A Herxheimer Reaction, or die-off, is a response that some people may experience when starting certain health protocols aimed at addressing bacterial, fungal, parasitic, and viral challenges. This reaction can cause various uncomfortable symptoms, which might make it difficult to continue with a health plan. However, these symptoms are typically temporary. It's important to work with a healthcare provider to manage any discomfort effectively. Read on to learn about a functional medicine approach to easing Herxheimer symptoms.
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What is a Herxheimer Reaction?
A Herxheimer Reaction, also known as Jarisch-Herxheimer Reaction (JHR) or die-off, is a response that can occur in individuals undergoing certain health protocols. JHR was first described by Austrian dermatologist Adolf Jarisch in the late 1800s when he noticed increased skin lesions in a patient after starting a health protocol for syphilis. A similar reaction was reported later by German dermatologist Karl Herxheimer. (1)
How Long Does a Herxheimer Reaction Last?
Not everyone undergoing a health protocol will experience a die-off reaction. For those that do, symptoms generally appear within 24-72 hours of starting the protocol. Symptom duration varies, but symptoms are usually self-resolving within 3-7 days. Sometimes, a person may experience Herxheimer symptoms throughout the course of the protocol. (2)
Herxheimer Reaction Symptoms
The most common die-off reactions appear flu-like in nature, including (1):
- Fatigue
- Brain fog
- Headache
- Body aches and pain
- Skin rashes
- Gastrointestinal symptoms: bloating, diarrhea, constipation, abdominal pain, nausea
- Fever and chills
- Changes in mood and increased irritability
Individuals experiencing a Herx Reaction often note that the symptoms present prior to starting the protocol are exacerbated, making it seem as though the Herx symptoms are simply signs of the underlying challenge.
Additionally, individuals often stop the protocol due to fear that Herx symptoms are signs of an adverse reaction to the agents used. Providers must distinguish between die-off and allergic symptoms, which usually occur minutes to hours after initiating the protocol and include nausea, diarrhea, hives, itching and tingling, swelling of the airways, and difficulty breathing (2).
What Can Cause a Herxheimer Reaction?
A Herxheimer Reaction is caused by the body's response to the breakdown of pathogens (e.g., bacteria, virus, yeast) and the resulting immune response. When a pathogen breaks down, it releases substances into the body, which can trigger an immune response. The human body has pathways to manage these substances, including the gastrointestinal tract, liver, lymphatic system, kidneys, and skin. However, these pathways can become less efficient for people with chronic challenges, contributing to a buildup of byproducts and intense Herxheimer symptoms. (3, 4)
Three common reasons for the onset of Herxheimer symptoms are starting an elimination diet, introducing probiotics, and starting certain supplements or prescriptions. Elimination diets, such as the low-FODMAP or anti-Candida diets, limit foods from the diet known to feed certain microorganisms in the gastrointestinal tract. Beneficial probiotics can support the growth of helpful organisms and contribute to a balanced intestinal environment. Finally, certain supplements or prescriptions may support the body's natural defenses.
Herxheimer Reaction can occur with the initiation of a protocol for various types of challenges. Chronic challenges are more likely to cause die-off symptoms, given the increased total load and their tendency to affect overall well-being. Commonly addressed challenges by functional medicine practitioners that are likely to cause die-off symptoms include chronic Lyme disease, SIBO and intestinal methanogen overgrowth (IMO), chronic Epstein-Barr Virus (EBV), Candidal overgrowth, and intestinal parasites.
Functional Medicine Labs to Test for Root Cause of Herxheimer Reaction
Below are labs to consider discussing with a healthcare provider before initiating a protocol to assess the status and function of elimination and detoxification pathways. Identifying imbalances in these pathways and supporting the organs of elimination prior to starting a protocol can help manage and reduce the severity of potential die-off reactions.
Liver Function
The liver is the primary organ of detoxification through phase 1 and phase 2 biochemical pathways. A liver panel measures markers of liver function and inflammation. If liver function is not optimal and inflammation is present, Herx reactions are more likely to occur due to the inability to manage and eliminate substances through the liver efficiently.
Kidney Function
Once substances have been converted to water-soluble compounds by the liver, the kidneys are responsible for eliminating waste products through urine. Kidney function can be measured with a kidney panel.
