Retox Reactions in Adrenal Fatigue Syndrome – Part 1

By: Michael Lam, MD, MPH; Justin Lam, ABAAHP, FMNM

Detox is important in Adrenal Fatigue, but watch out for retoxRetoxification, or retox, is connected to the natural detoxification process of the body. Detoxification is the process of removing toxins from the body. It is a fundamental process of our cells during its respiratory cycle. The most basic form of nutrition and detoxification is breathing. On each complete breath oxygen is consumed as a nutrient. The body then produces carbon dioxide as a waste product which is expelled from the lungs. The body’s detoxification operates round the clock to keep unwanted compounds out.

If the body is overworked, exposed to a large number of toxic elements, or if the body is damaged, as in the case with Adrenal Fatigue Syndrome (AFS), our detoxification process can be affected and become dysfunctional.
Many alternative practitioners advocate a regular program of detoxification as a way to maintain optimum health. Overly aggressive detoxification, however, can create a unique set of unpleasant symptoms, collectively called detoxification reactions. Those who are weak or in advanced stages of AFS suffer from a more severe form of retoxification, or retox.

Detoxification 101

In alternative medicine, detoxification commonly refers to the removal of heavy metals, xenobiotics, cigarette smoke, medications, alcohol, caffeine, and pollutants from our body. This can be done through enemas, flushes, oral ingestion of certain herbs, intravenous therapy, heat therapy, fasting, and juicing, just to mention a few.

Detoxification is a process largely carried out by our liver where it filters, oxidizes, reduces, and conjugates the metabolite byproducts for excretion out of out body by way of urine, air, sweat, and feces comfortably.

There are two phases of detoxification carried out by the liver cells on contact with toxins. Phase 1 liver detoxification is carried out by fifty liver enzymes known as the cytochrome P450 enzyme system. Glutathione is also produced, which is then used during Phase 2 of the liver detoxification. It is during the Phase 2 detoxification that special processes such as methylation, glutathione conjugation, and sulfation take place. These two phases, though basically dissimilar, are complementary biochemically and facilitate the body processes which keep it clean at all times in order for us to feel good. If the glutathione level is low or if the liver’s P450 pathways are compromised or imbalanced, dysfunction will surface. Because the liver is a rather large organ with a large reserve capacity, one may not detect any dysfunction until the damage is well entrenched even when laboratory tests are still normal because they are not sensitive enough to detect early damages. One can also be in a subclinical state of liver dysfunction and be symptomatic and have routine liver laboratory testing be normal.

The liver is key to detox and retoxGenerally, the actions of the enzymes during Phase 1 detoxification reduces the chemical toxicity of pollutants. Phase 2 is needed because some of the post Phase 1 metabolic byproduct compounds can be more toxic than the original compound. This phenomenon is called bioactivation. It is with the Phase 2 detoxification process that such chemicals are turned into harmless compounds and eliminated from the body. Any dysfunction or imbalance in Phase 1 and Phase 2 detoxification will lead to improper detoxification, resulting in increased toxin load within the body, triggering symptoms of endocrine, nervous system, immune, and other organ toxicities.

Bioactivation is a key concept to understand as its presence indicates increased toxic load and is a contributing factor of a more severe form of detoxification reaction called retox reaction.

Problems also arise when a normal liver has reached its maximum metabolic workload when stressed. Examples of stressors can include toxic chemical fumes, infection, or medications. If stressors are not removed the liver can start decompensating. This occurs during advanced stages of AFS. Unprocessed toxins waiting for breakdown may accumulate as a result and partially metabolize and a bio-activated toxic load buildup causes havoc within our body.

