FYI: The Ginger Tea Recipe is at the bottom of this handout...

Die-Off Reaction Handout If you are experiencing die-off reactions due to an herbal program, see the instructions below. Everything recommended here can be used to prevent or treat die-off reactions. 


Avoid introducing any new foods while incorporating GI-clearing herbs until you have stabilized (no symptoms for 1–2 weeks). This approach helps identify whether any symptoms are due to new foods or supplements. If you are on a low-FODMAP diet, reintroduce moderate-FODMAP foods first, followed by high-FODMAP foods. This gradual progression allows the herbs to target dysbiotic bacteria more effectively, much like setting cheese on a mousetrap to attract mice. Always proceed at your own tolerance level to ensure that your digestive symptoms do not worsen during this process. You can work on adding in AIP foods second, see the food reintroduction handout when you do this. If you are not on a lowfodmap diet, focus on AIP foods first.  

Die-off reactions may include fatigue, malaise, achiness, joint pain, skin issues, digestive issues, and not quite feeling like yourself. The goal is to increase the dose without causing symptoms that significantly affect your daily quality of life and ability to function.  Most patients ignore this advice; please don't be that patient.

To prevent and or treat die-off, follow the below protocol:

  1. If you are sensitive, increase your dosage by 1 cap at a time per day. As you add clearing herbs, ensure they are spread out evenly throughout the day at each meal (with food). If you are more sensitive, follow the stair-step protocol below.
  2. If you feel very confident and don't typically have supplement reactions, you could increase your clearing herbs in increments of 2-3 caps per day.
  3. You should only move to the next supplement in ascending to descending order down the protocol sheet once you have achieved the full dose (typically 6 caps) or the highest dose possible without an adverse reaction, <6 caps. You can use a fraction of 1 capsule if you are sensitive, like 1/4 or 1/2 a cap. You can mix the supplement in water, coconut yogurt, or apple sauce when you consume it. 
  4. Once the full dose (typically 6 caps) or the highest dose you can handle is reached <6 caps, the next supplement can be added following the same procedure as the first. Please continue taking the previously successfully added supplement and the new one next on your protocol sheet. 
  5. Taking the herbs with foods can also be tried to lessen the die-off reactions. You can gradually work back into taking herbs on an empty stomach (10-30 min before a meal) as you start to max out your dose and feel stable or better.
  6. The goal is to take everything at full dose (typically 6 caps), so as soon as you feel stable, you can gently start to work back up to maximal dose, adding in one capsule per day, if no negative reactions occur.
  7. If you haven't achieved the max protocol dosage after you have worked your way through the protocol. Once you are stable for one week, you can try to push the dose up till maximum dosage (6 caps) is reached or till negative symptoms occur. You can follow the same protocol as above. This can be done weekly until the maximum dose is achieved. 
  8. If you can't reach the max dose of 6 no matter what. Don't worry, just make sure you find your max dose. 
For Example:

  • Monday, 1 GI clear 1 at breakfast. Tuesday, 1 GI clear 1 at breakfast and dinner. Wednesday, 1 GI Clear 1 at breakfast, lunch and diner. If following the stair step protocol, we would now move down the list to the next supplement.
  • In this example we will use GI clear 2.  Thursday, 1 GI Clear 1 at breakfast, lunch and dinner with the addition of 1 GI clear 2 at breakfast. Friday, 1 GI Clear 1 at breakfast, lunch and dinner with the addition of 1 GI clear 2 at breakfast and dinner. Saturday, 1 GI Clear 1 at breakfast, lunch and dinner with the addition of 1 GI clear 2 at breakfast, lunch and dinner as long as no significant die off reactions occur (see above). Follow the same pattern for the next GI clearing supplement on the list. 

Stair Step Protocol For Sensitive Patients Summary:


  1. The stair step protocol is the same as above instead of shooting for 6 caps as your max dose on each clearing herb, we shoot for 3 caps instead. We stabilize for 1 week after all the clearing herb supplements are at 3 caps, or the max dose you can handle (In this situation 1 or 2 caps), then continue to ramp up to the full dose (typically 6 caps), or the highest dose you can handle under 6 caps per day. Every week you can try to nudge up the dose once you have been stable for that week time frame, with the goal of reaching 6 caps or your maximum dose with out feeling bad.
  2. Make sure you are add in additional binders to aide in the detoxification as well as the ginger tea. Make sure you bowels are moving consistently as well.

Stair Step Protocol Example: Maximum Dose of 3 Capsules On Each Clearing Supplement. 


Goal: Incrementally introduce each GI clear supplement, increasing the dosage daily until reaching a maximum of 3 capsules per day, while monitoring for adverse reactions. The name of the supplement doesn't matter, start with the first supplement on your protocol sheet and work top to bottom on your protocol sheet, below is just an example. 

Week 1: Introducing GI Clear 1 (with food - initially, move to empty stomach once fully stable on ALL clearing herbs).

  • Monday: Take 1 capsule of GI Clear 1 at breakfast. If still sensitive, can start at 0.5 to 0.25 cap, this goes for all sups.
  • Tuesday: Take 1 capsule of GI Clear 1 at breakfast and dinner.
  • Wednesday: Take 1 capsule of GI Clear 1 at breakfast, lunch, and dinner (reaching the maximum of 3 capsules per day).
If you have successfully introduced GI Clear 1 without experiencing significant die-off reactions, you may begin to incorporate the next supplement. If taking 3 capsules causes discomfort, adjust the dosage to the highest amount you can tolerate without experiencing significant negative symptoms.

