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

candida die-off prevention

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

[updated April 2019]

I am seeing dozens of patients that suffer from Candida hypersensitivity every week in my 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 of my patients have traveled hundreds of miles from other states to seek out my help.

What Do I Offer to Treat Candida?

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?

Candida Die-Off or 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.

Understanding Candida Die-Off

When you begin the candida diet, you may experience worsening symptoms of yeast overgrowth. This can be discouraging, but it is not a sign that the diet isn’t working. Actually, these severe candida symptoms are an indicator that you’re on the right track. During the transition to the new diet, substantial numbers of yeast cells begin to die at about the same time. This is known as candida die-off. As yeast cells die, they release toxic byproducts. These byproducts are responsible for the worsening of your symptoms. Proper preparation for the cleanse or a gradual approach to the transition can minimize the effects of candida die-off.

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 any more 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 by 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 Unique 3-Step Candida Treatment Process

The goal of treating candida overgrowth is to kill fungus and eradicate excess yeast. You never fully get rid of the yeast but we do get your yeast levels back into balance. Achieving this balance requires a 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 3rd 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, M.D.
Mitchell Medical Group in NYC and Long Island



About the Author – Dr. Dean Mitchell, M.D. dr dean mitchell smartest doctor in the room podcast

Dr. Dean Mitchell, M.D. is a Board Certified Allergist and Immunologist based out of NYC. He graduated from the Sackler School of Medicine and completed training at the Robert Cooke Allergy Institute in New York City. He is also a Clinical Assistant Professor at Touro College of Osteopathic Medicine, a fellow of the American Academy of Allergy, Asthma, and Immunology, and the author of Dr. Dean Mitchell’s Allergy and Asthma Solution: The Ultimate Program for Reversing Your Symptoms One Drop at a Time. Dr. Dean Mitchell, M.D. has also been featured in The New York Times, The Huffington Post, Fitness Magazine, Dr. Oz and News NY 1. Dr. Mitchell also hosts the podcast The Smartest Doctor in the Room – a combination of a lively, personal and in-depth interview with top healthcare specialists.

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