What is Candida die-off?

What is Candida die-off?

Once a candida infection (candidiasis) has been diagnosed and accurately treated, large amounts of fungal and yeast cells are killed off rapidly and a die-off phase can occur, this is known as a Jarisch-Herxheimer reaction (JHR) or Herxheimer reaction. This is a short-term reaction, taking place over a few days to a couple of weeks, as the body detoxifies. It is also called the HERX reaction or healing crisis.

This reaction was first noted during the 15th century in patients who were undergoing treatment for acute infections such as syphilis and were receiving mercury treatment (which is a weak antibiotic). It is an immune system response to the recovery and detoxification process that is known as the immune cascade23

The regular process of cell elimination of candida cells (the process that occurs naturally in the body when there is no overgrowth or infection) is vastly different to the pace of cell elimination associated with the treatment of infection. When candida yeast cells die, they release a noxious (harmful) substance that contains roughly 79 different toxins.  When large numbers of these pathogenic micro-organisms are killed off quickly, the cell death leads to a simultaneous release of toxins. This flood of toxins causes the kidneys and liver work overtime to try and remove them, and intensifies the symptoms experienced by the sufferer. This reaction often makes an affected person feel as though their health is not improving and that instead, the infection is actually spreading and worsening.

Some of these toxins include:

  • Uric acid
  • Ethanol
  • Acetaldehyde

The neurotoxin acetaldehyde has a wide range of detrimental effects on a person's health. It can kill brain cells and therefore impairs the functioning of the brain. The endocrine, respiratory and immune systems may all be affected. In addition, the red blood cells can also be damaged as their ability to transport oxygen through the body is hindered as the toxin attacks the membranes of the cells. It is easy to see how the release of this toxin can lead to symptoms such as fatigue and brain fog.

These toxins can also trigger allergic reactions which can lead to inflammation as the body’s ability to recognise non-threatening organisms is impaired resulting in certain substances or foods being identified as antigens. The immune system will, in turn, create antibodies as a means of fighting off the invaders, which leads to inflammation and candida die-off symptoms.

Candida die-off symptoms

The symptoms of Candida die off vary between individuals and each person will have their own unique degree of the symptoms depending on the site of the candida infection  as well as personal health status. 

It is often the case where the symptoms of Herxing are compared to the symptoms of seasonal allergies or a common cold, these tend to differ from person to person and can be more severe.

The by-products of the toxins involved will often cause inflammation which can lead to blocked sinuses and other sinus infections. Toxins such as acetaldehyde can lead to headaches, brain fog, nausea and fatigue. The liver will also be working at maximum capacity to filter the toxins out of the body which can result in pain within the abdomen.

It is best to always keep a medical doctor informed on the progress of recovery.

The below is a list of the most common symptoms experienced with a Herxheimer reaction:

  • Psychological issues such as anxiety, depression and mood swings
  • Muscle and joint pain
  • Elevated heart rate
  • Fever
  • Flatulence, bloating, gas, diarrhoea and/or constipation
  • Skin rash
  • Swollen lymph nodes or glands
  • Moderate to more severe headaches
  • Dry mouth and oral thrush
  • Sore or itchy throat
  • Sweating
  • Chronic fatigue
  • Inflammation
  • Brain fog
  • Sleep issues

In addition to these symptoms, the pre-existing symptoms of the current candida infection may progress, this is known as the healing reaction. In addition, the symptoms caused by toxins can be exacerbated due to the body having to use more energy to replace the damaged cells and defective tissue that the toxins and candida have caused during the infection.

Coping with Candida die-off

The exact amount of time a person will suffer from Herxing is based on the severity of their infection and reaction to treatment. If Candida albicans occurs in the colon and intestines, the infection can lead to other issues such as leaky gut syndrome (this is where candidiasis breaks through the intestinal lining and this results in the contents of the intestines leaking into the bloodstream). This will often result in the affected person experiencing a different reaction to the treatment.

 octors may suggest the use of liver supplements such as milk thistle which aid in the liver’s ability to rid the body of toxins or that the affected person reduce their dose of antifungals and probiotics should the Herxing symptoms become too severe.

There are a few things other things that can be done to help ease these symptoms should they occur (please note that the supplements listed should first be approved by a doctor before being taken):

  • Liver-support supplements – Milk thistle or molybdenum helps the liver to expel the toxins from the body. Molybdenum is especially helpful in those who are suffering from Candida die-off. This aids the body in the production of the enzymes needed to convert acetaldehyde into the acid known as acetic acid, this can then be converted into either helpful enzymes needed for digestion or be easily expelled from the body.
  • Drink enough water to help flush out toxins – Drinking water may help your body in eliminating toxins a bit faster as urine helps in transporting toxins out of the body. Hot showers, saunas and skin brushes (help to increase the circulation of lymphatic system) can also aid in detoxing the body.
  • Decrease stress levels – Stress can often weaken the body’s ability to recover and fight off the fungal infections. Stressing also increases levels of the hormone cortisol which can impact the immune system’s ability to function at full capacity.



23. Jarisch-Herxheimer reaction. BMJ. 1967;1(5537):384-384. doi:10.1136/bmj.1.5537.384

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