Tips for Dealing with Herxheimer or Die-off Reactions. Dealing With Yeast Die-Off (Herxheimer) Reactions
Yeast overgrowth can happen in response to improper diet, poor immunity, difficulties in digestion and antibiotic use. Poorly digested food can lead to putrefaction (rotting) and encourages the growth of organisms. Antibiotic use destroys the normal balance of gut flora and leaves an open field for bad bacteria and fungi to move in. Hormones and steroids can make this condition worse, too. Most importantly, over-consumption of simple sugars & refined carbohydrates will feed the yeast. If the immune system is weakened or there are not enough probiotic (“good” bacteria) to combat the yeast, then it begins to grow unchecked and cause symptoms, such as “leaky gut”.
In this blog, I am addressing specific patients who are being treated for fungal dysbiosis (yeast overgrowth), who may experience a worsening of their condition after starting a program for yeast control. This may be very unsettling & discouraging if it is not understood. It must be addressed effectively in order to avoid worsening symptoms. Here are some strategies to minimize the chances of suffering unnecessarily from a Herxheimer (die-off) reaction.
Common Symptoms of yeast die-off include:
Fatigue, brain fog, gastrointestinal distress such as nausea, gas, bloating, diarrhea or constipation, low grade fever, headache, sore throat, body itch, muscle and joint soreness or pain, flu-like symptoms. Other symptoms include: lethargy, intense sweet cravings, rashes, irritability, joint stuffiness, or muscle pain. In susceptible individuals with pre-existing neurological symptoms such as hyperactivity, irritability, tantrums, and difficulty concentrating, their symptoms may temporarily intensify.
Yeast die-off reactions are not necessarily a sign that yeast treatment is succeeding. It may be an indication that yeast cells are dying in large numbers, and an indicator of the body’s toxic overload. At that point, more poisons are being released than the body can adequately cope with at one time and may be a sign the system’s elimination pathways (liver, kidneys, & bowels) are overburdened or blocked (as in constipation or liver congestion)
If properly undertaken, treatment for yeast related health problems should not lead to severe yeast die-off reactions. Patients with elevated heavy metal levels may more problems with “die-off” symptoms
Strategies to minimize discomfort & shorten duration of die-off reactions
· Reduce the dose of anti-fungals: Some patients may have to stop altogether for a few days. Dr Jill will generally start doses slowly and increasing them over time to help you deal with the possible die-off symptoms
· Enzymes: Adding enzymes with meals may improve the digestion of foods and limit putrefactive short chain fatty acids with enzymes. Use pancreatic enzymes, NOT fungal or plant based enzymes.
· Stay hydrated: Dr Jill recommend 4-6 fluid ounces of warm water every forty-five minutes, throughout the day. Mineral water may help, too!
· Get your sleep: It is imperative to rest when experiencing yeast die-off reactions – 8-10 hours per night is essential.
· Neutralize toxins: There are ways to neutralize fungal toxins. Dr. Jill may recommend molybdenum, biotin, pantethine or liver support to accomplish this. Activated charcoal may also help.
· Alkalinize: You may buffer the toxins by taking alkalizing agents immediately upon experiencing die-off symptoms. Such products as AlkaSeltzer Gold. Drinking mineral water may also help.
· Antioxidants: Provide extra antioxidants to quench the oxidative reactions created by the toxins. Dr Jilll may prescribe vitamin C, Vitamin E or A, alpha lipoic acid or N-acetylcysteine.
· Sauna & baths: If you have access to a sauna, begin slowly (15 minutes per session) scrub all skin surfaces with a stiff brush and shower immediately afterwards. Another helpful detox regimen is Epsom salt baths – use 3-4 cups in hot bath and soak for 20min every night.
· Keep your bowels moving: You must address any issues with bowel elimination if you have constipation – if you are not eliminating, you will reabsorb any die-off toxins being released!
More remedies for constipation:
· Use magnesium citrate 500-1000mg daily or until normal, soft bowel movements 1 or more X daily. You may also add Ascorbic Acid 5-10grams daily to bowel tolerance.
· Start every morning with a tall glass of warm water. 8 oz of coffee may also be helpful.
