You’ve likely already taken some meaningful steps toward taking charge of your health. Perhaps you vowed to exercise more, get a better night’s sleep, or take control of your diet once and for all. Or maybe you ditched gluten, said goodbye to caffeine and alcohol, and bid refined sugar a bittersweet farewell. You feel great, right?

Maybe not. It could be that you felt terrific at first, and now you suddenly have flu-like symptoms or you’re dealing with headaches, brain fog, and even nausea. You might be thinking, “How could I possibly feel bad when I’m doing something so good for myself?” If this sounds familiar, it’s likely you are experiencing what is known as “die-off”.

Die-off, a form of a Herxheimer reaction, is a bodily process triggered by a sudden increase in endotoxins. Die-off is also fairly common when you first start avoiding certain food such as carbs, sugar, dairy, and alcohol. Die-off can cause irritability, fatigue, digestive issues, and other unpleasant symptoms that make sticking with beneficial lifestyle changes challenging to say the least. However, these symptoms are temporary, and the good news is you’re on the right track.

To help you avoid die-off — or to quickly remedy it — I have tried-and-true solutions. First, let’s discuss what die-off actually is and why it happens.

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What is Die-off?

When microorganisms in the body such as fungi, yeasts, and bacteria are destroyed, they rapidly begin releasing harmful substances called endotoxins into your bloodstream. Your immune system responds to this sudden flood of endotoxins by triggering an acute immune response resulting in inflammation that can be experienced throughout the body. This can lead to worsening die-off symptoms as well as the development of new ones.

Die-off or Herxheimer reaction is commonly the result of medications such as antifungals or antibiotics.1 However, what many people don’t realize is that die-off and its accompanying symptoms can also occur when they suddenly change their diets during a detox or cleanse — or switch to a healthy eating plan.

The Herxheimer Reaction

Die-off is also known as the Herxheimer Reaction or Jarisch-Herxheimer Reaction (JHR) and, despite how it may feel, is actually a sign that you’re going in the right direction. JHR was first described by Austrian dermatologist Adolf Jarisch in the late 1800s when he noticed an increase in skin lesions in a patient after starting antibiotic treatment for syphilis. In the early 1900s, a similar reaction was reported by German dermatologist Karl Herxheimer. 

The Jarish-Herxheimer reaction often goes untreated because symptoms such as fever, chills, body ache, and skin rash are often present before treatment, so worsening symptoms after treatment are simply overlooked as signs of the underlying infection. More commonly, however, the Herxheimer reaction is often mistaken for an allergy to antibiotics. 

As I mentioned above, the Herxheimer reaction occurs when microorganisms such as fungi and yeast are destroyed, meaning your treatment, diet, or detox is working. However, an increase in toxins is never a good thing. All those endotoxins released by dying microorganisms can place extreme strain on your detoxing organs as they attempt to bind and flush them out of your system. Plus, the longer toxins remain in your body, your chances of reabsorbing them increase drastically.

What Causes Die-Off?

Treatment of viruses, bacteria, and fungi, whether that be by taking antibiotics or starting a low-carb diet, can trigger a Herxheimer reaction. Die-off symptoms typically appear within six to eight hours after beginning treatment and resolve as you continue dieting or taking your prescribed medication.

Die-Off in Action

The bacteria and yeasts that live in your gut thrive on sugar. A small amount of these bacteria and yeasts, including Candida, are critical for digestion and beneficial to your gut health. However, if you’ve been consuming a diet high in carbs, sugar, and alcohol, you likely have a lot more of these microorganisms than your body needs. Through complex chemical processes, these microorganisms fuel your desire to consume even more carbs and sugars. So when you limit your intake of sugar and carbs, it starves this overpopulation, causing a Herxheimer reaction.

