In theory, a “healing crisis” is when your symptoms get worse before they get better, and this is a sign that you are healing. It’s also called a Jarisch-Herxheimer reaction or “die-off” (indicating the die-off of pathogenic organisms in the body.)
Where did this theory come from? In the late 1800’s/early 1900’s two doctors noticed that when they treated patients with syphilis, many of them went through a period of worsening symptoms before they felt better. These symptoms began within a few hours of the first injection of antibiotics and lasted for up to one day. They guessed that it was caused by toxins released as the syphilis spirochetes died. The doctors’ names were Adolf Jarisch and Karl Herxheimer. Since then, modern doctors have noticed this can happen when treating other spirochete infections (like Lyme Disease).
As you can see above, medical use of this term is limited to spirochete infections, and the symptoms last a short period of time. In the alternative health community, the term has been expanded to explain (and justify) any worsening of symptoms related to a new diet, supplement or treatment protocol. Believing that these symptoms are a sign of healing, many people “push through” for days or weeks, expecting to feel better, and only feel worse. For people with autoimmune disease, this can lead to an autoimmune flare.
A Harmful Crisis
When it comes to belief in a healing crisis, you’ll often hear people say, “If you feel badly, that’s how you know it’s working.” That’s a dangerous philosophy, because there are many reasons your body might react negatively, which have nothing to do with healing:
- The treatment may be stimulating your already overactive immune system. In a healthy body, our immune cells work in harmony. In an autoimmune body, one type of immune cell becomes dominant over the others, and our bodies’ defenses end up attacking us. Many herbs (including herbal antibiotics), probiotics and other supplements have a side effect of stimulating the immune system. Depending on our immune balance, this can have a positive or negative effect, which varies from person to person.
- You may be detoxifying faster than your body can process. There are two phases of liver detoxification. The first phase liberates the toxin, and the second phase deactivates it. Many people have difficulty with phase two. If toxins are liberated but not deactivated and excreted, they’re actually more dangerous than when they were stored inertly in your body. If you feel sick on a detox protocol, there’s a reason. You are essentially getting poisoned with your own released toxins.
- You may be exacerbating an underlying health issue. Autoimmune disease is complex, and often comes with other conditions. No two people are alike, and trial and error – both in terms of interventions and diagnosis – are part of the process. I know that’s frustrating. We want straight avenues to feeling better, and it can be demoralizing when an intervention makes us feel worse. A good functional medicine practitioner has the ability to look at your symptoms as signals from your body on what might be going on underneath, and that includes how you react to new protocols. If your practitioner always classifies negative responses as a sign of healing, it might be time to find a new practitioner.
How Can You Tell the Difference Between a Healing Crisis and a Harmful Crisis?
One of the tenets of the paleo autoimmune protocol, and the whole movement of n=1 self-experimentation, is that we learn to listen to our bodies and develop habits that optimize our health. For that reason, I’m reluctant to tell anyone to ignore negative symptoms. If you are going to have a bias, assume that if your body responds badly to a new healing protocol, that’s not a good thing. Here are some examples of “crisis” experiences, and how you can evaluate and get through them quickly:
- Low Carb Flu: Some people who go straight from a Standard American Diet (SAD) to the AIP experience something called “The Low Carb Flu.” The SAD diet includes a lot of sugar and foods that convert to sugar (grains), and your body is used to getting its energy from sugar. The paleo diet contains more fat and protein, and it can take time for your body to adjust to a new “fuel balance.” During that time, you may experience increased fatigue, headaches and brain fog. However, the goal with AIP isn’t to go low-carb anyway. So, if you have these symptoms, listen to your body and increase your carbohydrate intake. Make sure you have fat, protein and safe starches at every meal. All three macronutrients are important for our health. Some AIP safe starches are sweet potatoes, plantains, winter squash, parsnips, turnips, and yuca.