· Try a few tablespoons of extra virgin olive oil, several times daily on an empty stomach.
· Mix 2 TBSP of ground flax or chia seed into water & stir , let sit for 10minutes, stir & drink on an empty stomach.
Read more about the Yeast Epidemic here
Image Courtesy of Ohmega 1982 at http://www.freedigitalphotos.net/
I was having this last week and through the weekend, finding your blog and this article was timely. Magnesium did the trick for me – it was truely a blessing from God to get this information and I had sent for magnesium the week before all of this started, not because I was preparing – I just read about how great magnesium was for us. Just the first two tabs worked so well, that I doubled the recommended dose to 1,000 mg and I feel better than ever! I was having aches and pains before the Herxing started, but once it started I was in so much pain I could barely move and yet had to host my family from out of town for Christmas. Then I took the magnesium and it made the last day of their visit so much better. The magnesium worked immediately for me. Thanks so much for your help from afar Dr. Jill! God bless you!
Wonderful news, Kim! I hope you are feeling better soon… yes magnesium is simple, safe and profoundly effective!
Hey, great article and very beneficial. Ive recently carried out a couple of liver flushes (lime, garlic, ginger and olive oil) to help with my Psoriasis, which seems to have created an adverse effect than what I was hoping for.
Im now very gassy, itchy, feels like i’m consitpated but actually having diarrhea and more Psoriasis on the skin.
I did suspect a bacteria overgrowth (saliva test) and my naturopath believes this too…
My question is… due to the large amounts of lemon juice and garlic i had for 5 consectutive days – could this trigger a die-off? Ive started taking HCL with pepsin in case its low stomach acid.
Is there a connection between low stomach acid, liver flushing and die-off?
hope to hear back 🙂
Garry
Hi Garry,
Thanks for your comments! Yes, it is possible you triggered a “herx” reaction. I generally do not recommend the liver flush you are describing, especially without knowing what is going on in the gut, liver and gallbladder. With psoriasis you very likely have underlying imbalances in microbes in the gut (http://doccarnahan.blogspot.com/2013/01/healthy-gut-healthy-you.html) I suggest finding a functional medicine doctor to order more extensive testing, like the comprehensive stool analysis to determine the extent of dysbiosis and a determine a treatment plan. Garlic is a potent herbal anti-microbial and may have triggered your symptoms.
Take care
Dr Jill
Great article!
Hi, can you recommend or tell me how to find a good integrative medicine doctor in the western Chicago suburbs? thank you
You could try searching on http://www.functionalmedicine.org for physician in your area.
In the past two months I have started progesterone cream and estrogen suppositories and after about three weeks I started with a yeast infection and diarrhea that is continuing ..into second week or so … I am 53 and in menopause .. I am also started taking thyroid medicine t3 lioyhyronine.. Could yhe hormones be causing this .. I eat clean .. My diet has not changed on these new prescriptions .. I am losing weight with the diarrhea and I and eating more .. Only veggies, clean meat, protein , and only two fruits a day , no grain or bread or gluten , clean protein powder, organic Greek yogurt and all organic veg and fruits basically , lots of water .. Again only thing changed is the prescription .. Any suggestions
Help !
Hi Lisa, if you have underlying fungal dysbiosis, the hormones can make yeast worse
Does bentonite clay help with die off symptoms?
Hi Dr Jill, thank you for such great information. I have been dealing with candida overgrowth for several years. My diet is gluten-free, soy-free, dairy-free…you get the picture! I finally found a doctor to help me with this. She did a stool analysis and found that the candida is still high. She prescribed diflucan 100mg, twice a day. By the 5th day I was totally incapacitated…everything in my body was in such pain that I could not even sleep. I have stopped the medicine and I’m still trying to recover. I asked my doctor to prescribe nystatin instead, but she says it is not strong enough and wants me to stay on the diflucan and reduce it to once a day. I don’t think I can make it! By the way, she wanted me to take the diflucan for 60 days!!! How have your results been with nystatin? Any advice?
