feeling worse before it gets better....

Many people try natural medicine and feel terrible when starting a new supplement regime....WHY?

Well, there is a thing called the healing crisis. (Herxheimer reaction) You have abused or under nourished the body for so long that when you finally give it what it needs, it gets to work in making you better....however, this may be uncomfortable and not as pleasant as you may have wished...what natural health practitioners may call a healing crisis. Although uncomfortable and somewhat unpleasant, it may not be a negative response.

We do always want things to be easy and painless but sometimes it has to get worse before it gets better...pain before the gain, right?

The Herxheimer Reaction - Feeling worse before feeling better 

The Herxheimer Reaction is a short-term (from days to a few weeks) detoxification reaction in the body. As the body detoxifies, it is not uncommon to experience flu-like symptoms including headache, joint and muscle pain, body aches, sore throat, general malaise, sweating, chills, nausea, loose stools or other symptoms. 

This is a normal — and even healthy — reaction that indicates that parasites, fungus, viruses, bacteria or other pathogens are being effectively killed off. The biggest problem with the Herxheimer reaction is that people stop taking the supplement or medication that is causing the reaction, and thus discontinue the very treatment that is helping to make them better. Although the experience may not make you feel particularly good, the Herxheimer Reaction is actually a sign that healing is taking place. 

What Is The Herxheimer Reaction? 

The Herxheimer Reaction is an immune system reaction to the toxins (endotoxins) that are released when large amounts of pathogens are being killed off, and the body does not eliminate the toxins quickly enough. Simply stated, it is a reaction that occurs when the body is detoxifying and the released toxins either exacerbate the symptoms being treated or create their own symptoms. The important thing to note is that worsening symptoms do not indicate failure of the treatment in question; in fact, usually just the opposite.  

A Rose By Any Other Name 

Technically known as the Jarisch-Herxheimer Reaction, this syndrome goes by many names, including JHR, the Herxheimer Effect, the Herxheimer Response, a Herx Reaction, Herx or Herks. The most common terminology used is the Herxheimer Reaction. It is also often referred to as a healing crisis, a detox reaction, or die-off syndrome.  

History 

The phenomenon was first described by Adolf Jarisch (1860-1902) working in Vienna, Austria, and a few years later by Karl Herxheimer (1861-1942), working in Frankfort, Germany. Both doctors were dermatologists mainly treating syphilitic lesions of the skin. They noticed that in response to treatment, many patients developed not only fever, perspiration, night sweats, nausea and vomiting, but their skin lesions became larger and more inflamed before settling down and healing. Interestingly, they found that those who had the most extreme reactions healed the best and fastest. The patient might be ill for 2-3 days, but then their lesions resolved.  

A Medical Example 

The Herxheimer reaction is caused by the release of toxic chemicals (endotoxins) released from the cell walls of dying bacteria due to effective treatment. The Herxheimer Reaction is well recognized in medical circles and is certainly not confined to the world of natural medicine or supplements. 

For example, a recent study report (Feb ’04) on the treatment of Sarcoidosis found that, “. . . without exception, the improving patients are reporting periodic aggravation of their symptoms as an apparent direct response to the antibiotics. In other words, these patients say that their treatment makes them feel much worse before they experience symptom-relief.” The abstract of the study goes on to say, “This phenomenon is known as the Jarisch-Herxheimer Reaction (JHR) and is often referred to informally as Herx. JHR is believed to be caused when injured or dead bacteria release their endotoxins into blood and tissues faster than the body can comfortably handle it. . . . This provokes a sudden and exaggerated inflammatory response . . . . In Sarcoidosis patients, the Herxheimer reaction seems to be a valuable indication that an antibiotic is reaching its target.” In the conclusion, the author states: “In my work with Sarcoidosis patients, it is my experience that recovering MP patients understand and welcome the Herxheimer reactions even when they must endure temporary increased suffering. They accept it as the price that they must pay in order to get well and they even seem to find it gratifying to experience tangible evidence of bacterial elimination.“

Jarisch-Herxheimer reaction

Signs and symptoms

It resembles bacterial sepsis and can occur after initiation of antibacterials, such as penicillin or tetracycline, for the treatment of louse-borne relapsing fever (80-90% of patients) and in tick-borne relapsing fever (30-40%). An association has been found between the release of heat-stable proteins from spirochetes and the reaction. Typically, the death of these bacteria and the associated release of endotoxins or lipoproteins occurs faster than the body can remove the substances. It usually manifests within a few hours of the first dose of antibiotic as fever, chills, rigor, hypotension, headache, tachycardia, hyperventilation, vasodilation with flushing, myalgia (muscle pain), exacerbation of skin lesions and anxiety. The intensity of the reaction indicates the severity of inflammation. Reaction commonly occurs within two hours of drug administration, but is usually self-limiting.

