Physicians' Protocol For Using Antibiotics in Rheumatic Disease (SCLERODERMA)
By Dr. Joseph Mercola
The following is a modified version of Dr. Brown's protocol.
Rheumatoid arthritis affects about 1 percent of our population and at least two million Americans have definite or classical rheumatoid arthritis. It is a much more devastating illness than previously appreciated. Most patients with rheumatoid arthritis have a progressive disability. More than 50% of patients who were working at the start of their disease are disabled after five years of rheumatoid arthritis. The annual cost of this disease in the U.S. is estimated to be over $1 billion.
There is also an increased mortality rate. The five-year survival rate of patients with more than thirty joints involved is approximately 50%. This is similar to severe coronary artery disease or stage IV Hodgkin's disease. Thirty years ago, one researcher concluded that there was an average loss of eighteen years of life in patients who developed rheumatoid arthritis before the age of 50.
Most authorities believe that remissions rarely occur. Some experts feel that the term "remission-inducing" should not be used to describe ANY current rheumatoid arthritis treatment. A review of contemporary treatment methods shows that medical science has not been able to significantly improve the long-term outcome of this disease.
My Experience with the Dr. Brown's Protocol
I first became aware of Doctor Brown's protocol in 1989 when I saw him on 20/20 on ABC. This was shortly after the introduction of his first edition of The Road Back.The newest version is The New Arthritis Breakthrough that is written by Henry Scammel. Unfortunately, Dr. Brown died from prostate cancer shortly after the 20/20 program so I never had a chance to meet him. By the year 2000, I will have treated over 1,500 patients with rheumatic illnesses, including SLE, scleroderma, polymyositis and dermatomyositis.
My application of Dr. Brown's protocol has changed significantly since I first started implementing it. Initially, I followed Dr. Brown's work rigidly with very little modification other than shifting the tetracycline choice to Minocin. I believe I was one of the first people who recommended the shift to Minocin, which seems to have been widely adopted at this time.
In the early 90s, I started to integrate the nutritional model into the program and noticed a significant improvement in the treatment response. I cannot emphasize strongly enough the importance of this aspect of the program. It is absolutely an essential component of the revised Dr. Brown protocol. One may achieve remission without it, but the chances are much improved with its implementation. The additional benefit of the dietary changes is that they severely reduce the risk of the two to six month worsening of symptoms that Dr. Brown described in his book.
In the late 80s, the common retort from other physicians was that there was "no scientific proof" that this treatment works. Well, that is certainly not true today. If one peeks ahead at the bibliography, one will find over 200 references in the peer-reviewed medical literature that supports the application of Minocin in the use of rheumatic illnesses.
The definitive scientific support for minocycline in the treatment of rheumatoid arthritis came with the MIRA trial in the United States. This was a double blind randomized placebo controlled trial done at six university centers involving 200 patients for nearly one year. The dosage they used (100 mg twice daily) was much higher and likely less effective than what most clinicians currently use.
They also did not employ any additional antibiotics or nutritional regimens, yet 55% of the patients improved. This study finally provided the "proof" that many traditional clinicians demanded before seriously considering this treatment as an alternative regimen for rheumatoid arthritis.
Dr. Thomas Brown's effort to treat the chronic mycoplasma infections believed to cause rheumatoid arthritis is the basis for this therapy. Dr. Brown believed that most rheumatic illnesses respond to this treatment. He and others used this therapy for SLE, ankylosing spondylitis, scleroderma, dermatomyositis and polymyositis.
Dr. Osler was also a preeminent figure of his time (1849- 1919). Many regard him as the consummate physician of modern times. An excerpt from a commentary on Dr. William Osler provides a useful perspective on application of alternative medical paradigms:
Osler would be receptive to the cautious exploration of nontraditional methods of treatment, particularly in situations in which our present science has little to offer. From his reading of medical history, he would know that many pharmacologic agents were originally derived from folk medicine. He would also remember that in the 19th century physicians no less intelligent than those in our own day initially ridiculed the unconventional practices of Semmelweis and Lister.
