by Dr. Bill Rawls
Updated 8/18/22
It’s one of life’s cruel chronic illness jokes: You discover a new therapy for Lyme disease and are really optimistic about your odds of finally feeling better. Then, within a day or two of starting the regimen, your symptoms take a turn for the worse — intense fatigue, insomnia, and pain wash over you, and you feel like you did during your worst days of chronic illness. Could it be the dreaded Jarisch-Herxheimer reaction you keep hearing about from others undergoing Lyme treatment?
Unfortunately, answering that question is no easy feat. To help you better understand what’s happening, we’ll explain Herxheimer reactions and the best ways to differentiate them from other possible issues. Keep reading for advice, plus steps you can take now to feel better — without derailing your recovery.
Herxheimer Reactions, Defined
Herxheimer reactions were first observed in syphilis patients by dermatologists Adolf Jarisch and Karl Herxheimer in the late 1800s and early 1900s. They noticed that their patients receiving treatment often got worse before they got better. The phenomenon was dubbed the Jarisch-Herxheimer reaction and has since been shortened to Herxheimer reaction, herxing, or simply, herx.
“The classic explanation of a Herxheimer reaction in people with Lyme is that when borrelia bacteria are killed off by an antibiotic or herbal therapy, parts of dead bacteria called endotoxins are shed,” explains Dr. Rawls. “These endotoxins then circulate throughout the body and cause an intense whole-body inflammatory reaction. And that makes the war against microbes that’s already going on inside your body worse.”
In general, herx reactions are more common and more intense with conventional antibiotic use than with herbs, says Dr. Rawls. “With herbs, the bacterial die‐off is more gradual, and the immune response is less intense.”
Either way, the intensification of your symptoms can be disconcerting, and if you’re treating Lyme, the odds are good you’ll experience herxing: While there’s no clinical research on the prevalence of herxing, anecdotally, it seems the majority of Lyme patients experience it at some point. And provided it’s not too intense, that’s actually good news: “It’s often a sign that the therapy is working,” says Dr. Rawls.
How To Tell If It’s Herxing—Or Something Else
Herx reactions can throw you for a loop for a few reasons.
For starters, symptoms vary from person to person, says Dr. Rawls, and they’re easy to confuse with other health concerns that are also highly likely in those with chronic Lyme, including a disease flare-up, adverse reaction to a new Lyme treatment, or food sensitivities (digestive issues are highly common in people who have Lyme). What’s more, the timing of any of these issues can also overlap, making it difficult to track your symptoms to their source.
For help clearing up the confusion and determining what’s to blame for your symptoms, check out these helpful identifying characteristics:
HERX REACTION
Symptoms: Intensified fatigue, muscle pain, neurological symptoms, and flu‐like symptoms such as headache, nausea, and digestive distress. You may also experience symptoms not listed here; herx reactions are highly variable between individuals.
Onset: Symptoms intensify in tandem with starting a new therapy.
Telltale signs: Symptoms may gradually improve with the continuation of therapy and worsen again when you increase the dosage or add a new therapy.
LYME FLARE-UP
Symptoms: Intensification of fatigue, arthritis (joint pain, swelling, and stiffness), flu-like feelings, GI distress; there’s a recurrence of your usual Lyme symptoms.
Onset: Symptoms are often precipitated by any extra stress to your system (including emotional stress, poor diet, toxin exposure, physical stress, lack of sleep, or a new tick bite). Symptoms are not related to starting a new therapy, though the two may coincide if you experienced stress just before starting the therapy.
Telltale signs: Your best clue is timing: A Lyme relapse typically occurs while taking a stable dose of treatment and in reaction to some type of stress, so look for recent lifestyle changes (i.e., diet changes, travel, sleep deprivation, relationships trouble, mold exposure).
ADVERSE TREATMENT REACTION
Symptoms: An allergic-like reaction (hives, itching, skin rash, runny nose, watery eyes, wheezing). This is common in people with chronic Lyme disease, whose entire immune system is in disarray and more easily activated.
