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Die-Off Explained
Die-Off / The Herxheimer Reaction
Die-off, or the Jarisch-Herxheimer reaction, is a bodily process triggered by a sudden increase in endotoxins, the harmful, toxic substances which are released when microorganisms in the body such as fungi, yeasts and bacteria are destroyed. Rapid destruction of these microorganisms can cause endotoxins to flood the body, resulting in the immune system triggering an acute inflammatory response. This can result in the presence of acute inflammation throughout the body, leading to a worsening current SIBO/autoimmune symptoms as well as the development of new ones. Die-off commonly occurs during antibiotic treatment (Botanical/Nutraceutical as well as Pharmaceutical) and the sudden release of these bacterial toxins into the bloodstream can cause serious harm and damage in the body. It’s important to realise the potential severity of die-off consequences, avoid all possible damaging effects as much as possible and take all necessary precautions to protect your internal systems.
Die-Off Symptoms
Symptoms depend on the species of pathogenic bacteria colonising the SI, the level of bacterial burden, which antibiotics the individual is medicating with, the dosage, diet and numerous other factors. It’s no coincidence that the common die-off symptoms are similar to common cold and allergy symptoms as the immune response reacts to all potentially harmful microorganisms in a similar way -
- Brain fog
- Headaches
- Fatigue
- Mood changes - irritability, anxiety, depression
- Bloating, abdominal pain
- Diarrhea or constipation
- Joint and muscle aches and pains
- Nausea
- Skin reactions - rashes, eczema, dermatitis
- Flu-like symptoms
Defining Disease
“Health and disease are critical concepts in bioethics with far-reaching social and political implications. For instance, any attempt to educate physicians or regulate health insurance must employ some standards that can be used to assess whether people are ill or not.”(1)
Disease (noun) - a disorder of structure or function in a human, animal, or plant, especially one that produces specific symptoms or that affects a specific location and is not simply a direct result of physical injury.
- a particular quality or disposition regarded as adversely affecting a person or group of people.
The Die-Off, Disease + Inflammation Connection
We discuss the immune system, autoimmunity and how this relates to inflammation in depth on the SIBO + Autoimmunity page so we’ll only discuss its relation to die-off and the disease state here.
“Inflammation appears connected to almost every known chronic disease — from heart disease to cancer, diabetes to obesity, autism to dementia, and even depression.”(3)
Inflammation is a defence mechanism triggered when the immune system recognises damaged cells, irritants, and pathogens, and begins the healing process. When something negatively affects a part of our body, the body’s biological response is to remove the harmful stimuli. So inflammation is a vital part of a healthy immune response but it can become damaging.
There are 2 different types of inflammation which can occur in the body -
- Acute inflammation = inflammation which begins rapidly and becomes severe quickly. This can be the result of a serious infections such as tonsillitis or acute appendicitis, high-intensity exercise, a physical trauma or even just a scratch or graze. In the case of acute inflammation, it either improves, turns into an abscess, or becomes chronic
- Chronic inflammation = this is usually the result of pathogens that the body cannot break down, including some types of virus, foreign bodies that remain in the system, or overactive immune responses(4).
There are many ways in which we can lower and reduce inflammation levels in the body and is a significant part of the healing process. See the 5 Steps to AI + Gut Health.
The Diseased/Toxic State
Avoiding the Diseased/Toxic State
Surviving in the Chemical Soup aka the City
“We are exposed to 6 million pounds of mercury and 2.5 billion pounds of other toxic chemicals each year… The simple truth is that we are living in a sea of toxins and it is destroying our bodies and brains.”(5) Thus, supporting the body’s detoxing processes (the science of how our bodies get rid of waste), is vital to keeping internal systems functioning optimally.
Boosting our body’s detoxing processes is vital not only for those with chronic illnesses but all of us, as we are increasingly exposed to damaging pollutants which researchers believe are linked to the increasingly rapid rise of autoimmune conditions (6).
Que Sera Sera
Die-off is part of the healing process and is a good sign - it is an indication that you are clearing your body from pathogenic bacteria. A certain level of toxic build-up is inevitable and this is “toxic dump” just one of the many ways in which SIBO causes physical damage in the body. But this is also one of the easiest outcomes to support with supplements, by undertaking short water fasts and by taking the right precautions.
Supporting Detoxification
Multiple organs in our body are dedicated cleaners (liver, kidneys, gallbladder etc.) and are totally devoted to detoxing. They are normally really good at it but they have not adapted to deal with the sheer overwhelming daily bombardment of pollutants, chemicals, pesticides and toxins that fill the air, land, food and water in our cities; “We are living in a world that is over-burdened with toxins, from car and airplane exhaust to cleaning chemicals and perfumes, heavy metals, and dirty water.”(7) When gut health and other bodily systems are compromised, the body can fail to process and eliminate these toxins, they go through enterohepatic recirculation, where they are reabsorbed in the intestines and end up being re-circulated through the body, only to be re-filtered by the liver again until the detoxification process is successful. This causes a considerable energy drain and uses our body’s resources required for detoxifying the blood and when any internal system dysfunctions - the nervous, immune or circulatory systems - this cycle can occur daily(7).
Add to this the biotoxic burden from SIBO die-off and you can see why detoxing to avoid a diseased/toxic state, keeping our internal systems working optimally and our blood clean is so important and forms a vital part of the healing process. We discuss toxin binders in our 5 Steps to AI + Gut Health.
Die-Off Survival Guide
The Die-off Survival Guide
1 - Slow + Steady...
Reducing the bacterial burden takes time - approximately 6- to 12-months depending on each individual case. It’s important for you to be gentle and patient with yourself during this process and all stages of the healing process. When the excess microorganisms die too fast, the body simply cannot handle the huge toxic burden. Go slow! The SIBO diet and intermittent fasting themselves will also cause die-off so pacing yourself during Stage 1 will help reduce or even bypass the die-off discomfort. Taking too many herbs can cause damage and add to levels of toxicity in the body so you’ll want to start by taking the minimum therapeutic doses and increasing them gradually when the time is right. Remember to make note in a journal or on a calendar of which herbs you are taking, when and the dosages so that you can keep track of your treatment and symptoms and Healing SIBO progress.
2 - Reduce Your Toxic Burden
Taming the toxins is crucial to avoiding and/or reducing the die-off symptoms. We discuss this on the Gut Dysbiosis/SIBO In Depth page and list toxin binders in our 5 Steps to AI + Gut Health.
3 - Support Your Body’s Detox Mechanisms
The liver is your number one detox organ, which is why if you’ve been dealing with excess yeast in the form of Candida in your gut, your liver is probably not working optimally. That’s why it’s so essential to support your detox pathways. We focus on detox, liver and kidney support on the Essential Supplements page.
4 - Give Your Body a Break
Fasting is one of the quickest and most effective ways of detoxing which also allows your body a (very) well deserved break from the considerable amount of energy required to digest food.
We are biologically adapted to experience fast and feed cycles and when we halt caloric intake, our bodies naturally shift from the “Go-Go” mode into the “Rest and Repair” mode. Having an abundance of food available - as we do in modern western cities - and eating too frequently does not allow your body the time it needs to rest and repair, and undertake processes essential for the maintenance and optimal functioning of our internal systems. We discuss some of the most profound benefits of fasting on the Fasting for Gut Health page as well as some of the many different types of fasting, and intermittent fasting routines.