HYPOTHESIS AND EMERGING RESEARCH
Some 95 percent of Americans have already been infected with the Epstein-Barr Virus (EBV)—in the same family as herpes, and the cause of mono—explains NY-based Aviva Romm, M.D., a women’s health and obstetrics specialist and author of The Adrenal Thyroid Revolution. Most of us don’t develop symptoms, but they can be persistent, chronic, and widespread for those who do—Romm says symptoms can range from fatigue and aches to Hashimoto’s thyroiditis. What’s worse, Romm explains, is that EBV often goes unchecked in conventional medicine. Her upside: She says it’s entirely possible to heal from EBV and remain symptom-free. Here, Romm shares some of her functional protocol for doing so, along with the basics about EBV. (For a different POV on EBV and its connection to thyroid dysfunction, see this goop piece with Medical Medium, Anthony William.)
A Q&A with Dr. Aviva Romm Q What is EBV? A Epstein-Barr Virus (EBV) is a stealthy infection—one that tends to slip under the radar, but causes a wide variety of issues, especially in women. EBV is in the herpes virus family, as are other common viruses (including the kind of herpes that causes cold sores and the type that causes genital sores), shingles, and chickenpox. EBV is specifically responsible for causing mononucleosis (“mono”). Most of us have been exposed to EBV, even if we never had mono. Only 5 percent of people haven’t been infected; most of us just go through life as carriers, totally symptomless. For others, though, EBV can be a (silent) cause of fatigue, chronic aches and pains, depression, and Hashimoto’s thyroiditis. Q Why is there so much disagreement in the medical community around EBV? A Unfortunately, the medical community has long marginalized its role in chronic symptoms, so most doctors never think to check for it, leaving many thousands of women suffering with mysterious symptoms without an obvious cause or diagnosis. I learned early on in my career that EBV is far more common than I was taught in medical school, so I began testing for EBV in my patients with those chronic symptoms, as well as those with Hashimoto’s. This is something more doctors should pay attention to, but because EBV is often overlooked by conventional medicine, it’s important for women to be their own health advocates by being informed about EBV.
Q How does EBV spread?
A EBV is transmitted through saliva—drinking out of the same cups, kissing, or passing joints or cigarettes, for example. We might associate EBV with mono and “kissing teenagers,” but we can get infected at any age, and the virus can get reactivated at any time in our lives. A strong immune system can usually fight off EBV by creating antibodies, but periods of stress and fatigue, major life changes, or even menopause may make us especially susceptible to infection or reactivation of the virus.
Q What are the symptoms?
A EBV remains dormant in your system indefinitely, and reactivation can persist for months, like mono can. Thankfully, it’s usually much milder than mono, which is typically the worst when contracted in our teen years and early 20’s. Symptoms of EBV infection and reactivation include:
Fatigue (sometimes intense)
Achy muscles and joints
Swollen lymph nodes
Other persistent flu-like symptoms
Malaise and depression
A physical exam may reveal a swollen liver and spleen (but not always), and liver function tests may be abnormal.
Q Can you talk about the connection between EBV and autoimmunity? A EBV has been linked to autoimmune disease, including Hashimoto’s thyroiditis, systemic lupus erythematous, and a form of lymphoma, a cancer that affects the immune system’s B-cells. There are several theories about how these infections can cause autoimmune disease. We know that chronic infections keep your body in a state of low-level chronic alarm, activating the stress response and your adrenal system, leading to dysregulation in the immune system. It’s clear that autoimmune conditions are on the rise—they are especially common in women—and infection plays a role in triggering autoimmunity. The body has to work much harder to contain infection and inflammation when we are chronically overwhelmed and exhausted. Q Are there other concerns around EBV? A In my book, The Adrenal Thyroid Revolution, I show how a multitude of seemingly unrelated symptoms share one source, what I call Survival Overdrive Syndrome (SOS)—a condition that occurs when the body becomes overloaded by stress, poor diet, lack of sleep, toxic overload, and chronic viral infections that are inescapable in our world today. EBV is commonly “picked up” or reactivated when we’re in SOS, and it’s also harder for your immune system to kick it when you’re already on overdrive. Chronic infections like EBV keep your body in a low-level state of SOS (think of it like having a faulty car alarm that goes off for no reason), and they sneak in when we are distracted by life—stress, life changes, etc. There is, of course, no good time to deal with a disease, but infections like EBV are opportunists, kicking you while you’re down. The good news is that everything in your body is connected, so once you start getting your cortisol levels back on track, you’ll give your immune system some breathing room to quell inflammation and fight infection.
