by Gabriel Ariciu, DC

Approximately 80% of bacterial infections are associated with biofilms. (1) That is a seriously high percentage. Up until recently we viewed microbes as planktonic or passively floating, but this is clearly not the case. We are now looking at the majority of infections as being associated with biofilms. This has been quite illuminating on the subject.

When we hear infections we usually think of the common cold, the flu, strep throat, or even pink eye. These are common ailments that many deal with but we often overlook the persistent ones. These are often subclinical meaning they do not have many symptoms or the symptoms are vague pointing to anything and everything. Sometimes the infection lies dormant waiting for an opportune time to strike. These are hidden dangers lurking in the dark.  

We have written quite a bit about Lyme disease lately and this is closely tied to Lyme but also many other diseases as the above percentage indicates. Part of the reason Lyme is difficult to treat is due to biofilms. But even the ones I mentioned above have been shown to be difficult to treat. According to one study, strep throat or bacterial pharyngitis fails to respond to antibiotic therapy in 33% of cases. During this study, they tested for the formation of biofilms and all 99 isolates tested for biofilm formation. More studies need to be done but this is a striking one. (2) Biofilms are hard to diagnose but with 80% of infections being associated with them it is best to assume that all cases have biofilms.

What is a biofilm?

A biofilm is a community of microbes that adhere to a surface in an enclosed structure or matrix. The matrix is composed extracellular polymeric substances, minerals, blood components, DNA, and other particles. Biofilms can attach to many different surfaces including our teeth, yes our dental plaque is a biofilm. (3)

These communities or colonies provide a home not only to one bacteria, it can include other bacteria, viruses, protozoa, parasites, and fungi. Take for instance a Borrelia biofilm. It can include Anaplamsa, Babesia, Bartonella, and Ehrlichia. The structures are an ideal environment for survival. A variety of nutrients can be obtained and the exchange of DNA. The outer shell helps the microbes evade the immune system passing undetected and preventing eradication. They also hamper the ability of antibiotic therapy.

Take the case of chronic rhinosinusitis. It is a common disease affecting about 14% of the population in the US. It was shown that biofilms decrease the efficacy of antibiotics by creating a hypoxic environment, altering the pH, and lowering the metabolic activity of the bacteria. Essentially creating a place for bacteria to hibernate. (4) This is similar to spore creation. In life threatening situations fungi and certain bacteria can create spores to protect themselves from annihilation. The spores can withstand much more and prevail the inhospitable time until a more ideal environment is had. Like the bear hibernating its way through winter.

This is the reason so many patients after antibiotic therapy have a rebound episode or a flare up where the symptoms return and sometimes with a vengeance. Without the proper tools it can be like paddling upstream against a strong current.

A common infection to show up in many is Candida albicans. It is associated with yeast infections and thrush but it can also be systemic. Candida is a fungus that is normal to our gastrointestinal tract. But it can get out of had depending on diet, antibiotic use, and a variety of other ways. We find Candida and other fungal infections to be very common in our patients and Candida is known to create biofilms.

Another example, in my Lyme article I talked about why Borrelia burgdorferi is so hard to treat. It not only creates biofilms, but it can evade the immune system by hiding in the tissues outside of the blood and it can inhibit the immune system. It can also present in multiple forms such as a spirochete, L form, spheroblast, and cyst. (5)

This video showcases the variety of ways Borrelia can evade the immune system and persist it includes some information on biofilms and is rather instructive.

The above video is a computer generated illustration, below is a video of what a biofilm looks like in a lab setting. The scientists were able to see and study the bacteria forming biofilms.  

But like I said this is seen in all chronic infections and not just from Borrelia and chronic rhinosinusitis. Biofilms have been linked to Lupus, Crohn’s, ulcerative colitis, and IBD. (6) It is interesting that they are linked to those diseases because they are autoimmune diseases. Autoimmune diseases don’t happen for no reason. Something triggered the immune system to start targeting the body. The culprit is often an infection or a multiple of infections. Patients with chronic infections often have multiple infections at the same time. When the culprit is identified and eliminated often the autoimmune disease goes into remission. Of course, infections are not the only cause.

