1636 replies to this topic

[ForLyla]

Captains log, day never ending. Die off is a bitch! Not been feeling well at all lately due to die off from taking antifungals and super strict diet. The brain fog, anxiety and all my other symptoms are way worse. I keep trying to remind myself that its a good thing the yeast and bacteria are dying off but its so hard to function feeling this way.

[fishinghat]

Oh Lyla, I was hoping it wouldn't be this bad. Sorry for your problems. Drink plenty of fluids to help flush out the endotoxins and keep reminding yourself that it won't last for ever. Hang in there.

[ForLyla]

FH have you heard of die off being this bad? Thank you for keeping me in your thoughts.

[fishinghat]

I am not to familiar with fungal die off just bacterial die off but I know that can make you and usually does make you very ill. Heart pounding, anxiety,  constipation or diarrhea, sweats, etc. 

 

I will check into fungal die offs and let you now what I find.

 

By the way, which antifungal are you taking? Sorry, I forgot.

[ForLyla]

Thanks FH. I'm taking Nystatin and olive leaf extract.

[fishinghat]

Have a determined a specific fungal infection that you have or is this more a "lets see if it helps" prescription?

[fishinghat]

This article is a good summary of fungal die offs and their effects. One thing I did notice in the medical articles was that the set in of die-off symptoms usually begin within 3 to 5 days of starting the medication. I am going to do some more reading and will let you know if I find anything more. 

 

Could this be associated with your recent drops in Cymbalta?

[fishinghat]

Oooops

 

Forgot the link...

 

https://www.healthli...candida-die-off

[fishinghat]

https://www.about-ol...de-effects.html

Jarisch-Herxheimer reaction known to occur with  olive leaf extract.

Good basic info on this supplement.

 

https://examine.com/...e-leaf-extract/

Detailed scientific information on  olive leaf extract with medical references listed. 

[ForLyla]

Thanks for the info FH. I'm quite certain it's die off. I dont think I've been as sensitive to cymbalta this whole time as I thought. I was feeling good for a few months before I started to taper it but I think I've been inflicted with candida and methane overgrowth for years which led to such terrible withdrawals from these drugs. Dealing with candida is extremely complicated and way more prevelant than anyone could guess. It's been the source of my reflux all these years, not my hiatal hernia.

[fishinghat]

Hey Lyla, how do your symptoms compare to those given in the article for Candida die-off?

[ForLyla]

It's basically just an intensifying of symptoms. Worse brain fog and vision issues are the main ones. My reflux has been better but gets worse if I'm having really bad die off. Worse restless legs syndrome. Dizzy. Skin breakouts. Nausea. Fatigue. Anxiety. Insomnia. 

 

Die off really sucks or at least what I really hope to be and assume is die off. 

 

I'm taking milk thistle, molybdenum, NAC and vitamin c sporadically to help with die off but they don't seem to do much. 

[fishinghat]

https://examine.com/...al-significance

It seems to preferentially accumulate in the liver, kidneys, adrenal glands, and intestines[30] while excess intakes of molybdenum seem to cause alterations in these organs (kidneys and adrenals mostly[31]) in rat studies.

One case report in a male patient in his late 30s exists where ingestion of 300-800µg molybdenum for 18 days (in part due to a high-molybdenum supplement) resulted in neurological symptoms including psychosis and hallucinations resulting in a grand mal seizure and cortical brain damage.[37] The patient was treated with chelation therapy with success, but reintroduction of the supplement to demonstrate causation was not attempted.[37

 

Interesting, I know that molybdenum does react with adrenaline as that is part of the principals used in analyzing for serum adrenaline. I couldn't find anything in the medical journals other than it increases copper and chromium excretion.

[fishinghat]

What dose are you currently taking?

[ForLyla]

I'm taking about 250,000 units twice a day of Nystatin. Trying to work my way up slowly as the die off is so intense. Goes to show how bad my candida case is!

[fishinghat]

Sounds like a good approach. Hang in there Lyla.

[ForLyla]

Hey all... I wanted to give an update. Where have I been the last few months? Good question. Its been a big struggle with some good and bad news as to be expected.

