Pathogen & Parasite Die-Off Symptoms: How to manage detox side-effects
Whether it’s bacteria, yeast or parasite die-off symptoms, they can be a real struggle for many clients during a healing protocol. Understanding what causes die-off symptoms, the most common die-off symptoms experienced by clients, as well as ways to reduce their severity are all an important part of managing a natural protocol for SIBO, parasites, candida and numerous other pathogenic gut infections.
Here’s everything we’re going to cover:
> The science of die-off symptoms and why they occur.
> Why not all symptoms are die-off related.
> Common causes of die-off symptoms.
> The most common die-off symptoms when treating parasites and other pathogens.
> Ways to prevent and minimize die-off symptoms naturally.
Herxheimer reaction: The original bacteria die-off symptoms
The forefather of what we call die-off is known as the Jarisch-Herxheimer reaction (JHR). A Herx reaction, as it is commonly called, was first documented by European dermatologists Adolf Jarisch and Karl Herxheimer at the end of the 19th century. Their observation related to the short-term worsening of skin lesions (symptoms) after treatment with mercury (antibiotics). After syphilis began being treated with penicillin in the 1940s, Herx reactions were observed to occur within the first 24 hours of treatment and consisted of fever, chills, headaches and worsening of skin rashes. This is also called a healing crisis and many health practitioners will inform you that you will get worse before you get better.
And while the JHR only technically relates to spirochetal infections (spiral-shaped bacteria) and antibiotics, the concept of symptom-onset or worsening after starting treatment with antimicrobials has been seen to apply more broadly in clinical practice. This is why you’ll often hear practitioners talk about a Herx-reaction, even if it isn’t scientifically accurate. But, what we call ‘die-off symptoms’ is certainly something we see commonly when clients begin addressing bacteria, parasites and yeast pathogens using natural antimicrobials.
The die-off process is broken down into three distinct phases:
1. Cell death
2. Immune response
1. Cell death
Simplistically, as we treat pathogens like parasites, bacteria and yeast, they begin to die. This ‘cell death’ starts a cascade of reactions in the body that often end in new or increased symptoms. But what exactly happens during the ‘cell death’ process?
As shown in the diagram above, we think of ‘cell death’ as having two distinct phases; biofilm breakdown and the release of glycoconjugates. Let’s explore each one in a little more detail and explain their impact on die-off symptoms.
Phase 1 – Biofilm breakdown: biofilm is formed when individual microorganisms attach to the GI tract and clump together into a kind of colony. The biofilm acts as a shield or protective home for the bacteria, parasites or yeast living inside, making them difficult to detect and remove. Once we breakdown this protective matrix using natural biofilm busting supplements, it can release the individual pathogens out into the GI tract.
Phase 2 – Release of glycoconjugates: we try our hardest to be scientifically accurate with our posts, which is why we’ve used the term glycoconjugates instead of the more commonly used term ‘endotoxin’. This is because endotoxins really only apply to bacteria and we’re trying to cover parasites and yeast as well. But, the concepts are largely the same across the different organisms. We have lipopolysaccharides (LPS) for bacteria, GPI-anchored glycolipids for parasites and beta-glucans for yeast (e.g. candida). When each of the different organisms’ cell membranes start to breakdown, these glycoconjugates (toxins) will be released, triggering an inflammatory response.
2. Immune response
All of these various glycoconjugates act as toxins when released after the destruction of the cell wall of the main organism, which trigger pro-inflammatory responses. Basically your immune system starts working overtime to kill and clear these toxins from your body to avoid infections hanging around. LPS specifically, is also an exogenous pyrogen or fever-inducing substance, which explains the flu-like bacteria die-off symptoms experienced by many people during eradication. While inflammation is a natural response of the immune system and needed to overcome infection, it can, in the short term, lead to symptoms like aches and pains, skin rashes, headaches, etc, which we often describe as die-off.
All of the broken down biofilm and released toxins need to go somewhere. With a healthy GI tract, strong intestinal lining and regular motility, most of these toxins would move through the large intestine and be excreted via the stool. However, the majority of clients with a gut infection or overgrowth don’t have a healthy GI tract, but rather what we call a ‘leaky gut’.