Detoxification Triggers

Remember that the body is constantly undergoing a detoxification process. Only when there is a sudden imbalance in this process will a detoxification reaction be triggered. Three common triggers are:

  • Administration of antibiotics or certain diet regimes which can cause a sudden large-scale die-off of bacteria. A significant amount of toxins stored within the actual bacteria is released. This sudden flood of toxins can trigger a detoxification reaction.
  • Detoxification programs that cause the organs in the body (particularly the liver, which is a warehouse of drug and poison residues and metabolites) to purge their stored poisons and toxins can be a trigger. Our cells suddenly have an opportunity to release an even greater than normal quantity of stored toxins, metabolic wastes, pathogens and unwanted material. Examples include colon cleansing, liver flushes, aggressive use of anti-viral herbs, immune enhancers, and pathogen destroyers can all trigger a bacterial detoxification reaction, especially if one is weak.
  • Weight loss programs such as fasting or the use of weight-loss herbs can cause a rapid breakdown of fat cells (which are a storehouse for toxins) and trigger detoxification reaction.

Detoxification Reaction

Detoxification reactions also go by different names including healing reactions, healing crises, die-off, cleansing reactions, or Herxheimer reactions.

As mentioned above, the normal detoxification process is automated by the body and works continuously without us knowing. If aggressive detoxification modalities are administered and the body is not ready, there may be a sudden surge of toxic metabolic load in the body. In a normal healthy person, the body rebalances itself automatically by increasing its excretion mechanism to help get rid of toxin overload. No symptoms are felt.

For some, hot yoga may trigger signs of a retox reactionSometimes you may hear of healthy people feeling drained or exhausted after a hot yoga or sauna session, or after taking part in a liver cleanse, enema, or fasting protocol. It may take them anywhere from a few hours to a day or two to regain their composure. This is an early warning sign that the body’s detoxification process may be reaching its maximum workload. More rest is needed and the body will usually return fully to baseline function within a few days.

Those who are weak, or in early stages of AFS, fare worse as the body’s detoxification process is strained. A full-fledged detoxification reaction may occur, with symptoms that include fatigue, brain fog, anxiety, skin eruptions, diarrhea, bloating, stomach cramps, joint pain, low-grade fever, gastric discomfort, and headache. These generally resolve over time, but it can take upwards of one to two weeks. The first one to two days may be incapacitating.

Retox Reaction

The term retoxification, or retox, is generally used in the general public when a person resumes the consumption of alcohol, caffeine or other addictive substances after undergoing detoxification for those who are healthy. In the case of Adrenal Fatigue Syndrome, it refers to the body becoming retoxified as it is undergoing the normal automated detoxification process mentioned previously. In other words, additional insults above and beyond that of the normal detoxification process are levied on the body.

Retox reaction is a more severe form of detoxification reaction. A retox reaction is seldom experienced by normal healthy people or those in mild or early stages of AFS because the body possesses adequate reserves to compensate and adjust for the increased toxic load automatically. This, however, is a common occurrence for those in advanced stages of AFS or who are chronically ill and weak.

For example, sauna or hot yoga is a good detoxification modality, which uses heat. With heat, the blood vessels tend to dilate and toxins are released in the form of sweat. Normal people feel relaxed during sauna, invigorated afterward, and come away energized. Those in early stages of AFS don’t do quite as well. The toxic load within increases and improper or slowed speed of toxic clearance from the body may lead to a brief period of mild fatigue, headache, and lethargy. This detoxification reaction is usually self-limiting. After a few hours of rest, the body regains its posture and energy fully returns.

The same cannot be said for those in advanced stages of AFS (stages 3 and 4). For these individuals, even a few minutes within a sauna or under direct sunlight may be too much. Most are unaware of the damage within until they either stay too long or after the session is over. They experience what is called a retoxification reaction. It is important to detox when suffering from Adrenal Fatigue, but watch for retoxInstead of feeling good the heart rate goes up and continues to stay up for hours. Headaches, fatigue, and lethargy can last for days. Insomnia and hypoglycemia may be triggered that can go on for weeks or even months. In severe cases, one could be incapacitated.

A retoxification reaction, therefore, may be considered a severe form of detoxification reaction afflicting primarily those who are weak. Both are part of the toxic continuum but have important distinctions.

