Dissolve Biofilms With Fibrinolytic Enzymes: Autism Support

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A Novel Approach to Chronic Infection in Autism Spectrum Disorders

An Interview with Peta Cohen, M.S., R.D., founder of Total Life Center in Northern New Jersey. Cohen specializes in treating children with autism using a biomedical / nutritional model. Cohen received her Masters in Clinical Nutrition from New York University and has been a Defeat Autism Now! practitioner for the past ten years.

Focus: You have evolved a highly successful strategy to treating chronic bacterial infections and biofilms that involves some new insights and relies in part on fibrinolytic enzymes like nattokinase and lumbrokinase. I understand you are working with autism experts like Anju Usman, M.D. and functional medicine pioneers to get the word out on your new insights.

Cohen: I do a tremendous amount of testing and assessing the children through urine and faecal analysis. What got me so interested in nattokinase and lumbrokinase was the concept of what a biofilm infection actually is. If you do a medline search on biofilms and platelet aggregation, fibrinogen, and fibrin, boom, it’s there right in your face. Bacteria build biofilms by first aggregating together, and then rapidly weaving this protective web or matrix around them.  They build a polymeric matrix. It’s a sticky, gluey, mucus-y goop and it’s got fibrin in it to give it an intact structure. The bacteria recruit fibrinogen to create fibrin as part of that matrix. At that point they can shed their outer membrane, which has the proteins that serve as antigens and as a target of the missile of the immune system. They’re very protected. They’re very crafty in creating a way to survive and procreate and hide from the immune system.

Focus: Why are they protected, and how does that impact our health?

Cohen: They’re protected because they’ve built this matrix but are still alive, still fermenting and metabolising and leaching toxins into the bloodstream, although they may have a reduced metabolism compared to active, acute infection. Because of the biofilm they can no longer be reached by an anti-infectious agent or even the immune system. And because of the biofilm you may not find evidence of the infection in the faecal matter when you do stool cultures. For years, I knew from organic acid testing, from the short-chain fatty acids and metabolites the children were excreting, that they carried these infections. Yet when I did a stool culture I did not find the bugs.

Focus: When you began to work at dissolving the biofilms, did you find the bugs?

Cohen: Oh yes! But I found something else that was just as fascinating, something nobody was thinking about. Think about what that biofilm might really be made of. The biofilm matrix has a horizontal and a vertical weave. It’s standard knowledge that biofilm bacteria sequester calcium, magnesium and iron to help build that matrix. Minerals give the biofilm integrity—as if you’re building a wall. You don’t only want bricks, you want cement. To address this, first you use fibrinolytics to help dissolve the fibrin, then you use EDTA to chelate out the minerals. And guess what? We started getting huge dumps of toxic metal. Now why is that? I think the answer points to something so huge, whether we’re dealing with autism or lyme disease or multiple sclerosis or lupus or even cancer.

Focus: Why were the kids dumping toxic metals when you began to degrade the biofilms?

Cohen: Well, think about it. These are all positively charged cations, that’s why EDTA is able to chelate them well. Mercury, and copper, and other heavy metals are also positively charged. Why would the bug preferentially insert calcium or magnesium? It could use any positively charged metal. This has been the most fascinating part of my year-long work on biofilms. As we degraded this biofilm matrix and liberated these bugs, not only did the organic acid levels get higher—one child bounced into the 400’s—but the kids started to dump metals into the bowel. I felt like I’d exposed these little terrorists in a cell.

Focus: So the metals and the bugs are both in the gut?

Cohen: Right. At an Autism One Conference in Chicago last May, one researcher presented his proton analysis of brain tissue, attempting to verify the presence of mercury in the brains of autistic children, and he couldn’t find it. Yet he still found evidence of activation of the microglia (a type of glial cell that acts as the first and main form of active immune defense in the central nervous system) as a consequence of toxic metals. So where are these metals? I’m suggesting they are in the biofilm, along with the bugs, in the gut. If the biofilm wasn’t using toxic metals, along with common minerals, to build the biofilm, then why all of a sudden do I get these huge dumps of metals on stool tests?

