If you’ve ever gone to the dentist for a cleaning of dental plaque or noticed a ring of minerals in a glass after the water evaporates, you’ve encountered biofilms. Biofilms are a mucopolysaccharide structure where bacteria, fungus, and other organisms live in complex microbial communities.  In essence, the biofilms protect the bacteria and other organisms.

Biofilms are not inherently “bad or “good.”  The nature of bacteria is to reside in a biofilm.  While living in the biofilm, the microbes can share information, like antibiotic resistance genes.  And while they are protected by the biofilm, they can be 1000s of times harder to kill!  As a result, biofilms can also negatively impact your health. They are a common reason behind chronic infections, making recovery more difficult. Understanding how biofilms work and how to reduce biofilm formation is critical for your health.

Yet, we rarely talk about biofilms, even on functional medicine and holistic platforms. I want to break this cycle and share everything you need to know about biofilms, including tips for reducing biofilm formation naturally. Join me to learn about the fascinating world of biofilms!

 

shower interior Biofilms

What Are Biofilms?

Biofilms are a collection of microorganisms living in a structure. Free-floating microorganisms, called planktonic organisms, can attach to different surfaces.  They start producing this mucoid gel and create a colony. Various microorganisms can create biofilms, including bacteria, fungi, and protists (1, 2, 3).

You may not know this, but you encounter biofilms all the time. Biofilms can hide in your shower, in your sinuses, and even in your mouth (1). According to a study by the American Society for Microbiology, biofilms are very prevalent in showerheads in the United States and Europe (4). Using municipal tap water has a higher risk for biofilm colonization than showers using well water. Metal shower heads also have more biofilms than plastic ones.

Since biofilms are very comfortable in wet environments, they can also take up space in your mouth and accumulate on your teeth. This may increase your risk of dental issues. However, biofilms also exist everywhere there are microorganisms!  So they also affect other parts of your body, not just your oral cavity. Let’s talk about the specific issues with biofilms.

 

The Problem with Biofilms

There are two major problems with biofilms: they may contribute to infections and they may be resistant to antibiotics.

 

sick woman on couch

Biofilms and Infections

Did you know that about 80% of human infections are caused by biofilm-associated microorganisms (5)? This includes infections affecting your gut, urinary tract, genital organs, heart, lungs, teeth and oral cavity, skin, ears, and eyes.

Some researchers believe that antibiotics may trigger biofilm formation (6), although other researchers have shown that biofilm formation is just the nature of bacteria.  When biofilms get broken up by certain herbs or enzymes, the organisms residing in the biofilm are more susceptible to being killed, either by the substances or your immune system.  When this happens, some people can experience symptoms of feeling poorly, like they are coming down with a flu-like illness.. As biofilms are broken down in your body, the release of bacterial products triggers an immune reaction and symptoms.  This reaction is termed a Herxheimer-Jarisch reaction, Herx reaction or die-off reaction. (7).

Biofilms and Antibiotic Resistance

Biofilms are a protective “forcefield” to bacteria. They protect bacteria from extreme temperatures, high salinity, extreme pH, ultraviolet radiation, high blood pressure, antibiotics and even our immune systems.  (8).

Since biofilms protect bacteria from antibiotics, it means that bacteria within the biofilm colonies may become more resistant to traditional antimicrobial protocols. It’s as if the bacteria are having a party and sharing all the latest tech with each other!   This may pose a serious health risk. Antibiotics and antiseptics are supposed to reduce infection, but unless conventional medicine starts to pay attention to the presence and persistence of these biofilms, antibiotic resistance and severe infections will persist.

Unfortunately, biofilm bacteria can tolerate and survive antibiotic treatment too well because the biofilm doesn’t allow the antibiotics to pass through and do their job (9, 10). The poor efficiency of antibiotics and antibiotic resistance pose a serious challenge to the treatment of chronic infections (11). And even if some bacteria escape and are free-floating away from the biofilm, the planktonic form, if they have acquired antibiotic resistance genes from their neighbors in the biofilm, humans may be in trouble.

Now you can understand the nature of chronic wounds in the ear, nose, lung, GI tract, bladder, vagina and even in the prostate. (12). One study suggests that nearly 60% of chronic sinus infections may be linked to bacterial biofilms (13). Dental plaques are also biofilms (14). They are the most common ones that you are probably familiar with. The problem is that biofilm in your mouth can multiply, cluster, and form more microcolonies, leading to the growth of more pathogenic bacteria, causing more health issues.