Hi Cricket, That sounds like an intense herxheimer reaction and it likely means that your doc was on the right track. Nystatin is not systemically absorbed so may treat the gut but not if you have yeast in other areas of the body. Best to discuss with your doctor and make decisions together. Read more about yeast here.
best
Dr Jill
if we suspect there is yeast overgrowth,we can take lemon juice early in morning fasting to increase stomach acid.
You may take lemon juice but I am not sure there is any evidence it will raise stomach acid.
Hi Dr. Jill
In the talk you did for Genova on difficult GI cases, you mention that you have a handout for Herxheimer Reactions. Is this something you make available online or only through your office? Thank you! (great talk by the way)
Thank you, Andrew
I give this out to my patients
warmly
Dr Jill
What a great article, very helpful! Thank you. I have been dealing with sibo, ibs, gluten & lactose intolerance mostly because of extreme antibiotic use. I’ve been GF and LF for years now, eat a fodmap free diet for 2 years and still have extended belly plus pain. I did a spit test and it undoubtedly showed yeast. I’ve started a very low carb and high fiber diet and have had migraines straight through since 2 days in. I generally feel like I have a flu without the respitory issues. Taking Epsom baths now and drinking detox tea as well as oxygen therapy. My question is how long will this last? I really feel awful and don’t want to fall off the low-carb wagon!
Thank you, Sara
Sorry I forgot to mention I’m taking 150 billion + a day probiotics and trying to use enzymes at each meal but that’s very difficult as most enzymes make me extremely nauseous. Thank you!
Hi Sara,
Yeast can take 3-6 months to treat
warmly
Dr Jill
Also, you just started a Low carb diet, and doing this can cause an electrolyte imbalance(“Keto-flu”). Up your sodium intake, and magnesium. Trying drinking some broth and see if you feel any better after that. I often find I get headaches whenever my sodium is too low.
hey dr jill,
I had been suffering from some thyroid issues and after intense examination they discovered i have some yeast. Dr put me on fluconazole 200 mg daily for 3 weeks. In about the second day it hit me. I was getting sort of paranoid. It really felt very bad. As if i was having a heart attack. I am also on an intense diet. I had to bee taking warm bathes to cool down and drink linden leaves tea. In the past i was on h. pylori treatment and was being treated for hyperthyroidism. I am struggling and dr wants me to continue. I am trying to cope with die off symptoms which affect me a lot.
Hi Mario,
If you are having an intense detoxification reaction or herxheimer it is likely that you are overwhelming your body’s detoxification ability. In that case I always suggest patients slow down on treatment
warmly
DR Jill
Thanks…
I have stopped for now. My body feels numb. Is this normal… drinking a lot of water… It is and feels very strange My doctor wants me to continue with the pills. All he says is that it is normal.
Hi Dr. Jill
I am on my 3rd day of Organic Olivia’s parasite cleanse. I’ve had horrible herx reaction. Got flu like symptoms, sever headache, chest pain sore throat. It all started just a few hours after taking my first dose and now 3 days later it hasn’t gotten any better. The only reason I started this cleanse was because I had a case of pinworms. Along with my cleanse I am taking garden of life raw probiotics 100 billion. I am not sure how much longer I can endure these side affects my headache is excruciating. I don’t want to quit but I’m not sure if I’m doing more harm than good? Any advice would be greatly appreciated.
Thank you!
Nicole
Hi Nicole
I am not familiar with that program but feeling terrible is never a good idea. A herx reaction means you are overloading detox system and need to slow down or increase support for detoxification. You may also be reacting to an ingredient in the cleanse.
warmly
Dr Jill
Doc,
I’ll try to keep this concise; I recently (late September) became unemployed and left behind a lifestyle that I have discovered was toxic and unsustainable. Towards the end of my time at the job I was eating out two to three times a week, drinking a thermos full of coffee and smoking cigars on occasion, sometimes once or twice a week. After a few weeks of unemployment I started doing some light exercise and unexpectedly became bored with being home all day with all sorts of freedom. I was looking forward to it for a few weeks before transitioning to more schooling and new work.
