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Are you chronically ill or constantly battling one infection after another? Do you have a chronic infection that is unresponsive to treatment? The secret to getting your health under control may lie with addressing biofilms.


Biofilms are communities of microorganisms that have attached themselves to a moist surface. The cells composing biofilms secrete a gelatinous substance that protects them from anti-infective therapies, even the strongest antibiotics at high doses.

Biofilms can form almost anywhere that water is present including the digestive tract, the bloodstream and on teeth. In fact, that fuzzy residue on your teeth in the morning prior to brushing is the initial formation of a biofilm!


Biofilms are common in nature and their presence is not necessary something that we need to worry about. The pathogenicity is determined by the stage of development that the biofilm is in and the health of the host.

The following depicts the main stages in the establishment and life cycle of biofilms:

Biofilm Formation
  1. Single free-floating bacteria land on a surface
  2. Bacterial cells aggregate and attach
  3. Growth and division of bacteria
  4. Mature biofilm formation
  5. Part of biofilm disperses to release free-floating bacteria
  6. Repeat

Phase 1 biofilms are in the earlier stages of development (steps 2 & 3) and include the non-pathogenic forms of bacteria that we all have as well as the beginning stages of infection. In a healthy host, these immature biofilms are kept in a weakened state by agents found in healthy diets including many herbs, spices and enzymes.

When the host becomes depleted, the diet is insufficient, and/or a microbe is introduced to the system, the biofilm can grow and form into a Phase 2 biofilm. These more advanced biofilms have progressed through the steps of development and are much stronger and resistant to therapy. These biofilms have been implicated in difficult-to-treat pathologies including chronic sinusitis, resistant urinary tract infections, and certain pneumonias, among other chronic infections.

In my practice, I have seen biofilms play a large role in chronic gastrointestinal infections and SIBO cases that are more resistant to treatment. Oftentimes, addressing the biofilm is the magic key to successfully turn a resistant case around.


Unlike Phase 1 biofilms, Phase 2 biofilms are beyond the point of prevention and cannot be addressed with the herbs, spices, and enzymes that work in the earlier stages. These developed biofilms require disruption by agents that can “open” the biofilm up to allow the antimicrobial agents (e.g. antibiotics, antifungals) to gain access to the organisms contained within.

One of the most effective disruptors of Phase-2 biofilms is a bismuth-thiol complex that is a complex of bismuth subnitrate, ALA and DMPS. Currently, only compounding pharmacies are able to fill prescriptions of this complex. (Note: this complex is not the same as the sum of their parts; the bismuth and the thiol complex together to form a “super-molecule” that is critical for both their activity and safety).

For most people dealing with a Phase-2 biofilm, agents to disrupt the biofilm may need to be taken for 2-3 months before the biofilm “opens”. In advanced biofilms, it may even take a year! The practitioner will know that the biofilm is opening because of immune aggravation (e.g. flu-like symptoms) as the patient’s immune system is “seeing” the infectious material that was previously hidden from it.


If you have been dealing with a chronic infection that antimicrobials just don’t seem to touch, or you temporarily notice improvement only to find all your symptoms coming back even worse than before, you may have growth of a significant biofilm. These biofilms protect the organism from therapies and need to be addressed prior to antimicrobial therapy in order to achieve successful eradication.

If you believe biofilms may be the culprit behind why you aren’t getting better, talk to your doctor about a prescription biofilm agent to address your infection in a new way.

Dr. Nicole Hartman

About Dr. Nicole Hartman

Dr. Nicole Hartman is a naturopathic physician, a world traveler, a hiker, and a blogger. She focuses her practice in digestion, women's health and weight loss and takes an integrative, evidence-based approach to healthcare.