The Role of Biofilms in Chronic Fatigue Syndrome, Long COVID, and Fibromyalgia

Chronic Lyme disease. Candida that can’t get under control. High labs for Mycoplasma pneumonia. These stubborn bacterial or fungal infections may be due to biofilms. But what exactly are biofilms—and why do they matter when you're trying to recover your health?

What Are Biofilms?

Biofilms are structured communities of microorganisms—bacteria or fungi—that stick together and form a slimy, protective layer on surfaces. These surfaces can be anything from your teeth (plaque) to your gut lining or even inside medical devices. Within a biofilm, microbes are not floating around freely. Instead, they’re tucked into a sticky matrix made of sugars, proteins, and other molecules they secrete to shield themselves.

This protective layer makes biofilms incredibly resilient. Microbes living in biofilms are much harder to eliminate than free-floating microbes. They can resist antibiotics, evade immune responses, and persist in the body long-term.

Why Biofilms Are So Hard to Get Rid Of

In acute infections—like strep throat or a urinary tract infection—bacteria typically exist in a free-floating state called planktonic. These infections come on quickly, trigger a strong immune response, and are either cleared by the body or treated successfully with antibiotics. If you recover, you often develop lasting immunity.

But chronic infections are a different story. Instead of staying in that planktonic state, certain bacteria (and even fungi) can shift into a biofilm-forming mode. This shift isn’t random—it happens when microbes sense that enough of their same-species neighbors are nearby. They do this through a process called quorum sensing, where each strain releases and detects its own chemical signal. When those signals reach a certain threshold, the microbes recognize there’s strength in numbers and begin building a protective biofilm.

This happens not only with bacteria like Mycoplasma or Borrelia, but also with Candida, a yeast that’s commonly found in the body and frequently overgrows in people with postviral conditions. Candida albicans is well-documented to form biofilms, especially on mucosal surfaces like the gut or mouth. Once inside a biofilm, Candida becomes significantly more resistant to antifungal treatments and immune responses.

Inside any biofilm—whether formed by bacteria or fungi—not all organisms are equally active. Some go dormant to survive harsh conditions, like nutrient shortages or exposure to antimicrobials. These so-called persister cells can evade treatment, only to reawaken and repopulate the biofilm later. This is one of the main reasons why biofilm-related infections tend to recur and why long-term symptoms persist in so many people with ME/CFS, fibromyalgia, and long-haul COVID.

How Biofilms Relate to Postviral Conditions

After a viral infection, the immune system can become dysregulated. In some people, this immune shift opens the door to opportunistic microbes—organisms that wouldn’t normally cause problems but take advantage of a weakened system. These microbes can include bacteria (Mycoplasma pneumonae) or fungi (like Candida).

Once these organisms find a niche in the body—particularly in the gut, sinuses, or urinary tract—they may form biofilms. The problem? These biofilms protect the microbes from both your immune system and many treatments. This can lead to persistent low-grade infections, chronic inflammation, and worsened symptoms like fatigue, pain, and brain fog.

One important takeaway from recent research is that maintaining a healthy, diverse microbiome may help prevent any one species from gaining too much ground. A more balanced gut environment could make it harder for microbes to reach the critical mass needed for these coordinated actions, reducing their ability to cause problems long-term (Alcock, 2014).

Why Gut Microbial Diversity Matters

One reason a diverse gut microbiome is so important is that it may help stop certain bacteria from communicating and becoming harmful. When their numbers get high enough, they start acting differently—sometimes releasing toxic components or switching on harmful behaviors.

For example, a common microbe called Staphylococcus aureus can live harmlessly in the body, but when it grows in large numbers, it uses quorum sensing to shift from simply living in the body to invading tissues and causing damage.

The good news? Having a wide variety of microbes in your gut may keep any single group from growing too much. This makes it harder for bacteria to reach the level needed to trigger these harmful changes. So by supporting gut diversity, you may be help keep these microbes in check before they become a problem.

Nutrition Strategies for Supporting Microbial Balance

You can support microbial diversity and discourage biofilm formation through smart dietary choices:

• Fiber-rich plant foods: Beans, oats, leafy greens, and root vegetables help feed beneficial bacteria.

• Polyphenol-rich foods: Berries, green tea, olive oil, and dark chocolate can discourage harmful microbes and promote diversity but can also block quorum sensing (Lima, 2023).

• Fermented foods: In moderation, things like sauerkraut, kimchi, and kefir can help introduce beneficial bacteria—unless you have histamine issues.

• Minimizing added sugars & refined carbs: These can feed the kinds of microbes that form biofilms and cause trouble.

In addition to dietary strategies, certain supplements may help disrupt quorum sensing—the microbial communication system that triggers biofilm formation:

• Quercetin, luteolin, & baicalin (skullcap) are all natural compounds shown to interfere with quorum sensing signals in bacteria and fungi. These flavonoids may help prevent microbes from reaching the critical population needed to form biofilms or release toxins.

However, these compounds have poor bioavailability when taken in standard forms. To be effective, they often need to be used in liposomal formulations—which enhances absorption—or in very high doses, ideally under the guidance of a healthcare provider familiar with complex chronic illness.

• BioDisrupt® by Researched Nutritionals: This supplement is designed to support the breakdown of biofilms and has been used effectively in a proof-of-concept study (Jensen, 2023). It contains two proprietary blends.

• EnzymeDisrupt™: A blend of enzymes including lysozyme, serratiopeptidase, beta-glucanase, lipase, protease, cellulase, and hemicellulase, chosen for their ability to disrupt the biofilm matrix.

• HerbDisrupt™: A combination of herbs such as cranberry extract, berberine, rosemary extract, and peppermint oil powder, selected for their potential to prevent biofilm adhesion and interfere with quorum sensing.

• Additionally, BioDisrupt® includes N-acetyl cysteine (NAC), which may further assist in breaking down biofilms. You can try it here.

References

Lewis K. Persister cells. Annu Rev Microbiol. 2010;64:357-372. doi:10.1146/annurev.micro.112408.134306

Rowlands RS, Meyer Sauteur PM, Beeton ML, On Behalf Of The Escmid Study Group For Mycoplasma And Chlamydia Infections Esgmac. Mycoplasma pneumoniae: not a typical respiratory pathogen. J Med Microbiol. 2024;73(10):001910. doi:10.1099/jmm.0.001910

Alcock J, Maley CC, Aktipis CA. Is eating behavior manipulated by the gastrointestinal microbiota? Evolutionary pressures and potential mechanisms. Bioessays. 2014;36(10):940-949. doi:10.1002/bies.201400071

Lima EMF, Winans SC, Pinto UM. Quorum sensing interference by phenolic compounds - A matter of bacterial misunderstanding. Heliyon. 2023;9(7):e17657. Published 2023 Jun 26. doi:10.1016/j.heliyon.2023.e17657

Jensen GS, Cruickshank D, Hamilton DE. Disruption of Established Bacterial and Fungal Biofilms by a Blend of Enzymes and Botanical Extracts. J Microbiol Biotechnol. 2023;33(6):715-723. doi:10.4014/jmb.2212.12010