Week 1: Introducing GI Clear 2

  • Thursday: Continue with GI Clear 1 at 3 capsules per day. Start GI Clear 2 with 1 capsule at breakfast.
  • Friday: Continue with GI Clear 1 at 3 capsules per day. Increase GI Clear 2 to 1 capsule at breakfast and dinner.
  • Saturday: Continue with GI Clear 1 at 3 capsules per day. Increase GI Clear 2 to 1 capsule at breakfast, lunch, and dinner (reaching the maximum of 3 capsules per day).
If you have successfully introduced GI Clear 2 without experiencing significant die-off reactions, you may begin to incorporate the next supplement. If taking 3 capsules causes discomfort, adjust the dosage to the highest amount you can tolerate without experiencing significant negative symptoms.

Week 2: Introducing GI Clear 4

  • Sunday: Maintain GI Clear 1 and GI Clear 2 at 3 capsules per day each. Start GI Clear 4 with 1 capsule at breakfast.
  • Monday: Continue with GI Clear 1 and GI Clear 2 at 3 capsules per day each. Increase GI Clear 4 to 1 capsule at breakfast and another at dinner.
  • Tuesday: Continue with GI Clear 1 and GI Clear 2 at 3 capsules per day each. Increase GI Clear 4 to 1 capsule at breakfast, lunch, and dinner, reaching the maximum of 3 capsules per day.

If you have successfully introduced GI Clear 4 without experiencing significant die-off reactions, you may begin to incorporate the next supplement. If taking 3 capsules causes discomfort, adjust the dosage to the highest amount you can tolerate without experiencing significant negative symptoms.

After 1 week of stability on your current dose, you can apply the same protocol to increase from 3 to 6 capsules, following the same steps you used to adjust from 0 to 3 capsules.


Very Sensitive Patients who are on the program and still having reactions:
 
  1. If are having a reaction while already on the GI clearing or Hormone program, start with a 3-7 day supplement holiday before following below and get your symptoms back to baseline.  
  2. If you are confident the issue is from the GI clearing program only, based on the timing of the symptoms and the supplements, only pull this program (GI Clearing) out for 3-7 days, then follow the recommendations below. 
  3. Work your way from the top of each program downward (GI clearing program last if it applies), add in each supp 1 time per day with each meal. 
  4. You can add the dose in faster, but please go at your own risk. 
  5. You can keep the previous supplement in as long as you can tolerate them on the reintroduction.
  6. Once you are stable and adding in the digestive and adrenal program, you can start adding in the gi clearing program.
  7. The difference on the die off reaction program here is you will go slower as you will start with only 1 cap total for the whole day (not per meal like above) and gradually increase 1 cap total and adding 1 cap each successful day until the max dose is reached or until you have a negative reaction.
  8. If a negative reaction occurs, drop back to the previous days successful dose, stabilize till the symptoms are gone (typically takes a day or less) and move on to the next supplement while keeping the previous successful dose in place. 
  9. Once you have reached the optimal or max dose on each GI clearing supplement, add in the next supplement while keeping the previous supplement in at the max or optimal dose tolerated.
  10. If you haven't achieved the max protocol dosage after you have worked your way through the protocol. Once you are stable for one week, you can try to push the dose up till maximum dosage (6 caps) is reached or till negative symptoms occur. You can follow the same protocol as above. This can be done weekly until the maximum dose is achieved. 
  11. If you are still having issues a consult will be needed to dig in deeper. You can email the office so we can get you in right away, or you can schedule online. Click here to schedule a consult. 
  12. You can add in Dr. J's GI Binder to help bind up die off toxins in the gut. This supplement has bamboo based activated charcoal, chlorella and zeolite from volcanic soil. You can take at bed time and potentially when waking in the AM. Please take away from food and supplements. 
Notes: 

  • Die-off reaction may include fatigue, malaise, achiness and just not quite feeling like yourself.
  • Detox support and extra binders can be given to help improve die-off reactions if the above protocol isn’t helping enough. Charcoal, bentonite clay, diatomaceous earth, and certain plant-based fibers can be helpful in between meals.
  • Dr. J's GI Binder: You can take at bed time and potentially when waking in the AM. Please take away from food and supplements.
This concoction will help to reduce inflammation in your body, help decrease die-off reaction, improve digestion and enhance the potency of any herbs you are taking to eradicate an infection.





  1. Juice 3-4 pieces of ginger each one about the size of your thumb. You can also use a grater and grate the fresh ginger as well. Fresh ginger is always best.
  2. You can also use organic ginger juice concentrate to the same equivalent.
  3. Combine a quarter cup of ginger juice or tea with 12-16 ounces of hot water.
  4. Add 1/3 teaspoon to 1 tablespoon of Manuka honey (MGO 400+ is best), juice from 1/2 a lime or lemon (optional), and 1/8 teaspoon of cayenne pepper (optional). If you're sensitive to sugar, start with 1 teaspoon. Since you're sipping this throughout the day, the amount of sugar entering your body at one time is insignificant.
  5. Honey and cayenne are optional if you have a negative reaction to it. 
  6. Drink 12-16 ounces daily, not all at once.