A leaky gut is the simple term for intestinal hyperpermeability, a condition that allows macromolecules and microorganisms to get through the intestinal lining and into the bloodstream. This becomes problematic when you have a significant release of pathogens and toxins at the same time. As some of these toxins leak through the intestinal lining and enter the bloodstream, your immune system will continue to attack them and try to clear them from your body – firstly via the lymphatic system and liver, which help filter your body’s waste, before being sent to other drainage organs such as your kidneys, colon and skin.
This is not necessarily a problem in those with well-functioning detox pathways, it is what those systems are designed for and in healthy people can work just fine. Unfortunately, for many of those suffering from years of chronic digestive symptoms, these detox pathways can become blocked or sluggish. This means the body struggles to eliminate these toxins and allows them to recirculate in the body. This inability to eliminate toxins can make bacteria, yeast and parasite die-off symptoms more noticeable and last longer.
Common causes of die-off symptoms
Now that we understand the mechanisms of die-off symptoms, it’s time to look at the common causes. If die-off symptoms are the result of cell death, the release of toxins, inflammation and the body’s inability to clear these toxins, then the next question is: what causes such changes to occur? The three most common causes of die-off symptoms we see are:
> Starting an elimination diet. Switching to a real-food based diet that eliminates processed foods, sugar and other ingredients that feed pathogens will often cause the bad bugs to starve as we cut off their food supply. This effect is enhanced on certain IBS elimination diets like low-FODMAP, Paleo AIP and SIBO Bi-Phasic which are more extreme in the removal of foods that feed pathogens (e.g. sugar and other carbs).
> Introduction or increase of probiotics. Starting a probiotic protocol can effectively kill pathogens by overpowering them with the presence of ‘good guys’.
> Starting a protocol of antimicrobial, anti-fungal or anti-parasitic supplements. This is the most common and effective way to kill pathogens quickly and typically results in the most die-off symptoms.
Why not all symptoms are die-off related
Before we get into more detail about the common die-off symptoms, it’s important to understand that not all symptoms experienced while treating parasites, bacteria or yeast overgrowths are die-off related. There is a tendency to classify all kinds of reactions as die-off symptoms, but this isn’t always the case. Here are other possible reasons for symptom flares during eradication:
> Supplement or food reactions. Food intolerances and sensitivities are common in those with gut dysfunction and a leaky gut. Food reactions are typically an immune response to the proteins in certain foods, commonly eggs, nuts, gluten and dairy, rather than pathogen cell death.
> Parasite life cycles. Parasites typically have life cycles that can last between 7 and 21 days, meaning symptoms can flare during certain phases of these life cycles. If you find that you regularly have a good week or two and then feel terrible for a few days, this could be a sign that your parasites are alive, rather than dying.
> Other sources of inflammation. Because inflammation is at the heart of die-off symptoms, many other sources of inflammation can be confused with them.These other sources of inflammation could be mental/emotional or stress-related, new gut infections, excessive exercise or other forms of stress on the body.
Common bacteria, yeast and parasite die-off symptoms
Die-off symptoms are often similar to those of pathogen infections themselves, given that they are caused by the same types of toxins. The key difference is that bacteria, yeast and parasite die-off symptoms are generally more intense as these toxins are released in larger amounts in a shorter space of time. This is why it is normal to feel worse, for a few days at least, before feeling better.
The most common bacteria, yeast and parasite die-off symptoms are:
> Body aches and pains
> Skin rashes or reactions
> Mood symptoms (e.g. anxiety and depression)
> Respiratory phlegm or stuffy nose
> Increased GI upset
> Flu-like symptoms (e.g. fever and chills)
Die-off symptom: Fatigue
Fatigue is probably the most common die-off symptom reported by clients. Healing can be hard work, especially if your body is trying to fight a heavy load of pathogenic infections or parasites. During the early phase of an elimination protocol, you need to give yourself space to rest and fight, without placing too many additional stressors on the system.
Die-off symptom: Headaches
Detox and headaches often go hand in hand for many clients. While it can be exacerbated by the process of pathogen cell death, for many clients the biggest contributor to headaches is actually the removal of certain inflammatory foods like caffeine and sugar from their diet.
