H Pylori Die Off Symptoms: What to Expect & How to Manage It

Did you know that when you start an H pylori protocol you may experience die off symptoms that actually make you feel worse before you start feeling better?

Unfortunately, gut healing isn’t a straight and narrow path. And especially when you get started on an herbal H pylori protocol, it’s not uncommon to feel an increase in your upper GI symptoms before you start noticing them subside.

While this can be discouraging, this is actually a completely normal part of any treatment protocol.

This is a phenomenon known as a die off, or a Jarisch-Herxheimer, reaction.

So, whether you haven’t yet started your H pylori protocol and are trying to get a feel for what to expect, or if you’ve already started but are trying to learn if what you’re experiencing is normal, this blog post is for you!

In this blog post we’ll go over:

  • What exactly is die off and what causes those symptoms during an H pylori protocol
  • What you can expect during the course of your herbal H pylori treatment
  • Ways to best manage any die off symptoms you do experience
  • And how to know when your symptoms are more than die off and you might want to take a break

I have both personal experience with H pylori die off symptoms, and experience as a practitioner helping my clients navigate them. So, if you’re ready to learn all about die off symptoms and what to expect during your H pylori treatment, let’s go!

h pylori die off symptoms

What Causes Die Off?

The symptoms that you experience during a die off reaction are caused by the mass release of endotoxins from the H pylori bacteria when they are destroyed (or when they die off, hence the name).

The more formal name for this phenomenon is the Jarisch-Herxheimer Reaction, named after the dermatologists (Adolf Jarisch and Karl Herxheimer) who discovered it.

This die off phenomenon is actually your body’s natural response to the release of these endotoxins into the bloodstream. And it likely occurs to some degree every time you take antibiotics or herbal supplements.

It’s only when the bacteria or other pathogen you are working to destroy is present in such large quantities does this die off reaction become too much for the body to handle, and symptoms appear.

When your body is flooded with endotoxins, they travel through the bloodstream and elicit an acute immune response.

The subsequent inflammation and burden on your liver are what directly cause the worsening of symptoms you may be experiencing.

The severity and duration of your symptoms during this die off reaction depends on a few factors:

  1. The number of endotoxins present in your system, which is likely directly related to the number of bacteria you are killing off. So, in theory, a larger H pylori infection will elicit a larger endotoxin release, which may result in more severe die off symptoms.
  2. The level of inflammation triggered by the acute immune response. If you have an autoimmune disease or another condition that up-regulates your immune system, or if your body is already in an inflamed state, your die off reaction also may be more severe.
  3. The presence of any other infections. Whether you have additional gut infections on top of the H pylori or other co-infections like Lyme, can all impact the severity and duration of your die off symptoms.

And again, this reaction is a completely normal response by your body to the killing off of these pathogens.

It is, however, important for us to know how to identify a die off reaction, what to expect during it, and how to best manage the symptoms.

h pylori die off symptoms

Common Die Off Symptoms

When you’re going through H pylori treatment, it may be difficult to distinguish die off symptoms from a flare-up of your normal gut symptoms.

And this is common. Oftentimes die off symptoms closely mimic the symptoms of the bacteria you’re working so hard to kill off.

But don’t worry, by the time you’re finished reading this blog post, you’ll feel more confident in your ability to tell the difference between temporary die off symptoms and a flare-up of your H pylori symptoms.

Here is a list of some of the most commonly experienced H pylori die off symptoms:

  • Increase in bloating, gas, and nausea
  • Fatigue
  • Decreased appetite
  • Slowed digestion
  • Flu-like symptoms
  • Brain fog
  • Constipation and/or diarrhea
  • Skin changes like hives or itching

As we looked at earlier, die off symptoms are brought about by an increase in inflammation and liver burden from the release of endotoxins.

So, it makes sense that the majority of die off symptoms are related to inflammation (fatigue, brain fog), liver stress (brain fog, skin changes), and digestion (digestive symptoms, change in bowel habits).

h pylori die off symptoms

What to Expect When Starting a Treatment Protocol

Now that we know what a die off reaction is and some of the common symptoms, let’s dive deeper into what you can expect to experience when starting a new treatment protocol.

In my experience, die off symptoms usually begin anywhere from the day that you start your herbal supplements to two to three days after.

The timeframe within which you’ll start to notice die off symptoms depends on the severity of your gut infection, how healthy your gut is, and honestly, just you as an individual. Everyone is different and everyone responds to treatment protocols differently.

Once you do start noticing die off symptoms, you can expect to experience this mild to moderate increase in discomfort and symptoms for a few days to a few weeks.

Die off symptoms should not last longer than one to two weeks. And any symptoms lasting longer than that should be attributed to other factors like not tolerating a supplement well, or poor baseline gut health.

If that’s the case for you, skip down to the section titled “How to Know When to Take a Break” for some guidance on navigating long-lasting symptoms.

So, here’s a quick checklist to help you determine if what you’re experiencing is likely normal die off symptoms or not.

