Candida Die-Off Prevention: Dr. Mitchell's Preventive Prescription

I am seeing dozens of patients that suffer with Candida hypersensitivity every week in NYC and Long Island practices. I am especially impressed at how smart and well-informed so many of these patients are about the diet and their condition. In fact, many have travelled hundreds of miles from other states to seek out my help.

So, what can I offer them that they can’t do on their own?
Immune rebalancing: decreasing the Candida, yeast load and also to build up the body’s immunity to keep the correct balance of yeast in check. The biggest fear of patients knowledgeable on overcoming Candida overgrowth is that they will feel worse before they get better due to something they have heard called “die-off” reactions. What is die-off and does it really exist?

Die-Off or the so called Herxheimer Reactions

Die-off is also referred to as the Herxheimer reaction. At the turn of the century two dermatologists, Adolf Jarisch, an Austrian, and Karl Herxheimer, published papers on observations that patients receiving treatment for syphilis would develop specific symptoms due to the treatment. The treatment in 1902 for syphilis was Salvarsan or mercury- antibiotics didn’t come until forty years later. But apparently, these chemotherapeutic treatments induced cell death of the syphilis spirochetes which caused:

  • Fever, chills, headaches and muscle pains - you can feel like you have the flu.
  • This same effect has also been described in treating fungal infections (Candida is a yeast-fungus relative) and is attributed to the fungal toxins being released into the bloodstream.

My Early Mistakes

I’ve been treating Candida patients for over a decade. I admit early on I didn’t appreciate how serious these Herxheimer reactions could be.

I remember a specific case of a young man who came to me with chronic asthma, but also had recurrent oral thrush (Candida on the tongue) and fungus in his toenails. I wanted to reverse his apparent Candida overgrowth quickly. I discussed the diet with him and immediately started him on antifungal medication every day for the next week. At first, I didn’t know how he responded because he didn’t show up for his follow up appointment. It wasn’t until 2 months later that he returned for a visit for his asthma. When I asked him why he didn’t come back sooner, he said: “Well, the good news was that my asthma went away with the antifungal medication but I felt awful while taking it - so bad that I couldn’t get out of bed for a week!”

Because of how awful he felt he wasn’t willing to try anymore antifungals for fear of feeling worse and his white tongue had come back. I realized this Herxheimer reaction is real and I needed to protect my patients in the future- but how?

Liver Support and Detoxification

The key to preventing the Herxheimer reaction and Candida die-off I learned was boosting the liver’s ability to handle the toxic load of yeast that were dying off. The best way to do this was using injectable vitamins especially vitamin C, B vitamins and antioxidants like glutathione.

Why vitamin injections or IVs?
When we take any food, medicine or even supplements by mouth the stomach dissolves them and then they must circulate or pass through the liver which detoxifies the substance - this is called in medical terms the first pass effect. As a result of this, even the vitamins that you take by mouth only approximately 30% get into your bloodstream. These levels are not high enough to protect the body from a heavy die-off reaction. The liver’s ability to handle toxins involves 2 phases (see photo) and I specifically include these key nutrients to bolster the liver’s ability to handle the yeast overload. liver ability to handle toxins

Remember, the Herxheimer reaction occurs not due to the Candida diet as many patients believe, but from the antifungal medication that is necessary to decrease the total yeast load for patients to ultimately feel better. I have seen patients try and use herbal remedies to decrease the yeast with caprylic acid, garlic and P’darco tea but these herbal remedies are usually too weak to make a significant difference in a very sick Candida patient. However, they can be beneficial once a Candida patient is better.

My 3 Step Process

At Mitchell Medical Group, we recommend the 3 step process to combat Candida overgrowth and prevent die-off reactions:

  • The Candida diet for at least two weeks before considering the use of antifungal medications.
  • Injectable vitamins (in the buttock or IV) to boost the body’s tissue with these immune and liver fortifying nutrients for at least 3 weeks before we use antifungal medications.
  • Careful Prescribing of Antifungal medication: this means when we recommend an antifungal such as Diflucan we instruct the patient to take it every 3 rd day so the liver has time to cleanse itself before the next dose. We also quickly transition to a gentler antifungal, such as Nystatin for a few weeks to keep the bowels Candida clean . Caution: antifungals should be held if you are having severe constipation.

Staying Candida Clean

The long term solution to beating Candida is following the diet most of the time (learn our 80/20 rule), using key supplements along with probiotics. Ask about our Candida sublingual drops to keep your immune system strong to keep Candida in its place.

- Dr. Dean Mitchell
Mitchell Medical Group in NYC and Long Island

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