Die-off Herxheimer Reaction In Psoriasis

The Herxheimer reaction is mentioned just everywhere and not only in psoriasis discussions. People think that every bad feeling whether it is physical or mental is caused by die-off reaction.

In my experience the real die-off reaction which would be caused by death of microorganisms is quite rare compared to the amount of self-reported so called “herx” reactions.


People take various supplements which are so weak antimicrobials like weak chamomile tea and if they feel irritable, develop a rash or get itchy skin a few hours later they think it’s the die-off symptoms. It might be but often it has nothing to do with killing the pathogens.

I can say that I highly doubt it since many and I would say that most people do not have any die-off symptoms even when taking man-made drugs or strong antimicrobials like oregano oil.

Activated Charcoal induced die-off?

I highly doubt so, because activated charcoal binds the most toxins even those produced by bacteria and fungi. So taking activated charcoal would likely help to attenuate the possible die off symptoms rather than cause them.


I would take activated charcoal not only in psoriasis but generally to bind the toxins which would otherwise be reabsorbed multiple 100’s, thousands or even tens of thousands times.

There are many studies mostly from Russian scientists which concluded significantly prolonged lifespan in mice and rats ingesting higher amounts of activated charcoal based adsorbents.

There is a drug called Kremezin (AST-120) which is also an activated charcoal based drug popular mostly in Japan. This drug is prescribed in chronic kidney diseases and is able to significantly prolong the time when kidney transplantation is needed.

Activated Charcoal allergy

Recently I came up to a question where a guy asked if anybody else is allergic to activated charcoal.

It is believable that small particles of very fine activated charcoal might be absorbed into the bloodstream and cause something like allergic reaction.

It was proved that some types of particles of size up to 5 micrometers are absorbed into the bloodstream and distributed throughout the body.[1]

And some fine activated charcoals are made in particle sizes of 5 micrometers.

Depending upon the particle size of activated charcoal the surface area varies from 1000 m2/gram up to 3500 m2/gram which is unbelievably huge adsorbent surface if you think about it.

The surface area of small intestine was for a long time considered to be about 250 m2 but the recent study says it is only about 30 m2.[2]

However, even those 30-40 square meters of absorption area of small intestine is enough to leak the huge amounts of endotoxins into the blood and cause psoriasis eventually.

So, in a perfect world just 100 mg of activated charcoal would make up generously to cover the whole small intestine.

But in real life application one should take at least 1 gram of activated charcoal in order to make use of it.

Psoriasis improved on cholestyramine

You can read more about the effects of endotoxin adsorbents like activated carbon and cholestyramine in my previous post Cholestyramine and Activated Charcoal Help to Improve Psoriasis



1) Joshua J. Reineke, Daniel Y. Cho, Yu-Ting Dingle, A. Peter Morello, Jules Jacob, Christopher G. Thanos, and Edith Mathiowitzb. Unique insights into the intestinal absorption, transit, and subsequent biodistribution of polymer-derived microspheres. Applied Biological Sciences. Proc Natl Acad Sci U S A. 2013 Aug 20; 110(34): 13803–13808.

2) F Helander, Herbert & Fändriks, Lars. (2014). Surface area of the digestive tract—Revisited. Scandinavian journal of gastroenterology. 49. . 10.3109/00365521.2014.898326.

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