Die-off symptom: Body aches and pains
Body aches and pains are a very inflammatory type of symptom. With die-off, it is the inflammatory response of the immune system to the release of toxins that if overactive, can create these symptoms of muscle soreness and aching joints.
Die-off symptom: Skin rashes and reactions
The skin is a key elimination organ and your body may well try and eliminate excess toxins via the skin if the other systems of the body are overworked. If you’re the type of person who has skin issues, you may experience an increase or worsening of rashes, eczema or psoriasis flares, skin sores or breakouts. These are typically short-term reactions that quickly resolve themselves, but can be frustrating to manage.
Die-off symptom: Mood symptoms (e.g. anxiety and depression)
The connection between gut health and mood symptoms is well documented – we even wrote a whole blog about it HERE. As with other die-off symptoms, mood symptoms such as anxiety and depression can also flare during pathogen eradication. While these can be difficult to accept, awareness that your current mood is the result of temporary pathogen die-off and not other elements of your life circumstances, often makes riding out this phase more bearable.
Die-off symptom: Respiratory phlegm or stuffy nose
The body uses mucus and phlegm to capture and eliminate toxins. It is why we get a ‘runny nose’ when we have a cold or flu. It is for the same reason that an increase in mucus production is a common sign of die-off, as your body uses all the systems it has to help excrete these excess toxins.
Die-off symptom: Increased GI upset
With all the action happening in the gut, it is no surprise that increased GI upset is common during die-off. Diarrhea or constipation, bloating, gas and abdominal pain are often reported as pathogens die and excrete toxins into the gut. This is where the infection is and the site of their cell death. GI symptoms are also the most likely to be associated with non-die-off related causes discussed above such as food reactions and general symptom flares related to parasite life cycles, for example.
Die-off symptom: Flu-like symptoms (e.g. fever and chills)
Flu-like symptoms are the original Herx reaction observed over a hundred years ago. This type of die-off symptom is probably the most serious and is typically associated with spirochetal infection treated with heavy doses of antibiotics. A fever is also one of the ways the body tries to kill infections as most microbes can’t operate at high temperatures. Given the lower doses, longer timeframes and titration associated with natural antimicrobial herbs, flu-like symptoms are less common outside of conventional treatment.
Managing die-off symptoms
Effectively managing die-off symptoms requires an understanding of the various mechanisms causing them. This is why we spent so much time at the beginning of the post explaining the reasons why we get die-off symptoms. As a quick recap, the three difficult variables that impact die-off symptom severity are:
1. Quantity and speed of pathogen cell death – this will determine the size of the ‘toxic burden’ your body has to manage.
2. How active your immune system is and therefore the amount of inflammation your body creates.
3. How effective your detox pathways are at clearing toxins from your body.
With this is mind, our approach to minimizing die-off symptoms has three corresponding elements which we will discuss in more detail below:
1. Titration – the layered introduction of diet and supplements.
2. Reducing inflammation – helping calm the body’s immune response.
3. Supporting detox pathways – assisting the body with clearing toxins through our detox organs.
Titration of diet and natural supplements
Titration is the gradual introduction of a specific intervention. The faster and more intense an intervention, the bigger the release of toxins from dying pathogens will be in a short space of time. What we’re trying to do is to avoid dropping a bomb on an overgrown weed garden and then having to deal with the thousands of spores that get spread all over the rest of the neighborhood. What we’d prefer to do is go in there and weed the garden more selectively to avoid the negative repercussions.
To prevent or minimize the amount of die-off symptoms that our clients have to cope with, we use the following three titration strategies:
1. Natural antimicrobials – unlike antibiotics, natural antimicrobials or herbal supplements are typically a much more gentle approach to addressing pathogens and parasites. They are still pretty powerful and certain varieties can still cause die-off symptoms in my clients but these are generally less than typically caused by antibiotics.
2. Diet introduction – we like to start clients on an introduction gut-healing diet after our initial consultation and before we receive test results back. This typically gives us around a month for any effects of diet changes to settle down before starting a supplement protocol and introducing antimicrobials.
3. Supplement titration – we like to introduce one supplement at a time and build each product up slowly to full dose before moving onto the next. This allows us to monitor any reactions to particular supplements separately to die-off symptoms and adjust our dosing recommendations accordingly. It also means there is a slow build-up to the pathogen eradication process, reducing the quantity and speed of cell death your body has to manage. This contrasts with conventional antibiotic recommendations which start at full dose from day one, which is just one of the reasons this approach typically results in greater die-off symptoms.
