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Die Off Symptoms: Why You Feel Worse Before You Feel Better and What to Do About It

Have you, or someone you know, ever had a yeast, parasite, or bacterial infection and, after taking prescribed medications, ended up feeling even worse? We refer to this as "die off". Although this does not occur often, it is more common than you think.

But what is die off, why does it make you feel so bad, and is there something you can do about it?

What Is Die Off?

An image of a woman sitting on the couch as she sneezes into some tissueDie off is often referred to as a Herx reaction. It first gained attention when people with syphilis received antibiotics towards the end of the 1800s. They noticed that numerous people, within about 24 hours, felt worse after receiving their treatment. The various symptoms exhibited included headaches, fever, chills, and an increase in skin rash activity.

These days, those in the healthcare industry often see die off in those receiving appropriate medications that address bacterial, parasitical, or yeast infections. This is especially the case when people use natural medications. Essentially, die off happens when the death of infecting cells creates toxins and an immune reaction as your body tries to remove the toxins.

Die off goes through three stages.

Stage 1: Cellular Death

When you take medication to kill any infection resulting from bacteria, yeast, or parasites, the resulting cell deaths begin a cascade of events that could result in either worse, or new symptoms arising. For the purpose of this explanation, we will talk about a candida infection. But a similar sequence of events could occur for Lyme disease, small intestinal bacterial overgrowth (SIBO), or other infections. The process remains the same.

So suppose you take a medication to kill off an overgrowth of candida. First, you would see a breakdown of the biofilm around the yeast. The biofilm is what surrounds the yeast and protects it. Once broken down, however, the pathogens, in this case, the yeast, are released into your gastrointestinal (GI) tract.

In the case of candida, a yeast infection, we would refer to these released pathogens as beta-glucans. We would refer to them as lipopolysaccharides if it were a bacterial infection, or GPI-anchored glycolipids were it a parasitic infection. The bottom line is that all are toxins. And once released, these toxins trigger an inflammatory response governed by your immune system.

Stage 2: Immune System Activation

The release of these toxins kick-starts your immune system so that it can kill them and have them removed. Inflammation is the hallmark of an immune system fighting off toxins. You may experience a variety of new symptoms during this time, and even see existing symptoms take a turn for the worse. Many people, during this period, experience worsening symptoms such as headaches, aches, pains, and more.

Stage 3: The Detoxification Process

The toxins and bits of biofilm cannot stay in your body. They need to be eliminated. The obvious method is via excretion in stool. This poses no problem in those who have a healthy GI tract and intestinal lining. But for those with GI issues, such as leaky gut, this causes many health issues.

Leaky gut means the intestines are hyperpermeable. In other words, it allows all kinds of organisms to pass into the bloodstream because the spaces between the individual cells of the gut lining are larger than they should be. When these toxins leak into the bloodstream, they can cause a systemic attack on the body caused by your own immune system, as it becomes unable to properly differentiate toxins and its own cells.

At this stage, your immune system will make use of your liver and lymphatic system to filter any toxins and send them for elimination via your colon, skin, and kidneys.

Now, if your Detoxification Circuit works well, this still does not pose a problem when die off occurs. But if you have had GI issues for years, these detoxification pathways become slow or sometimes blocked. Your body may find it increasingly difficult to eliminate the toxins, meaning they continue circulating through your body. This means it may take your body much longer to get rid of them. Your die off symptoms may thus last much longer than usual.

The Role of Your Detoxification Circuit

An image of viruses floating towards the human bodyYour Detoxification Circuit forms part of your NeuroEndoMetabolic (NEM) stress response. The NEM is the system that governs your body’s perception, management, and recovery from stress. This stress may result from psychological, physiological, or environmental issues. In this scenario, stress is a result of an infection and the accompanying die off.

Your Detoxification Circuit is made up of your immune system, extracellular matrix, and liver. Together, these three rid your body of any toxins resulting from stress, such as the release of toxins due to die off. When healthy, your Detoxification Circuit addresses this stress without you knowing about it. But when in a state of imbalance, a variety of symptoms occur. These include anxiety, constipation, bloating, headaches, insomnia, and autoimmune flareups, amongst others.

When your liver is unable to keep up with the demand for clearing toxic metabolites, congestion can develop. As a result, damage can occur to your liver and the immediate extracellular space. Systemic inflammation may result as well.

Such a situation impacts your immune system. Due to an increase in toxic metabolites in your system, your immune system may become hyperactive. And instead of fighting off the problem, a hyperactive immune response may result in the creation of even more symptoms.

A Detoxification Circuit in a state of imbalance is especially disruptive if you also have adrenal fatigue. It may even result in adrenal crashes that could have severe consequences.

3 Common Causes of Die Off Symptoms

Understanding how the die off process works is one thing. But it leaves the question of why they occur in the first place.

While die off symptoms may have numerous causes, these three are the most common.

  1. Anti-fungal, antibacterial, or antiparasitic medications or supplements. These are commonly used for such an infection and are highly effective in getting rid of them. However, this sudden influx of toxins makes them the most common cause of die off symptoms.
  2. Probiotics. Probiotics are helpful, but they also promote a sudden increased growth of ‘good’ bacteria and a speedy decline in ‘bad’ ones.
  3. Dietary changes. When you suddenly change your diet to a healthier one that eliminates sugary or processed foods, you may find die off taking place. This is because the various pathogens in your gut suddenly have no fuel to ensure their survival, resulting in die off.