I discovered so far that I have candida and methane overgrowth and have been treating them with antifungals and antimicrobials. I've gone through periods of feeling pretty good and have had periods more so recently of feeling like death. Its been a huge struggle. I'll get to the good news first.

I took a 2 week round of fluconazole and had hellish die off. It was terrible and I still haven't recovered 3 weeks after stopping it. I dont know why. I also started intermittent fasting during this period and I don't know what did it but my acid reflux has been 90% better. I still have my bad days but its far better than it was. I saw my ENT last week and he confirmed that the swelling in my throat has gone down significantly. Its still not gone but this has been a big concern of mine so thankfully its better.

On another plus side, since September I've tapered my Cymbalta from 25.5mg to 23mg. Even though thats only 10% in a little over 5 months, I still consider this to be a big gain in this regard. Im hoping by end of summer I'll be at 20mg.

As for the bad news... I feel dreadful! Especially since taking the fluconazole. I dont know if its die off. Maybe fluconazole affects absorption of cymbalta to some degree. Maybe the change in acidity of my stomach has affected it. Who knows. But my heart pounding is back. Im waking up every hour on the hour. Im dizzy and my sinuses are wrecked. Terrible anxiety and brain fog. I've always had luck with just laying off everything before and eventually feeling better about 2 or 3 months later and that's what I'm doing now. My thought it that maybe my body needs to reach homeostasis and my nervous system needs to settle down a bit after all the die off etc. Would love your thoughts on this guys. I really thought that if I got rid of the acid reflux then everything else would go with it but its been the opposite. Reflux way better but feel worse everywhere else. I have no idea why. Im hoping within a couple months my hormones and crazy brain fog etc will settle down but I'm also terrified it won't.

[fishinghat]

Hi Lyla, great to hear from  you. Well you got two issues taken care of (heartburn and Candida) now once you stabilize you can focus on the Cymbalta some more. I would imagine the Cymbalta drop is still effecting you.

 

"I dont know if its die off. Maybe fluconazole affects absorption of cymbalta to some degree. Maybe the change in acidity of my stomach has affected it."

 

Probably, probably and most likely in that order.  lol

 

I am glad the Candida issue was detected and treated. After stopping the fluconazole I assume your dr put you on a good probiotic. 

 

"My thought it that maybe my body needs to reach homeostasis and my nervous system needs to settle down a bit after all the die off etc."

 

How true. Given your sensitivity to this process I wouldn't be surprised if it takes awhile. I am not surprised in the long lasting effects of the die off, it can be quite an experience but should settle down within a couple more weeks. 

[ForLyla]

Great to hear from you FH. Hope you guys have been doing ok over here. Sorry I didn't check in sooner. I've just been suffering so much lately and I've felt like suffering in silence.

To be honest, I don't think this candida beast is gone by any measure. My acid reflux is better, yes, but I think that may have just been due to gastritis getting better due to fasting.

I feel so sick. I sure hope this is the healing crisis. My anxiety, brain fog and vision issues are terrible to deal with. I've been tapering one bead every few weeks so I doubt its the drop. The timing is too suspicious with my antifungal treatment. Do you think stopping all supplements is the way to play this now and let things settle down. I had to stop the probiotics. They were making me too sick as well.

[fishinghat]

Lyla, your case is so unusual it is hard to say whether the supplements are helping or not, or making things worse. If you do decide to stop them then stop one supplement every week or 2 and see if a particular one was causing issues. 

[fishinghat]

You will probably find these interesting. You will note that brain fog and fatigue are some of the common symptoms. 

 

https://www.thecandi...y-like symptoms.

 

https://draxe.com/he...andida-die-off/

[ForLyla]

FH I know . I was convinced that candida was causing my brain fog but now I'm not so certain. I have this nagging feeling that cymbalta is involved somehow but maybe I'm wrong. Unless I've been going through die off for 5 months. I have heard of some people going through months long die offs. I did some tests recently so hopefully that will provide us some more insight.

[fishinghat]

Good idea on the tests. Of course, as you know, Cymbalta withdrawal is famous for brain fog and what you say about the Candida die-off lasting for months can also be true. Be sure to drink plenty of water to help flush the endotoxins out of the blood and eat a Candida diet as much as possible as well.

[invalidusername]

Hey Lyla!!

 

Wonderful to hear from you... and apologies for being late to the party! 

