Herxing, poppin’ pills that interact with each other, and not knowing when to back off on the antibiotics: these are just some of a Lymies everyday problems!
A Herxheimer reaction – better known as a herx – is a detoxification reaction to a treatment. Let’s say a treatment is working: this means that the infection is dying off. It also means that you are now left with dead bacteria in your system. When using substances or treatments that kill infections, we sometimes do not detoxify the dead debris as quickly as we kill the infection. In theory, a herx can occur from this backed up detoxification, and flu-like symptoms will follow for a few days or weeks. Some herx-like symptoms include body pains, sweating or chills, nausea and fatigue.
Our friends and family who do not have Lyme Disease often have a hard time fathoming how much pain – physical and mental – that Lyme Disease can cause. It doesn’t help that on top of this anguish, your doctors may tell you that “feeling worse before you feel better” is desirable. A lot of us strive for Herxheimer reactions, as they could indicate that the infection is dying off. We tell ourselves that we need to push through or even take more of the substance or treatment that is allegedly causing the herx.
When A Herx Is Not A Herx
Sometimes we mistake herxing with adverse drug reactions – or ADRs. It is quite difficult to determine if your crummy feelings are the result of a herx (a supposed good thing) or if they are ADRs (a bad thing). It’s scary how many Lyme patients will continue taking drugs prescribed by their doctors in belief that they are herxing, only to discover weeks or months later that the drugs were not helping and were actually making matters worse. An example of this is antibiotic use. People will get nauseous and experience stomach pains, and push through because they assume the pain indicates progress. I don’t know how many people I’ve talked to who have used long-term antibiotics and ended up with C. difficile and a poor immunity on top of their unwavering infections.
I wish I could tell you how to spot the difference between a herx and an ADR. This is a good time to remind you that I am not a doctor. My best guess would be that herxing goes away while ADR’s get worse. If it were me, I’d support my detoxification pathways as best as I could so that I could be confident that the dead debris were being eliminated. That way, I wouldn’t accept crummy feelings as a sign of a “herx” if it went on for more than a week. Other people might have more severe infections, and would possibly herx for a longer duration. Always be aware of the possibility that you are dealing with something other than a herx.
When You Are Too Drugged Up
A drug intended to kill an infection (thereby bringing on a herx) is technically a drug that causes adverse drug reactions. Since herxing is allegedly a sign that the drug is working, this kind of ADR is welcomed. However, most drugs fall into a spectrum of mildly to severely toxic. More times than not, drugs that cause herxing also cause other ADR’s due to this toxicity factor.
Lyme patients are a group of people that tend to be on cocktails of drugs. Antibiotics, painkillers, antidepressants, blood thinners galore. Not the fun kinds of drugs, unfortunately. However, given that many people with Lyme Disease have throbbing and sharp full-body pains, inflammation, adrenal deficiency, depression and other pains, drugs can be literal life-savers.
There are two concerns I have about this. One, drugs are toxic, especially when used in conjunctions (due to the increased risk in ADR’s). And two, because drugs are toxic, it’s healthier to keep our drug use to a minimum.
Drug metabolism happens when your body changes drugs, or xenobiotics, into more easily excreted products with the help of special enzymes. In other words, it prevents drugs from accumulating in your body by detoxifying them out. Yes, detoxification was a scientific thing before the alternative medicine hippies branded the word.
How It Works
Metabolising drugs takes a lot of effort. Generally, xenobiotics cannot be excreted in the urine until they have undergone a process to make them soluble in water. Drug metabolism usually occurs in the liver, which houses the enzymes needed to metabolize the drugs.
There are 2 phases of metabolism. Some drugs undergo both phases, while other drugs only undergo one of them:
Phase 1 metabolism is when the cytochrome P450 (CYP450) enzymes in the liver oxidize drugs. This makes them smaller and thus easier to excrete from the body.
Phase 2 metabolism is when an ionised group attaches to a drug. These groups include glutathione, methyl or acetyl groups. They make the drug more water soluble and thus easier to excrete.
When a drug has accumulated beyond your body’s detoxifying capacities, it can cause toxicity or hepatitis. This can occur when there is not enough glutathione to detoxify the drug out of your body. NAC (a precursor to glutathione) is actually quite the popular supplement in the rave community – a community that surely OD’s a lot.
Taking glutathione can help metabolize drugs and save your liver, but it will also remove the drugs from your body quicker. (Hmmm, why not just take less of the drugs so you don’t tax your liver in the first place and so you don’t waste your money on supplements to counteract your drugs? Sorry to go off topic but ugh, this is all too frustratingly common.)
Inducers, Inhibitors and Adverse Reactions
Inhibitors are drugs that stop enzymes from working as effectively. In other words, a drug that inhibits enzymes from metabolising it makes it (along with whatever other drugs you are taking) stay in the body longer.
Inducers make enzymes work better. So essentially, an inducer drug has the opposite effect of an inhibitor and speeds up the process of moving it (and whatever other drugs you are taking) out of the body quicker.