What can be done?

Medications are being created to try to eradicate biofilms. Some use a variety of antibiotic therapies. But that is if they are treating biofilm, often times it is overlooked. Take the case for Lyme disease again or any case for that matter. The antibiotics are given. The symptoms resolve and the patient is tested. The test comes back negative. But after some time passes the infection returns. So it is either a new case or the previous case was not resolved as once thought. The latter is usually the case with Lyme.

One thing that must be done is to prevent reexposure to the infectious agent. Whether it is mold in the house or a tick-borne illness, precaution must be take to prevent further problems. For the longest time I continued to have terrible sinus infections. They were frequent and debilitating. I was down for the count for several days at a time. They always tested for a mold infection. The issue was where we lived, once we moved and after an herbal regimen the problem resolved. So check your environment.

Another important aspect is to get checked for heavy metal toxicity. Among the other things I mentioned above heavy metals can also accumulate there. Heavy metals can cause a host of neurological problems and other issues. So it is best to get evaluated for them in addition to everything else I will talk about.

Our focus must be multifaceted to not only target the biofilm, but the microbes present, heavy metals as mentioned, vitamin and mineral deficiency, diet, etc. Bolstering the patient’s immune system and supporting the body is crucial to minimizing Herxheimer reactions and to make lasting change. A Herxheimer reaction or die-off happens when bacteria and other microbes are being destroyed, there is a release of toxins and other substances that increase the inflammatory response in the body. Inflammatory cytokines such as interleukin-6 and tumor necrosis factor alpha are released causing an increase of inflammation and with it an increase in symptoms. It is often said to patients that it will get worse before it gets better. The idea that the night gets darkest before dawn. In the case of Lyme disease, patients may have an increase of pain, brain fog, fatigue, short memory loss, etc. So our goal is to minimize this reaction or prevent it altogether.

We do this through a variety of means. One is to make sure we are checking the patient for every possible irritant whether it is a microbe, a food, a heavy metal, or another toxin. We want to leave no stone unturned. If a food or toxin that is within the patient’s control shows up, we have them remove it. Such as eating organic or removing gluten from the diet. This will decrease the overall inflammatory response and help the support the patient’s healing process. We also give some general guidelines for diet as well. We may see the need to support through certain vitamins and minerals such as Vitamin B9.

Another way is utilizing a variety of detoxification herbs. We commonly use several different herbs and what we give depends on the patient. Smilax officinalis is a common one we give to our patients. It is anti-inflammatory and hepatoprotective. It can protect against the toxins microbes release by binding them. It is also a broad spectrum antimicrobial and can support those with autoimmunity. (7) So herbs like these can protect against the endotoxins, mycotoxins, and other inflammatory substances biofilms and microbes release when biofilms are broken apart.

Finally, we commonly use a couple of essential oil blends to break apart biofilms. These products were formulated by Dr. Michael Lebowitz and they are quite effective. Some of the essential oils used are Piper nigrum, Rosmarinus officinalis, and Boswellia carterii. (8) In addition, to these we use a variety of other herbs that have antimicrobial properties. Like other herbs, essential oils are strong and are not recommended for cursory use. We recommend getting thoroughly evaluated by a skilled holistic practitioner.

A multifaceted approach must be used for a patient’s symptoms to resolve. Biofilms need to be addressed, but let me talk about one caveat. We are meant to live in harmony with the world around us that includes the so-called “germs” we live with. We have trillions of bacteria and other microbes in each of us. We have a symbiotic relationship. So eradication of all biofilms is not likely neither is it desirable. The goal is to eradicate pathogens and get the body back to a balanced relationship. We receive many nutrients and protection from our friends that live in us. This is why caution should be used with an antimicrobial substance such as hand sanitizers, soap, and antibiotics.

Well I hope this was informative and may have answered some of your questions. Biofilms are a major cause for why we see so many with chronic infections. Making up to 80% of all bacterial infections, biofilms need to be at the forefront of our mind when we are dealing with these infections. Even the acute ones, if we are not careful can quickly form a biofilm before they are eradicated entirely.