I feel worse, is detox or die-off the cause?

Surely one of the most challenging aspects of natural healing is that one might feel worse before getting better. Many people then become despondent and give up altogether. It is thus important to understand why the initial adverse symptoms are happening and moreover, how to overcome them.

The words detox and die-off are used interchangeably to describe the initial worsening of symptoms and it is important to distinguish between the terms and to understand what is happening in your body.


The formal definition for detoxification, ala detox, is a process or period of time in which one abstains from or rids the body of toxic or unhealthy substances. However, this is not merely abstinence from alcohol, drugs, smoking or other toxic substances. Detoxification is what our bodies do naturally to neutralise, transform and get rid of unwanted metabolic end-products and toxins. Without any particular diet or treatment plan, this is what our bodies do naturally – all day, every day. It is a primary function of our body to interact with various organs to neutralise, transform and remove harmful substances, thus toxins. We are daily exposed to toxins, they are everywhere, unavoidable and a normal part of life; metabolic end-products generated in our body, air and water pollution, pesticides and herbicides on and in food, preservatives, colourants and flavourants, heavy metals, pharmaceutical drugs, caffeine… the list is endless and our body works away the whole time to remove them from our system. Although the bulk of the work is done by the liver and the intestinal tract, the kidneys, lungs, lymphatic system and skin are all involved in this complex detoxification system.

‘Detoxification’ generally refers to improving and optimising the function of our body’s own detoxification systems. The best way to do this, is by decreasing the amount of toxins we put into our bodies, while at the same time supporting our body’s own detoxification and elimination systems with appropriate nutrients.

We need hundreds of enzymes, vitamins, minerals and other molecules to help rid the body of unwanted metabolic end-products and chemicals. The important concept to realise is that we need nutrients to support our detoxification processes optimally!  The more toxic we are, the more nutrients we need to support these vital detoxification processes. With the high toxic burden on our bodies today, we can’t afford to not supplement in addition to an organic wholefood diet.

Filtering the blood requires two phases of detoxification. Phase I helps to neutralise (oxidise) the toxins - this phase is where you need antioxidants such as vitamins C and E. Phase II adds chemicals (conjugation) to make the toxins soluble and possible for the body to excrete it. This is where you need nutrients such as molybdenum, glycine, MSM and sulfur-rich foods such as cabbage, broccoli and garlic. It is also important to support the kidneys during detoxification and additional liver support with good B-complex vitamins, magnesium, zinc and iron.  

When adverse symptoms are experienced during detoxification, it means that phase I and II in the liver is not well supported. Either phase 1 is upregulated, without the necessary phase II nutrient support to conjugate and excrete the toxins, or one has genetic vulnerabilities in the liver pathways which also need to be supported with the correct supplementation.  The detox symptoms merely means that too many toxins are released for your detoxification organs to cope with.

The following factors could bring about adverse reactions or flare-ups:

  • altering the dosage of drugs or supplements
  • introducing new foods
  • lifestyle events; lack of sleep, stress, over exercise
  • toxin exposure
  • inflammation or infection


A worsening of symptoms after dietary changes or following a specific treatment program, does not necessary mean die-off, although these term are often used in natural medicine to describe adverse reactions.

Die-off means a sudden, natural perishing of large numbers of a species, population, or community. The medical term for die-off is Herxheimer reaction. It describes what Karl Herxheimer saw when he administered medication to patients. When antimicrobials (antibiotics, anti-fungals, anti-virals and anti-parasitic medication) are given, the pathogenic micro-organisms will release more toxins as they are dying, which is commonly referred to as ‘die-off’ in natural medicine. Die-off is thus the reaction that happens when toxins from dying pathogens (bacteria, yeast, viruses and parasites) overwhelm the body’s ability to clear them out. The toxins released by the pathogens are referred to as biotoxins. Die-off is thus experienced when the body can’t effectively detox these biotoxins. When the pathogens die, they release all the noxious substances that they contain into the system. Some yeast cells can release up to 79 different toxins, such as ethanol and acetaldehyde.

Acetaldehyde, a known neurotoxin, causes a host of detrimental effects on your health. It impairs brain function, affects the endocrine, immune and respiratory systems and it can damage the membranes of red blood cells, reducing the ability of carrying oxygen throughout the body. It is therefore clear how a biotoxin such as acetaldehyde can contribute to non-specific symptoms such as brain fog and fatigue. Biotoxins also causes allergic reactions and inflammation that can lead to an array of undesirable symptoms.  

The toxic state in the body from die-off can produce adverse symptoms such as chills and fever, fatigue, nausea, depression, moodiness, muscle and joint pain, headaches, brain fog, dizziness, poor concentration and memory, elevated heart rate, palpitations, breath and body odours, sweating, itchiness, hives, skin rashes, acne, eczema and psoriasis flare-ups, swollen glands, blocked nose, excess mucous production, sinusitis, digestive problems – bloating, excessive gas, diarrhoea, constipation, cramping, recurring vaginal and prostate infections… and more. One experience typical flu-like or cold-like symptoms, with the whole body generally sluggish and working harder to fight something. Note that these symptoms could also be experienced during any detoxification process. People with elevated levels of heavy metals will experience more severe die-off symptoms. Pain in the abdomen over the liver area also means your liver is taking strain coping with the amount of toxins.

Changes that can provoke die-off reactions would be:

  • dietary changes – switching from a processed to whole-food diet, eliminating sugar and yeast (death of pathogens by starving - sugar feeds them)
  • introducing or increasing probiotic dosage (death of pathogens through competition with good microbes)
  • introducing or increasing dosage of antimicrobials (death of pathogens by destroying them)

Therefore, any change that will bring about a change in the microbiome (gut flora) can provoke the release of more biotoxins, with possible adverse reactions. The kind and severity of reactions will vary from person to person, depending on nutritional status, kind of pathogen, degree of infestation and detoxification ability, where genetics play a role too. It is important to understand what is happening, why it is happening and how to effectively manage the die-off.

Some people start a protocol and feel better almost immediately, noticing positive effects such as increased energy, better mental focus and improved elimination. However, they might become despondent when they experience a sudden flare-up of symptoms halfway through their treatment protocol. This could be due to a change in protocol, or simply because all the pathogens were not effectively killed off. This is especially true of parasites, as they have different life cycles with eggs or larvae hatching again after initial live parasites were destroyed. Viruses can also lay dormant before springing back to life and triggering symptoms all over again.

Other people will start an antimicrobial protocol or just a change in diet and feel worse right away in response to the toxicity. Die-off reactions are more than just the liver becoming overwhelmed. The whole detoxification system (lymphatic, liver, kidney, bowel, skin) becomes inflamed from these biotoxins it can’t clear out fast enough, often referred to as biotoxin illness.

Die-off symptoms usually last one to three days, but it can last up to a week or longer and will come and go throughout the protocol, becoming less severe over time. There are various strategies that one can employ to counter these adverse reactions. See my article on coping with adverse die-off reactions.



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