H Pylori Die Off Symptoms What to Expect

What’s Normal

  • Experiencing an increase in symptom severity and/or frequency for a few days
  • Noticing a mild to moderate increase in symptoms
  • Needing to take digestive enzymes and/or digestive bitters to help improve digestion
  • Mild to moderate skin reactions like hives, bumps, or sensitivity

What’s Not Normal

  • Experiencing an increase in symptom severity and/or frequency for weeks
  • Noticing a severe increase in symptoms
  • Disrupted sleep
  • Extremely low energy

Essentially, die off symptoms shouldn’t be so severe that you have to suffer through them. And if they are, what you’re experiencing is likely more than die off. Meaning you should check in with your provider to re-evaluate your treatment plan.

h pylori die off symptoms

Ways to Manage Die Off Symptoms

This is where we get into the good stuff. Now we get to dive into the practical ways you can manage any H pylori die off symptoms you may experience.

And remember, die off is normal – to a certain extent. So use these tips to help you manage the increase in symptoms at the beginning of your treatment protocol.

And once you get through that initial hurdle, you should be well on your way to being H pylori and symptom free!

Here are some of the best ways to manage H pylori die off symptoms that I teach to my one-on-one clients.

With Supplements

Adding a few more supplements to your already daunting H pylori eradication protocol may be the last thing you want to do.

But, strategically using a few additional supplements can make a huge difference in your die off symptoms those first few days on your new protocol.

These supplements aren’t a necessary part of an H pylori protocol, but they can make getting through the increase in symptoms a little more bearable.

Supplement #1: Add in a binder

As we already learned, die off symptoms are a result of the H pylori bacteria releasing toxic byproducts when they are killed off.

This flood of toxins into our gut and bloodstream is a lot for our bodies to handle. And one way to help reduce that burden, and therefore reduce our symptoms is to take a binder.

Binders help to bind up whatever they come in contact with in the GI tract.

This means that binders can help gobble up some of those endotoxins and shuttle them out of the body via stool.

With a binder, you’ll often notice a reduction in symptoms during this usually symptomatic die off period. And that’s what we’re aiming for!

The only things to keep in mind when using a binder are to take it at least 30 minutes before or 2 hours after other supplements so it doesn’t interfere with their effectiveness, and drink lots of water to keep your bowels moving.

Supplement #2: Add in a spore-forming probiotic

Spore-forming probiotics are another great supplement to add to your protocol to help with die off symptoms.

These probiotics, specifically, have been shown to reduce gut inflammation, which is a common result of the surge of endotoxins we experience when we first start a treatment protocol.

Another amazing study has shown that spore-forming probiotics (specifically the bacillus strain) were able to reduce the number of LPS endotoxins in the gut by 42%.

This is significant because the presence of endotoxins, as we see with die off, can actually damage the intestinal lining and cause what is known as leaky gut.

But, with the use of spore-forming probiotics, that damage can be reversed, lessening the impact of this die off period on your overall health.

My most recommended brand of spore-forming probiotic is Just Thrive. You can use the coupon code NinjaJT for 15% off your order.

Supplement #3: Use magnesium

One key piece to helping reduce the length and severity of die off symptoms is to keep your detox pathways open.

Our bodies have several ways of detoxifying, with the main three being through sweat, urine, and stool.

We’re going to touch on all of these detox pathways in these tips. But, a good place to start is by supplementing with magnesium to help keep your bowels moving.

Having 1-3 bowel movements a day is considered normal, and is essential for getting those endotoxins out of your system to reduce symptoms.

Magnesium citrate and magnesium oxide are the two best forms of magnesium to help increase bowel transit time and speed up that form of elimination.

With Diet

Diet can be a very important part of managing any die off symptoms you experience while on an H pylori protocol.

Dietary changes are usually less expensive than supplements but often require a little more forethought.

So, if you want to try to help decrease any die off symptoms without supplementation, give these three tips a try.

Diet Change #1: Eat liver-supportive foods

We already know that your liver and how well it’s functioning plays a large role in your die off symptoms.

So, it’s in our best interest to support our liver the best we can while we’re working on treating an H pylori infection.

And increasing your intake of bitter foods is one of the best dietary ways to do that.

Bitter foods help to stimulate digestive enzymes, liver enzymes, and bile production which all make the process of breaking down food and toxins much more efficient.

Examples of bitter, liver-supportive foods that you should include in your diet are things like:

  • Jerusalem artichokes
  • Dandelion greens
  • Beet greens
  • Kale
  • Nettles
  • Grapefruit

Aim to add one bitter food into your meals per day to help give your liver some love during this process.

Diet Change #2: Drink lots of water

Increasing your water intake will do so many beneficial things for your die off symptoms, and it’s free!

Adequate water intake is required for consistent bowel movements, and to ensure that you’re urinating regularly – checking off two of our detoxification pathways with just one change.

It’s generally recommended that you aim to get half your body weight in ounces of water a day. But if you’re experiencing die off symptoms, it wouldn’t hurt to increase that amount even more.

Water is your friend when your body is under stress, so drink it liberally.

Diet Change #3: Reduce alcohol intake

You probably already know this, but alcohol is a stressor for your liver.