As yeasts die, they release a toxic substance called acetaldehyde, which is the same byproduct produced when you drink alcohol. As yeasts die, they release a toxic substance called acetaldehyde, which is the same byproduct produced when you drink alcohol. Acetaldehyde is a neurotoxin that can be irritating to your brain and cause neurologic symptoms, which is why some people literally feel as if they are drunk while experiencing die-off. To make matters worse, yeast also produces a toxin known as gliotoxin. This can suppress your immune system and damage your liver cells.2 Because your body is being flooded with toxins faster than it can clear them, you can experience a range of issues that typically last 3-7 days.3

Die-off Symptoms

The Whole Body Symptoms of Die-off – Infographic – Amy Myers MD®The Whole Body Symptoms of Die-off - Infographic - Amy Myers MD® Whole-Body Symptoms of Die-off – Infographic – Amy Myers MD®

Because there is an increase in toxins circulating in your bloodstream during a Herxheimer reaction, your immune system jumps into action by entering into a state of inflammation. This results in a range of die-off symptoms that vary in duration and severity.

You are more likely to experience die-off symptoms if your detox pathways are compromised (e.g. if you have an MTHFR mutation), or you already have a high toxic burden and the dying microorganisms are overwhelming your system. You could also simply be clearing an overgrowth of pathogenic or opportunistic microorganisms too quickly.

Candida Die-Off

Candida die-off is a result of treatments used to combat an overgrowth of Candida yeast cells.4 When Candida is overproduced by your body, it breaks down the walls of the intestine and penetrates the bloodstream. This releases toxic byproducts into your body and causes leaky gut. Candida die-off symptoms can come on suddenly and range in severity.5

Candida Die-Off Symptoms

The most common Candida die-off symptom is a low-grade fever. Fluctuation in body temperature is often accompanied by other Candida die-off symptoms such as nausea, headache, or chills. In the flare stage, a Herxheimer reaction causes an aggravation of Candida die-off symptoms as your body attempts to flush the excess endotoxins from your body. 

You might notice Candida die-off symptoms beginning within a few hours of your first treatment and resolving within 24 hours. However, this can vary depending on the severity of your Candida overgrowth. During this time, you might experience Candida die-off symptoms such as:

  • Fever
  • Chills
  • Skin rash
  • Mild decrease in blood pressure
  • Muscle aches
  • Weakness

Another symptom to look out for is Candida die-off in stool. To identify Candida die-off in stool, look out for yellow, white, or brown mucus in your stool. Candida die-off in stool can also cause string-like or foamy consistency in your stool.

Do you think you have Candida overgrowth? Take this simple quiz to find out!

Minimize Candida Die-off & Fight Candida Overgrowth

While small amounts of yeast and Candida are normal inhabitants of your digestive tract, stress, a high sugar diet, a lack of healthy probiotic bacteria, immune suppression, and antibiotic use can cause it to grow unchecked and contribute to disease. You can take on Candida today by following the 30-day Candida Breakthrough® Program, which is formulated to minimize Candida die-off symptoms in addition to chronic Candida symptoms such as digestive issues, fatigue, brain fog, recurrent fungal infections, skin problems, mood swings, and more. 

By following the simple and proven three-action approach that includes all the powerful nutritional supplements to support yeast balance in the digestive tract and discourage opportunistic yeast growth AND an easy-to-follow anti-Candida diet meal plan full of foods that kill Candida, you will:

  1. Starve the Candida by removing foods that feed it from your diet. This means eliminating all sugar and alcohol, and restricting carbohydrates such as fruit, starchy vegetables, grains, and legumes. It also means ditching all fermented foods
  2. Attack the Candida by taking supplements that destroy Candida’s cell walls. The Candida Breakthrough® Program includes Candifense® and Caprylic Acid, both of which are excellent at breaking down the walls of Candida cells to destroy them. 
    • Candifense® is an enzyme-based formula capable of breaking down cellulase, the substance that makes up the cell wall of many opportunistic yeasts, including Candida albicans. It is a safe, effective, and gentle approach to maintaining a healthy balance of microflora throughout the digestive tract.
    • Caprylic Acid is a great way to support yeast balance throughout the body. This short chain fatty acid is well known to create an inhospitable environment for opportunistic yeast, especially in cases of Candida overgrowth.
  3. Repopulate your good bacteria by taking a high-potency probiotic that keeps Candida under control. While battling Candida, I recommend a probiotic supplement containing 100 billion colony-forming units (CFUs) to restore your gut’s healthy microbial balance. The Candida Breakthrough® Program contains my Probiotic Capsules 100 Billion: a potent, fourteen-strain probiotic for maximum digestive health and immune support that are excellent at crowding out Candida yeast and producing beneficial lactic acid in the gut, which Candida overgrowth hates!