Osler would caution us against the arrogance of believing that only our current medical practices can benefit the patient. He would realize that new scientific insights might emerge from as yet unproved beliefs. Although he would fight vigorously to protect the public against frauds and charlatans, he would encourage critical study of whatever therapeutic approaches were reliably reported to be beneficial to patients.
Revised Antibiotic-Free Approach
Although the antibiotics frequently worked and the six-month period of worsening that was part of Dr. Brown's protocol was virtually eliminated, I always felt like I had failed because I had to resort to the use of antibiotics.
This has now changed, as I have been able to implement a major change in my revision of the protocol that allows for a completely drug-free treatment of RA. The major change seems to be the use of Metabolic Typing, along with energy techniques. Since we have integrated Metabolic Typing with full use of EFT to address the stressors that seem to be universally present in RA, we have been able to cause RA to routinely go into remission without the use of antibiotics.
To say I am excited is a serious understatement.
Metabolic Typing allows each patient to get a unique diet that is right for their body. It is very easy to understand how a physician who successfully treats one patient with a particular diet would come to the conclusion that the diet that person was on was the "cure" for RA, when in fact nothing could be further from the truth. Another person with the same disease could quite possibly need an entirely different diet to receive any benefits, that is how powerful Metabolic Typing can be.
If you haven't yet read the book The Metabolic Typing Diet, I would strongly encourage you to do so as it reviews these topics extensively (it is definitely a book that belongs on the shelf of anyone with any interest in nutrition).
There are some general principles that seem to hold true for all Metabolic Types and these include:
- Eliminating sugar and grains (you can read more about this below)
- Having unprocessed, high-quality foods, organic if possible
- Eating your food as close to raw as possible
- Having omega-3 fish oil
I am overjoyed beyond belief that after 14 years of treating RA I can finally offer a drug-free, effective and rapid solution for most of those with RA with the aid of Metabolic Typing. However, it is clear that a perfect diet alone will rarely cause the RA to go into remission.
This is because RA is an autoimmune illness. It does indeed appear to be caused by an infection, as Dr. Brown speculated. But the central issue is why did the person acquire the infection in the first place? It is my experience that this infection is usually acquired when a person has a stressful event that causes a disruption in their bioelectrical circuits, which causes an impairment in their immune system. This impairment predisposes them to developing the initial infection and also contributes to their relative inability to effectively defeat the infection.
The antibiotics clearly seem to help most people fight the infection, but, as I mention above, there are better ways that address the underlying foundational cause of the illness.
I am quite convinced that energy techniques are required to resolve this energetic disruption. Prayer can certainly be one of them. However, in my experience, most have not utilized prayer in a way that rallies their body's resources to resolve the problem.
In my experience, energy psychology techniques are very helpful in this area and can be easily integrated with prayer. I happen to use EFT in my practice and you can download my free 25-page report to find out more about this technique
However, the emotional trauma that causes RA is nearly universally quite severe and is best treated by a professional. Trying to treat this trauma by yourself is somewhat similar to a general surgeon trying to perform an appendectomy on him or herself. Although it is possible, it is not generally recommended (Interesting aside: I read an article in JAMA about 10 years ago in which a surgeon in the late 1800s actually did this. Unfortunately, he died from complications.).
Dr. Partirica Carrington has actually compiled some guidelines on how you can find an EFT practitioner.
In the following sections I have included information about the antibiotic therapy for RA for anyone who is interested. However, I now recommend my drug-free approach for anyone fighting this illness.
Limiting sugar is a critical element of the treatment program. Sugar has multiple significant negative influences on a person's biochemistry. Its major mode of action is through elevation of insulin levels. However, it has a similarly severe impairment of intestinal microflora. Patients who are unable to decrease their sugar intake are far less likely improve.