Fast forward to now, I’ve started having increased anxiety and depression, something I’ve not had much experience with. I don’t have a good reason to be depressed or anxious, but I did some research into my toxic habits and discovered that an imbalanced gut environment could be at the root of my causes. I’ve started taking probiotics, multivitamins and fish oil supplements to try and re-balance the gut. Also, these past few days I took some garlic and oregano oil supplements to try and kill the excess bacteria, and it seems to have worked. I’ve been itching in various spots and have had bouts of minor drainage/ brain fog/mild depression as a result. I’ve been drinking lots of water and have adjusted my diet. No more coffee, cigars are gone and I am working to curtail my stress. I’ve also gotten back into taken herbs like lemon balm, st. john’s wort and ashwagandha.
My point in writing is to ask how long it generally takes to re-establish the gut biome that is necessary for these symptoms to ease. I’ve read various timelines, but am uncertain as to how long it takes.
Also, do you find coffee to be an okay addition to gut flora?
Hi Shane,
That is wonderful! I’m awfully proud of the fact that you took the initiative to get healthy and work on the gut! Balancing the gut starts with a very clean diet (generally gluten-free, dairy-free, processed food-free and sugar-free at the very least) As you mentioned, avoiding sweetened beverages and alcohol is also key. Probiotics are a great next step. Dealing with the dysbiosis with herbal regimens should improve the gut in 8 weeks or so. However, if you hit a road-block, be sure to find a functional medicine doctor to test so that you are not missing anything.
Best to you
Dr Jill
Hi dr Jill, I have been stuggle with an yeast infection for months now, I have tried everything, diflucan, flucess, vaginal inserts and nothing seems to work, I then ordered a bottle of yefense my symptoms started to clear up finally but however I find myself feeling tired and experiencing cold sweats and chest pains, overall I feel terrible I don’t know if to discontinue, but it’s the only thing that’s working for me
Hi Chrissy,
You might try backing off on dose for awhile and working with detox tips. IF that doesn’t help, then stop the product
warmly
Dr Jill
Dr, I suffer from all of these symptoms. My psychiatrist wrote me 150mg qd diflocan for 2 weeks, then nystatin for 3 months. I’m concerned about the hormones I take. I have secondary hypogonadotropic hypogonadism. Pituitary gland is “asleep”. I take testosterone cyp and arimidex because my estroidiol is 125. Also I have factor v lieden mutation (heterozygous). High risk for DVT / PE. The steroids are required for life so I hope that is not a problem. Oh, I eat a gallon of ice cream every night. I know this must stop. Thanks
Joshua Tackett
[email protected]
Hi Joshua,
Cut out sugar and ice cream and you will be doing yourself a huge favor!
warmly
Dr Jill
Hi Dr Jill,
I have a history of Lyme disease and have been dealing with leaky gut and yeast overgrowth issues off and on for many years. Recently I have been on a protocol of diflucan, prescription strength probiotics and L-Glutamine powder with immunoglobulin IgG. I also take digestive/pancreatic enzymes with each meal. I also use bioidentical hormones, Biest cream and testosterone. Do the hormones contribute to the fungal dysbiosis in my body?
Hi Susan
Estrogens can make it more difficult to eradicate fungal infections.
warmly
Dr Jill
Hi Dr Jill,
Thank you for the great article. My naturopath says I’m going through a healing crisis right now. I’m doing plenty of research about it. Most articles and books say they usually last about 2-3 days and in rare cases a few weeks. Have you seen any cases where a person has flu-like symptoms or fever/chills/sweats for over a week during a healing crisis?
Thank you!
Laura
Hi Laura
It can certainly last longer than a few days… I suggest cutting back on your regimen and increasing detox methods, like sauna, hydrotherapy and epsom salt baths.
warmly
Dr Jill
Hi Dr. Jill,
Great article. Thank you for it. I have been suffering with vulval lichen sclerosus for nearly 10 years. I suspect I have major gut dysbiosis, and have been slowly transitioning to Full GAPS, to then start Intro once I have some time off work in the summer. I am off most grains, only have small amounts of honey and fruit daily, nothing processed, eco meats. I live in Spain and my monetary limitations have made me really need to transition more slowly than I’d like. (I also cannot afford any naturopath, and the national health system wants me to continue steroid and hormonal treatment, despite a decade of them failing, and causing a whole host of additional problems.