 

surgery to treat biofilms

Current Methods of Treatment for Biofilms

Right now, the most common and efficient treatment for biofilm-related infections is removing the infected area, organ, or body part. After this, a new catheter, implant, or organ transplant is the next step (15).

For example, catheter-related urinary tract infections are very common due to biofilm-associated bacteria (16). The surface of a catheter is a perfect place for biofilms to form and grow, increasing the risk of infection. This makes removing the catheter necessary as part of addressing the infection. There are over one million cases of catheter-related urinary tract infections per year.

In the case of dental biofilm infection, sometimes an extraction and an implant is the next step. Unfortunately, biofilms may affect implants or crowns as well, which may cause further oral health issues (17, 18). Diabetic foot ulcers and decubitus ulcers can now understood to be polymicrobial biofilm colonies and need to be treated as such.   When an entire organ is affected, it becomes even more serious, requiring an organ transplant. Organ transplants are, of course, very serious and risky, and there is never a guarantee of being able to get a new organ (15).  This is obviously an extreme case.

This sounds very drastic and it is, unless we know better methods to break up biofilms.  Conventional medicine focuses on suppressing or preventing infections is generally done through either an early aggressive antibiotic protocol in an attempt to circumvent the formation of the biofilm, or a long-term suppressive antibiotic regimen once the biofilm is formed.

However, as you know, biofilm bacteria can become tolerant to antimicrobial agents compromising recovery (15). Regular antibiotics, antimicrobials, and antifungals may not be able to kill a biofilm-coated bacterial or fungal infection. Thus, biofilms can contribute to persistent bacterial infection despite endless antibiotic protocols. High levels of proinflammatory cytokines, along with antibiotic-resistant bacterial infections, may be a sign of biofilms. There may be a variety of underlying issues behind chronic inflammation and chronic infections, so it’s important to work closely with a doctor to make sure biofilms are in fact the root cause of the issue.

 

Diagnosing Biofilms

Detecting and diagnosing biofilms can be a challenge. Strategies may differ between localized biofilm infections and free-floating planktonic infections. Let’s consider someone with urinary frequency and symptoms of a urinary tract infection.  A urine culture is a 40-year-old technology, and it only is able to identify high amounts of planktonic bacteria.  If there aren’t enough free-floating bacteria in the specimen, the culture will come back negative, even if the bladder is teeming with biofilms!  One way to identify biofilm colonization is to use proteolytic and fibrinolytic enzymes to “break up” the biofilm and then follow that with a more contemporary technology called Next Generation Sequencing or NGS.

There is currently no single standardized protocol for the diagnosis of biofilm colonies, but the methods we currently employ are helping patients!  Some labs have the capacity to examine samples under a high-power microscope (19, 20). At the Spring Center, we use, trust, and recommend MicroGenDX for diagnosing biofilm colonies using PCR and NGS.

Their technology has taken the mystery out of bacterial colonization in places like the nasal passages, sinuses, bladder, vagina, and prostate! I’m so excited that we now have an amazing tool to identify which organisms are causing the problem and exactly which antimicrobials we can use to eradicate them! This is a game-changer for patients who have been struggling with recurrent symptoms for years in any of these places. For example, whether someone has long-standing interstitial cystitis (IC) or just frequent urination, the Next Generation Sequencing urine test is a true game-changer!

Part of the problem is the biofilms that protect the organisms. I find that often the first layer of bacteria is common, like E. coli, and then often Enterococcus faecalis. In some people, we will see more of the typical vaginal flora colonizing the bladder, like species of Lactobacillus.  Although they are normal in the vagina, they don’t belong in the bladder!

In some patients, identifying a biofilm colonization in the sinuses, bladder, or prostate has been life transforming, for we have identified the source of systemic inflammation in the body and are slowly eradicating it.

Much like peeling an onion takes time, so does breaking down and eradicating a lifetime of biofilm. Younger patients in their 30s can anticipate shorter rounds of testing and treatment, but those folks in their 70s should know it takes persistence during treatment to find a complete resolution. But as one of my feisty 70s-year-olds said recently, after about 4 rounds of testing and treatment, her symptoms are 80% better across the board. Her joint pain is better, her mast cell symptoms of skin inflammation and rashes are better, her urinary frequency, which kept her up 3-4 times a night, was down to once a night, and so on. She was in awe of how many seemingly unrelated symptoms had improved.

