Let’s face it—no one wants to experience the dreaded Jarisch-Herxheimer reaction (commonly called a Herxheimer reaction or a “herx”) when undergoing Lyme disease treatment. We’ve all heard horror stories about them, and for some Lyme patients, the thought of having to endure this reaction on top of disabling symptoms is too much to bear. In some instances, a patient may choose to delay or reject treatment altogether to avoid an increase in these unpleasant Lyme disease symptoms.
What is a Herxheimer reaction?
A herxheimer reaction occurs when bacteria from Lyme disease and coinfections or yeast are killed off during antimicrobial treatments, such as herbal therapies or antibiotics. Often, it occurs when you begin a new treatment, but it can also happen at different points throughout treatment.
As bacteria or yeast die off, the body releases proinflammatory proteins (known as cytokines) in response to an influx of toxins. While some cytokine activity bolsters the immune system to fight infections, too many of these chemicals can have adverse effects. An overabundance of cytokines in the body leads to pain, fatigue, a suppressed immune system, cognitive issues and brain fog; essentially, a worsening of many of the symptoms of Lyme disease.
But are you powerless against toxins, increased inflammation, and excess cytokines running bonkers through your body? Using a variety of supplements, lifestyle changes, and detox methods, you can lessen herx reactions and support your body during treatment. Over the years, I’ve tried many things, and I’d love to share with you the ones that have helped me the most.
5 Ways to Manage Herxheimer Reactions
1. Activated charcoal- In a previous article entitled, A Quick Guide to Seven Popular Toxin Binders, I mentioned the benefits of this low-cost supplement for reducing the body’s inflammatory responses to toxins. As someone who tends to be sensitive to many supplements and medications, I’ve found activated charcoal to be a gentler approach to binding adverse substances and facilitating their removal from my body.
Consult with your doctor before using any toxin binders, as they must be taken a few hours away from other medications, herbs, or supplements to prevent these remedies from getting absorbed, as well.
2. Glutathione- Glutathione is referred to as the body’s master antioxidant, and it helps to support the liver through the detoxification process. I’ve used this supplement in an oral form, called liposomal glutathione, and in an intravenous drip. Although this supplement can be a bit pricey, it’s one of my favorites for mitigating the effects of a herx, and it improves my energy, decreases brain fog, and helps me to sleep better at night.
3. Infrared sauna treatments- Infrared saunas assist the body with the detoxification of toxins and heavy metals that are stored in fat cells. An infrared sauna is different from the steam saunas you might be familiar with at your local gym or spa. The temperature range for an infrared sauna is typically 110-130 degrees (depending on the machine), which is significantly less than a steam sauna. Infrared saunas heat the body from the inside out, allowing the heat to penetrate more deeply. A 30-minute sauna session improves circulation, reduces pain, helps you feel calmer, and assists your body with detoxification. Before investing in an infrared sauna, please consult with your health care provider. There may be some instances where sauna sessions are contraindicated.
4. Epsom salt baths- Magnesium sulfate, the primary mineral in Epsom salts, has a relaxing effect on muscles and the nervous system, and is an inexpensive way to diminish herxes during Lyme disease treatments. Not only does this mineral-rich salt reduce pain and inflammation, but it also boosts the detoxification capabilities of both the skin and the liver thanks to the compound sulfate. Sulfate draws out toxins through the skin and cleanses the liver by enhancing the production of bile. Since Epsom salts can lower blood pressure, you may want to begin with a foot bath to gauge how you feel using this method of detoxification.
Subscribe to the World's Most Popular Newsletter (it's free!)
5. Exercise as tolerated- While exercise is probably the last activity you feel like doing when you’re experiencing a herx, it can be one of the best ways to reduce your symptoms when done appropriately. Your lymphatic system–a network of tissues, organs, and fluid that eliminates waste and disperses immune cells throughout your body– is stimulated through movement and contractions of your muscles.
There are two important points to remember when incorporating exercise into your treatment protocol: First, don’t overdo it. If you feel exhausted after an activity, you’ve done too much, and you need to scale back. Second, don’t engage in strenuous aerobic activity, as this can suppress the immune system for up to 24 hours following exertion. When beginning an exercise regimen, you may need to consider seeing a physical therapist or a trainer, so you can have an individualized program to rebuild your strength and stamina without pushing yourself to the limit.
These are the things that I use to improve my die-off symptoms. There are many additional options, so, with some trial and error, you’re likely to find something to support you through this challenging aspect of treatment.
This article was first published on ProHealth.com on March 21, 2017 and was updated on June 16, 2019.
Jenny Lelwica Buttaccio, OTR/L, is an occupational therapist and certified Pilates instructor whose life was transformed by Lyme disease, chronic fatigue syndrome and interstitial cystitis. She is creator of the DVD, New Dawn Pilates: pilates-inspired exercises adapted for people with pelvic pain. Jenny is a health and wellness advocate and blogger who writes about her journey on The Lyme Road as she continues to pursue her personal healing with the support of her husband and two rescue pups. You can find her on Instagram: @jenny_buttaccio or Twitter: @jennybuttaccio
Burrascano Jr., J. (2008) Advanced Topics In Lyme Disease: Diagnostic Hints And Treatment Guidelines For Lyme And Other Tick Borne Illnesses. Retrieved from http://www.lymenet.org/BurrGuide200810.pdf
Jernigan, D. (2008). Beating Lyme Disease. Wichita, KS: Somerleyton Press.
Ross, M. (2014, November 8). Herxheimer Die-Off Reaction: Inflammation Run Amok. Retrieved from