The term retoxification reaction denotes the underlying pathophysiology process of a body under multiple insults and repeated damage from toxin overload. In addition to the increased release of normal metabolic byproducts during a detoxification process, the body is further damaged by the onslaught of highly toxic bio-activation of partially metabolized components not properly funneled to the next level of the normal detoxification process for neutralization. On top of that, there is usually significant congestion at the extracellular matrix that leads to retarded recovery.

Read Part 2 Now!

© Copyright 2015 Michael Lam, M.D. All Rights Reserved.

Dr. Lam’s Key Questions

Benefits: The coffee enema increases bile flow and removes toxins in the large intestine so they will not be absorbed. Dangers: Fatigue, headache, and stomach ache are symptoms of a coffee enema because the body can not rid the toxins quick enough.

Toxins represent a drain on the body as the anti-inflammatory response takes energy to work. Toxins inside the cells are very damaging to the mitochondrial, RNA and DNA.

It could be both, and the situation varies from person to person.

Detox is important in Adrenal Fatigue, but watch out for retox
5 - "Hello, Dorine."
Hello, Dorine.

Just wanted to check in and update you on my progress and my situation. I'm still using certain AFS supplements from Supplement Clinic, along with other supplements that work for me. As always, thanks for all your support and teaching along the way. It continues to serve me every day.


  • Benjie says:

    What is the best way to reduce detox reactions?

    • Dr.Lam says:

      A comprehensive rebuidling program by someone who knows what they are doing. It is very tricky in the setting of AFS as many are fragile and sensitive.
      what works for one may make another worse.

  • Bonnie says:

    How do you know if it is the foods that you are eating that can be causing your detox reaction?

    • Dr.Lam says:

      It is hard sometimes, but a detailed history and being attuned to the body’s whisper can help.

      Dr. Lam

  • Wu Ping An says:

    Are fatigue reactions from saunas or being out in the sun too long caused by detoxing or retoxification?

    • Dr.Lam says:

      Could be both, not to mention an intrinsic temp regulatory problem that comes with AFS.

      Dr. Lam

  • Ariel says:

    If Ive had a retoxification issue with my detox, should I consider an alternative detox all together or reduce the strength of the current detox program?

    • Dr.Lam says:

      It really depends on the overall state of where you are and what you are trying to accomplish. It could be neither or both as the situation warrants.


  • Chantel says:

    Is there a way to detox while suffering from adrenal fatigue? Or should I hold off on any detoxification?

    • Dr.Lam says:

      It depends on the person. Generally speaking, the weaker you are, the more careful you should be.


  • Carol says:

    Will retox happen to a normal, healthy person?

  • Jim says:

    This sounds like the reason many of my friends had negative reactions to some of the programs I was on. Interesting topic and good read.

  • Noelle says:

    How do i keep myself from detoxing to quickly?

    • Dr.Lam says:

      Most people are not in tune with their body. It is a process that take a lot of experience. If you are in that category, you should seek professional help for best clinical outcome.

      Dr Lam

  • Mimi says:

    Why do people crash when they “detox too quickly”? I thought detoxing is a good thing. What’s going on exactly that causes them to crash?

  • Ayla says:

    Can getting a cold or flu trigger retoxification?

  • Danail says:

    Dr Lam, how do I recover from neurotransmitters depletion and adrenal fatigue? I am on paxil 20 mg I tried every adaptogen you can think of, Rhodiola, Mucuna etc. I get great for 3-5 days, great improvement and then I crash dramatically (Rhodiola causes psychosis and some sort of anxiety attack on 5-6th day and Mucuna I crash and go into apathy and depression ).

    I cannot seem to tolerate any of it? What does that mean? I also cannot tolerate high doses of vitamin C and B (anxiety), tried Glutamine also did not work, Zinc and Calcium cause severe constipation, Ltryptophan – super sleepy, 5HTP not working St Johns Worth ‘ Anxiety, Ltyrosine- terrible headaches….I have IBS as well.

    Please help me find a proper treatment, I am really desperate!!! Please contact me via email

    • Dr.Lam says:

      When your body is sensitive, recovery needs to be personalized and systematic. We need a more detailed history to structure a program. It can be done through our nutritional coaching telephone program.

      Dr Lam.

