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Biofilms: The Rampant Bacterial Party Keeping You Sick

by Dr. Mitchell Rasmussen, DC, CFMP, FRC-ms

A biofilm is a population or community of bacteria living in an organized structure at a liquid interface. Scanning microscopy years ago revealed that biofilm bacteria live in cellular clusters (microcolonies) and are encapsulated in a matrix. This matrix is made up of something known as an ‘extracellular polymeric substance’ (EPS). This EPS is separated by open water channels which act as a sort of circulatory system for the delivery of nutrients to the colony as well as for the removal of metabolic waste products from the colony.

To pare it down: You can think of a biofilm as a well-protected burrow where bacteria can just kind of ‘hang out’.

The EPS matrix creates a barrier against antibiotics. This barrier is quite a robust defensive barrier; BUT it also limits the ability of oxygen and food to penetrate the colony. Typically, bacteria located deep within the biofilm matrix will starve and die. So – the biofilm does have its limits as a haven for bacterial partying.


According to the US National Institutes of Health, Biofilms account for over 80% of microbial infections in the body.

Additionally, standard antimicrobial therapies often fail to adequately eradicate biofilms. This often results in chronic, longstanding infections, as well as the need for surgical removal of affected areas.

Within these biofilms, residing infectious microbes have increased resistance to antibacterial compounds; and this is one mechanism by which antibiotic resistance has increased over time.

chronic NSAID use

Further Problems from Biofilms...

I want to quickly discuss something else biofilm colonies tend to do; and I find this very disgusting.

It has been shown that the pathogens residing within a biofilm will occasionally ‘come out and play’. This is when you get your acute symptoms associated with the hollow space organ you’re struggling to maintain health in (re: sinus, lungs, urinary tract, vagina). The immune system reacts with white blood cells and tissue damage. Some of the colony will be killed. The survivors now EAT the die off!

<<The pathogens literally FEED on the mess that they triggered your immune system to create as a means of self-preservation.>>

Standard Antibiotic Therapies often fail to adequately eradicate biofilms. They allow an infection to live on and reoccur.

Biofilms in the Respiratory Tract


There are many biofilms that involve/infest our respiratory system. Numerous infectious processes are now thought to involve biofilm formation: Recurrent upper respiratory airway infections, bronchitis, pneumonia, cystic fibrosis, bronchiectasis to name a few.

We also see biofilms associated with chronic hollow space organ dysfunction of all kinds; sinuses, bladder/urinary tract, vagina, GI tract, etc. Hollow spaces are ideal places for chronic infectious process to ‘set up shop’ – warm, dark, moist.

Evidence suggests that almost all strains of Pseudomonas Aeruginosa (a common infection in those with Cystic Fibrosis) have the capacity to make a substance known as ‘alginate’. >> Alginate is a primary matrix of biofilms.

There have also been bacterial biofilms identified in adenoid tissue of children with recurrent upper airway inflammatory issues, often associated with chronic ear infections. The thought is that these biofilms represent a bacterial “reservoir”. This allows the chronicity of these mucosal tissue reactions, as well as the resistance to antibiotic therapy.

I look at it like this – If you keep getting chronic: gut issues, urinary tract issues, sinus issues, or respiratory issues; and you keep taking antibiotics; YOU HAVE A BIOFILM ISSUE!

And IF your chronic issues are associated with biofilms, the antibiotics you keep taking will NEVER fully eradicate your problem.

If you get a sinus infection every year – you have a biofilm problem.

If you get a UTI every few months – you have a biofilm problem.

If you have chronic GI issues – you likely have a biofilm problem.

Ibuprofen Functional medicine view


What we find clinically is this:

If we give you substances known to inhibit/breakdown biofilms while you’re taking your antimicrobials (pharmaceutical or otherwise), then we get much better outcomes

As a note – this is all occurring within the context of the entire choreography of your immune system repertoire; and we would be remissed if we didn’t treat this as well as the rest of your immune polarization physiology.

In other words, “Nothing occurs in a vacuum. You aren’t just a ‘biofilm problem’. Your immune system responses will likely need other kinds of support concurrently. And everybody’s immune system physiology is different, regardless of biofilm status.”



N-acetyl cysteine (NAC) has been shown during in vitro studies (as well as in our clinic) as an effective biofilm inhibitor by numerous mechanisms:

  1. Inhibition of biofilm formation

  2. Disruption of already formed biofilms (both initial AND mature)

  3. Reducing bacterial viability within the biofilms

There is some evidence that NAC by itself, or in combination with antibiotics, can decrease the risk of exacerbations of chronic bronchitis, COPD, and rhinosinusitis. We use oral NAC in the clinic with our patients. That being said, there are times where NAC may not be the best option – as in somebody with a histamine intolerance.

We also like using a substance known as “Monolaurin” for many biofilm conditions.

Depending on the clinical presentation, there are other substances we may use for biofilm disruption – NAC and Monolaurin are far from an exhaustive list.

>> Dosing, length of treatment, and substances used will all depend on the needs of the patient.

We are nuanced in our approach.


Mitchell Rasmussen Functional Medicine Doctor Denver Colorado

Dr. Mitchell Rasmussen, DC, CFMP serves as Director of Functional Medicine at The Facility in Denver, CO. He sees patients in-person and via Telehealth to get to the root cause of dysfunction and restore a state of well-being using nutritional intervention, supplementation, and lifestyle change.


Functional medicine Denver co

Want to work with a functional medicine doctor to run labs and assess nutrient status? Struggling with hormone imbalance, IBS, weight gain, mood changes? Let's look at BIOCHEMISTRY. Read more about Functional Medicine at The Facility here.

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NSAID Use Inflammation Resolution Toxic Functional Medicine Denver

(Respir Med. 2016 Aug;117:190-7. Blasi F, Page C, et al.)

(Nat Rev Drug Discov. 2003 Feb;2(2): 114-22. Davies D.)

Donlan R. M. (2002). Biofilms: microbial life on surfaces. Emerging infectious diseases, 8(9), 881–890.

(Treat Respir Med. 2005;4(4): 241-53. Kobayashi H.) (Pediatr Med Chir. 2008 Jan-Feb;30(1):31-4. Galli J, Calo L, et al.)


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Dr. Mitchell Rasmussen - Doctor of Chiro
Kate Daugherty - Nutritionist - Function
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