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by Dr.Jeff

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Are You Experiencing Die-Off?

This classic pattern of die-off is not what is commonly seen with natural anti-candida protocols that use herbs and non-prescription substances. As opposed to antibiotics which suppress immune system function, natural products are known to enhance immune system function.

Date:   2/10/2012 6:26:37 PM   ( 30 mon ) ... viewed 2427 times

The Herxheimer Reaction was originally described by Adolf Jarisch and Karl Herxheimer and originally named the Jarisch-Herxheimer reaction. It traditionally has been associated with the treatment of syphyllis with antibiotics and other compounds.
The Herxheimer, or Die-off Reaction as it has commonly come to be known, can be described as when the death of bacteria or fungus and the leaking out of all of their intracellular components into the surrounding tissues and fluids occurs faster than the body can remove them. This is commonly associated with the use of antibiotics. Classic signs of the Herxheimer/Die-off reaction are muscle aches and pains, fever, chills, headaches, flushing of the skin, irritability, generally feeling unwell, etc. The intensity of the reaction usually indicates the degree of inflammation. Inflammation is a result of the immune system’s white blood cells producing chemical messengers called cytokines that drive the inflammatory response as part of the healing process. This immune response is initially repressed by prescription antibiotics and antifungals, but then increases proportionately as the number of dead cells and toxins flood the body. This is typically seen with antibiotics in that they initially can produce a lessoning of symptoms, but then the person feels worse due to the cytokines and inflammation.

This classic pattern of die-off is not what is commonly seen with natural anti-candida protocols that use herbs and non-prescription substances. As opposed to antibiotics which suppress immune system function, natural products are known to enhance immune system function. Which aspect of the immune system gets enhanced could play a role in determining whether or not inflammation and the “die-off” reaction are felt. In the model of the Herxheimer reaction above, the cytokines in that immune response produce inflammation (a Th1 response). There are also other cytokines produced by white blood cells which control or dampen inflammation (a Th2 response). Th2 immune responses are commonly present when fungal candida is active in the body, as candida has the ability to manipulate our immune responses to produce a Th2 vs. Th1 response. Candida does this because the Th1 response is more effective against candida. It’s one of the many survival mechanisms that candida can use to create favorable conditions within the body for its continued growth.

In nature, plants are known to inhibit other organisms, not destroy them. The effect is to create a balanced system. If an organism doesn’t fit within a natural ecosystem, it doesn’t grow there, or does so in very limited amounts based on the space and conditions available. At a microscopic level, plants are extremely complex organisms that will produce the exact substance needed to respond to whatever threat is at hand, be it microbe, plant, insect, or animal. It’s interesting to note that antibacterial or antifungal substances produced by plants don’t create antibacterial/antifungal resistance in those microbes affected by them, something man has never come close to duplicating. In fact, these plant-based substances are designed to inhibit, not kill other organisms, and it is through this process of inhibition that balance is achieved.

If herbs create a “die-off” reaction, the best explanation for this would be that by inhibiting candida, the immune response was able to shift from a Th2 response to a more inflammatory Th1 response which then created the cytokine-driven response that makes people feel lousy, something they are told to expect as a sign of candida being killed. That is an oversimplification as it is only certain aspects of a Th2 response that help to regulate inflammation. The belief that herbs are creating a die-off reaction by killing candida doesn’t make much sense, as herbs and plants produce substances that inhibit, not kill candida.

Present-day medicine is driven by many misunderstandings about microbes, man, and the human body. The approach that microbes are bad and need to be destroyed is quickly dissolving into the past, at least from a scientific standpoint. Pasteur popularized this belief, but later rejected it based on the evidence present. Pharmaceutical companies and the medical profession have embraced it and as a result have created an industry that prays on people’s fears. The Warrior model of medicine, all too often, is still embraced by many holistic practitioners and lay people as the answer. Holistic practitioners by-and –large still seek to destroy microbes, albeit by more natural means, instead of bringing resolution to health challenges through balance and detoxification.

The concept of “die-off” comes from this Warrior model and is embraced as a sign of success against the “enemy.” Mostly, I believe that it is a misinterpretation of what is taking place. It makes people feel better about the approach they are using, but I think it is misleading. Herbs and plants shouldn’t produce a die-off via killing candida, but they could create it through inhibition and an immune system shift, both of which are desirable. The problem that I see in this approach is that it would not correct the imbalance, but suppress it. The best approach would be to reverse the fungal form of candida back to its normal yeast form, detoxify the body, support the Th1 immune response, and help to support the normal flora of the intestinal tract. All of this can be achieved safely and effectively without disrupting the delicate balance of the intestinal flora.

In the end, I think the use of the term die-off is confusing, misleading, and perhaps, detrimental. I think that it dis-empowers people by taking them further away from the truth. The truth is sufficient enough for all of us to stand on.

For more information on Dr. McCombs Candida Plan, go to,
or call us at 888.236.7780 to ask questions or schedule a consultation.

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