What Is a Herx Reaction?
Well, for starters, the word "Herx" is a shortened nickname. Here's one of the clearest explanations I found on Lyme Disease Blog:
The Jarisch-Herxheimer reaction (or Herx for short) is an inflammatory response to antibiotic treatment for certain diseases (although some non-antibiotic treatments can produce the reaction). It’s also referred to as a “healing crisis” or “die-off,” meaning a detoxification of dead or dying bacteria and other pathogenic organisms in the body.
....A person with one of the Herx-causing infections has a certain number of tiny foreign organisms in their body. The number of infectious organisms can be in the thousands or millions. Each individual organism is made up of its own cell with its own internal structure and contents. If that cell dies through an attack by the immune system or an antibiotic drug, it bursts open and releases its contents. Millions of cells bursting at the same time introduces a significant amount of cellular material in the body. These spilled contents cause the Herxheimr reaction, When the spilled contents are cleared from the body, the reaction stops.
Historically, the theory has been that the reaction is caused by dying organisms releasing endotoxins. Recent experimental research suggests that the rapid and massive overstimulation of the patient’s immune system causes the symptoms. The immune system’s job is to recognize and attack foreign antigens in the body. When dead organisms spill their internal contents, a huge number of foreign antigens become present all at once. The body reacts by releasing immune system modulators (or cytokines) (e.g., Interleukin 6, Interleukin 8, and tumor necrosis factor, among others). These cytokines are what cause the fever, chills, and low blood pressure. Either way, the body gets assaulted and fights back.As the blog post explains further along, the phenomenon was named with respect to syphilis treatment. You may or may not know that syphilis has a lot of similarities to Lyme disease; both are caused by a type of spiral-shaped bacteria called spirochetes which can be very difficult to get rid of and tend to leave the blood stream and settle into joints and tissues. Given the explanation above and the immune system's role in a Herx reaction, it makes sense that some people with ME/CFS being treated for viral infections or yeast overgrowth also experience Herx reactions; as is typical, our immune systems over-react.
Unfortunately, we have had to become experts in Herx reactions because our oldest son has been enduring them for the entire seven years of his treatment for tick infections, to date (though he is much, much better these days), and my own Lyme disease rears its ugly head every few years. Treating babesia and bartonella (two other tick-borne infections that he has as well as Lyme) can also cause Herx reactions, and the immune dysfunction of ME/CFS (which we both have) just makes it all that much worse. That blog post I quoted from above says that Herx reactions can last days or weeks, but our son - and many others with both ME/CFS and Lyme - has experienced a severe worsening of symptoms that lasted many months initially and still pops up if he tries to increase his treatment or make other changes, even seven years later.
Ways to Lessen a Herx Reaction
He has been so totally disabled by Herx reactions at times (and I have been with my latest relapse of Lyme) that we have become desperate to find some way to help, so I've done a lot of research and have talked to a lot of people. Here is a list of some remedies to lessen Herx reactions, from our doctor, our dietician, various articles and experts, and other people. We use most of these:
- Adjust Dose of Treatment - whether you are on antibiotics or an herbal protocol for tick infections or antivirals or antifungals for ME/CFS, your first line of defense when you Herx badly is to adjust the dose of your treatment. Herxing is a sign that your body can't detox fast enough, so if a Herx is severe or lasts more than a few days, you should always back off on the dose or even take a bit of time off and then restart at a lower dose - see below for details.
- Burbur, parsley, and pinella drops or a burbur-pinella combination (the links are to the cheapest source I could find) - you can use 8-10 drops of each in about 4 oz. of water, wait one minute, and drink. Do this every 2 hours if needed. Some sources say that you can take these every 15 minutes and they will eliminate your Herx within an hour! We'll have to try this - we've never taken that much before.
- Chlorella (our dietician recommends Allergy Research Group's King Chlorella) - 6-10 of the tiny green pills, up to twice daily, but it's best to start with a low dose and gradually build up. Too much chlorella can cause stomach cramp, nausea, and diarrhea, especially in the first two weeks (as I discovered myself!). But it seems to help a lot, so I will continue to use it but will be careful with dosing.
- Milk thistle - my son and I already took it, but I've increased the dose; it helps the liver to work more effectively, filtering out toxins; it's essential for anyone who takes a lot of supplements and/or medications. Take 1 capsule 2-3 times daily.
- Dandelion root - this is another supplement to help improve liver function, but you should only take 1-2 capsules a day. People with ME/CFS should not take TOO much dandelion root because at higher doses, it can act as a diuretic and cause fluid loss (which is very bad for OI and will make all symptoms worse).
- Curcumin (our dietician recommends Meriva Soy Free and we like the 500 mg capsules though it also comes in a lower dose of 250 mg) - this has been life-changing for our son! Our Lyme doctor and dietician said you really can't take too much - it is a potent anti-inflammatory with no negative effects - so our son takes 1-2 of the 500 mg pills up to 3 times a day (as have I recently). As an anti-inflammatory, it is especially helpful for joint pain, though it has many other benefits, too, helping cardiac system, brain, and more. Bonus: Many studies have shown curcumin to boost mood and help antidepressants to be more effective in those with depression!