Q How do you test for it?
A A simple blood test can confirm EBV; this conventional test is both readily available and generally reliable.
Q How do you treat patients with EBV?
A First of all, it is totally possible to send EBV into dormancy and to remain symptom-free. And, if you’re living with Hashimoto’s, know that it’s one of the most reversible conditions I see in my practice. That said, there is no specific conventional medical treatment for recurrent or chronic EBV. Many functional and integrative medicine doctors use an antiviral medication used in the treatment of herpes and shingles that’s considered relatively safe. Patients have reported it to help with symptoms and shorten the duration of their illness. However, given the overall safety of herbs and supplements, they are generally my go-to with EBV. I encourage a four-part program to heal and nourish, which lets your immune system more easily keep this virus in check.
1. R&R—Rest and Repair Your Mind and Body
REST: Get plenty of restorative sleep. Poor quality sleep is no joke. When we are tired, we’re more irritable, depressed, our hormones are a wreck, we can’t lose weight, we can’t concentrate, our digestion is a mess, we get more zits, we get sick more often—and our immune systems don’t have time to repair and rebuild. REPAIR: Incorporate relaxation techniques to help reset a stressed immune system. Spending more time doing activities like meditation, being in nature, deep breathing, yoga, relaxing self-care, and gentle exercise can all shift your brain out of survival mode, which is crucial when you’re healing.
2. Boost the Immune System Through Food Emphasize immune-boosting foods, including:
Dark green, leafy vegetables to improve immune defenses and promote regularity and healthy detoxification and digestion
Vitamin-A rich carrots and sweet potatoes to promote healthy immunity
Dark berries (blueberries and blackberries), which are packed with antioxidants that scavenge free radicals (aka scrubbing away the rust)
Nuts and seeds, rich in protein, minerals, and good quality fats (essential for growth and development to help the body repair)
Good quality protein plays a crucial role in the immune system, so make sure you’re getting some at every meal: organic, free-range, antibiotic-free eggs, chicken, red meat, fresh fish (each a couple of times/week), and canned sardines
3. Support the Immune System & Fight the Virus: Use immune supportive, antiviral, and anti-inflammatory herbs and supplements that have been shown to be effective in fighting against the EBV virus (and/or viruses in the herpes family). Some that I like:
Zinc Citrate: Immune supportive (30 mg/day, take with food to avoid nausea)
St. John’s Wort: Antiviral and relieves depression (300-600 mg/day)
Lemon Balm: Antiviral and relieves stress and anxiety (500-1200 mg/day)
Licorice: Antiviral, anti-inflammatory, and an adaptogen (150 mg/day)
Echinacea: Anti-inflammatory and antiviral (300-500 mg/day)
Daily probiotic containing Lactobacillus and Bifidobacterium strains (at least 10 billion CFUs/day)
4. Give Extra TLC to Your Stress Response and Immune System To reset and restore immune system and stress response regulation, I favor the use of the adaptogen herbs such as ashwagandha, holy basil, and reishi for general immune support. You can find a complete EBV and hidden viral infection protocol in my book. My recommended daily protocol usually combines the herbs and supplements in step 3, plus your choice of adaptogen(s), also taken daily, for up to 3 months. These are all safe while breastfeeding; only zinc, echinacea, and St. John’s Wort are safe in pregnancy. Please check with your health practitioner before using any supplements if you’re pregnant, if you’re on medications, or if you have a serious medical condition.
REFERENCES: Written by: the Editors of goop
Ader, R., Cohen, N., & Felten, D. (1995). Psychoneuroimmunology: Interactions between the nervous system and the immune system. The Lancet, 345(8942), 99-103. doi:10.1016/s0140-6736(95)90066-7
Allahverdiyev A, Duran N, Ozguven M and Koltas S: Antiviral activity of the volatile oils of Melissa officinalis L. against Herpes simplex virus type-2, Phytomedicine. 11(7-8):2004; 657–661.