If you have a very active (or overactive) immune system, you can experience quite a lot of inflammation-related die-off symptoms. Symptoms like fatigue as well as body aches and pains are common amongst those with high levels of inflammation. There are two main ways we help to manage inflammation:
1. Rest and reducing stressors – giving your body the space to fight and heal from pathogenic infections is an important part of managing inflammation. This means prioritizing plenty of good quality sleep, especially between the hours of 10pm and 2am, as this is when the majority of physical repair happens in the body. It also means avoiding activities that will add additional stress to your body – like intense or excessive exercise. It can be challenging for your body to overcome inflammation if you are constantly adding more sources to the pile.
2. Anti-inflammatory foods and supplements – giving your body a natural anti-inflammatory boost can assist with reducing the severity of inflammation-related die-off symptoms. Our go-to anti-inflammatory supports include:
> Omega-3’s – from good quality fish oil supplements or food based sources such as flaxseed, chia seeds, walnuts and oily fish.
> Anti-inflammatory spices – adding turmeric, ginger and cinnamon to your food or having them in tea is an easy option.
> Antioxidants from green leafy vegetables and dark colored berries.
> Additional supplements like glutathione, quercetin and vitamin C can also help when needed.
Supporting detox pathways
Helping your body to clear excess toxins via our detox organs is an important part of avoiding die-off symptoms and also reducing their severity after onset. The two most effective ways we have found to support these detox pathways include:
Liver support: The liver is the primary organ we focus on to remove bacteria and their lipopolysaccharide (LPS) from the bloodstream. The same applies for other glycoconjugates from parasites and yeast. It is this removal function that helps to reduce die-off symptoms. Our goal is to support both phase 1 and phase 2 liver detoxification pathways, typically using supplements that are a blend of naturals like N-Acetyl-Cysteine (NAC), St Mary’s Thistle, Dandelion and many more. We are also able to use markers on lab testing to assess phase 2 liver detoxification to know whether additional support in this area will be required during your protocol.
GI binders: GI binders can be used to bind up toxins like a magnet and carry them all the way through the digestive tract to be eliminated in the stool. By cleaning up these excess toxins, it prevents them from being absorbed (or reabsorbed) into the bloodstream and causing further die-off symptoms. There are three different types of binders we typically use to assist clients minimize die-off symptoms:
> Charcoal – activated charcoal is a broad spectrum binder that works extremely well in acute cases of die-off symptoms. Because it can bind to microbes as well as minerals, vitamins and nutrients, it is best used on a short-term basis and taken well away from other foods, medications or supplements. It is our affordable go-to option to get on top of die-off symptoms quickly.
> Clays – bentonite, zeolite and pyrophyllite clays are more selective (less broad-spectrum) than charcoal but can still bind to some nutrients. This means they are a gentler form of binder that can be taken for weeks rather than days.
> Chlorella – an algae with a love of toxins, chlorella is a great ongoing support product to assist with die-off and toxins associated with eradication protocols. As a living organism, it binds to toxins rather than essential nutrients which means it can be used as an ongoing preventative support throughout your protocol. It is unlikely to provide relief once die-off symptoms hit, but that’s what we have charcoal and clays for.
Additional strategies to support detox and minimize die-off symptoms
Here’s a few additional strategies we often recommend to boost our client’s detox pathways and help minimize symptoms of die-off:
> Hydration – simple but effective, keeping fluids up during a protocol can help flush toxins through the system.
> Epsom salt baths – the benefits of epsom salt baths include; 1) that they are relaxing 2) can increase magnesium levels to help with aches and pains 3) will help draw toxins from the skin and 4) can increase sulfate levels which is helpful for liver detox.
> Infrared sauna – some clients have reporting benefits from using infrared sauna during a protocol. Whether it is due to their relaxing effects or their reported ability to increase your blood circulation and stimulate the sweat glands, releasing built-up toxins in the body, these results may vary from person to person. Keeping up hydration and restoring electrolytes is important if you choose to experiment with infrared saunas.