I read that borax can be helpful for those with LS, and began doing twice weekly soaks with 1 Tbs. of borax (in a small tub). I then got so sick, I thought I had a 2-week long flu, until I realized this could be a Herxheimer reaction. I backed down to 1 tsp in a bath a week, and after the first 2, I was fine at that level, but my 3rd, again, I woke up and all the same symptoms, congested, nauseous, mild headache, chills, swollen glands in my throat, body aches. Do you think that such a small amount of borax in bath water can have such a big impact? I will again back off. I really can’t mother or work feeling constantly like I’m nursing a flu, but at the same time, I am noticing improvements to my vulval skin. I plan to try some of your suggestions! Sorry for the length … I guess I needed to unleash my perpetual state of imbalance. Thanks!
I don’t know what it is I’m dealing with but I believe it’s candida. I believe I was misdiagnosed with anxiety/panic and it actually was this. I have been sick for over a year now. I’m 6 months off the doctor rx’d medication for the anxiety. It’s been a total nightmare. During this time, I developed yeast in my mouth and in my urine. I was rx’d Nystatin and then later Diflucan as the former failed to rid it all. It seems to just re-occur. The pain from this is unreal and I’ve been experiencing a lot of off moods-crying hysterically and just feeling so off. I’m wondering if that sounds right for candida or something else..I so need help with this..thank you
Hi Kim,
You may need to support your immune system or look for what might be causing the recurrence…. things like weak immunity and mercury can make candida hard to eradicate.
warmly
Dr Jill
Hello ,My ND tested me (via stool and saliva samples) for suspected parasites but found that i have moderate yeast with low total salivary sIgA level. He started me on oil of oregano tablets, soil based probiotic and caprylic acid. Ive been taking the combination for 3 weeks and feel worse! nausea, acid reflux, lump in throat, stomach pain. Could my symptoms be die-off symptoms? I had all these symptoms prior to starting the treatment , all the symptoms started right after i had a miscarriage. I believe excess hormones from pregnancy cause the imbalance in my guts. Would you agree?
Hi Tyra, this is quite typical… I suggest decreasing dose and going more slowly with treatment until you can tolerate the full dose. You may need to assess immune function and other factors like mercury levels, too
warmly
Dr Jill
Hello Jill
My ND linked me in to your article. I have Hashi’s, under active thyroid, SIBO and Candida. I have debilitating anxiety most days along with nausea. I am GF, dairy and sugar free and following Bi-Phasic Diet. My ND says I am methane dominant but my levels arn’t that bad. She says I also have histamine problems. She is treating my SIBO and has me on numerous supplements. I started on Neem (1 three times daily) about a month ago and added in some Allimed starting on a quarter cap a day and I built up to 3/4 cap where I have been now for nearly 3 weeks. A couple of days after starting the Allimed I think I had some awful die-off which lasted a couple of days. I had a good week last week with little or no anxiety, 5 days in a row is the most I have felt well in over 2yrs. But a week ago I started to go downhill again with the anxiety, nausea, fatigue, weak, brain fog, aching joints. My ND says that die-off can come in waves and she believes it’s happening again. She gave me Toxaprevent, charcoal, high dose VitC for the die-off. She said that Allimed doesn’t suit everyone and I wondered whether I should stay on the 3/4 cap or lower it. What would you advise please?
Do you think I am experiencing die-off again? I feel very frightened as I write because it feels like my head is going to explode and I am in fear and flight mode constantly. Are these normal symptoms?
Amongst many supps I am also taking HCL & Pepsin and Designs for Health Plant Enzymes but I spotted in your article not to have plant enzymes. Why is this please? My ND didn’t seem concerned by them.
My symptoms are not being helped by the fact that my T3 is very low, I don’t seem to be able to convert well and I don’t understand why, nor did my former Endo.