SIBO Die-Off

Small Intestinal Bacterial Overgrowth, or SIBO, occurs when the bacteria in your small intestine become unbalanced and overgrow. Most of your gut bacteria are meant to be located in your large intestine and colon, where they help break down food, synthesize vitamins, and eliminate waste. When bacteria normally found in the large intestine and colon begin to colonize in the small intestine, bacterial overgrowth occurs. Small intestinal bacterial overgrowth can also occur when there is an overgrowth of otherwise normal bacteria in the small intestine itself. 

After you begin treatment, and the overgrown microbiota begins to die, your immune system kicks into high gear to combat the increase in endotoxins being released into your system, causing a wide range of SIBO die-off symptoms.

SIBO Die-Off Symptoms

As the dying microorganisms fight to stay alive in your gut, you might experience SIBO die-off symptoms such as:

  • Chills
  • Fatigue
  • Headache
  • Muscle aches
  • Brain fog
  • Exacerbation of SIBO symptoms (bloating, constipation, diarrhea, etc.)

You may experience only one of these SIBO die-off symptoms, or you may even experience all possible SIBO die-off symptoms at once.

H Pylori Die Off Symptoms

Helicobacter pylori (H pylori) is a type of bacterial overgrowth that causes chronic inflammation in the gut and is a common cause of ulcers worldwide. H. pylori causes inflammation by invading your stomach lining and producing a cytotoxin called vacuolating cytotoxin A (Vac-A), which can lead to ulcer formation. Because H. pylori infection disrupts the delicate balance of bacteria in your gut, it may be a precursor to developing full-blown SIBO. H. pylori die-off symptoms include: 

  • Digestive issues such as bloating, gas, nausea, and vomiting
  • Fatigue
  • Decreased appetite
  • Heartburn
  • Low red blood cell count (anemia)
  • Peptic ulcers
  • Bad breath

Do you think you have Small Intestinal Bacterial Overgrowth? Take this quiz to find out!

Treating your SIBO is a 3-step approach that works to eliminate the overgrowth and restore your gut’s natural balance. My SIBO Breakthrough™ Program is a step-by-step process to help you beat small intestinal bacterial overgrowth for good. In it, you find all the information you need to get control over the overgrowth. With the SIBO Breakthrough™ Program, not only do you get information, supplements, and a solution, you also get the support you need to take on these three steps:

  1. Starve the overgrown bacteria by removing foods that feed it from your diet including sugar and alcohol and limiting inflammatory foods such as starchy vegetables, carbohydrates, grains, and legumes.
  2. Attack the bacteria. The SIBO Breakthrough™ Program includes Microb-Clear®, a potent combination of herbs and beneficial fatty acids to prune back the overgrown bacteria that don’t belong in your small intestine. What’s more, the cutting-edge botanical extracts in Microb-Clear® support optimal bacterial balance and play a beneficial role in supporting optimal yeast and parasite balance.
  3. Restore your good bacteria in your gut. The SIBO Breakthrough™ Program includes three powerful supplements to support a strong immune system, optimal digestion, and nutrient absorption. 
    1. Primal Earth Probiotic™ contains three highly researched strains of bacteria that don’t feed the SIBO fire, and instead are delivered in a seed-like protective barrier so they arrive intact in your large intestine and colon.
    2. Coconut Charcoal is activated charcoal derived from coconut shells to absorb the toxic byproducts released by the dying bacteria in order to ease die-off symptoms. 
    3. The Myers Way® Vanilla Bean Paleo Protein is amazingly delicious, gluten-, dairy-, and sugar-free so you can quickly and easily prepare the delicious smoothies included in the 30-day meal plan.

