When healing your gut, you are likely to experience gut bacteria die off symptoms, so I want to cover these bases for you.

Die-Off Reaction

Are you asking yourself any of the following today?

Can die off cause severe symptoms? I’m talking such extreme fatigue and lack of energy that you can barely stand? Lightheaded, dizzy, uncontrollable tremors. 

Will I experience die off from starving the bacteria through diet alone or is it only from antimicrobials/antibiotics?

I’m getting more strict with my diet and wondering if die off symptoms occur then as well?

What are die off symptoms? 

Do die-off symptoms mimic SIBO symptoms? Gas, upset stomach, nausea, indigestion, slowed digestion, occasionally heartburn.

How long after starting a healing protocol for SIBO do the SIBO die-off symptoms begin?

Oh, I could go on and on.

There are SO many questions with regards to die off reactions, so let’s address them.

What Exactly IS a Die Off?

I love how Dr. Matthew Eidem explains die off in a simplistic way,

Die-off is an accepted nickname for the period where toxins from dying bacteria are being released all at once while they are being eliminated. During this die-off time period, you are susceptible to experiencing temporary discomfort.

Die off, also known as a a Herxheimer Reaction occurs when someone has an adverse reaction to these toxins.

More formally, the Jarisch-Herxheimer reaction was first identified by two dermatologists, Adolf Jarisch and Karl Herxheimer, while studying syphilis.

It’s often colloquially referred to as simply a Herxheimer reaction, or a “Herx.”

In the studies and theory presented it typically occurs after antibiotic treatment.

However, make note that you can experience them from antimicrobial treatment, major dietary changes, and anything else that the entire body is trying to eliminate. 

Dr. Josh Axe states,

When you experience candida die off, this is a sign that your body is temporarily inflamed, including your liver, adrenals, kidneys and other organs/glands. Metabolites like the neurotoxin called acetaldehyde or gliotoxin, as well as proteins and inflammatory cytokines (like tumor necrosis factor alpha, interleukin-6 and interleukin-8 ), are circulating in your system, which causes you to feel “off.”

Dr. Josh Axe

Gut Bacteria Die Off Symptoms

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Gut Bacteria Die Off Symptoms agutsygirl.com

One of the biggest questions people allude to are around,

How would I know if I’m having a Herx reaction? What are the most common symptoms I might experience?

Here is a list filled with a variety of symptoms you might experience with die-off:

  • Flu-like symptoms
  • Brain fog
  • Fever and chills
  • Bloating (possibly even more than before)
  • Diarrhea and constipation (possibly even more than before)
  • Nausea and vomiting
  • Joint pain
  • Changes in bowel movements
  • Headache
  • Moodiness (mood swings) and irritability and/or other impaired brain function
  • Hypotension (low blood pressure) and/or dizziness
  • Insomnia
  • Hyperventilation
  • Tachycardia (a heart rate over 100 beats a minute)
  • Flushing
  • Myalgia
  • Worsening of skin lesions and/or other skin issues in general (skin rashes, acne, etc.)
  • Fatigue
  • Swollen glands
  • Soreness near liver/abdomen

Sources: HEREHERE, and HERE

SIBO vs Candida vs Other Die Off Symptoms

I most commonly hear of die-off symptoms as they relate to SIBO (small intestinal bacterial overgrowth), but other common die-off condition-specific questions regard candida die-off symptoms, Lyme treatment die off, mold exposure, H.pylori, and pathogen and parasite die off.

In general, the list of uncomfortable symptoms could be the same regardless of what you’re dealing with.

However, the unpleasant symptoms you’re experience will typically have more to do with the condition you’re experiencing in general.

For example, with SIBO, the symptoms are largely related to digestive processes and gut issues – and namely those with the small intestine. 

And, since Candida is a yeast overgrowth, those symptoms might also other infections related to nails, skin, the urinary tract, and the mouth.

And so on…..

20 Gut Bacteria Die Off Symptoms agutsygirl.com

….But are These Symptoms “Real?”

These symptoms are very real, though doctors might try to tell you otherwise.

I always think about the post I wrote, “Yes, SIBO is Real” when coming back to this conversation.

IF you’re experiencing it, then YES, it is real! 

It’s not for anyone else to determine if what you are personally experiencing is real or not.

However, one thing to make note of is that you should not experience them for long periods of time. And if you continue having them for a long duration and experience a worsening of symptoms, make sure to see your healthcare practitioner as there could be something that’s not working with your treatment protocol. 

How Long Do Die off Symptoms Last?

Typically, these symptoms only last for about 3 – 7 days. 

If the duration would be longer, then your healthcare provider is likely to let you know this; they would also be able to provide you better insight as to why you might experience a longer die off period. 

The Best Ways to Address Gut Bacteria Die Off Symptoms

While it’s NOT pleasant dealing with die-off symptoms (I have experienced many/most at one point or another on my gut healing journey), I also will tell you that while going through them I simply TRUSTED THE PROCESS.