 

Read your updates with interest and like you say, some positives and some not-so-positives. But it is the fact that the positives are there that is the key. With each one written off, there is less to have return to. 

 

As has always been the case, Hat has been the one to discuss the symptoms with you as this is primarily his area, but your courage never ceases to amaze me.

 

IUN

[ForLyla]

IUN and FH, how are you guys? I'm sorry I didn't respond sooner. I've been very up and down and have lost interest in a lot of things. I'd say right now I'm about 50/50 for good days and bad days but my lows are lower and my highs are higher. When I'm in a bad wave, it's off the charts. Not sure why. I think maybe the fluconazole did have an impact on Cymbalta. Right now I'm just living free of anything except for the odd bit of magnesium as I'm deficient. 

 

I REALLY need your help with this guys. So my last ultrasound found cholesterol polyps and gallstones and I'm beginning to wonder if this is the root cause of many of my problems. Perhaps I'm not emptying bile properly and it's causing this constant buildup of bacteria in my small intestine as the bile isn't breaking it down. SO I'm debating taking a new medication that dissolves stones and cholesterol polyps called URSODIOL, also known as Ursodeoxycholic acid. OR another thing I'm considering is ox bile first. Ox bile isn't supposed to be as effective but it's the first line of attack. Any information you guys have or could find would help me more than you could know. 

 

Thanks for always having my back guys. This site. The work you guys do. People like you and Gail will always hold a place in my heart. 

[fishinghat]

I know that many of the articles I read about fluconazole and recovery from a Candida infection can sometimes take up to a year to settle down. 

 

Cholesterol polyps, also referred to as cholesterolosis, is a little studied but common occurrence. There is no known negative effect from this condition and many drs do not believe it needs treatment however some say it is not the normal condition and should be addressed. 

 

Gallstones is a different story as they can have a profound effect on nutrition, emotion al stability, processing of medications etc. The presence of these may have a pronounced effect on your past history of symptoms. I would strongly urge you to consider your drs advice on dissolving these gallstones.

 

Cholecystectomy - The surgical removal of the gall bladder

 

The surgical removal of the gallbladder often results in Postcholecystectomy Syndrome 

 

https://www.ncbi.nlm...pubmed/19337637

J Gastrointestin Liver Dis. 2009 Mar;18(1):67-71. 

Postcholecystectomy syndrome - an algorithmic approach.

BACKGROUND AND AIM: 

The postcholecystectomy syndrome includes a heterogeneous group of diseases, usually presenting as abdominal symptoms following gallbladder removal. The clinical management of these patients is frequently without an evidence-based approach.

METHOD: 

We evaluated 80 patients with postcholecystectomy problems consecutively admitted during a period of 36 months. The liver function tests (LFTs) assessment and transabdominal ultrasound (TUS) were followed by endoscopic ultrasound (EUS). Endoscopic retrograde cholangio-pancreatography (ERCP) was then performed depeding on the results. With knowledge of the final diagnosis, the probable evaluation and outcomes were reassessed assuming that ERCP would have been performed as the initial procedure. Final diagnosis was confirmed by a combination of imaging findings, as well as clinical follow-up of 6 months.

RESULTS: 

In 53 patients biliary or pancreatic diseases were diagnosed: common bile duct stones, chronic pancreatitis, pancreatic cancer, papillary tumors, cholangiocarcinoma, insufficient cholecystectomy or sphincter of Oddi dysfunction. The other 27 patients had non-biliary symptoms (dyspepsia, IBS, etc.) and were consequently managed according to the symptoms. The sensitivity and specificity of EUS were high in the subgroup of patients with biliary or pancreatic symptoms (96.2% and 88.9%) and helped to indicate subsequent ERCP.

CONCLUSION: 

An algorithmic approach which used EUS for the initial evaluation of the patients with postcholecystectomy problems decreased the number of ERCPs by 51%, having as a consequence a decreased morbidity and mortality in this group of patients.

 

https://www.ncbi.nlm.../pubmed/7729279

Dig Dis Sci. 1995 May;40(5):1149-56. 

Abnormal sphincter of Oddi response to cholecystokinin in postcholecystectomy syndrome patients with irritable bowel syndrome. The irritable sphincter.

