, for instance, the amino acid abnormalities, we might be talking about or fatty acid abnormality, they are not necessarily the cause, they are the reaction of the body to a deeper causation such as a chronic cellular infection creating the body’s responses, and of course people will respond on a basis of a genetic and individual response to that infection. So if you had an infection and I had an infection, our responses may be quite frankly different. There are obvious genetic problems with male/female – we have a different genetic heritage and differential environmental body types, so the identified sub-groups in Newcastle research identified people’s responses to, I believe, deeper issues such as this possible chronic infections and inflammation.

JUDY: Could the Marshall Protocol be used for severely disabled CFS people or CFS people with liver dysfunction? Iis it suitable for everybody?

DR GARY DEED: We are talking about Trevor Marshall who investigated the presence of organisms such as sarcoidosis and found good response using a very structured protocol to prevent overt negative reactions to treatment of micro-organisms he felt were responsible. Sso one of the problems with this treatment, if it is not done in a structured way, people can have reactions against use of antibiotics. We all realise agents such as these chemical agents can cause problems in the human body, problems with the gut and what we call a Herxheimer reaction where certain organisms killed can create an immune inflammatory response which can be quite damaging and can be fatal in some people. So Trevor Marshall developed the Marshall Protocol to allow people to minimise their reactions to this therapy, therefore it can be applicable to even the severely disabled people because it is allowing some level of biological or body level protection. But it can also be used for people that are less disabled,. It’s not limited to any particular sub group.

JUDY: Can you just briefly tell me Trevor Marshall’s background?

DR GARY DEED: I can’t speak for Trevor personally. He is certainly a scientific researcher who did a lot of work, Australian born, Australian trained, went to the United States and has done a lot of research into sarcoidosis amongst other things and biochemical reactions to infections. So from his combined knowledge and probably a little bit of intuition and a good bit of lateral scientific thinking, he has developed this protocol - which he has firm faith that works and clinicians around the world as well. I think it wouldn’t have taken off if there wasn’t some basis to what he was saying. Certainly there aren’t randomized control trials on this therapy, and one has to understand the limitations about what we are talking about in that way. However that doesn’t mean that there is some validity behind this protocol.

JUDY: You just mentioned antibiotics there, I wonder if you could just briefly describe what’s involved with the Marshall Protocol and what drugs are involved?

DR GARY DEED: The Marshall Protocol really relies upon the belief that there are infections creating illnesses such as sarcoidosis. The majority of persons with Chronic Fatigue Syndrome and the Protocol identify the organisms as being bacterial of the primitive bacteria, such as rickettsia, mycoplasma, and Chlamydia - which is consistent with other international research in some of these patients. They use certain antibiotics of a certain type which address those certain strange microorganisms. That is the easy part of the Protocol, there’s no rocket science in that. The biggest part of the Protocol was the discovery that certain ACE inhibitors - angiotensin converting enzyme inhibitors - were shown to prevent some of the negative inflammatory reactions that occur with die-off of these organisms. Die-off being when you kill an organism, the cellular contents of the cell that is damaged by those micro-organisms can release inflammatory markers which create infection, fever, confusion etc and, in fact, some of the epiphenomena of the symptoms of chronic fatigue.So the two cores are a certain antibiotic in a very graded protocol and a protective agent which is an ACE inhibitor which he was very particularly concerned about which is called Olmesartan or Benicar in its trade name. Also the Protocol involves checking certain vitamin by-products in the human body, because Vitamin D in particular has been shown to influence the severity of the reactions through many, many very complicated chemical pathways[, and it is] not just a vitamin but a hormone that has regulation of neuronal tissue and immunological tissue.

JUDY: Just two questions here. You talked about ACE inhibitors. There are so many CFS people that have low blood pressure anyway, I’m sure they would be concerned about using one of these drugs.

