Managing a Herx Reaction

Well, it's a real kick in the pants when you are struggling with a disabling illness and then its treatment makes you even sicker, but that's what many people with Lyme disease have to deal with, as well as some people with ME/CFS being treated with antivirals (and sometimes, antifungals). It's called a Herx reaction, and, as we have seen with our son, it can be completely incapacitating.

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 (which is, unfortunately, no longer available):

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 that 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 (thirteen, as of 2020) years of his treatment for tick infections, though he is much better than he was and continuing to make progress. My own Lyme disease rears its ugly head every few years. Treating babesia and bartonella (two other tick-borne infections that our son has/had 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 all these 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 completely 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 (follow instructions on the labels) 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!
• Chlorella. Our dietician recommends Allergy Research Group's King Chlorella, which we've used for years. Take 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. I also recently discovered these combination tablets that contain both chlorella and spirulina (another known detox remedy).
• Milk thistle.  My son and I already took it for both methylation support and glutathione, but I've increased the dose. It helps the liver to work more effectively, filtering out toxins and is essential for anyone who takes a lot of supplements and/or medications. Take 500 mg 2-4 times daily.
• 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 brand is in a form that is well-absorbed). This has been life-changing for our son! Our Lyme doctor and dietician said you really can't take too much. Curcumin, the main component of the spice turmeric, is a potent anti-inflammatory, so it has positive effects on pain, the nervous system, GI issues, and even the immune system.  It has no negative effects, so our son takes 1-2 of the 500 mg pills up to 3 times a day (as have I recently also). As an anti-inflammatory, it is especially helpful for joint pain, though it has many other benefits, too. Bonus: Many studies have shown curcumin to boost mood overall and help antidepressants to be more effective in those with depression!
• Boswellia.  This is a newer 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. Several studies have shown that curcumin and boswellia taken together are even more effective.
• 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. Of the forms of glutathione you can administer yourself, 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. When my son's Herxing got even worse in early 2020, he started weekly glutathione IVs, which help tremendously and have allowed him to finally increase his dose of treatment for Lyme and bartonella after being stuck at a tiny dose for a very long time.
• Extra soluble fiber (see Help Eliminate Toxins below).
• Water (cold or hot) with lemon juice. This helps the body to become more alkaline, which is best for the immune system and the gastrointestinal system. It's a great way to start the day and can help with digestion, too.
• Alka-Seltzer Gold. This (be sure it is the Gold type) also helps to make the body more alkaline. It can be used on its own or with other supplements (see Help Eliminate Toxins below).
• Dry Brushing. This became trendy recently in beauty magazines, but it can also help with detox. You use a brush on your dry skin (there are lots of articles and 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 have found that if I'm already Herxing badly, dry brushing can temporarily make it worse (I guess by moving more toxins out into the bloodstream), so use with caution and be ready for a worsening.
• Epsom salt baths or foot baths. These magnesium-rich salts are a well-known way to soothe aching muscles or joint pain and can help with detox. However, people with ME/CFS (and many with Lyme, MCAS, or fibromylagia, too) have to be careful that the bath isn't too warm, especially if they have not yet effectively treated Orthostatic Intolerance (OI). Bath temperature should be kept below body temperature to avoid triggering a bad OI response. If you feel worse after a hot bath or shower, you have OI.
• Heat treatments, like sauna and hot tubs. These also help your body get rid of toxins, but they should be avoided by anyone with ME/CFS or OI 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!):

  • Day 1: 2 charcoal capsules + 2-3 Magnesium citrate capsules

  • Day 2: 1-2 citrus pectin capsules + 2 Alka-Seltzer Gold or 1 Bicarb Formula

  NOTE: Do NOT use Magnesium Citrate as a source of magnesium supplements--it (and also magnesium oxide) is very poorly absorbed, which is why is it works for this purpose! For daily magnesium supplements (essential for pain, sleep, nervous system, cognitive function, and more), use magnesium malate and/or magnesium-l-threonate instead).
  

Adjust the Dose
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 many 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, using the Herx treatments above to help. 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.

My son still over-reacts to his treatment for tick infections and still Herxes badly sometimes, and my own Lyme disease has popped back up after several years of remission, so my attention has again been turned to managing a Herx reaction, as I am Herxing much worse this time than previously. I recently discovered that we can take many of the Herx supplements far more often than we thought, so I have updated all of the information in this post and included some dosage guidelines for each item, as well as adding a few more to the list. Hope this helps!

What works best for you for Herx reactions?

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