And if you’re experiencing die off symptoms, you want to be giving your liver all the love and support you can.

This means taking a step back from alcohol for a few weeks or more is probably a good idea.

This doesn’t need to be a permanent change. But I’d recommend that you remove alcohol from your life for at least as long as you’re experiencing die off symptoms.

Studies also show that alcohol is a gut irritant and a driver of gut inflammation, So removing alcohol for the entirety of your gut healing protocol might be something worth considering.

With Lifestyle

And last, but definitely not least, let’s look at a few impactful lifestyle changes you can make to help reduce die off symptoms.

Lifestyle changes aren’t as simple or as sexy as adding a new supplement to your routine. But, they can be some of the most impactful changes you can make when it comes to maintaining a healthy, thriving gut for the long term.

So here are three lifestyle changes you can make to help support your body when you’re dealing with die off.

Lifestyle Change #1: Sweat regularly

Here is our last piece of the detoxification pathway puzzle, sweating.

Our body removes certain toxins only through sweat. And when you’re dealing with a large number of endotoxins, and your liver is working overtime, you want to make it as easy as possible for your body to detox.

Making sure you’re sweating regularly is an easy way to do that.

Any way that you can get your body active and moving can help increase circulation and induce sweating, but it doesn’t have to be strenuous if you don’t want it to be.

Exercises like walking, yoga, or bike riding can work up just enough of a sweat to be effective. 20-30 minutes of sweating a few times a week is really all you need.

Or, using an infrared sauna, if you have access to one, can be extremely helpful with the detoxification process during your treatment protocol.

Lifestyle Change #2: Take detox baths

Detox baths aren’t as interesting as they sound, but they are extremely beneficial.

They’re essentially baths with some strategically added minerals and other supplements to help pull toxins out through your skin.

When it comes to reducing die off symptoms, supporting detoxification is the name of the game. And adding in some detox baths can really help in that category.

The Wellness Mama has a great post with some simple detox bath recipes that you can probably get started with tonight!

Lifestyle Change #3: Try lymphatic drainage

Lymphatic drainage is another helpful detoxification technique that helps move stagnant lymph through your body to flush out toxins and other waste that it’s carrying.

You can do this gentle form of massage at home, on yourself. And it’s incredibly effective at stimulating the movement of lymph and the transportation of toxins out of the body.

Lymph Love Club is one of my favorite lymphatic resources on the internet, and she has many video tutorials on how to do these techniques on yourself.

How to Know When to Take a Break

Die off symptoms at the beginning of H pylori treatment are to be expected. But, it’s helpful to know when the symptoms you’re experiencing are likely more than die off.

As we discussed, die off symptoms are going to be a minimal to moderate increase in symptoms over the course of no more than 1-2 weeks.

Any symptoms that are more severe in nature or last longer than 2 weeks are likely not able to be contributed to die off.

Symptoms that make it difficult to function normally during the day, or are causing you to not be able to eat, sleep, or exercise as usual are ones that shouldn’t be considered normal.

Starting a treatment protocol shouldn’t knock you off your entire routine and completely wreck your health. If so, there is likely something else going on.

Other factors that might be contributing to more severe symptoms at the start of a treatment protocol are things like:

  • Starting supplements too fast
  • Reacting poorly to an ingredient in a supplement
  • Needing to improve baseline gut health and function first

So, if you’re really struggling and it’s been a while since you’ve felt good on your protocol, stop. There is no need to stick it out, and no one gets a prize for feeling the worst during their treatment protocol.

If you have a practitioner, let them know how you’re feeling and ask what can be done to lessen symptoms and troubleshoot what’s going on.

And if you don’t have a practitioner, it’s probably time to find someone who has experience working with people like you and successfully eradicating H pylori.

I’d love to be that person for you! I’ve worked with many clients to successfully eradicate their H pylori, improve their gut health, and eliminate their symptoms.

If you want to work with me one-on-one, you can fill out this quick form. And I’ll be in touch to schedule a free Discovery Call to get a game plan in place for getting you feeling better!

The Bottom Line

The Bottom Line

Die off symptoms at the beginning of any H pylori treatment protocol are normal.

And it’s also normal to not experience any increase in symptoms.

Everyone is unique, and each case of H pylori is going to behave a little differently.

It’s important to remember to take your treatment protocol slow, take care of yourself while you’re going through it. And most importantly, remember that your body wants to be healthy.

Sometimes we try so hard to do everything right in our healing attempts, that we end up getting in our body’s own way.

Trust the process, trust your practitioner, and trust your body. You will find healing, promise.

And let me know if you try any of these recommendations to help lessen die off symptoms. Which ones worked best for you? Leave your answer in the comments!

2 thoughts on “H Pylori Die Off Symptoms: What to Expect & How to Manage It”

  1. Is it safe to take mastic gum while breastfeeding for h pylori? If not, what is something helpful I can take until weaning.

    Thank you.

    1. Jessica Washington, FDN-P

      The general recommendation for pregnancy and breastfeeding is that you should not do any treatment protocols, including mastic gum. It’s best to wait until you’re finished breastfeeding.

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