The Problem with Biofilms
Biofilms are protective communities for germs like Borrelia, Bartonella, and even intestinal yeast. In biofilms, germs evade the immune system and hide from herbal and prescription germ killers. Biofilms can cause:
- regimen resistance,
- antimicrobial resistance, and
- relapse once antibiotics or herbal antimicrobials are stopped.
In addition, biofilms provide an environment where persister state of Bartonella and Borrelia can hibernate. For more information about persisters see Persister Lyme & Bartonella Options.
Biofilms are not unique to yeast and tick-borne infections. They are known to occur based on scientific studies in various infections such as staph infections of the skin and in Candida yeast infections. Research shows biofilms are active in Bartonella, Borrelia and yeast.
How Lyme Disease Biofilms Work
In biofilms germs produce and cover themselves in a layer of sugar slime called mucopolysaccharides. To add structure, the germs recruit a protein found in blood called fibrinogen which they use to create a fibrin protein skeleton. Because the fibrin gives structure, the germs in biofilms can rid themselves of their outer protein coverings. This makes it harder for the immune system to react against them. In addition, the slime layer covers the germs so the immune system cannot see them. Antibiotics or antimicrobial supplements may have difficulty reaching the germs. In biofilms germs use efflux pumps to remove antibiotics creating antibiotic resistance.
Within the biofilms, the germs establish highly organized structures and functions. For instance they have tubes they use to take in nutrients. They also communicate using various chemical messengers, excrete waste through channels and perform other complex activities to promote the longevity of the community. Biofilms require calcium and magnesium and contain other minerals and heavy metals.
Biofilms grow and thrive through a number of steps. First biofilms have to stick to surfaces; this is called adherence. Then germs in biofilms talk to each other through quorum sensing making the germs and biofilm stronger. Germs in biofilms use efflux pumps that flush antibiotics out. Biofilms also grow through germ swarming motility where some bacteria develop tails to rapidly spread.
Biofilms also contain various types of bacteria, in addition to tick-borne infections or yeast. These bacteria, the fibrin-based proteins, and the mucopolysaccharide sugar slime provide the architectural structure which holds the biofilm together.
Biofilms May Block Progress
When I practiced in Seattle, I intentionally supported the reduction of biofilms
- at the end of a regimen to prevent relapse or
- when a regimen was not progressing well due to resistance usually between six to nine months.
Some physicians address Lyme disease biofilms at the very beginning or throughout the entire course of care. In my practice I did not do this. My observation was that 90 percent or more of my patients got well without specific biofilm regimens. We know based on the work of Alan MacDonald MD that biofilms exist in brain tissues of people with Lyme. However, there is no scientific evidence that they occur in every individual who has Lyme and associated diseases. Furthermore, even if they do exist in all that have borrelia infection, there is no scientific evidence that they universally block regimen progress.
One reason people can get better without specifically addressing biofilms is all antibiotics can decrease biofilm size. Research by Eva Sapi PhD shows that the antibiotics doxycycline, metronidazole, tinidazole, and amoxicillin can reduce biofilm size by various degrees. The best of these is the drug tinidazole which reduces biofilm by 50 to 55 percent. While doxycycline reduced biofilm by 40 percent, metronidazole by 30 percent and amoxicillin by 30 percent. Note she did not study the whole list of antibiotics I often used to manage Lyme disease described in A Lyme Disease Antibiotic Guide.
How to Support Biofilm Reduction
Based on my review, there are a handful of scientifically supported approaches to reduce or eliminate Lyme & Bartonella biofilms and many theoretical approaches. I call some “theoretical approaches” because specific research supporting their use has not been done in the lab or in humans.
Research-based Options
Eva Sapi PhD and her colleagues are performing groundbreaking Lyme Disease research. In 2010 and 2011 she published two articles based on petri dish experiments in her lab. The first shows that the herbs otoba bark extract and cat’s claw tinctures used together completely eliminate biofilm communities. They also eradicate nearly every germ living in them. Another study of five different antibiotics shows that prescription tinidazole decreases the size of biofilm communities by 50 to 55 percent. It also eliminates the germs living in them by over 90 percent. Based on my review of her research, I believe the best antimicrobial approach that eliminates biofilms and the germs that live in them are the herbs otoba bark extract and cat’s claw tinctures. Prescriptive tinidazole is a very close second though.
In late 2015 Dr. Sapi published another petri dish study showing that stevia extract from Nutramedix decreases biofilm size by nearly 40 percent while eliminating most Lyme germs in the biofilm. She also showed stevia can kill persister cells of Lyme. For more information about stevia see Stevia for Lyme Disease. However, my clinical experience working with stevia, prior to stopping clinical practice in 2018, suggests that in living people, stevia does not work.