In this sense, when you are taking a medication, you are not just taking a drug – you are also taking either an inhibitor or an inducer. Adverse drug reactions can occur because of this. Let’s say you take the antibiotic Erythromycin (an inhibitor), and you also like to drink grapefruit juice everyday (also an inhibitor). As a result, last night’s dose of antibiotics might stagnate in your liver longer than expected. This is bad news if you’re ready to pop your next dose. If you don’t have enough glutathione (or other detoxifying agents) to compensate for an overload of Erythromycin in your body, a toxic overdose or liver damage can occur.
Sex, age, and even gut bacteria composition affect drug metabolism. Genetic deficiencies of particular enzymes can play a big role as well. For example, some people suck at metabolising codeine, while others metabolize it quickly. A small dose of codeine could kill a slow metabolizer, but do nothing for a quick one.
Even the food you eat is a factor in how drugs are metabolized! As I mentioned, grapefruit juice is an inhibitor. So is pomegranate. Brussels sprouts and garlic, on the other hand, are inducers.
Here’s just one more to blow your mind: cigarette smoke is also an inducer.
A Recap Of Drug Metabolism
When CYP450 enzymes are inhibited or induced by drugs, clinically significant drug-to-drug interactions can cause adverse reactions. Knowing which ones inhibit and which ones induce your enzymes can minimize the possibility of negative interactions between all those pills you pop to (try to) feel normal. If they are not doing what they are supposed to – or if you think you are having a month long herx – then you may be having an adverse drug reaction.
Doctors Don’t Always Know Best
I want to bring to light that although doctors are trained professionals, their recommendations are not always appropriate. I hate to break it to you if you hadn’t already figured this out, but doctors are humans like the rest of us. They could be well-meaning and simply trained to prescribe a pill-for-every-ill. Or they could be aware of the dangers of over-prescribing but do it anyways for the superficial results or money-grab. Either way, doctors have developed a reputation for over-prescribing.
How Did This Happen?
Once upon a time, drugs were invented. They were derived from natural compounds from medicinal plants. Or in the case of antibiotics like penicillin, drugs were made from naturally occurring blue mold.
These compounds were set at odds with the metabolic process known as cell wall synthesis. Cell wall synthesis is a process unique to the bacteria that cause infectious diseases; the process was not found in animal cells. The providential distinction between bacterial cell and human cell metabolism made antibiotics both safe to use and highly selective in their action. They could literally morph illness out of existence.
When a person experienced multiple symptoms, chemists aimed to identify The Dominant Symptom so they could develop a drug that would modify the effects of its process, blocking or altering what Dr. Jeffrey Bland calls the “misstep” in metabolism. And so medicine evolved. In the complexity of medicinal compounds, we found ways to simply turn particular metabolic pathways “on” and “off.”
“A different kind of development process evolved to create these drugs, and it profoundly reshaped the pharmaceutical industry.” Dr. Bland writes in The Disease Delusion. “The process begins with what is known as high-throughput screening, in which chemists evaluate exactly how tens of thousands of chemicals synthesized in the lab influence the metabolic activity being targeted.”
“The smaller the amount of chemical required to interfere with a particular step in the metabolic process, the more active the chemical is considered to be – and the more effective the drug.”
After passing as safe in animal and human testing, a label can be smacked onto a compound and put on the market. Your doctor can prescribe these to you, Bland says, “as a short-term therapy to cure an acute illness caused by the specific misstep in a particular metabolic process for which the drug was developed.”
From doctor’s training to reasons involving insurance, doctors are taught to treat illnesses that derive from single causes, or remediating an acute injury or medical event like a stroke or heart attack.
If you have multiple symptoms, it’s not uncommon for doctors to prescribe multiple drugs. Doctors look at symptoms as single causes and remedy them for relief. When our medical complaints are multidimensional, one drug just won’t cut it. But thanks to a thriving pharmaceutical industry, there are drugs for all of our symptoms. With the right drug cocktail, we literally don’t need to feel anything.
The problem is that a chronic illness can’t be fixed without finding the root cause of the illness. Many of us are starting to use drugs intended for acute use indefinitely.
Painkillers, antidepressants, statins…we use them to treat the effects but not the ultimate cause of our many symptoms. They mask symptoms, but don’t help you get over them. Often times, our symptoms persist and more are created. The outcome is that our health does not improve and we constantly up our meds. I don’t like to get “political” but surely, big pharma is happy to have lifetime consumers buy their products.
Find The Cause
If you want a quick fix, drugs can be that for you. If you want to get to the root cause of (ideally) all of your health woes, it will take some investigating. More investigating than a mediocre doctor will help you with.
I personally love learning about how every system of the body is connected: How your thyroid problems may actually be a cause of imbalanced reproductive hormones or low-carb diets, or how osteoarthritis may be a cause of poor calcium distribution rather than poor calcium absorption. I’m not suggesting you make research a full time job. I am suggesting that you learn about your basic anatomy, especially of your problem areas. Be patient enough to try, for example, getting adequate sleep to normalize your cortisol levels, before taking Cortef.
In another more practical and awesome section of this book, I will talk about some important indicators of our functional health status (also known as biomarkers) as well as the seven core physiological processes that, when strong, win the battle with chronic symptoms.
Spoiler alert: the physiological processes are: assimilation and elimination; detoxification; defense; cellular communications; cellular transport; energy; and structure.