Because, once they ended, my digestive system was far better off.

That said, here are some things to do for those 3 – 7-ish days while dealing with the massive release of toxins to help reduce negative side effects:

1. Sleep

I cannot stress this one enough. I believe it’s the number one thing you can do reduce the inflammatory response. 

And the good news is that this one won’t cost you a dime.

Sleeping during this time period will allow for two things:

  1. Repairing to occur and
  2. Time passes

Honestly? I never want to wish time away, but when you’re this miserable and for the short term, the more sleep you offer yourself, the better off you’ll be.

No matter what, sleep while gut healing is always a good idea, but maybe even more important is now when you are having these more intense symptoms.

2. Supplement

Since die off symptoms are an inflammatory response due to endoxoins, this causes teh immune system to increase autoimmune responses and inflammation.

Therefore, you’ll want to ensure you’re fully supporting the immune system.

Some of my favorite supplements for immune support include:

  1. Tummy Soothe – this one is, hands down, my favorite supplement for overall gut-immune support. It is a comprehensive blend of immunoglobulins and N-acetyl-D-glucosamine, specifically formulated to help repair and support the health of the gut lining.
  2. Quercetin
  3. Vitamin C
  4. Curcumin
  5. Molybdenum
  6. A high-quality probiotic supplement
  7. Garlic – my hack for this one? I get pickled garlic and eat it whole, raw almost daily (typically 2 per day)
Tummy Soothe guthealingsupplements.com #supplements

Tummy Soothe fosters a healthy inflammatory response in the GI tract and supports the intestinal barrier to help fight off antigens, boost digestive function and create a protective barrier within the digestive tract. 

Save 15% at checkout when you use code BLOG.

3. Lifestyle Changes

Remember, right now, your #1 goal is to reduce stress and exposure to any further toxins to quell the intense symptoms.

Here are some key things to do during this time:

  1. Sleep. Yes, go back to number 1. It’s THAT important.
  2. Reduce stress. You hear me talk about this one all the time so while it’s always a good thing to reduce stress, focus even harder on it now. HERE is a list of 8 stress management tactics to try.
  3. Drink lots of water. This will help ensure you’re flushing your system as much as possible. Keep in mind that you should also ensure proper electrolyte consumption during this time period as well – it’s a delicate balance.
  4. Keep things moving. Again, you want to flush your system and a MAJOR component to this is ensuring bowel movements. Choose things like: magnesium, epsom salt baths, Vitamin C, bone broths, massage, etc. for keeping you regular. One way to combine massage with keeping things moving at home is with THIS hack….and you can do it at home for free!

I could go on and on with the lifestyle changes so if you want even more, HERE is a list of 21 lifestyle changes for gut health.

Other Die-Off Notes

Here are some other things to make note of when it comes to gut bacteria die off symptoms:

  1. Yes, antifungal medications and herbal antimicrobials protocols can also produce this unwanted symptoms. Dr. Pimentel stated, “Well, natural antibiotics are still antibiotics. Bacteria still get resistant. That’s where we get our penicillins: from the plants.”
  2.  Unless you’re having an allergic reaction or the total days for these symptoms is extending beyond 7 days, try your best to stick to the treatment plan your practitioner has given you. While this is never intended to be medical advice, IF the medical advice you have already received includes a specific protocol and plan for treatment, see it through. If you’ve ever read my 28-day Rifaximin and Neomycin SIBO Journal, you know how miserable I was. HOWEVER, I also made note that I “stayed the course,” and, in hindsight when it came to this (final!) SIBO treatment, it was exactly what I needed. The die-off was bad, but I then healed for good. 
  3. Make sure THIS is the time when you will for sure choose anti-inflammatory foods. During the days of treatment, what you eat is very important….
  4. However, YES, introducing a super-strict diet can produce negative reactions. If you’ve never been accustomed to eating an anti-inflammatory diet, then your body will “reward” you with these reactions. Again, aim to stay the course.

I truly hope this has helped!

Gut Healing: ELEVATED

If it has, and if you want to dig in deeper, I’m inviting you to join Gut Healing: ELEVATED.

This is a 30-day PROCESS. It’s the FRAMEWORK and a detailed outline for what to do, day-by-day for 30 days to learn everything you can not only about the gut, but about how you will apply it for YOU and your own journey.

It’s my decade+ – long journey wrapped in one package with everything I learned, how I healed, and the SYSTEM that got me from there to here.

me before bloated, gassy, sick, gut agutsygirl.com

This was me THEN: bloated, gassy, sick

This is me TODAY: no bloat, healthy, thriving

me today no bloat, healthy, thriving gut healing agutsygirl.com

My ONE goal with A Gutsy Girl is to make sure YOU, too, heal your gut and heal your life.

And yes, it can get ugly with die off, but you can and WILL heal.

If you liked this information on gut bacteria die off symptoms, you might also enjoy:

  1. Candida Diet
  2. Irritable Bowel Syndrome vs Inflammatory Bowel Disease
  3. The Elimination Diet


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