- Boswellia - this is a new one for us, another herbal supplement with anti-inflammatory properties (so, again, great for joint pain). Lyme specialists recommend 1-2 capsules up to 3 times a day, before meals. We've only just recently starting taking it, but both of us think it is helping.
- Glutathione - this is an essential nutrient in our bodies that helps with immune function, detox, the nervous system, energy production, and much more. EVERYONE with ME/CFS or Lyme should be taking glutathione and/or working to increase their body's production of it, but it's especially important for Herxing. Most effective are glutathione intramuscular injections or nasal spray. Next best is liposomal glutathione. This post on increasing glutathione explains all the different forms and how to get them, as well as glutathione precursors and ways to help your body make more on its own.
- Extra soluble fiber (see Help Eliminate Toxins below).
- AI#3 and Puerarin - these Herx herbal supplements are a part of the Zhang protocol for tick infections, which my son and I are just about to switch to. Whether you are on the full protocol or not, you can use these products for Herxing, taking 1 capsule of the AI#3 3-4 times a day, before meals for joint pain and/or 1 capsule 3 times a day of the Puerarin for fever, muscle aches, or Raynaud's. In my searches, I have found 3 main websites that sell the Zhang protocol: Dr. Ron's, Darin Ingels ND (I learned of the Zhang protocol from his book), and HepaHealth.
- Water (cold or hot) with lemon juice - helps the body to become more alkaline, which is best for the immune system and the gastrointestinal system.
- Alka-Seltzer Gold - also helps to make the body more alkaline - can be used on its own or with other supplements (see Help Eliminate Toxins below).
- Dry Brushing - this is something that became trendy recently in beauty magazines but that can help with detox. You use a brush on your dry skin (lots of articles & videos online for how to do this and what direction to brush, etc.), before a shower or bath (see caution below) to stimulate the lymphatic system to help your body detox more effectively. I just ordered the brush at the link (with a removable handle), so I will let you know how it goes!
- Epsom salt baths or foot baths - though people with ME/CFS have to be careful that the bath isn't too warm - it should be below body temperature to avoid triggering a bad Orthostatic Intolerance response. Some people with tick infections (even without ME/CFS) also have OI.
- Heat treatments, like sauna and hot tubs, which help your body get rid of toxins - these should be avoided by anyone with ME/CFS because the heat dilates blood vessels, making OI much worse and making you feel very sick.
- Help your body to eliminate the toxins. One way to help your body
with this detox process and manage the Herx reaction is to help your
body eliminate the toxins quicker. You want to help clear out all the
dead bugs and their by-products. Our dietician recommended the following
on alternate days for 2-3 weeks or until you feel better, in between
meals and meds (be sure not to take these close to food, medications, or
supplements because they will sweep out everything in its way, not just
the bad stuff. Also be sure you can get to the bathroom!):
None of these things helped our son very much at first. No matter what we did, he was still completely incapacitated while on antibiotics. Lyme experts say that there is no benefit to just enduring a severe Herx reaction; in fact, if your body can not clear the toxins, then you aren't making any progress against the infection(s). With this in mind, you need to find the optimal dose where you ARE making progress but your body can detox properly and you are not incapacitated.
Even at a low dose, our son was still severely ill, so we had to go VERY slowly and gradually with the antibiotics in those early years. With doxycycline, he went completely off of it until the Herx symptoms cleared and he started to feel better (for him, 5-7 days), and then he began again, taking just 1 pill (100 mg) every 3 days (normal dose is 2 pills each day). Once he was able to tolerate that fairly well, we increased it to one pill every two days, and so on. It took him over 18 months to work up to a full dose.
So, your first line of defense with a severe Herx lasting more than a few days should be to reduce the dose of whatever you are taking to kill the infections (antibiotics, antivirals, or antifungals, whether prescription or herbal) until the Herx is tolerable. As I said above, it does no good to suffer through a severe Herx - "no pain, no gain" doesn't work here! You need to give your body a chance to keep up with detox and get rid of the by-products of your treatments. My son switched to a 100% herbal protocol about four years ago for his tick infections, but he still reacts strongly to the herbal treatment. You may have to go super-low dose, as I described above for my son, taking only 1 pill every 3 days (or for him now, just 1 drop of the herbal blend a day when 30 drops a day is standard - he started with just 2 drops each week), but you have to find the "sweet spot" for you - where you can tolerate the treatment and still function. Then, as you adjust and feel better, you can very slowly and gradually increase the dose, but again, only as much as is tolerated. Many Lyme specialists say to only increase the dose when you are feeling good - if you are still feeling bad, it's a sign that your body is not yet keeping up with detox. In this way, you will make slow but steady progress and still be able to function.
What works best for you for Herx reactions?