Focus: What exactly is your therapy and what sequence do you use?

Cohen: I start with enzymes like nattokinase and lumbrokinase, as well as other mucolytic enzymes, to get the best, broad fibrinolytic effect. Dr. Usman feels nattokinase is particularly good at degrading strep biofilms and I think that strep is a very big player in these childrens’ health. I will run strep titers and they will be extraordinarily high. And these children—and certainly some adults as well—will manifest strep as a comorbid infection that has significant implications for neurological function. They will have very Obsessive Compulsive Disorder type tendencies, and sometimes almost psychotic outbursts. There isn’t a precise, sudden onset with obvious symptoms.

Focus: How much do you recommend?

Cohen: Remember, these patients are very young; some are just a few years old. So I will recommend half a capsule of each, two times a day. That would be a 50 milligram capsule of nattokinase, and a 20 milligram capsule of lumbrokinase. First do the enzymes along with EDTA, then thirty minutes later, add in an arsenal of antimicrobials. I use formulations containing berberine, artemisinin, citrus seed extract, black walnut hulls, artemisia herb, echinacea, goldenseal, gentian, tea tree oil, fumitory, gentian, galbanum oil, oregano oil, neem, and pharmaceuticals as well when necessary, such as Vancomycin, Diflucan, Gentamycin.  I use a different one every day. Then an hour later you come in with the binders to help mop up the debris. I use chitosan, citrus pectin, a special bicarbonate formula, organic germanium, chlorella and others. I also use buffering agents, such as buffered vitamin C, since when the body is destroying bacteria it becomes acidic. Minerals must be assessed, and repleted when necessary. I test bloodwork and “pees and poos” (urine and stool) every two months to monitor the process.

Focus: Enzymes, EDTA, antimicrobials, binders, and buffering agents. What are the clinical results?

Cohen: They’re fantastic. It’s like the missing piece. I had one little autistic boy who lives in the city who is loaded with viruses and infections and is now almost fully recovered. His mother used to complain about the terribly high levels of copper in his bloodstream and that his hair was like a copper mattress. We measured the hair but there was a marginal amount of copper in it. He was not eliminating. As we got into the thick of the biofilms his copper blew out of his body in his stool, for months and months. He’d been loaded with copper. I’ve had other children struggling for ages to get mercury out, and out it came.

Focus: It sounds like this approach would work for any chronic illness in which chronic infection plays a role.

Cohen: Yes, I think biofilms are a huge missing piece in Lupus, Lyme Disease, Multiple Sclerosis and any autoimmune-type chronic infection. You have to ask, what compels the immune system to maintain this state of dysfunction? Ask yourself, how could an organism perceived by the immune system as foreign survive its presence? Either something has corrupted the immune system, or the organism has transformed itself in a way that the immune system can’t find it. That’s what the biofilm does. I believe it’s one of the biggest medical issues we’re dealing with today.


J Dermatol Sci. 1997 Nov;16(1):2-10 Biofilm formation of Staphylococcus aureus strains isolated from impetigo and furuncle: role of fibrinogen and fibrin. Akiyama H, Ueda M, Kanzaki H, Tada J, Arata J.

The formation of membranous structure (thickness from the plastic tissue-culture coverslip (hematoxylin-eosin) > 1 mm; periodic acid-Schiff-positive) was more prominent with Staphylococcus aureus (S. aureus) strains isolated from impetigo (coagulase types I.V origin) than with S. aureus strains isolated from furuncle (coagulase type IV origin) (P < 0.05) in the plastic tissue-culture coverslip in human plasma after 72 h. Attachment of S. aureus cells to a plastic tissue-culture coverslip was more marked in 0-3% fibrinogen/tryptic soy broth (TSB) than in plasma (P < 0.05).

The formation of the membranous structure was observed on the plastic tissue-culture coverslip with 0.3% fibrinogen/human serum but not with 0.3% fibrinogen + 5% glucose/TSB. Electron microscopy revealed abundant fibrin around S. aureus cells at 4 h and Ruthenium red-positive materials increased at 24 and 72 h in plasma. Staphylococcus aureus cell attachment to the plastic tissue-culture coverslip in plasma decreased by addition of levofloxacin (LVFX) at 1/2 minimum inhibitory concentration (MIC) and clarithromycin (CAM) at 1/4 MIC.