  • Issac says:

    After completing a few mild detoxes, do the risk of retox reactions reduce ?

    • Dr.Lam says:

      The probably of retoxification reduces the more healthy you are and not related to how many mild detoxes you went through.

      Dr Lam

  • Joe says:

    Can a tea cleanse cause retox?

  • Loren says:

    Hi Dr Lam. I’m taking dandelion root because I’ve discovered after a lot of trial and error that my liver is congested and has been causing my digestive issues, constipation as the main culprit. However, whenever I take herbs for liver cleansing I feel so over stimulated and can’t sleep properly (not ideal when recoverIing from AF) I know my liver needs this support, otherwise I won’t use the bathroom without laxatives. Should I try a more gentle approach? And how long should I do it for? Some people have to do this for life! 🙁 I’m only 22 and feel like 90 year old :/

  • Anna says:

    Can my rx meds cause a retox reaction? I take vicodin occasionally for chronic pain, and warfarin for an artificial heart valve.

  • Cynthia says:

    How does fasting work as a detox? Would it be good to take something like glutathione while fasting?

  • Anjeanette Antonucci says:

    I am currently experiencing this right now. I was at the beginning of stage 3 AF when I decided to get help. I’ve been on a detox program for Adrenal Fatigue and Epstein Barr for about 2 months now. I’ve been on Lauricidin for the past month. I’ve been experiencing an increase in fatigue, nausea, headaches, brain fog, anxiety, loss of appetite, back pain, and acne. They did subside after about a week of starting starting the Lauricudin. However this past week I had gluten and alcohol, which is something I haven’t had since starting this program 2 months ago. My symptoms returned with avangence. I’m not sure if it’s from the Lauricidin detox or the reexposue to gluten and alcohol, or both?

  • Albert says:

    Can a sauna treatment set one into a crash if he is not careful?

  • Junniper says:

    Makes a lot of sense

  • Stephanie says:

    great article! i now have a better understanding of how detoxification works. i look forward to reading part 2 of this article.

  • Ellie says:

    How do you know which detoxification tool to use and when?

    • Dr.Lam says:

      that is a good question. The correct answer lies in understanding your own body and the state of AFS. If you know both, you will have a good idea of what is best. For example, unless you are strong, coffee enema as a detox tool can worsen your AFS. If you are not experienced or in tune with your body, seek the help of a professional is best. Each modality has its pros and cons. There is no “good or bad” methods.

      Dr Lam

  • Scott says:

    I have/had a combo of issues: Hashimotos and my meds not working so trying to regulate that, adrenal fatigue, and a Candida overgrowth. Nuked the Candida but now I have sever upper back pain on either side of my spine just below my shoulder blades. I have been on a paleo autoimmune protocol for 4 months and have dropped just over 30lbs. I get very light headed when I stand up. What’s going on and what should I do?

    • Dr.Lam says:

      What you experieinced is not uncommon among those whose adrenals are weak as a result of agressive efforts to fight Candida. The collateral damage suffered as a result can lead to the body being triggered into what is known as a catabolic state as one possibility. There are other possible reasons as well. you should see your doctor to find out what is really going on. Click Catabolic State & Adrenal Fatigue Syndrome for more information.

      Dr Lam

  • Gisselle says:

    Hi, could a missed period a cause of detoxification reaction? I believe I have adrenal fatigue and I have been taking herbal teas that are antiviral. I have felt one symptom of adrenal fatigue which is extreme thirst that’s hard to quench get a little worse again, before it was getting better. Also, I have been feeling quick and sharp aches all around my body, but not so painful just I haven’t felt that before. My period, as I mentioned before is the latest it has ever been, since I’m used to a regular cycle. More than 12 days late so far. I haven’t been sexually active so I know that’s not to blame. Or i might have lost my period…

    • Gisselle says:

      I meant retoxification reaction. Oh and I checked to make sure about my late period and its actually 20 days late…

    • Gisselle says:

      Oh and one more thing I have forgot to mention is that I am sick right now with a sore throat, which might be part of the retoxification reaction?