Abstract

Standard biliary manometry, including cholecystokinin (CCK) provocation, was performed on 42 consecutive patients (36 F, 6 M, median age 45 years) with postcholecystectomy syndrome (PCS) who had no evidence of organic disease but who had objective clinical features suggesting sphincter of Oddi dysfunction (SOD) (classes I and II). Patients were subdivided into those with (N = 14) and without (N = 28) irritable bowel syndrome (IBS) using a validated symptom questionnaire based on the modified Rome criteria. Resting sphincter of Oddi (SO) motor parameters (basal pressure, contractile amplitude and frequency, and proportion of retrograde contractions), the presence of abnormal manometry, and the presence of an abnormal response to CCK were compared in the two groups. No significant differences in resting parameters of SO motor activity between patients with and without IBS were observed, and abnormal biliary manometry as a whole was not more prevalent in either group (8/13 and 18/27, respectively). An abnormal response to CCK (failure of complete inhibition of phasic contractions), however, was demonstrated in five of 12 patients with IBS compared with only one of 23 patients without IBS (P = 0.01). In patients with postcholecystectomy SOD, an abnormal response of the SO to CCK thus appears to be an important feature of the subset of patients with concomitant IBS.

Note - That is 33% who had IBS.

 

https://www.ncbi.nlm...les/PMC3335764/

Aliment Pharmacol Ther. 

Biliary events and an increased risk of new onset irritable bowel syndrome: A population-based cohort study

Background

Prospective data are lacking to determine if IBS a risk factor for cholecystectomy, or if biliary disease and cholecystectomy predisposes to the development of IBS.

Methods

Validated symptom surveys sent to cohorts of Olmsted County, MN, (1988–1994) with follow-up in 2003. Medical histories were reviewed to determine any “biliary events” (defined by gallstones or cholecystectomy). Analyses examined: 1) time to a biliary event post initial survey and separately, 2) risk of IBS (Rome II) in those with vs. without a prior biliary event.

Results

1908 eligible subjects mailed a follow-up survey. For aim 1) of the 726 without IBS at initial survey, 44 (6.1%) had biliary events during follow up, in contrast to 5 of 93 (5.4%) with IBS at initial survey (HR 0.8, 95% CI 0.3-2.1). For aim 2) of the 59 subjects with a biliary event at initial survey, 10 (17%) reported new IBS on the follow-up survey, while in 682 without a biliary event up to 1.5 years prior to the second survey, 58 (8.5%) reported IBS on follow-up (OR=2.2, 95% CI 1.1-4.6, p=0.03).

Conclusion

There is an increased risk of new IBS in community subjects who have been diagnosed as having a biliary event.

Note - apparently fairly common

[fishinghat]

URSODIOL

• Gallbladder stone dissolution with ursodiol treatment requires months of therapy. Complete dissolution does not occur in all patients and recurrence of stones within 5 years has been observed in up to 50% of patients who do dissolve their stones on bile acid therapy. Patients should be carefully selected for therapy with ursodiol, and alternative therapies should be considered.

• With an ursodiol dose of about 10 mg/kg/day, complete stone dissolution can be anticipated in about 30% of unselected patients with uncalcified gallstones < 20 mm in maximal diameter treated for up to 2 years. Patients with calcified gallstones prior to treatment, or patients who develop stone calcification or gallbladder nonvisualization on treatment, and patients with stones > 20 mm in maximal diameter rarely dissolve their stones. The chance of gallstone dissolution is increased up to 50% in patients with floating or floatable stones (i.e., those with high cholesterol content), and is inversely related to stone size for those < 20 mm in maximal diameter. Complete dissolution was observed in 81% of patients with stones up to 5 mm in diameter. Age, sex, weight, degree of obesity, and serum cholesterol level are not related to the chance of stone dissolution with ursodiol. 

   

  Partial stone dissolution occurring within 6 months of beginning therapy with ursodiol appears to be associated with a > 70% chance of eventual complete stone dissolution with further treatment; partial dissolution observed within 1 year of starting therapy indicates a 40% probability of complete dissolution.

