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Herx-Type Symptoms Related to Antimicrobial Use Some of the most common die-off symptoms observed in our clinic include: Fatigue and low energy Brain fog or poor concentration Headaches Muscle or joint pain Flu-like symptoms (chills, mild fever, body aches) Gastrointestinal issues like nausea, bloating, diarrhea, or gas Skin rashes Mood changes, like depression While not every person experiences all of these, having many of them is not unusual during gut-based antimicrobial protocols or Lyme treatments