Causes

The Jarisch-Herxheimer reaction is classically associated with penicillin treatment of syphilis. Duration in syphilis is normally only a few hours. The reaction is also seen in other diseases caused by spirochetes, such as borreliosis (Lyme disease and tick-borne relapsing fever) and leptospirosis, and in Q fever.[1] Similar reactions have also been reported to occur in bartonellosis (including cat scratch disease),[2][3] brucellosis,[4] typhoid fever,[5] trichinosis,[6] and cerebral trypanosomiasis.[7]

Pathophysiology

The Herxheimer reaction has shown an increase in inflammatory cytokines during the period of exacerbation, including tumor necrosis factor alpha, interleukin-6 and interleukin-8.[8][9]

Treatments

Prophylaxis and treatment with an anti-inflammatory agent may stop progression of the reaction. Oral aspirin every four hours for 1–2 days, or 60 mg of prednisoneorally or intravenously has been used as an adjunctive treatment [citation needed]. However, steroids are generally of no benefit. Patients must be closely monitored for the potential complications (collapse and shock) and may require i.v. fluids to maintain adequate blood pressure. If available, meptazinol, an opioid analgesic of the mixed agonist/antagonist type, should be administered to reduce the severity of the reaction. Anti TNF-a may also be effective.[10][11]

History

Both Adolf Jarisch,[12] an Austrian dermatologist, and Karl Herxheimer,[13] a German dermatologist, are credited with the discovery of the Jarisch-Herxheimer reaction. Both Jarisch and Herxheimer observed reactions in patients with syphilis treated with mercury. The reaction was first seen following treatment in early and later stages of syphilis treated with Salvarsan, mercury, or antibiotics. Jarisch thought that the reaction was caused by a toxin released from the dying spirochetes.[14]It is observed in 50% of patients with primary syphilis and about 90% of patients with secondary syphilis.[1]

References:

1) Loscalzo, Joseph; Fauci, Anthony S.; Braunwald, Eugene; Dennis L. Kasper; Hauser, Stephen L; Longo, Dan L. (2008). Harrison's Principles of Internal Medicine. McGraw-Hill Medical. pp. 1048–67. ISBN 0-07-146633-9.

2) Rolain JM, Brouqui P, Koehler JE, Maguina C, Dolan MJ, Raoult D (June 2004). "Recommendations for treatment of human infections caused by Bartonella species". Antimicrob Agents Chemother 48 (6): 1921–33. doi:10.1128/AAC.48.6.1921-1933.2004. PMC 415619. PMID 15155180.

3) Koehler JE; Duncan LM (September 29, 2005). "Case records of the Massachusetts General Hospital. Case 30-2005. A 56-year-old man with fever and axillary lymphadenopathy". New England Journal of Medicine 353 (13): 1387–94. doi:10.1056/NEJMcpc059027. PMID 16192484.

4) Madkour MM (2003). "Brucellosis". In D. A. Warrell, Timothy M. Cox, John D. Firth. Oxford Textbook of Medicine. Oxford: Oxford University Press. p. 545. ISBN 0-19-262922-0.

5) Keith Parker; Laurence Brunton; Goodman, Louis Sanford; Donald Blumenthal; Iain Buxton (2008). "Protein synthesis inhibitors and miscellaneous antibacterial agents". Goodman & Gilman's manual of pharmacology and therapeutics. McGraw-Hill Medical. p. 768. ISBN 0-07-144343-6.

6) Grove DI (2003). "Nematode infections of lesser importance". In D. A. Warrell, Timothy M. Cox, John D. Firth. Oxford Textbook of Medicine. Oxford: Oxford University Press. p. 809. ISBN 0-19-262922-0.

7) F.P. MacKie (1935). "The Jarisch-Herxheimer reaction in trypanosomiasis with a note on the morular cells of Mott". Trans R Soc Trop Med Hyg 28 (4): 377–84. doi:10.1016/S0035-9203(35)90132-8.

8) Vidal V, Scragg IG, Cutler SJ et al. (December 1998). "Variable major lipoprotein is a principal TNF-inducing factor of louse-borne relapsing fever". Nat. Med. 4 (12): 1416–20. doi:10.1038/4007. PMID 9846580.

9) Kaplanski G, Granel B, Vaz T, Durand JM (July 1998). "Jarisch-Herxheimer reaction complicating the treatment of chronic Q fever endocarditis: elevated TNFalpha and IL-6 serum levels". J. Infect. 37 (1): 83–4. doi:10.1016/S0163-4453(98)91120-3. PMID 9733392.

10) Fekade, D; Knox, K; Hussein, K; Melka, A; Lalloo, DG; Coxon, RE; Warrell, DA (Aug 1, 1996). "Prevention of Jarisch-Herxheimer reactions by treatment with antibodies against tumor necrosis factor alpha.". The New England journal of medicine 335 (5): 311–5. doi:10.1056/NEJM199608013350503. PMID 8663853.

11) Coxon, RE; Fekade, D; Knox, K; Hussein, K; Melka, A; Daniel, A; Griffin, GG; Warrell, DA (Mar 1997). "The effect of antibody against TNF alpha on cytokine response in Jarisch-Herxheimer reactions of louse-borne relapsing fever.". QJM : monthly journal of the Association of Physicians 90 (3): 213–21. doi:10.1093/qjmed/90.3.213. PMID 9093599.

12) Jarisch A (1895). "Therapeutische Versuche bei Syphilis". Wien Med Wochenschr 45: 721–42.

13) Herxheimer K, Krause D (1902). "Ueber eine bei Syphilitischen vorkommende Quecksilberreaktion". Deutsch Med Wochenschr 28 (50): 895–7. doi:10.1055/s-0028-1139096.

14) "The Jarisch-Herxheimer reaction". Lancet 1 (8007): 340–1. February 1977. PMID 64863.