- Digestive Symptoms: Some people experience digestive symptoms when they switch to the AIP and will mistakenly think the new paleo foods are the problem, when really, an underlying health issue is being illuminated. If you have trouble digesting fats, your gallbladder might need support. If you have trouble digesting meat, you might have too little stomach acid or a deficiency in digestive enzymes. If you have trouble digesting everything, you might have an h. pylori infection. If you experience bloating, you might have small intestine bacterial overgrowth. If your autoimmune symptoms increase with certain food groups, you might have a pathogenic bacteria, fungi or parasite causing those symptoms. “Test, don’t guess” is the recommendation. Both Angie and Mickey had digestive symptoms that led to diagnosing and treating infections that boosted their personal healing.
- Probiotics: These can cause transitional digestive symptoms as your microbiome changes. You might experience increased flatulence, bloating or changes in bowel movements. You can limit this effect by starting with a very small dose. Begin with one capsule, and if that’s too much, open the capsule, and begin with 1/4 of its contents and work your way up. If you are using a probiotic powder, start with the smallest spoon they provide. These symptoms shouldn’t be permanent or debilitating. If you have a strong negative reaction to a probiotic (mental or physical distress), stop taking it, and seek one that you tolerate better. Probiotics can contain allergens (most are dairy-based, so read labels carefully). They also stimulate the immune system, so you want to find one that stimulates yours in a way that helps it balance, rather than increases your autoimmune response. It can take trying a few different probiotics before finding the one that’s right for you.
- Antibiotic/Anti-parasitic/Anti-fungal: This is one place where worsening symptoms (both physical and mental) might indicate a healing crisis. I’ve polled my friends in the autoimmune paleo community, and many have experienced a herxheimer reaction with these prescriptions. It doesn’t happen every time, but it can happen sometimes. Since these are temporary prescriptions, this is one situation where it can be worthwhile to “power through.” Be sure to discuss your symptoms with your doctor, though, to be sure it’s not an allergic reaction. And if you’re taking an herbal antibiotic, consider the possibility that you might be having an autoimmune reaction to the immune-stimulating herbs. There is usually more than one choice of herb or prescription for these protocols. Feel free to ask your doctor for an alternative that might be easier for you to tolerate. Also ask if you can lower the dose, to control the die-off response. Lastly, do everything you can to support your body’s ability to detoxify: get plenty of sleep, and try epsom salt baths.
- New Supplements: When supplements are added to your healing protocol, they should have a specific goal, such as reducing inflammation, helping to regulate your immune system, or supporting your adrenals. They are designed to make you feel better. Feeling worse is a sign that a supplement isn’t working for you. First, check the bottle carefully and make sure it doesn’t contain non-AIP ingredients. (Many supplements contain dairy, grains and soy.) If your supplement is allergen-free and your body is still reacting negatively, then that supplement isn’t for you. It’s very common in the autoimmune community to find one person who responds very well to a supplement, and another who responds poorly. We’re all unique, which is why we need to trust what our body tells us.
- Detox Cleanses: These are popular in the alternative health community in the form of juice and water fasts, or “cleansing herbs.” Neither is recommended for anyone with autoimmune disease. The autoimmune protocol diet itself is naturally detoxifying at a rate your body can handle. (Remember what I wrote about the two phases of liver detox. Cleanses tend to overactivate phase 1.) If you want to support your body’s natural ability to detoxify, focus on nutrient density, and do gentle supports like epsom salt baths, saunas and dry skin brushing. Listen to Sarah Ballantyne’s recent podcast for details on the science behind detoxification.
I lost a TON of weight by cutting my carbs! I’ve been doing low carb/paleo for over two years. I recommend it to all of my friends needing to lose weight. I also recommend the 21 day sugar detox to get started. It really helped me get goin!
This is a wonderful, thorough piece. Thank you so much for answering many questions that have been nagging at me.
One further question regarding detox: does the mechanism of a coffee enema differ from that of a juice cleanse.? I have been considering trying the enema (and I read somewhere that you tried it as well, and got rid of some skin spots).
many thanks again!