In the majority of die off cases, the symptoms shortly clear up on their own, although extreme cases may need some form of intervention. This usually happens due to Detoxification Circuit dysfunction.

Symptoms Associated With Die Off

While the most common die off symptoms closely resembles those of the original infection, they tend to be worse. You may also experience an increase in different symptoms. It is thus quite normal that, when addressing the initial infection, you often feel worse for a few days before you see signs of improvement. The most common symptoms include the following:

An image of a man taking his tempature and holding his hand to his forhead

  • Fever
  • Chills
  • Stuffed nose
  • Fatigue
  • Aches or pains throughout the body
  • Feelings of anxiety
  • An increase in GI issues

Many people may think they are dealing with a cold or flu, judging from these similar symptoms.

Many people also find they develop a skin rash. This quite normal reaction is due to the body trying to expel toxins through the skin. People suffering from eczema or psoriasis may experience a flare-up during this time.

Other Causes of Die Off Symptoms

Before you ascribe all your possible symptoms to die off, it is important to consider other causes. Examples include:

  • Other inflammatory sources, including excessive exercise, an injury, or even emotional stress.
  • Food intolerances or sensitivities, often found in those suffering from any type of gut dysfunction. These are often immune responses to certain food compounds.
  • The life cycle of certain parasites, usually between one to three weeks, often results in a flare-up in symptoms similar to those experienced during die off. If this is the case, your parasites have not died off and are very much alive. You may need to address this.

How to Deal With Die Off Symptoms

Your die off symptom severity depends on how quickly the pathogen dies off, how many toxins are released in your body, your immune response, the corresponding amount of inflammation, and the health of your Detoxification Circuit.

Managing your symptoms, however, focuses on several natural support measures. These measures support gut health, help address inflammation, and promote healthier detoxification pathways.

  • Herbal supplements and natural antimicrobials, a gentler approach to dealing with initial infections, can cause die off but not to the extent typically seen when using conventional antibiotics.
  • Improve your gut health by following a natural gut-healing diet.
  • Introduce appropriate supplements slowly. This may limit die off speed and thus limit symptoms.
  • Make sure you get enough sleep to allow your body time to heal. Enough rest also allows your body to better manage inflammation.
  • Try to limit your stress exposure. This implies both physical and mental stress. Do not over-exercise during this time, for example.
  • Consider the use of natural anti-inflammatories. Good anti-inflammatory supplements include omega-3 fatty acids, quercetin, vitamin C, and glutathione. Anti-inflammatory food choices containing omega-3s include fatty fish, flaxseed, and walnuts. Leafy green vegetables and berries are good antioxidants, while spices like cinnamon, turmeric, and ginger also have anti-inflammatory properties.
  • To support your liver function, and thus promote Detoxification Circuit health, you could consider the use of certain herbs such as dandelion, glutathione, and milk thistle.
  • Using a GI binder may also help with detoxification. They may help get rid of toxins because they bind to them. The result is then eliminated through the usual pathway. Examples of GI binders include activated charcoal, bentonite clay, and chlorella.
  • Drink plenty of water. Fluids help flush toxins from your body. So, always drink enough water.
  • Using an infrared sauna increases blood circulation and promotes sweating. Sweating is one of your body’s ways of releasing toxins and so promotes detoxification. Be sure to stay hydrated and have plenty of electrolytes with this method.
  • Taking an Epsom salts bath increases your magnesium levels. This may reduce the aches or pains associated with die off. It also helps remove toxins and is extremely relaxing. It may also help increase your body’s sulfate levels, which play a role in detoxification.

In Closing

An image of a woman streatching in bedWhile not pleasant, the symptoms associated with die off tells you that your immune system is actively working to heal your body from a parasitical, fungal, or microbial infection. And though you may feel worse during this period, it does not last too long. You will soon feel better. But there are steps you can take to manage these symptoms and improve your health overall.

If suffering from die off symptoms, the following may help alleviate the situation.

  • Try making dietary changes that support immune and detoxification functions.
  • Consider adding support supplements slowly.
  • Get enough rest and stay hydrated.
  • Consider a sauna or an Epsom salt bath to help support detoxification.

When considering supplements or other protocols for die off management, please do so with the advice of your healthcare practitioner. They are best able to determine dosage and suitability.

If you would like to know more about or need assistance in dealing with die off, the team at Dr. Lam Coaching can help. We offer a free** no-obligation phone consultation at +1 (626) 571-1234. We will privately discuss your symptoms and various options. You can also send us a question through our Ask The Doctor system by clicking here.

© Copyright 2023 Michael Lam, M.D. All Rights Reserved.

Dr. Lam’s Key Question

Firstly, getting rid of infectious agents may ultimately help improve adrenal health in the long run. On the other hand, your adrenals may become overtaxed during die off due to the increased symptoms and the extra work needed to detoxify your body. Thus, it's best to talk to a doctor aware of adrenal fatigue to discuss your options.

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