• Watchful Waiting

  Watchful waiting has the advantage that no therapy may ever be required. For patients with silent or minimally symptomatic stones, the rate of development of moderate-to-severe symptoms or gallstone complications is estimated to be between 2% and 6% per year, leading to a cumulative rate of 7% to 27% in 5 years. Presumably the rate is higher for patients already having symptoms.

• Abnormalities in liver enzymes have not been associated with ursodiol therapy and, in fact, ursodiol has been shown to decrease liver enzyme levels in liver disease. However, patients given ursodiol should have SGOT (AST) and SGPT (ALT) measured at the initiation of therapy and thereafter as indicated by the particular clinical circumstances.

   

  Aluminum-based antacids have been shown to adsorb bile acids in vitro and may be expected to interfere with ursodiol in the same manner as the bile acid sequestering agents. Estrogens, oral contraceptives, and clofibrate (and perhaps other lipid-lowering drugs) increase hepatic cholesterol secretion, and encourage cholesterol gallstone formation and hence may counteract the effectiveness of ursodiol.

   

  Ultrasound images of the gallbladder should be obtained at 6-month intervals for the first year of ursodiol therapy to monitor gallstone response. If gallstones appear to have dissolved, ursodiol therapy should be continued and dissolution confirmed on a repeat ultrasound examination within 1 to 3 months. Most patients who eventually achieve complete stone dissolution will show partial or complete dissolution at the first on-treatment reevaluation. If partial stone dissolution is not seen by 12 months of ursodiol therapy, the likelihood of success is greatly reduced.

   

  https://dailymed.nlm...dience=consumer

   

  Side Effects

  Drug information provided by: IBM Micromedex

  Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

   

  Check with your doctor immediately if any of the following side effects occur:

  More common

  1. Bladder pain
  2. bloody or cloudy urine
  3. difficult, burning, or painful urination
  4. dizziness
  5. fast heartbeat
  6. frequent urge to urinate
  7. indigestion
  8. lower back or side pain
  9. severe nausea
  10. skin rash or itching over the entire body
  11. stomach pain
  12. vomiting
  13. weakness

  Less common

  1. Black, tarry stools
  2. chest pain
  3. chills or fever
  4. cough
  5. pinpoint red spots on the skin
  6. severe or continuing stomach pain
  7. sore throat or swollen glands
  8. sores, ulcers, or white spots on the lips or in the mouth
  9. unusual bleeding or bruising
  10. unusual tiredness or weakness

  Incidence not known

  1. Clay-colored stools
  2. dark urine
  3. difficulty with swallowing
  4. headache
  5. hives or welts
  6. hoarseness
  7. large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  8. loss of appetite
  9. nausea
  10. redness of the skin
  11. slow or irregular breathing
  12. tightness in the chest
  13. unpleasant breath odor
  14. yellow eyes or skin

   

  https://www.mayoclin...ts/drg-20066618

   

  Drugs metabolized by CYP 3A4: Studies indicate that CYP 3A4 activity may be influenced by ursodiol.

  https://pdf.hres.ca/...pm/00002670.PDF

[fishinghat]

Ox bile

 

No significant medical research on its effects.

 

Below is a link to the best website I found on ox bile. References included by links. 

https://selfhacked.c...le-supplements/

[ForLyla]

Thanks so much for your research FH. I appreciate it so much. 

 

So yesterday I was stupid and decided to take ox bile and a few uva ursi pills. My heart started to pound wildly and I feel like I did back in full blown withdrawal. Absolutely terrible. That confirms it that theres no supplement on the planet that is safe while your hormones are all messed up from these drugs. I just hope that it didn't set me back for weeks or months again taking that stuff yesterday. All the killing I did of good bacteria last year gave me overgrowths I think. I took heavy doses of oregano and fluconazole and they ruined me. I don't know if I'll ever get back to normal now. And my reflux is just as bad as ever. I'm feeling really discouraged. 

[invalidusername]

Hi Lyla,

 

Interesting what has now been found and to my mind your diagnosis sounds quite stable to me - although my knowledge in the GI area isn't quite as advanced and the neurochemicals, so again Hat is your man for the information - of which he has done his usual bang up job. 

 

But the disruption of the good bacteria, the whole flora/fauna balance is paramount for the respective ph balance. This is often overlooked by many in the medical profession - rarely are they able to to concentrate on more than one drug at a time, thus ignoring the potential interactions...