One of the major benefits of implementing the dietary changes is that one does not seem to develop worsening of symptoms the first three to six months that is described in Dr. Brown's book. Most of my patients tend to not worsen once they start the antibiotics. I believe this is due to the beneficial effects that the diet has on the immune response.
Antibiotic Therapy With Minocin
There are three different tetracyclines available: simple tetracycline, doxycycline, or Minocin (minocycline). Minocin has a distinct and clear advantage over tetracycline and doxycycline in three important areas.
- Extended spectrum of activity
- Greater tissue penetrability
- Higher and more sustained serum levels
Bacterial cell membranes contain a lipid layer. One mechanism of building up a resistance to an antibiotic is to produce a thicker lipid layer. This layer makes it difficult for an antibiotic to penetrate. Minocin's chemical structure makes it the most lipid soluble of all the tetracyclines.
This difference can clearly be demonstrated when one compares the drugs in the treatment of two common clinical conditions. Minocin gives consistently superior clinical results in the treatment of chronic prostatitis. In other studies, Minocin was used to improve between 75-85% of patients whose acne had become resistant to tetracycline. Strep is also believed to be a contributing cause to many patients with rheumatoid arthritis. Minocin has shown significant activity against treatment of this organism.
There are several important factors to consider when using Minocin. Unlike the other tetracyclines, it tends not to cause yeast infections. Some infectious disease experts even believe that it even has a mild anti-yeast activity. Women can be on this medication for several years and not have any vaginal yeast infections. Nevertheless, it would be prudent to have patients on prophylactic oral Lactobacillus acidophilus and bifidus preparations. This will help to replace the normal intestinal flora that is killed with the Minocin.
Another advantage of Minocin is that it tends not to sensitize patients to the sun. This minimizes the risk of sunburn and increased risk of skin cancer. However, one must incorporate several precautions with the use of Minocin. Like other tetracyclines, food impairs its absorption. However, the absorption is much less impaired than with other tetracyclines. This is fortunate because some patients cannot tolerate
Minocin on an empty stomach. They must take it with a meal to avoid GI side effects. If they need to take it with a meal, they will still absorb 85% of the medication, whereas tetracycline is only 50% absorbed. In June of 1990, a pelletized version of Minocin became available. This improved absorption when taken with meals. This form is only available in the non-generic Lederle brand and is a more than reasonable justification to not substitute for the generic version. Clinical experience has shown that many patients will relapse when they switch from the brand name to the generic. In February 2006 Wyeth sold manufacturing rights of Minocin to Triax Pharmaceuticals (866-488-7429).
Clinically it has been documented that it is important to take Lederle brand Minocin. Most all generic minocycline is clearly not as effective. A large percentage of patients will not respond at all or not do as well with generic non-Lederle minocycline.
Traditionally it was recommended to only receive the brand name Lederle Minocin. However, there is one generic brand that is acceptable and that is the brand made by Lederle. The only difference between Lederle generic Minocin and brand name Minocin is the label and the price.
The problem is finding the Lederle brand generic. Some of my patients have been able to find it at Wal Mart. Since Wal Mart is one of the largest drug chains in the US, this should make the treatment more widely available for a reduced charge.
Many patients are on NSAID's which contribute to microulcerations of the stomach which cause chronic blood loss. It is certainly possible they can develop a peptic ulceration contributing to their blood loss. In either event, patients frequently receive iron supplements to correct their blood counts.
IT IS IMPERATIVE THAT MINOCIN NOT BE GIVEN WITH IRON. Over 85% of the dose will bind to the iron and pass through the colon unabsorbed. If iron is taken, it should be at least one hour before the minocin or two hours after. One recent uncommon complication of Minocin is a cell-mediated hypersensitivity pneumonitis.
Most patients can start on Minocin 100 mg. every Monday, Wednesday, and Friday evening. Doxycycline can be substituted for patients who cannot afford the more expensive Minocin. It is important to not give either medication daily, as this does not seem to provide as great a clinical benefit.
