SIBO: The SIBO Die-Off Effect

SIBO: The SIBO Die-Off Effect 


When someone has a Jarisch-Herxheimer reaction, they are having a reaction from a syndrome that results from aggressive treatment of a major body infection. This condition was first discovered when doctors began to heavily treat syphilis infections but is now known to occur in anyone who is treating an overgrowth of microorganisms, fungal or bacterial. The Jarisch-Herxheimer reaction happens because sudden and highly effective treatment kills the numerous maladaptive organisms that were creating havoc inside of your body. When those bugs die, the body becomes overwhelmed with the sheer numbers of toxins and proteins released, leading to an intense inflammatory reaction.  

With a SIBO infection that is being treated properly and depending on the levels of bacteria in the patient, these intense reactions occur due to the release of cytokines. Cytokines are tiny proteins stimulated by the inflammatory proteins and toxins from the die-off of the germs. This die-off response is too strong or intense and leads to excess inflammation throughout the body. The inflammation and stress in the body then create dysbiosis and upset the body’s delicate balance. The inflammatory response syndrome is calls SIRS- systemic inflammatory response syndrome. This die-off is part of the process of a working treatment. 

Why makes the die-off process begin? 

The die-off occurs when overgrown bacteria, parasites or fungus are killed at a rapid rate faster than the body’s filter system, the liver and kidneys, can keep up with for removal. Thusly, the treatment is what makes the die-off process begin.  

In a typical case, this normally means prescribed antibiotics or antifungals. Although, many more patients are triggering this reaction by following a strict SIBO or Elemental diet, or a probiotic that effectively kills or starves the SIBO organisms and alters the microbiome in the patients gut.  

What are the symptoms of a SIBO die-off? 

The most common symptom of die-off is inflammation throughout the body. Many people report that it feels as if they are coming down with the flu. The patients SIBO symptoms may worsen as the die-off progresses. Usual symptoms include: 

  • Fever and chills 
  • Fatigue and malaise 
  • Muscle aches 
  • Skin rash 
  • Brain fog and headache 
  • Worsened SIBO symptoms like abdominal pain and bloating, diarrhea, constipation, etc. 
  • In severe cases, vomiting and dehydration 

Is it really SIBO Die-off? 

For those patients who deal with flaring symptoms regularly, it may be difficult to tell if your SIBO infection is in die-off mode, or if you are simply in a flare. Other things can complicate the reaction even more, depending on the patient’s treatment of other medical issues. This is why it is important to track any changes made to your diet or medical regimen when your SIBO treatment begins.  

When tracking your symptoms and diet, be sure to record every detail including:  

  • What has changed 
  • Times and dates of changes or issues 
  • Symptoms 
  • Any details of what may have caused the issues 

Decreasing Die-off Symptoms 

There are many things that the patient can do to make the die-off process easier to handle, or last for a shorter duration. Because the die-off reaction is an inflammatory event, you should decrease your body’s overall inflammation in any way you can. Here are some ideas: 

  • Staying hydrated. Drink fluids every hour. Some people may benefit from alkaline or mineral water as well as this may help to decrease the acidic environment created by cytotoxins. Also, warm or room temperature water aids in digestion & ice water can hinder and slow digestion. 
  • Getting rest. Your goal should be at least eight hours of sleep a night. Restorative sleep naturally decreases your body’s ability to make cytokines. If you cannot get eight, get as much as you can. 
  • Eating antioxidant-rich foods or supplements. Cytokines produce many reactive oxygen species, causing significant inflammation. Antioxidants combat this, such as curcumin (found in turmeric), glutathione, and selenium. 
  • Digestive enzymes may help with symptoms and clear your intestine of rotting and undigested food that feeds SIBO bacteria and yeast. 
  • Detoxing. Soaking in Epsom salt baths or sitting in a sauna. Soak in warm Epsom bath for about 20 minutes or sit in a sauna for about 15 minutes to help relax and detoxify. Remember to stay hydrated as both will increase your temperature. 
  • Talking to your doctor or herbalist who prescribed the antifungal or antibiotic to discuss decreasing the dose while you manage your symptoms. 
  • Making sure you have regular bowel movements as this will also help with elimination of die-off toxins and proteins. Epsom salt baths, magnesium, and hydration are gentle ways to relieve constipation. 

Die-off symptoms and severity will vary from patient to patient. For those patients who have other inflammatory issues, the reaction can be quite severe. Stay steadfast in your fight against SIBO and be confidant and firm in your treatment plan.  

If you suspect you may be dealing with SIBO, or a Jarisch-Herxheimer reaction from another infection, be sure to discuss these events with your medical care team and follow their advice for your specific situation.  

Resources Used: 

Reclaiming Intimacy 

Johns Hopkins 



Back to blog