  • Alex says:

    How often should one do a detox?

    • Dr.Lam says:

      There is no set rule. Those with AFS should be careful not to detox without first preparing the body. Also bear in mind that what is considered “normal intensity” for one person can crash another person. The more advanced the AFS, the higher the risk. That is why generally speaking, if you have AFS , you should not attempt self navigated detox to avoid crashes and relapse.

      Dr Lam.

  • Pia sylveser says:

    Dr. lam…. I was in the midst of a huge Candida elimination program. At the time I began the program I didn’t realize my adrenal glands were so weak. I was taking anti fungal herbs to kill yeast and then began a very strict diet. I became really weak and lethargic for about a month…. We realized this had something to do with my adrenal glands not keeping up with the detox. The nutrionist then immediately began an adrenal protocol which has now made me ten times worse. No I am in overdrive and can’t calm down. I can’t sleep and I am in a constant state or “racing”. How can I make this stop. Also symptoms like this never this severe tend to happen to me at this time every years?!???

    • Dr.Lam says:

      Your body is weakened with the yeast elimination program and made further worse with the “adrenal protocol” which put additional stress on your system. Thus you are “wired”. We deal with this issue quite frequently and the body is telling you it does not like what you are doing. You need to go back to your health provider. At this fragile state, you need to be very careful and have a comprehensive recovery approach and avoid any more stimulants. Its a long road ahead but the body can often heal itself with proper program. Click Total Body Approach for more information.

      Dr Lam

  • kathleen walker says:

    I was in bed for a year 1/2 20 hours a day after what I believe was a retoxification nightmare. After over-detoxing in a weakend state of AFS, I ended up in the ER shaking uncontrollably. After that night, I was non-functioning in the bed. Dr. Lam is the only person on the face of the earth who knew about my condition. I didn’t stick with him, only because there was nothing that could be done for almost 2 years except rest, pray, and try to eat. All in all it was 7 years of sickness. I still have AFS and I suppose always will, but I manage it now and function pretty well—no travelling though—and have to be careful not to get overstimulated. With this condition you cannot consume any sugar, and obviously no caffeine including decaf. You need to totally change your lifestyle and heal any anger. I could go on and on, I should write a book about that experience. No one would believe it. Thanks for listening.

  • Kat says:

    Thank you for the informative articles; I am definitely suffering retoxification. What are some of the specialized ways you deal with advanced AFS, especially for those of us who can’t tolerate adaptogens and supplement support?

    • Dr.Lam says:

      the key is to be to match the body’s state of function to the degree and intensity of detoxification that has to happen on a consistent basis. Taking the time to know the body is the most important as they body will tell you what it can and cannot tolerate. you cannot push the body beyond the limits. the general concept of detoxification is outline in my articled called Detoxification , and it contains many tools from flushes, to enemas to cleanse. No tool is off limit, and every tool has it pros and cons and one need to know in depth each one in order to know when to use it to what intensity and frequency. the key is not the tools but knowing the body so well you can be fluid with the decision which can change from day to day. The right tools at the wrong time can crash you. that is why it is so difficult for most who do not have experience that do this daily. concepts and theories dont work unfortunately. It all comes down to experience. I dont mean to be non specific but simply is not possible to be protocolized as the process is not only science but also an art as practice of coaching is.

      Dr Lam

  • Evelyn Batchelor says:

    Retoxification Reaction and Adrenal Fatigue Syndrome article sent to me Nov. 17/15 was very interesting. However, Part 2 comes up reading 404 ARTICLE NOT FOUND. I would like to have this.

  • Claudia says:

    What, then, is recommended to those with adrenal fatigue to detoxify?

    • Dr.Lam says:

      There is no easy answer to this because everyone is different. If you in a early stages of AFS, then liver cleanses and fasting can be considered. The weaker one is, the more careful one should be. Extensive clinical experience is needed to avoid crashes while getting the job done, and this is why most self navigation efforts fail, say to say. We have developed various specialized ways to deal with this matter, and even in the best of hands, some trial and error is required.

      Dr Lam.