Parasite Die-Off

A parasite is any organism that lives and feeds off of another organism. Usually, intestinal parasites are parasitic worms that feed off the material in your body. Some examples include tapeworms, roundworms, pinworms, whipworms, and hookworms. Parasites can release neurotoxins, heavy metals, viruses, and other toxins when they die, resulting in a wide range of parasite die-off symptoms. What’s more, if you have an autoimmune disease and your body is unable to detox, those toxins are left to recirculate as they wait to be detoxified. This can exacerbate parasite die-off symptoms. 6 

Parasite Die-Off Symptoms

Parasites typically have life cycles that can last between 7-21 days, meaning parasite die-off symptoms can flare during certain phases of these life cycles. During a flare, parasite die-off symptoms include:

  • Fatigue
  • Headache
  • Skin rashes
  • Teeth grinding
  • Weight loss
  • Flu-like symptoms
  • Insomnia

These parasite die-off symptoms can be as unpleasant as the as the living period of a parasite, or even worse. If you are experiencing parasite die-off symptoms, it is important to take care of your health as soon as possible. 

The Myers Way® Parasite Breakthrough® Kit helps promote and maintain a healthy and normal population of probiotic bacteria in your digestive tract. It includes two powerful, pharmaceutical-grade supplements designed to help tackle the issue of microbial imbalance, as well as help populate the digestive tract with beneficial probiotic bacteria that are normal residents in your digestive tract:

  1. Microb-Clear® has the ability to create an inhospitable environment for opportunistic microorganisms such as parasites, and does a fantastic job of helping to promote the ideal environment for beneficial probiotic bacteria to move in and colonize the digestive tract. 

Probiotic 100 Billion Capsules help to repopulate your large intestine and colon with beneficial bacteria, often helping to restore normal digestion and optimal microflora balance.

How to Avoid Die-off

When you have an overgrowth of bacteria, whether it be Candida overgrowth or SIBO, it can break down the walls of your intestines—causing leaky gut—and is then able to travel throughout your body. From there it can colonize in your skin, ears, thyroid, respiratory tract, and other areas of your body, leading to a host of symptoms including brain fog, skin irritation, seasonal allergies, mood swings, and autoimmune disorders. And if you’re dealing with a parasite, these symptoms increase greatly as your detoxing organs become compromised.

So, if a Herxheimer reaction is an indication that you are clearing an overgrowth of bacteria and yeast from your body, why would you want to avoid it? Aside from feeling miserable, die-off is a toxic state. The longer your body remains in this toxic state, the more likely you are to reabsorb the toxins being released by the dying microorganisms.

So let’s take a look at some of the ways you can prevent Candida, parasite, or SIBO die-off symptoms while you transition to a healthy diet. Then, if you’re already experiencing die-off, I’ll cover the steps on how to reduce your symptoms so you can start feeling great again!

1. Go Slow

First, it’s important for you to be gentle on yourself. I don’t believe that you need to feel bad in order to feel good. When you clear an overgrowth of microorganisms too quickly, your body simply cannot handle the huge toxic burden from the acetaldehyde being produced. Take it slow! Begin by gradually transitioning to a diet of less sugar and fewer carbs each day to lessen your die-off symptoms. I also recommend supporting your body with a combination of supplements that naturally support a healthy balance of yeast in your digestive tract and encourage beneficial bacteria growth.

2. Reduce Your Toxic Burden

One reason you may experience die-off is that you already have a high accumulation of toxins in your body. Taming the toxins is crucial to help you avoid die-off symptoms. Review Pillar III of The Autoimmune Solution for tips on how to reduce your toxic burden.

3. Support Your Detox Pathways

Remember what I said about gliotoxin damaging your liver cells? Your liver is your primary detox organ. If your liver is not working optimally, it could be why you’ve been dealing with excess yeast in the form of Candida in your gut. This is why it’s so essential to support your detox pathways.

One of my favorite tools for supporting detox pathways is Acetyl-Glutathione. Glutathione is your body’s most powerful detoxifier, and can help your body process and eliminate toxins. As a bonus, glutathione supports your immune system. Supplementing with glutathione will help your body counteract the immunosuppressive effects of gliotoxin, and you’ll be better equipped to deal with die-off.

