SIBO Die Off Symptoms: What They Are and How to Prevent Them

Small intestinal bacterial overgrowth (SIBO) is a condition characterized by an imbalance of bacteria in the small intestine. This imbalance leads to uncomfortable symptoms including bloating, gas, nausea, constipation, diarrhea, and sometimes nutrient deficiencies. (1, 2)

To correct this imbalance, you can either take a dose of prescribed antibiotics or follow an herbal treatment program as the first step. No matter which path you take initially, the next step will be to follow a special SIBO diet plan to support gut healing and to prevent relapse.

Unfortunately, even more uncomfortable symptoms can occur during that first step of treatment (i.e. the eradication phase), which are called die off symptoms.

Not sure what I mean by “die off”? Then you’re in the right place!

This article will explain what die off is, why it makes you feel worse before you feel better, and provide you with actionable ways to help reduce these uncomfortable symptoms.

What is SIBO Die Off?

You’re probably asking yourself, what exactly is SIBO die off and why does it happen?

One theorized explanation is the Jarisch-Herxheimer reaction (JHR). The JHR was first discussed in the late 1800s when syphilis patients were observed to have worsening symptoms shortly after the start of treatment. Today, the JHR is defined as a reaction the occurs within 24 hours of starting antibiotic treatment for certain infections including syphilis, Lyme disease, and relapsing fever. (3)

While this reaction was first discovered in syphilis patients, the reaction has now been observed in other bacterial, fungal, and protozoal (such as malaria and dysentery) infections. Moreover, it often goes undiagnosed because many of the most common symptoms are either present before treatment starts or get misidentified as an allergic reaction to the antibiotics. (3, 4)

What are the SIBO die off symptoms?

The most common symptoms include: (3, 4, 5, 6)

  • Fever
  • Chills
  • Skin rash
  • Body aches
  • Headaches
  • Low energy
  • Hyperventilation

Other, less common but more severe symptoms include: (5)

  • Meningitis
  • Respiratory failure
  • Liver and kidney disfunction
  • Heart issues
  • Early uterine contractions in pregnant women
  • Increased risk for strokes and seizures

Although these less common symptoms sound serious and a little scary, there is little to no evidence the JHR is fatal or long lasting. (5)

Why do these die off symptoms occur and how long does die off last?

According to a recent review of the current research surrounding the JHR, the exact reason these symptoms occur is still unknown. (3)

That being said, the main theory suggests that as the bacteria, fungus, or whatever microorganism is causing the initial infection is dying off, toxins are also being released into the body and trigger an immune reaction. However, this theory is controversial and has little scientific evidence to support it at this time. (5)

Everyone’s reaction to the JHR is different, meaning the length of time the symptoms last depends on the severity of the infection and the individual. In general, symptoms resolve on their own within 1-2 days. (3)

Lastly, more research involving die off specifically related to SIBO needs to be done in order to confidently connect the two. It’s also important to remember that worsening symptoms may simply be because the bacterial overgrowth is not being treated correctly. This is one more reason why it’s so important to work with a medical professional during treatment. (7)

Can die off be treated/prevented?

The primary method of treatment is to treat the symptoms. This includes: (3, 5)

  • Over-the-counter drugs to treat fever, body aches, and headaches (i.e. Tylenol and ibuprofen)
  • Antihistamines to help with skin rashes and itching

Other recommendations include:

  • Eating enough and a variety of dietary fiber – this keeps your bowels moving and allows your kidneys and liver to focus on detoxing your body (8)
  • Drink lots of fluids – helps to flush out toxins through the urine
  • Stress management – high levels of stress impair you immune system and make it harder to recover from illness/injury
  • Get 7-9 hours of sleep per night – this is just essential to overall health, including digestion and immune function

If symptoms don’t resolve in a couple of days and/or get worse, talk to your healthcare provider immediately. If symptoms become severe (i.e. trouble breathing, rash that covers a large portion of the body, high fever that doesn’t go away), go to the hospital.

Explanation of SIBO die off symptoms and how to treat them

Final Thoughts

There is no way to completely prevent the JHR from occurring, but you can treat the symptoms to make yourself more comfortable in the moment. Symptoms should start to resolve on their own within a day or two, however if they are not resolving or are getting worse, see your health care professional or go to the hospital immediately.

As always, it’s important to work with a healthcare professional in order to develop a treatment and monitoring plan that is specific to your body and your needs.

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