I have asked my ND if there are any other tests she can do, although I have had many over the last 2 yrs trying to find out what is wrong. I also have a very long history of anxiety and I am 55 now; in fact anxiety is troubled me for most of my life. I did have a 23andme test done last year which picked up various things but I know that test isn’t accurate. My ND recommended a mycotoxin and dried urine neurotransmitter test would be useful. I did have an Organic Acid Test done a few months ago and she recommended that we could do it again (but no the genetic side of it). I so need more help right now. She is my third ND, so much better than the last two but it doesn’t hurt to ask someone else’s opinion. Hope to hear from you, thank you, Jennie
Hi Jennie
Many plant based enzymes are made with aspergillus which can be a problem for mold/yeast sensitive patients
warmly
Dr Jill
Hi Jill, me again. Spoke with my FD about my plant enzymes and she has recommended Designs for Health Digestzymes but then in the next sentence she said to take just one with each meal because they are quite potent which has worried me now in trying them, not that my SIBO levels are that high apparently. I was going to have a look around to see what is available but I have no idea what I am looking for as regard ingredients. She has recommended Designs for Health digestzymes. Do you think they are a good one for me pleaseCan you help please? Thank you
Hi Jennie,
Yes, that sounds like a good idea…some patients also need betaine HCl
warmly
Dr Jill
ingredients:- Betaine HCL 200 mg
GastroENZ™ Proprietary Blend 180 mg
Ox Bile Extract, Protease (DPPIV), Amylase, Pepsin, Protease SP, Glucoamylase, Lactase, Acid Protease, Invertase, Lipase
Because of a throat infection, I went on a detox and took colloidal silver. Maybe too much. I developed anxiety and think it may be a herx. What can I do?
Hello! Im wondering how much is tOo much w symptoms from die off. I have some achiness and trouble sleeping, but nothing else really. I read alot about slowing down when you have candida symptoms but i dont feel like the symptoms im having are too much. I am takihg omegas, vitamins w aloe vera for obsorption, and milk thistle for liver help.
Hi Lori,
That is quite possible. If you feel poorly you may need to slow down or stop your treatment plan
warmly
Dr Jill
Hi Dr. Jill
This is a very helpful posting.
A quick question…What dosage of molybdenum do you recommend to help mitigate candida die off symptoms?
Thank you
500mcg to 1mg twice daily
Thank you for this very helpful information. I started treatment for Candida overgrowth a few weeks ago. I started to have die-off symptoms (headache, abdominal bloating/cramping and flu-like symptoms. Symptoms would resolve if I decreased dosages of herbals and increased hydration/rest. However, each time I increase the herbal amounts the symptoms get worse.
Would a dietary supplement of Beef Liver (Vital Proteins capsules) also help with liver congestion?
Hi Christine,
You might need to go slowly and support the detox routes with NAC, R Lipoic acid and milk thistle in addition to epsom salt baths
warmly
Dr Jill
If doxycycline is taken for ivf treatment pre implantation and it creates symptoms of dizziness and feeling sick can this be related to heavy metals (amalgams) and liver being sluggish? Also citrate lowers ceruloplasm which is also liver implication of not having elimination pathways being helpful in removing toxins that the doxycycline might be trying to force out. Should there have been heavy metal testing or candida Dino testing prior to starting In vitro preimplantation phase. Thanks.
Molybdenum is also a problem with copper issues. Not sure it does not create problems.
What are you thoughts on coffee enemas for detox ? Bentonite clay?
Thank you for all your wonderful information.
Some patients find these incredibly helpful. I love clay and charcoal for binders.
Hi Dr. Jill,
I believe I am experiencing die-off reaction in the form of a rash that is mostly located in my armpits. I’ve been taking probiotics, following the anti-candida diet, and taking the supplement, saccharomyces boulardii. The rash went from being 4 small spots to over 26 large spots. Do you recommend doing a liver cleanse and if so, what cleanse do you recommend?
I was taking candidase for balancing yeast levels, I have read many good reviews about this product but as for myself, I started having an odor while taking these supplements. I stopped the pills and I’m noticing the odor just a couple of times a day. I take an epsom salt soak every day. It’s been a couple of weeks. Do you have any suggestions please. Thank you
I suggest stopping and adding probiotics like lactobacillus now
Thank you for the quick response!