DR GARY DEED: I think that is a very valid question, and it is interesting in the understanding of the use of anti-hypertensives anyway, let alone ACE inhibitors and blood pressure control. It is demonstrated that these agents will lower blood pressure significantly more in people who are hypertensive already than those that are normotensive (that is they have normal blood pressure). So giving them to a person with normal blood pressure doesn’t tend to lower the blood pressure significantly independent of whether the personal has chronic fatigue or not. Clinically I have not noticed people suffering hypotensive effects [] enough that I would consider the agent to be dangerous. In fact most people tolerate it quite well at the doses recommended.

JUDY: The other question was about the Vitamin D tests, can we get those done easily?

DR GARY DEED: What we are looking at there is measuring the ratio between the naturally occurring 2, 25-hydroxy calciferol which is hydroxyl 25 Vitamin D and also the 1, 25-hydroxy which is also supplemental Vitamin D as well. So the idea is that these tests are available in Australia but not done easily. Again the Marshall Protocol has a very set protocol of measuring it and having frozen serum, and at the current time there is some dilemma with laboratory testing - especially in Queensland, here - about getting the accurate results. So one has to be very cautious interpreting those with the current problems with keeping the serum frozen as per the Trevor Marshall Protocol.

JUDY: Foods that contain Vitamin D, are they indicated in this as well?

DR GARY DEED: One would be very cautious [about] eating certain foods and you [would] probably need some education on what sort of foods are necessary to avoid, and I think that is a whole other story. Some people do consume significant amounts [of Vitamin D] and in fact sometimes, a well balanced healthy diet has a lot of Vitamin D in it. One would just be cautious because [qith] a high level of Vitamin D intake the more possible severe Herxheimer reactions can occur.

JUDY: In that case, sunlight would be implicated, and bright lights as well.

DR GARY DEED: That is certainly so, and especially in Queensland, as you know, with our beautiful weather we have here, one would be very cautious. And there are certain techniques that have been developed to help prevent inadvertent raising of Vitamin D and raising of risk.

JUDY: That would include the special Noir sunglasses that block out Infra red as well as Ultraviolet light?

DR GARY DEED: Yes.

JUDY: What about the Herxheimer reaction, is that something people with CFS can control during the therapy?

DR GARY DEED: A Herxheimer reaction can be controlled by sometimes even backing back off doses of antibiotics and ensuring the person is compliant with Olmesartan or other ACE inhibitors that they wish to try. But Olmesartan is the ideal therapy and certainly again, measuring the Vitamin D levels in a person accurately and making sure that they are doing Vitamin D reduction measures really does help. Herxheimer reaction can vary from a slight nausea to full blown aches and pains in muscles, fevers, night sleep disturbance and even cardiac rhythm problems [and] cough. Some people have died, and [] they may not have died from the antibiotic itself but actually from the Herxheimer reaction created in a person who was unsupported and didn’t follow certain protocols independent of chronic fatigue. That could happen with these antibiotics.

JUDY: Some people would be apprehensive about taking antibiotics long term. Is this a valid worry - although I do understand that it is almost homeopathic doses of antibiotics?

DR GARY DEED: I always express concern in a holistic management of a patient. Again, the Marshall Protocol is very careful to stop some of the inadvertent die-off effects of these micro-organisms. However, again, we have to worry about the gut, changes in good gut bacteria. There are two antibiotics: Minomycine and then, further on if tolerated, another recommended antibiotic. Minomycine has a risk in some people of sun sensitization anyway, so one would be very careful about maintaining the Protocol with Minomycine and care with the reduction of Vitamin D. Very rarely, some people develop raised intracranial pressure and, very rarely, some people can get scarring of the lungs. These effects are quite low in incidence worldwide, but I think people need to understand what to do and [how to] follow the Protocol carefully and minimise the risk.

JUDY: Do you have any idea how long the therapy might take?

DR GARY DEED: Certainly the therapy may take up two years.Miracles can happen but in my clinical experience it would probably take about two years.

JUDY: I understand that Trevor Marshall states that this treatment is curative. How would you define that?