First a disclaimer: Sarah Ballantyne doesn’t recommend coffee enemas on the AIP since they aren’t validated in the scientific literature. She has also expressed concern that they might irritate the digestive tract and wash out beneficial bacteria. So I just need to be clear that my coffee enema use is an n=1 experience (a self-experiment that works for me.). I did a series of weekly coffee enemas for 6 weeks and then dropped to once a month. I have found them to be beneficially detoxifying and surprisingly relaxing. The spot that disappeared was a “liver spot” – a darkened patch of skin over my liver. I do think you can do them too often. Some websites on the internet recommend them daily, and I think that’s a bad idea. I also don’t recommend them weekly long-term. Monthly is a good maintenance level for me.
Thanks for your reply, Eileen. I am becoming increasingly interested in the coffee enema concept, which Dr. Kharrazian recommends for SIBO patients (I am among them, alas). Also, I recently learned that it was in the Merck Manual until the 70s, when the medical establishment for some unknown reason removed it. But, as always, self experimentation is the key, and I will proceed with caution and with the oversight of my naturopath.
As usual your post is very timely . I’m having trouble distinguishing between autoimmune symptoms and symptoms related to an unresolved Lyme infection, complicated by other recent infections. I don’t think I’m herxing, but I am concerned with the possibility of aggravating my auto immunity (I have Hashimoto’s) with the herbal antibiotics I’m currently using. I just don’t know what’s what!! The most troubling symptom is tremors which haven’t conclusively been linked to anything. I will see a neurologist in early June. I hope he will be able to pinpoint the reason for the tremors and other neuro symptoms, but I don’t know if that’s how it works, especially when Lyme is in the picture. I’m also taking prescription probiotics (VSL) and had no idea these could over stimulate the immune symptoms. You’ve given me a lot to consider. Many thanks Eileen!
Thanks for sharing your experience, Claire. I hope you find clarity soon. Gentle hugs to you!
PS. VSL is a dairy-based probiotic, which means it contains trace amounts of lactose and casein.
Great article, as always! Do you know what supplements support adrenals, but do not enhance the immune system? Been taking meds for RA for 20 years to suppress my immune system. After finally stopping prednisone recently, I had an adrenal crash. Many adrenal support concoctions on the market contain immune enhancing ingredients. I feel caught in the middle! I really appreciate your research, informative and inspiring articles, and the wonderful round table recipes! Thank you so much!
Hi Denise. I did a podcast recently on adrenal recovery, which included some supplement recommendations that I believe are AIP-friendly, but you would need to verify the ingredients to be sure: https://www.phoenixhelix.com/2015/03/28/episode-15-adrenal-fatigue/ . Also, there’s a great article here on Autoimmune-Paleo that talks about 8 lifestyle habits to heal the adrenals: https://autoimmune-paleo.com/eight-key-lifestyle-habits-to-support-adrenal-healing/ . Wishing you energy and health!
[…] bit of a Herxheimer effect ("die-off" of harmful pathogens). You can read about it here: Is A Healing Crisis Really Healing? – Autoimmune Paleo (And @brooklynAnn — so glad you found this thread too ) Posted via Mobile […]
I am wondering if you can clarify what cleansing herbs may be? I am taking some homeopathic anti-fungals for Candida and am wondering if those may be making me feel worse.
I listen to a lot of your podcasts they are so helpful-I also have RA and T1DM and reading this wondered what you thought of kombucha – often linked to ‘healing crisis’?!
Hi Hannah. Sorry for the delayed reply. Kombucha shouldn’t make you feel bad. It makes me feel good! If it does make you feel bad, it’s much more likely to be a yeast sensitivity response than a “healing crisis”. That said, sometimes people simply drink too much of it. A 4-8 ounce serving is a medicinal dose. Anything more than that is more than the body needs. But if you react negatively to even that small a dose, I recommend you avoid it.