Healing can take time, but be patient, be persistent, and don’t give up. But what does it look like? Several rounds of testing and appropriate treatment based on your results!

I recommend this process for testing:

  • We begin with at least 5-7 days of Kirkman Biofilm Defense or other “biofilm “buster”, 1 cap twice daily away from food and supplements to “unearth” the bacteria. If you have known hypercoagulability, we will extend that time to 2 weeks or more, and will add fibrinolytic enzymes to the Kirkman proteolytic enzymes.
  • Then we are ready to collect specimens for testing. Women’s kits include urine and vaginal specimens. Men’s kits include both urine and semen specimens. These can be collected at home by the patient. Any nasal swab testing must be done by a professional.
  • Continue the Biofilm Defense until we get the results, and layer in the fibrinolytic enzymes like Boluoke, or change the proteolytic enzymes based on the microbes.
  • Once we have the results, we treat issues based on the sensitivity patterns and allergies we find.
  • Then, we wait for 1 to 2 weeks on the biofilm busters after antimicrobials. This is called the wash-out period.
  • Then, we are ready to repeat the test.
  • We prescribe lots of probiotics while undergoing therapy. We also provide support for Herxheimer reactions also, if needed.

Insurance coverage varies depending on the test kit.  For example,  MicroGenDXWomen’s and men’s kits cost $299 and nasal or urine-only kits are $249, but nasal and urine-only kits may be covered.

 

Medicine herbal pills

Solution for Biofilms

If biofilms are often resistant to antibiotic treatment, what can we do about it? Great question.

Bacteria don’t just lump together for no reason. So why do they form colonies? They need to communicate with each other (19). Bingo!

So if we want to interrupt and reduce biofilm formation, we need to disrupt the communication between bacteria. This process is also known as quorum sensing (QS). So-called quorum sensing inhibitors (QSIs) may help to disrupt the communication signal between bacteria and prevent them from accumulating and forming colonies.

QSIs may include certain foods, micronutrients, enzymes, herbal supplements, and supplements. In the next section, I will share a list of QSIs that may naturally interrupt bacterial communication and reduce biofilm formation. However, it’s important that if you are dealing with an ongoing infection or suspect biofilm issues, you work with a doctor for an accurate diagnosis and treatment. Taking supplements without fully understanding your issue may not be the best solution and may even be risky when it comes to chronic antibiotic-resistant infections. You may learn about becoming a patient  with us at the Spring Center for individualized support here, my team and I would love to find the root cause of your issues and find the right treatment protocol.

Foods That May Reduce Biofilm Formation

You may try adding the following foods to your diet to reduce biofilm formation. Some of these foods, such as omega-6 fatty acids and ginger, are also available as supplements.

Here is the list of foods that may reduce biofilm formation:

  • Manuka honey, other honey, and propolis (20, 21, 22)
  • Ginger (23)
  • Garlic (24)
  • Cranberry (26)
  • Olive oil (oleic acid) (26)
  • Omega-6-rich foods (linoleic acid) (26, 27)
  • Coconut oil, other coconut foods (caprylic acid) (28)
  • Apple cider vinegar (acetic acid) (29)
  • Xylitol (30)
  • Stevia (31)

Enzymes That May Reduce Biofilm Formation

Enzymes have many benefits for digestion and health. Some enzymes may help to disrupt biofilm formation. You may use these as supplements. However, I recommend that you speak to a functional medicine doctor to see which enzymes are right for you.

Enzymes that may reduce biofilm formation:

  • Trypsin (32)
  • Nattokinase (33)
  • Serratiopeptidase (34)
  • Lumbrokinase: This is an enzyme we use a great deal as a fibrinolyc. It may offer inhibitory effects on platelet aggregation and may help cardiovascular health.

Non-Herbal Supplements That May Reduce Biofilm Formation

You may also try some non-herbal biofilm disruptors. Again, speaking with a functional medicine doctor is important to help you decide which one of these supplements is the right option for you.

Non-herbal supplements that may reduce biofilm formation:

  • Zinc (35)
  • Iron (36)
  • Manganese (37)
  • Magnesium (38)
  • NAC (39)
  • Chitosan (40)
  • EDTA (made by chelating magnesium and calcium) (41)
  • Zeolite (42)
  • Colloidal silver (43)
  • Ozone/ozonated water (44)
  • Chlorella (norspermidine) (45)
  • Monolaurin (46)
  • Lactoferrin (47)
  • L Reuteri (48)

Herbal Supplements That May Reduce Biofilm Formation

You may also try some herbal biofilm disruptors, although I suggest that you work with your healthcare team.

