Dr. Kyle Warren
Meghan Feir Walker
One of the first obstacles you’ll likely face in an effective Lyme protocol is a Herxheimer, or die-off, reaction. This often derails patients from continuing their protocols because their symptoms temporarily intensify as they kill off Lyme bacteria. As I’ve started understanding the Herxheimer reaction in Lyme more thoroughly, I’ve changed my Lyme protocols over the years to better address the patient’s needs and minimize these severe reactions.
Throughout this article, I’ll address what a Herxheimer is, what symptoms are often produced, reactions to antimicrobials and non-antimicrobials, signs you should slow down the protocol, and how we minimize Herxheimers in our clinic.
What is the Herxheimer reaction?
A “Herxheimer” or “Herx” reaction is short for a Jarisch-Herxheimer reaction (JHR) and describes when a patient feels worse after beginning treatment.
In the late 1800s and early 1900s, Dr. Jarisch and Dr. Herxheimer were dermatologists who noticed worsening skin lesions in patients with syphilis after beginning treatment.
Just like Lyme, syphilis is a corkscrew-shaped spirochete, and there are many similarities and applications between the two diseases.
Symptoms of a Herx can vary depending on the infection but often include fever, chills, nausea and vomiting, headache, tachycardia, hypotension, hyperventilation, flushing, myalgia, exacerbation of skin lesions, and other heightened problems. These types of Herxes can occur with syphilis, leptospirosis, Lyme disease, and relapsing fever.
Why a Herx happens with Lyme support protocols
When you kill certain bacteria with antimicrobials, your immune system starts responding. Your body has to efficiently clean out the dead bugs, but if it can’t, Herxing will begin to rear its ugly head. In this study, researchers discovered that dead Lyme bacteria that haven’t been cleared out of the body can cause even more inflammation than live bacteria (which is still more than plenty, thank you very much).
As with every toxin, your body needs to effectively get rid of the bacteria through its detox and excretion pathways. Once you kill the bacteria, they need to be carried to the lymph system to be disposed of through sweat, urine, or feces.
When the immune system sees dead debris of Lyme bacteria fragments, it can temporarily increase inflammation. As the immune system increases inflammation, symptoms can become more severe. This can be confusing—and scary—for patients, but it means you’re on target, killing the bacteria you need to kill.
Despite hitting the target, experiencing a Herx isn’t what we aim for because it means your protocol is out of balance, making you feel more miserable than necessary.
Common symptoms of a Herxheimer response: What a Lyme Herx feels like
Depending on the infections you have and how they’ve affected your body, Herx reactions can vary. Symptoms you already experience regularly can become much more severe.
Herxing might bring on worsened headaches, chills, and fevers. However, heightened symptoms can include symptoms associated with your nervous, vascular, and digestive systems. You may experience a slowed-down digestive system, nausea, and other problems. Or you may have strange and extra painful nerve-related symptoms, heightened fatigue, brain fog, air hunger, tachycardia, palpitations, a racing heart, worse POTS-like symptoms, and other issues. Whenever you start any type of antimicrobial, you want to look for a change in symptoms or a dramatic change in the severity of symptoms around the time you start taking them.
Don’t just push through a Herx
What are the signs that you may need to slow down your protocol?
In our clinic, if you react to a product, I’ll have you stop taking it for three to seven days before reintroducing it at an even lower dose. If you react to a product twice, I will probably swap it out for a different one. There are many different options for immune support and killing the bacteria, and we’re looking for the ones that your body will tolerate.
Lyme patients and/or those suffering from Bartonella, Babesia, and various other co-infections are miserable enough without symptoms becoming even more severe. Most patients feel horrendous and are just getting by as it is, so cranking up the intensity of their myriad symptoms can make it unbearable.
Early in my career, when I used heavy antibiotic protocols to treat Lyme and co-infections, some patients had to quit the protocol because the onslaught of symptoms was too severe for them to handle. Unfortunately, this was standard practice among Lyme doctors. You just kept telling your patients to push through it.
When I look back on this approach, it seems crazy, but it’s what we were doing. Now, I can’t disagree with this practice more. In the last 10 years, I’ve worked hard to keep my Lyme protocol effective while reducing these Herx reactions, making it a smoother ride for my patients.
Every Lyme patient needs a protocol that not only kills the bugs but supports their body's needs along the way, making it tolerable and doable for them to keep going.
The best protocol is the one your body can tolerate.
Over the years, I’ve found that pushing you faster than your body will go does not speed up the process. It just creates more havoc, adds misery, and often makes people quit the protocol altogether. You want to go as fast as your body will let you. If you're Herxing, you're getting a response, but you want to find the balance between supporting your body and killing the bacteria.
It takes time to heal from Lyme and tick-borne illnesses, and you don't want to suffer more than you already are, especially when it’s completely unnecessary. Having a more well-balanced approach with Lyme and co-infection protocols makes it easier on you and takes about the same time.
Supporting your body through a Herx response
I know it can be tempting to quickly do whatever it takes, no matter the pain in your quest to rid yourself of Lyme and co-infections, but it’s often unnecessary and unhelpful.
Yes, you want to kill the Lyme and other infections, but there are ways to avoid such intense die-off or Herx reactions.
The following approach to minimize Herxing works over 80% of the time with my Lyme patients in our clinic.
Step No. 1
Don’t jump into taking antimicrobials right away. We don’t start the protocol with guns blazing, killing the bacteria. We need to support and strengthen your body first.
Step No. 2
Before killing any bacteria, you need to support your immune system and detoxification pathways.