Comprehensive Stool Test
Many substances are eliminated from the body through stool. Individuals with digestive dysfunction, especially constipation, may be more prone to Herx symptoms if substances cannot be eliminated through stool and are instead reabsorbed into circulation, contributing to systemic inflammation. A comprehensive stool test measures various markers related to digestive health and function, providing information that helps guide recommendations to support gut health and bowel movements.
Genetics
Genetic variations (SNPs) can change the function of enzymes involved in phase 1 and phase 2 detoxification pathways, increasing the risk of reduced detoxification capacity. Understanding SNPs can help predict an individual's response to certain medications and supplements and assist in making specific recommendations to support detox pathways.
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Functional Medicine Approach to Managing Herxheimer Reaction
Effectively managing die-off symptoms requires understanding the variables that impact symptom etiology and severity. While it is important to remember that a Herx reaction is usually self-limited and self-resolving, initiating a protocol to manage and alleviate symptoms can ease discomfort and support adherence to the protocol. Slowly adjusting dietary and other interventions, reducing systemic inflammation, and supporting the body's natural pathways are critical in minimizing Herx symptoms successfully.
Nutrition and Dietary Considerations for Herxheimer Reaction
Extreme elimination diets can cause die-off symptoms and restrict essential nutrients needed for overall health. While minor dietary adjustments can be beneficial to supporting a healthy gut, such as limiting refined sugar and certain processed foods, emphasis should instead be on incorporating nutrient-dense, anti-inflammatory foods into the diet.
An anti-inflammatory diet, such as the Mediterranean diet, emphasizes eating a wide variety of fresh, whole fruits and vegetables, unsaturated fats, whole grains, fatty fish, tea, herbs, and spices. Fermented and live-cultured foods (i.e., yogurt) also support a healthy microbiome and intestinal health and may help reduce inflammation. (5)
In addition, how you prepare and cook food can matter just as much as the food you eat. Avoid deep frying and grilling at high heat to avoid intake of saturated and trans fats and advanced glycation end-products (AGEs) created by high-heat cooking. Instead, cook your foods by steaming, baking, or stir-frying over lower temperatures. (5, 6)
Supplements and Herbs That May Support Herxheimer Reaction
Adding dietary and herbal supplements can provide additional antioxidant and detox support to help manage inflammation and support the body's natural processes.
Activated Charcoal
Activated charcoal is a broad-spectrum gastrointestinal binder that may help manage substances in the digestive tract. Binding and eliminating substances may help prevent them from irritating the gastrointestinal lining and from being reabsorbed into circulation, potentially reducing inflammation and die-off symptoms.
Vitamin C
Vitamin C is a potent antioxidant that may help manage free radicals to limit their effects and reduce inflammation. Along with supplemental oral vitamin C, you can increase vitamin C intake through diet by increasing your intake of citrus fruits, tomatoes, bell peppers, strawberries, and cruciferous vegetables.
Magnesium
Magnesium plays many essential roles in the body. Regarding the Herxheimer Reaction, oral magnesium may support regular bowel movements, helping manage elimination through the bowels.
Liver Support
The liver is the primary organ that helps manage substances in the bloodstream. There are many natural supplements and herbs that may support phase 1 and phase 2 liver detoxification pathways, including N-acetylcysteine (NAC), glutathione, milk thistle, turmeric, and dandelion root.
Additional Complementary and Integrative Approaches for Herxheimer Reaction
Additional strategies to support pathways and manage Herxheimer symptoms include the following:
Sauna
Infrared sauna therapy is a method that may support detoxification through sweating (7). Staying well hydrated and replacing electrolytes after sauna therapy or any other activity that stimulates sweating is important.
Epsom Salt Baths
Epsom salt is rich in magnesium and sulfate. Soaking in an Epsom salt bath may help increase systemic magnesium and sulfate levels, both important for detoxification pathways. Additionally, hot baths can ease aches and pains, stimulate sweating, and promote relaxation.
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Summary
A Herxheimer Reaction is a set of symptoms caused by a natural immune response to initiating a health protocol. Although die-off can be uncomfortable, it may indicate progress in addressing a challenge. Working closely with a healthcare provider can be beneficial to distinguish Herx symptoms from a symptom flare or an adverse reaction to the protocol. Many interventions can be implemented before and during a protocol, focusing on reducing inflammation and supporting pathways. Doing so can help manage and ease symptoms of a Herxheimer Reaction.
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