Herbal supplements that may reduce biofilm formation:

  • Curcumin (turmeric) (49)
  • Ginger (23)
  • Cinnamon (50)
  • Black cumin oil (51)
  • Quercetin (52)
  • Resveratrol (53)
  • Berberine (54)
  • Boswellia (55)
  • Oregano oil (56)
  • Vanilla (57)
  • Ginkgo biloba (58)
  • John’s Wort (59)
  • Neem (60)
  • Alfalfa (61)
  • Eugenol (62)
  • Mangosteen (63)
  • Kaempferol (64)
  • Gentian violet (65)
  • Andrographis (66)

Other Options That May Reduce Biofilm Formation

You may also try some other supplements as biofilm disruptors. Again, given that many of us are colonized with biofilms and there is the potential risk for die off symptoms, it is wise to work together with your health care team so that they can help guide you.

Biofilms act like lasagna. The “film” being the flat pasta and the bacterial matrix being the meat and cheese layers. As we use specific biofilm “busters” to break up the biofilm, the underlying bacteria are released and can be killed by the antimicrobials and your immune system.

My favorite Biofillm busters:

  • Kirkman Biofilm Defense: This is a a great broad-spectrum product
  • Boluoke: This is a good choice for those with hypercoagulability. The biggest problem with biofilms is when someone has an underlying hypercoagulable state (that means too much blood clotting) due to genetics, like factor V leiden, Prothrombin gene mutation (or Factor II mutation or Prothrombin G20210A, or a relative newcomer called PAI-1 or plasminogen activator inhibitor which is showing up in 90+% of my patients!), or autoimmunity such as antiphospholipid antibody symptoms. It appears that fibrin gets incorporated into the biofilm and strengthens the biofilm, making the colonization harder to eradicate and sometimes even “see” when we are running testing. This is the reason that we pre-treat everyone before testing with some form of biofilm buster.
  • Priority One Biofilm Advanced: Klebsiella, pseudomonas, and a handful of other species require a special biofilm buster that includes bismuth. Priority One Biofilm Advanced Phase 2 includes the necessary bismuth.

Further Tips to Reduce Biofilm Formation

Your diet and lifestyle matter. The right dietary and lifestyle choices may help to reduce biofilm formation and infections. I recommend paying attention to the following:

  • Follow a nutrient-dense diet: A poor diet can fuel microbial overgrowth and compromise the immune system in fighting infections. Following an anti-inflammatory, nutrient-rich diet may help to reduce the risk of health issues. Remove inflammatory foods, including refined sugar and carbs-refined oils, foods you are sensitive to, deep-fried foods, and overly processed foods. Eat lots of greens, vegetables, sprouts, fermented foods, herbs, spices, fruits, and organic animal protein. Remember to include biofilm-disrupting foods and herbs in your diet, as listed earlier.
  • Follow good dental hygiene: Good dental hygiene is critical for reducing biofilm plaque formation. Brush and floss your teeth thoroughly twice a day. Don’t forget to clean your tongue with a tongue scraper. Try oil pulling in the morning. Get regular dental cleanings and visit a biological dentist for oral health care.
  • Clean your shower head: As I mentioned earlier, biofilms can frequently form and hide in your shower head. Biofilms may also hide in your drains, other taps, toilets, and similar areas. Clean these areas thoroughly and regularly, and replace them as needed. Oh, and don’t forget your refrigerator ice and water dispensers!
  • Talk to your doctor: If you are experiencing chronic symptoms, talk to your doctor. Functional medicine practitioners like me, can help you get tested for biofilms and check for other underlying reasons behind your health issues. We can also help you to come up with a strategy to reduce biofilm formation and treat your symptoms.

 

spring flowers

Next Steps

Are you dealing with biofilms, chronic infections, or other chronic health issues? Or do you just want to optimize your health even more?  Either way, we can help!  If you want to improve your health, I welcome you to schedule a functional nutrition consultation with my nutritionist, Sarah. Visit our store for products.

And stay tuned for more information to help you uncover the root cause of your health issues, improve your nutrition, repair your body, and regain your health naturally.

You can learn more about becoming a patient at the Spring Center for individualized support here. You can schedule a nutrition consultation with Sarah here.