The most common reason cause of the Jarisch-Herxheimer Reaction are taking high doses of antifungals or antibiotics, but the condition can also occur when rapid changes of diet cause large-scale die-off of gut microflora overgrowth (also see: SIBO Diet)
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However, there are also cases when additional factors such as lack of sleep, poor diet, and deficiency of other vitamins like iron, folate, and others, contribute to the issue