More recent studies show that a Microbe + Biofilm Support Complex with
- Bilberry fruit extract, Grape seed extract, Shiitake mushroom extract, Golden Sea root, Noni fruit extract, Garlic bulb, White Willow bark, Milk Thistle seed, Raspberry fruit, Echinacea Purpurea plant extract, Echinacea Angustifolia root, Black Walnut hull, Black Walnut Walnut leaf, Lavender oil, Oregano oil, Galbanum oil, Tea Tree oil, Fumitory aerial parts extract, Gentian Lutea root
could be an effective product to support biofilm disruption. Petri dish experiments show it eliminates nearly 100 percent of biofilm. This combination works in a number of different ways. One way is by preventing germs from sticking to surfaces called adherence; another is to block quorum sensing where germs in biofilms talk to each other making the germs and biofilm stronger. Germs in biofilms use efflux pumps that flush antibiotics out. And the herbs in the Microbe + Biofilm Support Complex appears to block these pumps. Finally it limits germ swarming motility where some bacteria develop tails to rapidly spread.
The latest study shows that a Biofilm Support + Enzymes Complex made with
- lysozyme, serratiopeptidase, beta-glucanase, lipase, Protease 4.5, cellulase, hemicellulase, cranberry extract, berberine, rosemary extract, peppermint oil powder, and N-acetyl cysteine
addresses adherence, quorum sensing, germ swarming motility, and the fibrin protein matrix. This mix of enzymes, herbs, NAC and oils worked effectively to reduce Lyme biofilms in the lab.
The latest research from Ying Zhang, MD at Johns Hopkins University shows that various volatile oils can break down biofilms. His work does not indicate how these oils work. The three oils that breakdown Lyme biofilms in his lab experiments also kill persister cells. The oils are oregano, cinnamon, and clove. This research is promising. However, a few years ago there was a fad to use various types of essential oils for Borrelia. My observation is that most did not benefit from this approach. So it is possible that the petri dish findings of Ying Zhang, MD will not necessarily work in living people.
Theoretical Supports
As I noted above biofilms require magnesium and calcium, have various minerals and heavy metals, have numerous types of bacteria living in them, and contain fibrin protein structures and mucopolysaccharides substances. Theoretical regimens address these various components. Some physicians address biofilms by
- starving the germs by eliminating or limiting calcium and magnesium,
- removing minerals and heavy metals with the chelating agent EDTA,
- breaking up the protein fibrin matrix with enzymes like lumbrokinase, protease, or nattokinase,
- breaking up the sugar matrix with enzymes like serratiopeptidase, beta-glucanase, lipase, cellulase, and hemicellulase,
- using herbs like cranberry fruit extract, berberine, rosemary extract, peppermint oil, and N-acetyl cysteine which individually or collectively may alter germ swarming motility, adherence, quorum sensing, or even kill biofilm bacteria.
Regarding eliminating calcium and magnesium or limiting them, I do not support this. Biofilms exist in us, so of course they require the same minerals that we do to survive. I do not think we should starve the host (a person with Lyme) to kill the germ.
The theoretical approach I used in my practice was Lumbrokinase. It may break down the fibrin protein skeleton that holds the biofilm together. This alone is enough to break up the biofilms. Using Lumbrokinase alone I have seen great improvements in my patients with resistant Lyme and decreased episodes of relapse. An alternative to the Lumbrokinase is nattokinase, but it is a much weaker fibrin dissolving enzyme and I did not find it effective.
Biofilms Approach
When to Disrupt Biofilms
Based on my clinical experience, I found it helpful to disrupt biofilms when resistance to antibiotics or herbal antimicrobials was blocking progress. As I noted above, most antibiotics can reduce Lyme disease biofilm size, so it is possible there is no need for the targeted approaches I discuss below. More recently, I find it is key to support the reduction of Biofilms in a Bartonella regimen.
Approaches that Seem to Help
I find the ingredients in the Microbe + Biofilm Support Complex above very useful to target biofilms based on the clinical response of my patients. The Microbe + Biofilm Support Complex can be used with both herbal antibiotics and prescription antibiotics. My other favorite approach is to use otoba bark extract and cat’s claw tinctures. When using these two herbs, I would stop all prescriptive antibiotics. Dr. Sapi’s work suggest this is the most effective approach, and this is what I observed in my practice as well. Another approach is to use prescriptive tinidazole in an antibiotic approach. I like lumbrokinase, if an antibiotic approach is working fairly well, or if otoba bark extract and cat’s claw tinctures do not work, or if a person cannot tolerate the nausea or abdominal cramping that can occur with tinidazole. It is safe to add lumbrokinase to any antibiotic regimen.
One newer approach is to use ingredients in the Biofilm Support + Enzymes Complex I discussed above. I am finding this biofilm combination more effective than the ingredients in the Microbe + Biofilm Support Complex.
For information about dosing see the following separate articles I have on this site. For information about tinidazole see A Lyme Disease Antibiotic Guide. See also Otoba Bark Extract and Cat’s Claw Tinctures, and Lumbrokinase.
One word of caution, when reducing biofilms, sometimes Herxheimer die-off reactions can occur. In a die-off reaction the immune system makes more inflammatory chemicals that can temporarily make the Lyme and associated diseases symptoms worse.
Disclaimer
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