DR GARY DEED: Curative in the fact that he, Trevor of course, is very interested in the micro-organisms and the inflammatory response. Remember the body is a plastic organ and inflammation in the human body can be quite damaging to organs such as the liver and the brain, nervous tissue etc, so you can cure a person of these micro-organisms and they don’t have any further trigger but the epiphenomena, the symptomatology from damage to plastic organs such as the hypothalamus which is a major regulating system, the adrenals, the liver etc, may remain and may need to be managed but the progression of the condition should not occur. The symptoms should be able to be better controlled because there is less of the initiator of the problem which is removed. So if that’s a good cure I think that’s a good thing, but we have to look holistically at managing people.

JUDY: How are people able to access a practitioner willing to treat a person using the Marshall Protocol but interestingly enough, I find the web site really has some superb features on it where it offers a lot of online support.

DR GARY DEED: I believe that is part of it, but some people can’t negotiate the web, and the information is dense. Some form of information service or advisory service I think is necessary. It’s a lot for one doctor in his surgery to do all and explain the whole outline for this therapy, and I think we are trying to develop better networks to support people well before they go on the therapy, so that they follow it properly because of the necessity to minimise risk and maximise benefit.

JUDY: Ideally people would be able to have their own general practitioner to care for them and write scripts for the antibiotics and other drugs. I see the web site actually offers some support for medical practitioners as well, so that means not one doctor has to handle all treatment.

DR GARY DEED: I agree with that, and I think more educational services for general practitioners or whoever is managing this needs to be done to make sure access to this form of therapy is maximised.

JUDY: I would just like to go back to what we talked about earlier which was Paul Cheney’s statement that I read about his theory that severely disabled CFS people actually being in heart failure. How would you link this information to Trevor Marshall’s research?

DR GARY DEED: The interesting phenomena and I think Paul Cheney is probably on the money for assessing a significant portion of people’s damage from this chronic infection that is yes it can damage the control mechanisms of blood volume for instance, control mechanisms are sympathetic, which is the nervous systems adrenaline driven control mechanism of the heart. But are they the cause of the illness? or the epiphenomena from a core problem? - of what I believe is a pro-inflammatory state. Both blood borne and certainly I believe hypothalamic. I believe the infections can in fact this very control centre inside the brain which is at the base of the brain above the pituitary gland. This area of the brain is like a Pentium chip in a Windows computer. That is, that it integrates many many different levels of information, and then either produces an hormonal output via the pituitary or it creates changes in the nervous system that then output it through the sympathetic or the parasympathetic nervous systems - which are the adrenaline and acetylcholine up-regulator and down- regulator of unconscious functions throughout the body including the adrenal, the heart, the gut etc and also blood vessels. Think of the hypothalamic area controlling sleep architecture, controlling temperature regulation, controlling blood volume, controlling many things, metabolism and controlling the major hormonal master-gland, the pituitary. Inflammatory damage to that area can lead to problems with cardiac function. This sort of compensated cardiac failure that occurs may be an epiphenomenon from a core problem of infections driven inflammation affecting master control areas – adrenal, hypothalamic areas of the body. I’m not saying that occurs in all patients, and the trouble is the damage that occurs is individual, but the majority of people seem to have similar symptoms - and I think Paul Cheney picked that up about the heart - but quite blatantly, I think it may be more than that. Managing that is important if you want to make people feel better as well as addressing the core underlying problem which may be these chronic infections.

JUDY: So to wrap up, I would have to ask you if you think we are “closer to the money” after all these years with CFS and our understanding of it?

DR GARY DEED: I really do. I think with the amount of research that has gone on for those enlightened people in this world, of intellectual understanding, I think we are very close to the money of understanding this plague can effect people with severe Chronic Fatigue Syndrome. Chronic fatigue exists but Chronic Fatigue Syndrome is quite unique. My concern is that patients now are closer to the money - but in the real world out there, there is discrimination, lack of support, both personally and emotionally, for persons suffering from CFS, but in my own heart I feel we still have a fight to go on. I think until everyone is liberated not only from this illness but also the stigma of this illness, we’ve got a fight to work on. You know, I’m here, everyone’s here and we’re ready to keep marching on. A bit of work to do yet……..

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