In our clinic, I always start by having patients take something like red root or red sage, herbs that offer fabulous support for the lymph system. This is especially helpful if you’re struggling with Anaplasma, Ehrlichia, Rickettsia, or Babesia.
The G3M Lime Powder is terrific because it blocks Galectin-3, and it especially helps minimize Lyme and Bartonella die-off reactions. It’s made of modified citrus pectin, which can support your cellular health, immune system, and detoxification systems.
I often have patients take a product called Microbe Binder, especially if someone has GI problems. Microbe Binder is a dairy-free immunoglobulin-based product with immune-balancing properties that helps bind and dispose of bacterial fragments.
We frequently use other immune-balancing and detoxification pathway support products like alpha lipoic acid, glutathione, or NAC.
These are my top go-tos to help balance the immune system and support your detoxification pathways. I might shuffle these products around based on the infections and nutrient deficiencies you’re suffering from, but almost every one of my patients takes a combination of these products before starting antimicrobials to kill the bacteria.
Step No. 3
After we get your immune system more balanced and supported, it’s time to introduce the big guns. In our clinic, I like using a combination of antimicrobial herbs and nutraceuticals to effectively break down biofilms and kill the bacteria. Each product is generally spaced out by about a week. I also start each product at a lower dose for about three days before bumping up to a larger dose.
You can go slower than that, but I find this process works well for the majority of people. This needs to be a gradual process to minimize or avoid Herxing.
What if you support your immune system and detoxification pathways but continue Herxing?
What do you do if you’ve taken the immune and detoxification system support, but you still start reacting when introducing bacterial killers?
It's important to understand what you're reacting to, which is why we introduce these killers one at a time.
When a patient is reacting to a product, but the product has 10 different ingredients, it can be hard to determine which ingredient the patient is reacting to. They could be reacting because of a Babesia die-off, or a Lyme die-off, because of a sensitivity to a specific ingredient, or because another process in their body is off.
If you’re reacting, write a list of the symptoms you’re experiencing and when they started.
Generally, when you’re experiencing a Herx reaction, it's your usual symptoms on steroids. If you struggle with fatigue and joint pain, you’ll probably be extra exhausted and in pain. If you struggle with dizziness, brain fog, and sleep problems, Herxing will probably cause major sleep problems, worse dizziness, and your brain fog will intensify.
With Herxheimer reactions, you’re looking for an exacerbation or flare of your specific symptoms when adding killers.
When you have that Herx, it means you're on target, you're on track, but you're out of balance. We're trying to balance the immune and body support with the killers, and those must be balanced in a unique way for each individual.
I wish everyone could just take two pills and voila—no Herxing—but everyone is unique, and there’s a bit of an art to balancing your body’s immune system, detox pathways, and responses while killing bacteria.
What if you react to something besides the antimicrobials?
What should you do if you react to a non-killing product?
Patients often assume they’re Herxing if they react to a product. However, that’s not always the case.
A Herx reaction specifically describes a reaction to an antimicrobial, whether that's an antibiotic, an herb, or another type of therapy that's designed to kill bacteria or dismantle biofilms (so the killers can get access to the bacteria). These antimicrobials are killing bacteria, causing an immune reaction.
However, you can react to non-killing agents for various reasons.
For example, sometimes I have patients who react to glutathione. Glutathione isn’t an antimicrobial, so if you react to something like glutathione, you are not having a Herx reaction.
This kind of reaction means something different. This is why we always introduce things one at a time in our clinic. If you start feeling worse, I want to know what’s causing the reaction.
Reacting to something that's a killer, such as oregano, cryptolepis, or garlic, is very different than reacting to glutathione, which is not a killer. It tells me totally different things as a doctor, and completely different adjustments need to be made to your protocol.
It’s always important to go slowly enough to track what's happening, and if you're having a problem, you want a doctor who knows how to troubleshoot it.
Learn more about Lyme-related care
Years ago, in my practice, 20% of people had a smooth Lyme recovery, but 80% of people had terrible reactions. It was rough running a clinic with that many side effects. I called it “high drama.” I was taught that was the only way and you just had to force people through these Herx reactions and tell them to suck it up. In my experience now and for the past decade+, I believe forcing patients through Herx reactions is absolutely the wrong way, particularly with neuro-Lyme patients. After learning more about Herxheimers and how to support the body better, I can avoid my patients getting Herxes 80% of the time by helping balance the immune system and introducing the killers one at a time at a slow and steady pace.
When you’re trying to heal from Lyme disease and co-infections, it's always an up-and-down process. There are often bad and better days, but we're trying to make the road toward recovery as smooth a process as possible.
Everyone’s healing journey with Lyme disease and co-infections is unique. Due to a variety of factors unique to each individual, some people recover faster than average, while others take longer. But the important thing is that you and your doctor are listening to your body and how it responds to your protocol.
Remember, thorough tick-borne illness tests must be done to know exactly what you’re dealing with, and an effective Lyme protocol should include support for your body, along with antimicrobials to kill the bacteria.
Take control of your health
If you’re ready to take control of your health and look into whether Lyme disease and co-infections are the cause(s) of your health problems, reach out to our clinic and set up your free consultation with one of our team members. They will go through your history, symptoms, and next steps with you.
If you choose to test for tick-borne illnesses and other tests, you can figure out what you’re fighting. Discovering what your body is fighting is the first step in recovering.
You can get better from Lyme and co-infections!
To learn more about Lyme disease and co-infections, check out our Lyme page and blog.
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