Polysaccharide production of S. aureus cells on the plastic tissue-culture coverslip in plasma decreased with the addition of CAM at 1/4 MIC. Fibrinogen is closely related to initiation of infection but biofilm formation requires the conversion of fibrinogen to fibrin. Thus, attachment of S. aureus cells to the plastic tissue-culture coverslip, conversion of fibrinogen to fibrin by coagulase-prothrombin complex, and production of abundant glycocalyx by S. aureus cells are at least required for the production of biofilm in staphylococcal skin infection.

Appl Environ Microbiol. 2008 Aug;74 Fibrinogen induces biofilm formation by Streptococcus suis and enhances its antibiotic resistance. Grignon L, Grenier D.

In this study, we showed that supplementing the culture medium with fibrinogen induced biofilm formation by Streptococcus suis in a dose-dependent manner. Biofilm-grown S. suis cells were much more resistant to penicillin G than planktonic cells. S. suis bound fibrinogen to its surface, a property that likely contributes to biofilm formation.

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12 Comments. Leave new

  • Charlotte Bridge
    October 30, 2009 11:32 am

    I found this so interesting that I am going to try this on my son.

    It all makes such sense!


  • Hi Michael,

    Never ceases to amaze me each time I read articles of probiotics L.Rhamnosus in particular.

    Everybody should have LGG as part of their Natural Medicine Cabinet at home .

    My question – can LGG be taken for a long period of time?? and for how long?

    In my experience with my autistic daughter, she has been taking LGG and S. Boulaardi on a daily basis for years now and I find that these control a lot of her bloating and flatulence and keep her regular motions. She rarely falls ill and if she does they are just minor colds and rids of it in 2 days.

    Last but not least, a big thank you for all that you are doing so well for the profession and the public.


    • Michael Ash
      June 28, 2010 8:09 am

      Hi Nina
      There have been questions concerning the validity of long term probiotic supplementation, in that a pulsing or rotation may provide better results. This is to fail to understand the role of the innate immune receptors in the principle tissues of the gastrointestinaltract. We have a number of specialised receptors called Toll Like Receptors and NOD receptors, plus others that in effect read the codes contained in the bacterial motifs and cell walls. The immune system therefore continuously adapts to the microbiota in a cyclic, dynamic cross talk where intestinal epithelial cells play an important role in instructing noninflammatory responses for a steady-state control of bacterial growth, or triggering inflammatory mechanisms that can clear the gut from harmful invaders.
      The system is complex and robust in the sense that many players with partially overlapping roles act to keep the integrity of the intestinalmucosal barrier. Failure of thesemechanisms involves genetic and environmental triggers and leads to alterations in the mucoal immune response that can have far reaching consequences.

      To your question – there is no problem with long term supplementation, it is safe and whilst effective do continue. The nature of the bacterial colonies adhesion properties may suggest that probiotics have a tough job in terms of dissolving or at least disrupting the biofilms, but the communication between the receptors and the bacteria is enhanced with daily ingestion.


  • Hi
    I too think this makes a lot of sense…however, was wondering what specific mineral formula would be used to replenish the good minerals that we need, if in fact there is a deficiency to begin with….?

    • Minerals most likely to be depleted are magnesium and zinc, although blood work can identify these fairly quickly, taking blood samples can be problematic. Some minerals may be tested using oral challenge tests and in other cases a simple multimineral formula may be all that is required – clinical guidance from a trained therapist will assist in this decision.

  • I have what i believe to be biofilm in my facial tissue due to cosmetic fillers. I have been dealing with this issue for several years. Please help. I’ve been to dozens of doctors who continue to say that they have no idea what Im talking about. They have not answers. Should i follow the same protocol with the lumbrokinase? Is serrapeptase or mucolytic enzymes better? I am so desperate. Ive considered ozone injections also.