[…] If you respond negatively to a treatment protocol, they change their recommendations accordingly. The goal is for you to get better, not worse. And while some treatments such as parasite cleanses can make you feel worse for a few days, that should be temporary, and ideally avoided altogether. The term “healing crisis” is overused in the functional medicine community. A good practitioner won’t tell you to power through. They will reassess the situation. Resource: Is a Healing Crisis Really Healing? […]
[…] Healing crisis is an over-used term. True die-off reactions are short-lived, usually just a few days. If the reaction persists longer than a week, it’s usually an intolerant/allergic reaction to the supplement or antibiotics, and you should stop taking them. Then wait a week for the flare to settle, and try again with a gentler treatment protocol. Dr. Ruscio will switch from a multi-herbal protocol to a single herb – wait to see if it’s tolerated – and only add another if the patient responds positively. Some patients are very reactive, and a simpler treatment is better. […]
Thank you for this article, I also love your podcasts. I have started the AIP after slowly cutting down on sugar, caffeine and gluten amongst other things. I barely had any symptoms but now after a week full AIP I have started getting facial flushing. Hard to know if it’s a healing crisis or a harmful crisis but I am being as diverse as possible. The only thing I’m having a lot more of that I didn’t used to is coconut, what with the oil, flour, flakes etc. So confusing.
Hey Emma, have you considered that you might be sensitive to histamines? AIP isn’t specifically low-histamine, and some foods recommended (like fermented foods, or broth) can be high histamine. That might be something for you to explore! Good luck.
I started a gut healing protocol recently. I was already primal so I wasn’t expecting a huge crisis, other than being tired as my body tries to heal. I did notice I started getting flushing, irritation, and what a dermatologist would probably dx as rosacea. The only other time I’ve ever had this was during my pregnancies. My cycle also shifted, in a good way, but I got a lot of chin breakouts (they cleared fast!). For me, I believe the flushing was a sign of my hormones trying to find their balance. I don’t know if this could potentially be the case for you? For me it lasted about a week. Histamine intolerance is also worth investigating. Good luck in your healing!
Tomorrow is my 30th day of AIP and I certainly feel so much better. The brain fog is minimized and my energy is (mostly) consistent throughout the day. What hasn’t improved – in fact it’s gotten worse – is constipation. It’s been a problem for 15 years but I finally found some relief pre-AIP through Aloe juice. When I started AIP, I didn’t drink the Aloe but after two weeks without a bowel movement, I started drinking it but that hasn’t helped either.
Are there any suggestions for dealing with this?
Two weeks without a bowel movement is absolutely problematic – at that point I would definitely be seeking out some OTC relief there. My first recommendation would be to make sure you are taking a good magnesium supplement – a lot of people find that natural calm (or any form of magnesium citrate) helps soften stool and get things moving again. Also, using a squatty potty to get into the right position can be really helpful. The Paleo Mom has a very informative article about constipation here: https://www.thepaleomom.com/treating-constipation-without/. I hope you are able to find a solution soon – I wouldn’t say this is a typical response to an elimination diet, so another thing to consider is if you are eating more of a food you previously hadn’t eaten much of before. You could be sensitive to AIP-legal foods (like coconut, or starchy veggies). Good luck!
I have Ulcerative Colitis and started AIP a month ago, and have been having chronic mild diarrhea. Any suggestions on what to do to help minimize the diarrhea?
Hi Amy! We aren’t medical practitioners and can’t troubleshoot medical issues through comments. I recommend checking in with your doctor to see what could be going on, it sounds like you may be experiencing a flare of your condition.
Please help…I’ve had give for over 3 years. I’ve had many many tests. All were negative. The best of the 7 drs I saw said 90% of the time the cause isnt found. I don’t want any more prescriptions…I’ve read much about leaky gut and liver detox. I recently started the diet recommended by Dr. Axe with many many supplements.I’m pretty sure I’m in the healing crisis stage, but my only symptom is terrible, way-worse-than-usual itchy itchy hives!! They are do so bad. Tonight i read that some believe that the healing is actually RETOXING….or detoxing too fast. How do I slow down my detox?? I’m si miserable but I want yo ane this through….
Hi Teresa! I’m so sorry to hear about the negative reaction you are experiencing. Unfortunately we are not medical practitioners here, nor are we familiar with Dr. Axe’s diet or supplements. I would suggest reaching out to your doctor for monitoring or support, or consider hiring a health coach to integrate with your medical team to help walk you through the changes. We have a listing of practitioners we’ve trained here: https://aipcertified.com. Good luck!