Onset: Symptoms develop within about an hour of taking a new medication or herb
Telltale signs: Your symptoms get better when you take an allergy remedy such as an antihistamine. *See your doctor as soon as possible if you experience signs or symptoms of a drug allergy. Call 911 if you experience signs of a severe reaction or suspect an anaphylaxis after taking a medication.
FOOD SENSITIVITY
Symptoms: Fatigue, joint pain, muscle pain, general achiness, brain fog, irritability
Onset: Symptoms occur within hours to a couple of days after an offending food is consumed.
Telltale signs: Your symptoms get better when you eliminate the food(s) from your diet. Doctors can order testing for food sensitivity and heavy metal toxicity, however, the best determinant of food sensitivities is an elimination diet.
If these guidelines don’t describe your experience with herxing exactly, take heart. In the beginning, you may go back and forth between knowing whether what you’re experiencing is a herx reaction or something else, but with time, you will become better at distinguishing herxing and discover ways to ride it out.
It’s Herxing. When Will It End?
If you’ve determined (or strongly suspect) that you’re herxing, your next question is likely: How long will it last?
Unfortunately, there’s no cut-and-dry answer — everyone’s experience is individual, says Dr. Rawls. Some may feel better after a few days or a few weeks; others may experience herxing for as long as two to three months (though symptoms tend to wax and wane throughout that time).
The good news is, there’s a lot you can do to help ease a herx reaction and move beyond the symptoms more quickly. The quickest solution would be to discontinue your Lyme treatment. But that’s not necessarily the best option, says Dr. Rawls.
“Fundamental advice with herxing is to continue therapy at whatever dose you can tolerate. Sometimes you will have to reduce the dose to stay comfortable, but you can increase again later,” says Dr. Rawls. “If your symptoms improve over days to a couple of weeks, that suggests confirmation that it’s a herx. And as your symptoms ease up, you can gradually increase the dose until the desired therapeutic dose is reached.”
If your symptoms do not improve, it may be an indication that the therapy is not working. In this case, Dr. Rawls suggests either increasing the dose or adding other herbs or other therapies. If symptoms gradually start getting better, then you know you’re on the right track.
That said, if your symptoms are debilitating, back off on your treatment dosage or even stop altogether, advises Dr. Rawls. Then, once your symptoms are tolerable, you can gradually increase your dosage again.
Smart Ways to Ease Herxing
The number one way to find relief from herxing is to address the underlying cause for needing Lyme treatment in the first place: Factors that stress your cells and impair your immune function.
“Stressed cells are what makes people vulnerable to chronic Lyme,” explains Dr. Rawls. “Restore the health of your cells, and not only will your immune system be better at battling Lyme microbes, your body will be stronger at withstanding the side effects of treatment and overcoming herxing as well.”
To begin, work your way through what Dr. Rawls calls “Cellular Stress Factors,” which contribute to inflammation and intensify either a herx reaction or a Lyme relapse. These include poor nutrition, emotional stress, environmental toxins like air pollutants and mold, physical stress, and excessive exposure to radiation from modern sources like computers, cell phones, and microwave towers.
Once you’ve begun to take the pressure off your cells by decreasing your exposure to these disruptors, your body will be better equipped to handle both microbes and the endotoxins they create as they die off. The result: You start to feel better.
From here, there are a number of additional lifestyle habits you can adopt to help alleviate a Herxheimer reaction — all of which also contribute to restoring cellular health and immune functions and thus contribute to Lyme recovery, says Dr. Rawls. Here are his recommendations:
1. Fresh Ginger Tea
In general, drinking a lot of liquids is a good idea, but fresh ginger tea, in particular, has potent systemic anti-inflammatory properties for reducing Herxheimer symptoms. Plus, it’s great to soothe digestive symptoms. You can make it from fresh ginger root or use organic tea bags.
