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

stages of candida

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.

Candida Diet and Pre-Cleanse

The first step in reversing Candida involves diet. To reverse Candida, you have to change your diet and embrace the Candida diet.

The diet can be intimidating to anyone, but it doesn’t have to be. The basics start with avoiding the key FOOD enemies: refined sugar, wheat (bread and pasta), and dairy (milk and cheese).

I know what you’re thinking – what’s left to eat? Plenty!! When I treat my patients I give them a handout on the Foods You Can Eat and the Foods You Must Avoid. I personally go over these items to make sure it is clear where certain exceptions can be made.

If you have Candida overgrowth it is critical that you have essential minerals and vitamins in your body so your liver (the main organ for detoxification) can handle the Candida cleanse phase necessary to rid the yeast overgrowth.

In conversations with Ann Boroch, N.D., author of The Candida Cure, we both agree on the importance of this nutritional support in making the cleanse phase easier for the body to handle.

At Mitchell Medical Group, we achieve this by giving patients high dose B vitamins and magnesium through injections. I also recommend oral supplementation, but unfortunately, only about 30% of these nutrients get absorbed and the injection route hastens the process of achieving vitamin and mineral fortification. It is typical to do an initial series of these treatments for 4 weeks to achieve immune protection. The treatment can then be spaced out every two weeks, and eventually once a month as an ongoing source of protection.

Candida Cleanse

Candida imbalance starts in the gut, so the gut has to be carefully cleared of excess Candida through an antifungal medication.

The most effective antifungal medication I have found is Diflucan. Diflucan is a potent antifungal that not only clears out excessive yeast in the gut but it also travels throughout the body to clean up the Candida outside the gut in places like the liver, the sinuses, the vagina, the skin, and even the brain.

I prescribe Diflucan for just 3 days, with one pill to be taken every 3rd day to give the liver the chance to refresh. After this 9 day period, you’ll switch to a milder antifungal medication, Nystatin, that essentially cleanses the bowel to keep the Candida in check. Typical you’ll remain on the Nystatin for at least 90 days to make sure the Candida doesn’t have a chance to excessively repopulate.

Immune Build-Up

Once the Candida is under control, it is important to bolster the immune system to achieve long-term protection. This is when probiotics are most valuable.


Re-populating the “good bacteria” in the body is the proper seed we want to plant in our body. There are many good probiotics, but I prefer ones that require refrigeration and are encapsulated, so they reach the small intestine, as well as the stomach. Probiotics should preferably be taken on an empty stomach and not at the same time as the Nystatin, as this can cancel the effects.


My recommendation for the best probiotic for Candida patients, and everyone else is Visbiome High Potency Probiotic 112.5 billion live bacteria or Primadophilus. They both meet all the above criteria.

Check out Primadophilus Optima by Nature’s Way on Amazon.

A deep level of lasting protection can be achieved with Candida sublingual drops. These are natural extracts obtained from companies that make allergens, such as pollen and molds. Patients take the drops under their tongue regularly to boost their immunity to Candida. The Candida sublingual drops are typically taken for a few years to get lasting protection. It also helps protect patients when they deviate from the Candida diet (we are only human after all) or need antibiotics for an infection.

In patients with more advanced Candida (brain fog and chronic fatigue), it is often necessary to consider using intravenous vitamins with high dose Vitamin C, B complex and magnesium to speed up recovery along with the other modalities listed.

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.

At Mitchell Medical Group in Manhattan and Long Island, we are adept at diagnosing and prescribing the appropriate Candida treatment so you can get back on your game! The wonderful news from our experience is that patients start to feel better in 30 days, and that is definitely something good!

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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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References

What a candida die-off is and why it makes you feel so lousy. Healthline.com. https://www.healthline.com/health/body/candida-die-off

The Jarisch-Herxheimer Reaction: Revisited. ResearchGate, April 2013. https://www.researchgate.net/publication/236598753_The_Jarisch-Herxheimer_reaction_Revisited

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