Steps to Reduce Die-off Symptoms

1. Take Coconut Charcoal

Coconut Charcoal binds to toxins and helps flush them from your body safely and quickly. Coconut Charcoal is activated, which means that it’s been heated to extremely high temperatures in order to create millions of tiny little pores, giving it an incredibly large surface area that allows it to bind the toxins contributing to die-off.

The way that charcoal works is through adsorption, rather than absorption. It’s full of negatively charged ions that work like magnets to attract positively charged elements such as the toxic byproducts released during die-off. These byproducts bind to the outside of the activated charcoal and get trapped in its tiny little pores. Once trapped, the charcoal effectively carries these harmful byproducts out of your body so they don’t get reabsorbed.

I recommend taking one capsule of Coconut Charcoal in the morning and one capsule in the evening to help minimize die-off symptoms.

2. Drink Plenty of Water

You want to make sure you’re drinking at least 8 oz. of filtered water while you’re taking Coconut Charcoal in order to support your digestion since charcoal may cause constipation. In fact, drinking water is vital during the detox process as it is. My motto is when it comes to detoxifying, you need to make sure you’re peeing, pooping, and sweating every single day! Drinking plenty of water will help ensure that you’re doing all three of these.

Stirring a scoop of Organic Greens into your water is a simple and effective way to supercharge your detox efforts with immune-boosting greens and superfoods. Organic Greens also contains spirulina and chlorella, which are natural chelators that can help speed up the elimination of toxins from your body.

3. Sweat

When it comes to sweating, my favorite way to sweat out toxins is to get in my infrared sauna. I suggest you learn more about infrared saunas, how they work, and why they’re beneficial for your health. I personally use mine a few times a week and it’s a great way to sweat out toxins.

Not everyone has room for an infrared sauna in their house and that’s ok. You can always do light exercise or use a traditional sauna at your local gym to help you sweat out the toxins.

4. Prioritize Sleep

Sleep is critical while you are working to overcome die-off because it’s when your detox pathways are the most active! I recommend getting 8-9 hours of sleep while you are detoxing so that your body has plenty of time to rest and rejuvenate.Again, if you’re not experiencing die-off, bravo! And if you are having any die-off symptoms whatsoever, fear not… Following these simple steps will get you back on track in no time at all.

I am so proud of you for taking your health into your own hands, and remember: you don’t have to go through this alone! If you’re looking for some additional encouragement to achieve your optimal health, check out The Myers Way® Community on Facebook!

Die-Off FAQs

How long does die-off last?

How long your die-off symptoms last varies based on the condition you’re treating. However, die-off symptoms are typically short-lived and often last between 3-7 days.

What are Candida die-off symptoms?

Some of the most common Candida die-off symptoms include fever, chills, muscle aches, weakness, skin rash, and a mild decrease in blood pressure.

What are SIBO die-off symptoms?

If you’re treating small intestinal bacterial overgrowth, you may experience SIBO die-off symptoms such as bloating, chills, constipation, muscle aches, and brain fog.

Article Sources

  1. The Jarisch–Herxheimer Reaction After Antibiotic Treatment of Spirochetal Infections: A Review of Recent Cases and Our Understanding of Pathogenesis. Thomas Butler. NCBI. 2017.
  2. Gliotoxin stimulates the apoptosis of human and rat helatic stellate cells and enhances the resolution of liver fibrosis in rats. M C Wright, R Issa, D E Smart, N Trim, G I Murray, J N Primrose, M J Arthur, J P Iredale, D A Mann. NCBI. 2001.
  3. 5 Die-Off Myths Everyone Needs to Know About. Steven Wright. Healthy Gut. 2019.
  4. What a Candida Die-Off Is and Why It Makes You Feel So Lousy. Cameron White, MD. Healthline. 2019.
  5. What to Know About Candida Die-Off. Deborah Weatherspoon. Medical News Today. 2020.
  6. 12 Parasite Die-Off Symptoms and How to Fight Them. Dr. Todd Watts, Dr. Jay Davidson. Detox Learning Center. 2018.