2. Anti-Inflammatory Therapies
Some good ones to try:
Turmeric and Boswellia
As anti-inflammatory herbs, turmeric and boswellia are excellent for reducing systemic inflammation associated with Herxheimer reactions, and it’s hard to take too much of them either. Dr. Rawls recommends 175 mg of turmeric and 75 mg of Boswellia, twice daily.
Marine Source Omega-3 Fatty Acids
Omega-3 fatty acids offer anti-inflammatory support, especially for high-fat tissues such as the brain. Both fish oil and krill oil reduce inflammation, but krill is better absorbed and also contains the antioxidant astaxanthin, which provides extra anti-inflammatory support. The suggested dose for krill oil is 500 mg, 1-3 times daily.
Red Root
Good for stimulating and clearing dead cellular debris from the lymphatic system, red root also supports a healthy liver and spleen, optimal immune function, and swollen lymph nodes.
Chlorella
A freshwater algae, chlorella does wonders for healing an irritated stomach and restoring digestive function. It’s also great for detoxing and healing in general. The typical maintenance dose is 5 to 7.5g total a day, and for additional support, we suggest 10g total a day. Chlorella can be taken any time of day. For best results, take it with food. (Avoid products that also contain spirulina, a blue-green algae that potentially contains toxins.)
Adaptogenic Herbs
These help reduce herxing and moderate the effects of stress. Some to try:
- Chinese skullcap (450 mg, twice a day)
- Cordyceps (450 mg, twice a day)
- Reishi mushroom (175 mg, twice a day)
- Rehmannia (50 mg, twice a day)
3. Proteolytic Enzymes
There are a variety of proteolytic enzymes that will work to help break down immune complexes and reduce inflammation. Bromelain (from pineapple) is a good choice; the dose is 500-1000 mg, one to two times daily. It’s sometimes found in combination supplements for joint health. Generally, it’s best to take enzymes on an empty stomach to absorb them directly.
4. Heat Therapy
Heat can be very soothing during herx reactions. A far infrared (FIR) sauna or a hot bath is excellent for removing toxins from the body. Adding Epsom salts to your bath can also help soothe muscles and joints.
5. Fresh Air
Forests and beaches or shores alongside open water are especially beneficial. Take your shoes off and walk barefoot: Called “grounding,” it’s a good practice for reducing inflammation in the body.
6. Relaxation Practices
Decreasing stress is key to normalizing the body’s adrenaline-cortisol response. But even when we feel unwell, most of us still try to push our limits. However, when you’re in the throes of a herx, don’t be afraid (or ashamed) to say “no” if you need to. Only agree to do what’s necessary, and let the rest go until you are back on your feet.
Need some extra help to bring on the calm? Use lavender essential oil. Research suggests it may be beneficial for easing insomnia, anxiety, and stress. Apply it to the bottoms of your feet before bed to help with sleep.
Thoughts on Herx Prevention
There’s a decent chance that if you increase the dosage of your current treatment or introduce a new one to your Lyme regimen, the herxing may return. It’s not entirely avoidable, says Dr. Rawls, but you can take steps to help fend off and reduce symptoms.
For instance, a few days before you change up your therapy, Dr. Rawls recommends adding some extra turmeric and krill oil to your daily routine; these help support a healthy immune and inflammatory response. He also suggests working to curb your mental and physical stress.
In general, the most successful approach to experiencing better health is to focus on reducing cellular stress and restoring healthy immune function. Do that, and you’ll rebound faster from herxing and begin to feel better.
Dr. Rawls is a physician who overcame Lyme disease through natural herbal therapy. You can learn more about Lyme disease in Dr. Rawls’ new best selling book, Unlocking Lyme.
You can also learn about Dr. Rawls’ personal journey in overcoming Lyme disease and fibromyalgia in his popular blog post, My Chronic Lyme Journey.
1. Dhakal A, Sbar E. Jarisch Herxheimer Reaction. [Updated 2022 Apr 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557820/
2. Koulivand PH, Khaleghi Ghadiri M, Gorji A. Lavender and the nervous system. Evid Based Complement Alternat Med. 2013;2013:681304. doi: 10.1155/2013/681304