    • Hello Kellie

      The additional ingredients should be added after cooking, the dose and the number of ingredients will vary from person to person. The standard start point is the apples, cinnamon and the organic natural yogurt and if required a few raisins. Then if needed the probiotics and the other agents may be added at the doses suggested or at a level that suits.

      The typical length of time is 1-6 months depending on age of person and length of problems, some respond very quickly. Others need to revisit the programme from time to time depending on life’s experiences and medication use.

  • Please Help:

    After combing the web for treatment for Candida Krusei in the gut at 2+ level.
    I find very little except in treating it when it’s in the bloodstream and it’s not very
    encouraging. The main cause was from low diversity of the gut bacteria due to
    past years of Probiotics. How can I tell if there is a Biofilm formed yet? Can a
    daily dose of 500mg NAC help keep the Biofilm from forming or keep it at bay?
    What about Diatomaceous Earth, Nattokinase, Lumbrokinase, or Essential Oils
    BFB 1 and 2 or Interfase ? When breaking up the Biofilm, is there a risk of it
    getting the bacteria in the blood? Can I take these items without the antifungal
    to keep the Biofilm at bay till I find out what Antifungal to take? Do I have to cut
    back on Minerals even though I have Osteoporosis and am concerned about
    being able to rebuild bone? Have you heard about the Marshall Protocol? Is
    Candida a Th1 Pathogen? I don’t know what doctor to see because this is
    the first detected case my gastro doctor has had over the years. Any questions
    you can answer would help.

  • I am guardian/grandmother of 8 yr old fraternal twin boys, both Autistic/non-verbal. One has GI issues the other has asthma. The one that has GI issues, I have on Bentonite Clay for detox and digestive enzymes. The other, I just purchased MucoStop enzyme blend hoping for some improvement. I am so intrigued by your research and findings on biofilms. I want to start them on these suggested enzymes. My question is, is it okay to blend the Nattokinase and Lumbrokinase along with the other enzymes or should they be given separately? I have to break the capsules and half the powder for the right dose, dissolved in water. I can just add these to the mix if they will not interfere with each other.
    Thank you.

  • Very interesting article! I only have two questions:

    “for years, I knew from organic acid testing, from the short-chain fatty acids and metabolites the children were excreting, that they carried these infections.”

    1. Do we know for sure that increased short-chain fatty acids in feces are predictive for a bacterial infection? Which metabolites are meant over here?

    2. When minerals are used by bacteria in creating the biofilm, do we suspect a decrease or increase in serum/blood mineral levels such as magnesium and zinc? I would guess a decrease right, or is my thinking not right?


    Kind regards,


  • Ricardo Grave-Resendes
    April 19, 2023 12:20 am

    Hello! What is your opinion on bismuth-thiol biofilm disruption?

    • The data thus far describe bismuth-thiols as broad-spectrum, potent, and stable antibacterial agents. Their activity,
      solubility, and stability are dependent on several factors, including pH, temperature, and the thiol concentration. They can be formulated as powders or liquids, either in acid- or alkaline-soluble forms. The versatility of these compounds stems from their different solubilities and activities in different systems and from an interchangeable thiol component.

      Bismuth-thiols are active against a broad range of bacteria, as well as some viruses and fungi. At subinhibitory
      concentrations, CPS and biofilm formation are suppressed, which could interfere with bacterial adherence, colonisation, and evasion of host defenses.

      Bismuth and thiols also neutralise each other’s toxicity. The likely mechanism of action is at the cytoplasmic membrane,
      where bismuth inactivates respiratory enzymes, leading to reduced energy output and inhibition of CPS expression the basic substance that makes up biofilms.

      Higher concentrations collapse the membrane potential, inhibit growth, and kill bacteria without promoting lysis or release of endotoxin.

      Bismuth-thiols are projected for use in a variety of medical and industrial applications. With the emergence of highly
      resistant bacteria, bismuth-thiols are an exciting group of alternative agents active against a wide range of pathogenic microorganisms. As these novel compounds are refined and developed for a variety of applications, they promise to be an important addition to the antimicrobial armamentarium.

      Michael Ash DO, ND, BSc (Hons), RNT
      Managing Director .


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