Tetracycline type drugs can cause a permanent yellow- grayish brown discoloration of the teeth. This can occur in the last half of pregnancy and in children up to eight years old. One should not routinely use tetracycline in children. If patients have severe disease, one can consider increasing the dose to as high as 200 mg three times a week. Aside from the cost of this approach, several problems result may result from the higher doses. Minocin can cause quite severe nausea and vertigo. Taking the dose at night does tend to decrease this problem considerably.
However, if one takes the dose at bedtime, one must tell the patient to swallow the medication with TWO glasses of water. This is to insure that the capsule doesn't get stuck in the throat. If that occurs, a severe chemical esophagitis can result which can send the patient to the emergency room.
For those physicians who elect to use tetracycline or doxycycline for cost or sensitivity reasons, several methods may help lessen the inevitable secondary yeast overgrowth. Lactobacillus acidophilus will help maintain normal bowel flora and decrease the risk of fungal overgrowth.
Aggressive avoidance of all sugars, especially those found in non-diet sodas will also decrease the substrate for the yeast's growth. Macrolide antibiotics like Biaxin or Zithromax may be used if tetracyclines are contraindicated. They would also be used in the three pills a week regimen.
The other drug used to treat rheumatoid arthritis is clindamycin. Dr. Brown's book discusses the uses of intravenous clindamycin. It is important to use the IV form of treatment if the disease is severe. Nearly all scleroderma patients should take an aggressive stance and use IV treatment. Scleroderma is a particularly dangerous form of rheumatic illness that should receive aggressive intervention.
A major problem with the IV form is the cost. The price ranges from $100 to $300 per dose if administered by a home health care agency. However, if purchased directly from Upjohn, significant savings will be appreciated.
For patients with milder illness, the oral form is preferable. If the patient has a mild rheumatic illness (the minority of cases), it is even possible to exclude this from their regimen. Initial starting doses for an adult would be a 1200 mg dose once a week.
Patients do not seem to tolerate this medication as well as Minocin. The major complaint seems to be a bitter metallic type taste, which lasts about 24 hours after the dose. Taking the dose after dinner does seem to help modify this complaint somewhat. If this is a problem, one can lower the dose and gradually increase the dose over a few weeks.
Concern about the development of C. difficile pseudomembranous enterocolitis as a result of the clindamycin is appropriate. This complication is quite rare at this dosage regimen, but it certainly can occur. It is important to warn all patients about the possibility of developing a severe uncontrollable diarrhea. Administration of the acidophilus seems to limit this complication by promoting the growth of the healthy gut flora.
If one encounters a resistant form of rheumatic illness, intravenous administration should be considered. Generally, weekly doses of 900 mg are administered until clinical improvement is observed. This generally occurs within the first ten doses. At that time, the regimen can be decreased to every two weeks with the oral form substituted on the weeks where the IV is not taken.
What To Do If Severe Patients Fail To Respond
The most frequent reason for failure to respond to the protocol is lack of adherence to the dietary guidelines. Most patients will be eating too many grains and sugars, which disturb insulin physiology. It is important that patients adhere as strictly as possible to the guidelines.A small minority, generally under 15%, of patients will fail to respond to the protocol described above despite rigid adherence to the diet.These individuals should already be on the IV Clindamycin.
It appears that the hyaluronic acid, which is a potentiating agent commonly used in the treatment of cancer may be quite useful. It seems that hyaluronic acid has very little to no direct toxicity but works in a highly synergistic fashion when administered directly in the IV bag with the Clindamycin.
Hyaluronic acid is also used in orthopedic procedures. The dose is generally from 2 to 10 cc into the IV bag. Hyaluronic acid is not inexpensive as the cost may range up to $10 per cc.One does need to exert some caution with its use as it may precipitate a significant Herxheimer flare reaction.
Patients will frequently have emotional traumas that worsen their illness. Severe emotional traumas can seriously impair the immune response to this treatment.
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