Astani A, Navid MH, and Schnitzler P. Attachment and penetration of acyclovir-resistant herpes simplex virus are inhibited by Melissa officinalis extract. Phytother Res. England; 2014;28(10):1547-52.
Astani A, Reichling J, and Schnitzler P. Melissa officinalis extract inhibits attachment of herpes simplex virus in vitro. Chemotherapy. Switzerland; 2012;58(1):70-7.
Barzilai, O., Sherer, Y., Ram, M., Izhaky, D., Anaya, J., & Shoenfeld, Y. (2007). Epstein Barr Virus and Cytomegalovirus in Autoimmune Diseases: Are They Truly Notorious? A Preliminary Report. Annals of the New York Academy of Sciences, 1108(1), 567-577.
Benvenga, S., Guarneri, F., Vaccaro, M., Santarpia, L., & Trimarchi, F. (2004). Homologies Between Proteins of Borrelia burgdorferi and Thyroid Autoantigens. Thyroid, 14(11), 964-966.
Benvenga S, Santarpia L, Trimarchi F, Guarneri F (2006). “Human Thyroid Autoantigens and Proteins of Yersinia and Borrelia Share Amino Acid Sequence Homology That Includes Binding Motifs to HLA-DR Molecules and T-Cell Receptor”. Thyroid 16 (3): 225–236.
Costenbader, K.H. & E.W. Karlson. 2006. Epstein-Barr virus and rheumatoid arthritis: is there a link? Arthritis Res. Ther. 8: 1186–1193.
Eo SK, Kim YS, Lee CK and Han SS: Possible mode of antiviral activity of acidic protein bound polysaccharide isolated from Ganoderma lucidum on herpes simplex viruses, J Ethnopharmacol. 72(3):2000; 475–481.
Fujinami, R. S., Herrath, M. G., Christen, U., & Whitton, J. L. (2006). Molecular Mimicry, Bystander Activation, or Viral Persistence: Infections and Autoimmune Disease. Clinical Microbiology Reviews, 19(1), 80-94.
Ghaemi A, Soleimanjahi H, Gill P, Arefian E, Soudi S, and Hassan Z. Echinacea purpurea polysaccharide reduces the latency rate in herpes simplex virus type-1 infections. Intervirology. Switzerland; 2009;52(1):29-34.
Glaser, R. (2005). Stress-associated immune dysregulation and its importance for human health: A personal history of psychoneuroimmunology. Brain, Behavior, and Immunity, 19(1), 3-11. doi:10.1016/j.bbi.2004.06.003
Harley, J.B. et al . 2006. The curiously suspicious: a role for Epstein-Barr virus in lupus. Lupus 15: 768–777.
Lennette, E.T. 2003. Epstein-Barr virus. In Manual of Clinical Microbiology. vol. 2, 8th ed.
P.R.Murray, E.J.Baron, J.H.Jorgensen, et al . Eds.: 1331–1340. ASM Press. Washington, DC.
Nolkemper S, et al. Antiviral effect of aqueous extracts from species of the Lamiaceae family against Herpes simplex virus type 1 and type 2 in vitro. Planta Med. 2006; 72: 1378-1382.
Padalko, E.Y. & X. Bossuyt. 2001. Anti-dsDNA antibodies associated with acute EBV infection in Sjogren’s syndrome. Ann. Rheum. Dis. 60: 992.
Pender, M.P. 2003. Infection of autoreactive B lymphocytes with EBV, causing chronic autoimmune diseases. Trends Immunol. 24: 584–588.
Poole, B.D. et al . 2006. Epstein-Barr virus and molecular mimicry in systemic lupus erythematosus. Autoimmunity 39: 63–70
Aviva Romm, M.D. is a Manhattan-based integrative women and children’s physician, and author of The Adrenal Thyroid Revolution. Romm did her medical training and internship in Internal Medicine at Yale School of Medicine and her residency in Family Medicine with Obstetrics at Tufts Family Medicine Residency. She’s also a midwife and herbalist, and a graduate of the University of Arizona Integrative Medicine Residency program. The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of goop, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.