What is a Herxheimer Reaction and What Should I Do?

When starting the SCD, some people feel worse for the first few days. This is as a result of what’s called a Herxheimer reaction. This next excerpt, from our book, The SCD for Autism and ADHD, describes why this might happen, as well as ways to help get through those initial days.

Because Beth’s 4-year old son David suffered from autism, she decided to start a dairy-free version of the SCD. Initially, Beth spent 2 weeks becoming familiar with the diet, setting up her kitchen, and coordinating a “start day” with her family. In addition, her best friend, who lived nearby, agreed to help with the cooking.

On the 1st day of the diet, David refused to eat anything, but he kept hydrated with water. On the 2nd day, David began eating the SCD food and using probiotics, but he appeared overcome with tiredness, spending much of the day lying on the couch. David also developed bad breath. His mother Beth recognized the fatigue and bad breath as withdrawal symptoms.

To help ease David’s discomfort, Beth prepared a relaxation bath for him, which included Epsom salt. She also watched him closely to make sure he kept hydrated. Three days later, the withdrawal symptoms lessened and David’s energy returned.

During the first 1–3 days of the diet (including the use of probiotics), most children experience withdrawal symptoms. These include fatigue/lethargy, bad breath, foul gas, headaches, aching limbs, irritability, and/or nausea. Harmful bacteria (or parts of this bacteria) are the cause of these symptoms. Once these bacteria are deprived of energy and encounter probiotics, they begin to die-off. As the bacteria break down, the toxins in their cell membranes are released into the bloodstream. These toxins, in turn, cause withdrawal symptoms, also known as a Jarisch-Herxheimer reaction.

This process may be seen in the diagram below:

These symptoms are a positive sign that the diet is working. However, it is also a difficult time for the child. In anticipation of this detoxification reaction, plan appropriately for school and therapy sessions:

  • If your child is in school, consider keeping him or her home during this time.
  • Have your child take a break from intensive educational therapies, such as behavioral therapy.

Other therapies may help, especially occupational therapy or physical therapy that allows for running, swimming, jumping, swinging, and other gross motor skills.

Comforting a Child During Withdrawal

The best way to comfort a child depends on his/her personality. If a child wants to sleep, allow him/her to do so. If your child likes to cuddle, then cuddle. On the other hand, some children want to run around during this period. That’s fine too. Two recommendations that we make during this time period are:

(1) Keep Your Child Hydrated

As well as drinking water, a homemade electrolyte drink may be used:

  • 1 quart boiled water
  • 2 tablespoons honey
  • 1/4 teaspoon baking soda

Mix the ingredients in a container and let the drink cool.

This can be kept in the refrigerator for up to 2 hours, and then a new batch should be made.

It’s important to make your own electrolyte drink. Store-bought electrolyte/sports drinks contain sugars and additives, such as food colorings; these are prohibited on the diet.

(2) Epsom Salt Relaxation Bath

To prepare the bath, fill a tub with warm water and mix in the following:

  • 1/2 to 1 cup* of Epsom salt* (without added scents or coloring)
    (A similar mixture for adults would use 2 cups of Epsom salt.)
  • 1/2 cup of baking soda
  • 1 drop of lavender essential oil (optional)

Bath Time for Child: 12 to 20 minutes

Monitor the bath. It shouldn’t be longer than 20 minutes. The bath will help draw out some of the toxins, most likely leaving a child groggy. In addition, Epsom salt baths provide magnesium and sulfate, which are absorbed by the skin. Note: the Epsom salt may make the tub slippery.

Jarisch-Herxheimer Reaction and Blood Toxins

The die-off symptoms, or Jarisch-Herxheimer reactions, are also well documented as a reaction to antibiotics. In a 1984 study published in The Journal of Infectious Diseases, researchers used animals to better understand how antibiotics caused a die-off reaction.

The test animals were infected with Escherichia coli, a type of bacteria that can cause stomach cramping, bloody diarrhea, and vomiting. This bacterium is often found in contaminated water or food, especially undercooked ground beef.

After infecting the test animals with Escherichia coli, researchers treated the animals with either antibiotics or a placebo:

  • For the animals given antibiotics, the levels of endotoxins in the blood increased 10-fold to 2,000-fold while the actual level of bacteria in the blood was decreasing. In some animals, the level of endotoxins “continued to increase for hours,” even after all the bacteria had been cleared from the blood.
  • In the placebo group, the endotoxins did not increase but stayed proportional to the amount of bacteria.

The study showed that when antibiotics kill bacteria, the level of endotoxins in the blood increases significantly. It’s these endotoxins that cause the “withdrawal” symptoms.

With dietary changes, bacteria deprived of energy begin to die-off. Probiotics too have an antimicrobial effect. As a result, the combination of the SCD and probiotics leads to more endotoxins being released and the occurrence of withdrawal symptoms.

Summary: Die-Off: Withdrawal & Detoxification Symptoms

  • When starting the diet, most children experience withdrawal symptoms from the die-off of harmful bacteria.
  • These symptoms include fatigue/lethargy, bad breath, foul gas, headache, aching limbs, irritability, and nausea.
  • During this time, the child will need “down time” to recover.
  • Behavioral therapies might need to be reduced. If your child is in school, consider keeping him or her home during the detoxification period.
  • It is important to keep hydrated.
  • It helps to use Epsom salt baths.

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