How can I tell the difference between die-off and a bad reaction to herbs or antibiotics? - Aspire Natural Health

How can I tell the difference between die-off and a bad reaction to herbs or antibiotics?

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In this Episode Dr. Gerstmar discusses:
-How do you tell the difference between die-off and a bad reaction to herbs or antibiotics
-What is die-off and why does it happen
-Common symptoms of die-off
-The critical need to understand if you’re a sensitive person
-A story of someone suffering from die-off and another of someone suffering a bad reaction to the herbal formula used



Hey Folks,

It’s Dr. Gerstmar from Aspire Natural Health, and in this quick video, I want to share with you how you can tell the difference between die-off and a bad reaction to herbs or antibiotics.

We need to start by talking about die-off. If you haven’t seen them, I’ve talked about die-off in the past and ways to help deal with it when you have it, so please, go go back and take a look at those. They’re worth your time.

Alright, as a quick reminder, die-off, also called Herxheimer reactions or Jarish-Herxheimer reactions after the two doctors, Dr. Jarish and Dr. Herxheimer who first described the reactions, is when we begin killing off large amounts of bacteria, viruses, parasites, or all of the above.


Now if we’ve had this chronic infection or dysbiosis for a while the immune system has come to a kind of uneasy truce with it.

And when we start changing things by putting in antibiotics or herbs to kill off this load of ‘bad stuff’, the immune system can get hit by a wave of debris from these bugs, and that can stimulate an inflammatory reaction.

There’s a spectrum of die-off. For some people die-off is non-existent, for others it’s very mild, and for some people it can be very severe.

So here’s what typically happens. Your practitioner has done some testing showing you have a load of stuff that we don’t want to be there. And they prescribe you a therapy to kill off that stuff.

There are a lot of ways to do it, ranging from diet changes, to herbs, to prescription drugs. And one is not necessarily better than another. Some situations can be fixed with simple diet changes, while others will absolutely need herbal medicines, and still others really need a prescription drug to do the job. That’s why having a good practitioner on your side is so vital, so you don’t waste your time with therapies that aren’t going to be effective for you.

A really important piece here before you begin any therapy is to recognize if you’re sensitive or not. At Aspire Natural Health we work with a lot of sensitive people, who have large reactions to small amounts of stuff, and who have to begin slowly when they begin therapies. Most people who are sensitive know they are, but if you’re not sure, you can just think about other substances you put into your body. How do you respond to caffeine, or things like Tylenol or Advil, or alcohol? If you know you’re especially sensitive and end up having to take like half the normal dose of things, then when you begin any therapy aimed at killing off excess bacteria, or viruses, or parasites, you’re going to need to go low and slow in your approach.

And please, please be sure to tell the practitioner you’re working with. Over the years we’ve had a few people have some really rough experiences when they forgot to tell us how sensitive they were and we ended up blasting them with a dose that was too strong for them. And lastly on this point, if you tell the person you’re working with that you’re sensitive and they don’t adjust their treatments for you, LEAVE. Go find another provider. That is a bad practitioner. I’ve seen many examples of it over the years, and it’s maddening. There are other providers out there who will listen to you and adjust your therapies so they work correctly for you.

Okay, so you begin doing the therapy your practitioner has recommended. And again, everyone’s response is going to be different.

But for a decent number of people within a day or two they begin to notice some symptoms.

The most common symptoms of die-off are things like bloating, diarrhea, less commonly constipation, headaches, brain fog, tiredness, and rashes.

People can also have worsening of specific symptoms they’re dealing with. So someone who has Rheumatoid Arthritis and pain in their joints can see that pain flare up with die-off.

Now most die-off reactions last between 1-7 days, with 2-3 days being the most common length. Anything very severe or lasting more than about 10 days needs to be brought up as it might be something other than just die-off.

So we use those guidelines to get a sense of if what we’re seeing is die-off or if we’re dealing with or something else.


Let me give you an example:

Truong (not his real name) came to us with a whole host of digestive issues. Testing showed SIBO and large intestine dysbiosis. Truong told us he was very sensitive to supplements and medications, so we began very slowly with a very small dose of antimicrobial herbs. Within a couple of days of starting the herbs Truong felt terrible – with a rash, digestive upset and a migraine. We urged him to gently push on, and after a couple of days the symptoms began to disappear and he began feeling better than he had in a long-time. This is an example of die-off, an initial, relatively brief period of increased inflammation and a flare of symptoms, followed by an overall improvement.

If it’s not die-off what else could be going on?

Let’s use another example of a person we worked with:

Melinda (not her real name) had Crohn’s disease, and testing revealed extensive large intestinal dysbiosis. Melinda told us she had no sensitivities, but we began with a lower dose of a liquid herbal preparation and asked her to work her dose up. She did well until she hit a moderate dose when she found a lot of digestive upset. Over a period of 6 weeks we adjusted her dose up and down looking for the right dose for her but found that she could never raise her dose over that moderate level without continuous symptoms that never improved. Suspecting a sensitivity to the formula we were using, we switched her to another formula and found that she could tolerate much higher doses without any issues whatsoever.

Does that help clarify the difference between die-off and a sensitivity to whatever therapy you’re using?

Die-off typically builds over a day or two, peaks, and rarely lasts more than 5-7 days. Then as you clear the current load of ‘bugs’ you will be able to take that dose without further issues. If you raise the dose you may again have some die-off but it will follow that same pattern.

If you have a sensitivity to the therapy you are using, the symptoms will remain continuous, lasting for as long as you continue taking the therapy, and you will never have an adjustment to it.

So there you have it…


Are you having die-off or a sensitivity whatever you’re taking? Should you continue taking it and push through or switch to something else?

One way to tell is by the character of your reaction.

Most die-off reactions last between 1-7 days, with 2-3 days being the most common length. And they feature an adjustment period where you should be able to tolerate that dose without further die-off symptoms, unless you stop taking it for a while and allow the ‘bugs’ to grow back again.

Now if you didn’t know, I’ve created a number of FREE reports with some of our best information inside to help with a number of digestive and autoimmune issues. They’re all available for FREE on our website.

We know how hard it can be to find the right doctor and whether the integrative doctor you find is really the right choice for you, or are you just going to spend a bunch of money and end up not any better than when you started.

We’ve put together a Quick Guide to Finding the Right Integrative doctor for you, will the questions you should be asking to make sure whoever you work with is going to help you get the results you want. All you need to do it fill out the short form below and we’ll happily send that to you for FREE. So click down below.

At Aspire Natural Health we are experts at treating digestive issues and autoimmune diseases. If that’s you, we’d love to connect.

We offer a no-obligation no-pressure chat to see if we can help you, and if we’re the right fit to work together.

If we are, we’ll move forward, and if we’re not, we’ll do our best to connect you with the person who can best help you.

You have nothing to lose, so call us now at 425-202-7849 or email us at

Until next time folks…Take care!


At Aspire Natural Health we are experts at helping people suffering with digestive issues and autoimmunity.

Are you looking for help?

Email us at or call us at 425-202-7849.

The first step of our process is to see if we’re a good fit for one another. If we are, we’ll talk about next steps. If not, that’s okay, and we’ll do our best to help you find the right person.

Everything is no-obligation and no-pressure, so you don’t have to worry. You have nothing to lose!

Call us at 425-202-7849 or email us now!

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