Would it surprise you to know that over 90% of Americans are harboring a potentially harmful virus called Epstein Barr (EBV)?  It’s a fact, but fortunately for many people this virus lies inactive, regulated by the immune system.1 However, not everyone is so lucky.  For some this virus can trigger exhausting, painful and chronic symptoms while being easily overlooked by providers. That’s because EBV is complicated and many questions about how this virus interacts with human cells are still being investigated by researchers every day. Let’s look at what we know for now.

What Is the Epstein Barr Virus? 

The Epstein Barr virus is one of the eight herpes viruses (herpesvirus 4) known to affect humans.  Like many herpes viruses, it’s normally spread through close and intimate contact like kissing or sexual activity due to transfer of saliva, blood or semen. However, even sharing food or drinks can pass the virus from one person to another.  

Also congruent with other herpes viruses, it can hide dormant within human cells after the initial infection and unknowingly be transferred to others.  For many, the virus can be reactivated one or more times throughout life causing an array of frustrating and sometimes debilitating symptoms.2

Symptoms

EBV is most commonly known for causing mononucleosis (mono).  For children, they may experience EBV in a mild form making it appear like a typical childhood illness.  While teens and adults tend to experience more severe symptoms such as terrible fatigue, for weeks and sometimes months. While some people may never experience a reoccurrence, others, especially those with a weakened immune system or autoimmunity, can develop grave symptoms time and time again. Common symptoms of initial infection include:

  • fatigue
  • fever
  • inflamed throat
  • swollen lymph nodes in the neck
  • enlarged spleen
  • swollen liver
  • rash

While the initial EBV infection can range from unnoticeable to downright exhausting, the real damage is done once EBV sets up shop in the body and begins to affect immune cells and genetic expression. Recent research has shown that a protein in the EBV (EBNA2) interacts with DNA, turning genes on and off.  At the same time, it hinders B cells of the immune system, therefore promoting disease progression.3

This research linked the following autoimmune diseases to EBV

  • Celiac disease
  • Type 1 diabetes
  • Systemic lupus erythematosus (SLE)
  • Multiple sclerosis (MS)

Aside from autoimmune related diseases, EBV is also associated with increased risk of cancer, especially head and neck, as well as lymphoma.4 Some people may develop symptoms reflective of chronic fatigue syndrome or fibromyalgia which is often associated with chronic active Epstein Barr virus (CAEBV).5 EBV is not the ONLY cause of these symptoms, but it can be a contributing factor for cancer, chronic pain or chronic fatigue.

Prevention and Treatment

At this time, there’s no effective way to prevent EBV.  There’s no vaccination or medication that can fight this virus before it’s in a position of power within the body.  We can test for EBV, but due to its prevalence, that sheds little light on the situation.

That being said, some tests do tell us if the virus is active or if the body has an impaired ability to recognize and fight the virus. In many people that exhibit autoimmune or other serious diseases associated with EBV, their body has lost the ability to fight the virus effectively.  In others, their body confuses the EBV virus with its own healthy tissues and launches an attack against itself, causing autoimmunity.

Targeting the Immune System

Because EBV interferes with proper immune function, one of the most effective ways to address this frustrating pathogen is by strengthening the body’s innate ability to fight and heal.  

Over time, chronic infections like EBV, wear the immune system down.  Therefore, shoring up the immune system can simmer the symptoms of EBV.   Consider that there are millions of people with this virus that are NOT suffering from the symptoms that I’ve laid out. For some reason, their bodies are capable of keeping it at bay. My goal with patients is to help them reach that same state so their bodies are no longer vulnerable.  We do that by addressing critical elements of wellbeing that foster immune balance. Here are 6 essential elements to ability to keep EBV in check.

Get a Handle on Stress

Stress is a major factor for the immune system’s ability to manage injuries and illness. Stress can even bring EBV out of the shadows, triggering it into an active state. In fact, a 2017 study found that higher perceived stress was associated with higher levels of EVB antibodies.6   

Chronic stress forces the immune system, which is meant to respond and then go back into a resting state, to be tuned to the “ON” position all the time.  Immune inflammatory molecules meant to protect us travel throughout tissues and cause damage. This overworked immune system becomes dysregulated and loses its ability to fight pathogens or cancer cells, instead turning its attention on healthy tissues.  Addressing stress is one of the most powerful lines of defense for treating EBV.

Clean Up Your Diet

There are two tricks to good nutrition  

  • Remove anything that is causing damage.
  • Get plentiful amounts of essential nutrients.

These tasks are more and more difficult for the average American to achieve.  The Standard American Diet (SAD) is filled with pesticides, additives, sugar, and unhealthy fats, while being woefully lacking in micronutrients crucial for optimal health. It’s essential to clean up your diet to push EBV back into the shadows.

Address Intestinal Integrity

Often in tandem with a poor-quality diet, we’ll find a compromised intestinal wall.  The gut is meant to absorb digested nutrients but protect against pathogens entering the bloodstream.  Viruses and other factors can cause leaks in the intestinal wall, referred to as leaky gut or intestinal permeability.  This causes ongoing inflammation from undigested food and microbes passing into circulation. So, healing the gut is a priority for anyone dealing with EBV.

Take A Stand Against Toxins

Often unknowingly, we are inhaling, ingesting and absorbing toxins at every given moment.  That’s because our environment is now laden with pollution and poisons. Chemicals in water, food, and the air lodge in the body and irritate the immune system.  Air pollution is now considered a leading contributor to chronic disease.7

This means we can’t ignore the chemicals that we let into our home via cleaning and personal care products, on our furniture, carpets and the like.  We need to reduce pesticides on food and purify our water. Every small choice adds up to less body burden which gives your immune system a better chance of fighting the infections we can’t control like EBV.

Sleep Soundly

Sleep is the body’s time for healing, so if you aren’t getting good quality sleep, it’s extremely difficult for the immune system to keep up.  Ongoing bouts of insufficient sleep increase inflammatory chemicals and can trigger genes that lead to disease.8-9 Sufficient sleep, on the other hand, has been shown to decrease insulin resistance and increase insulin sensitivity, a critical shift in the right direction for those dealing inflammation and chronic infection.

Supportive Supplements

Your body may need extra help boosting the immune system and quieting the symptoms of EBV.  Much of this can be done with the other tips I’ve offered, but there are incredibly powerful supplements that can calm inflammation and promote healing as well. Some supplements naturally strengthen the immune system, while others act directly on a viruses ability to replicate and cause damage.  

Getting Started

In functional medicine, we look for the root of symptoms, instead of stopping once we have a diagnosis.  That means that instead of establishing that EBV is involved with symptoms and then working to hush the symptoms, we dig into the reasons that immune system can’t keep the virus at bay. I’ve covered the six essentials that must be addressed to reset the immune system.  Now you need to know how to take control of health and reverse your symptoms. Follow this effective and simple guide and you will be well on your way.

Boost Your Stress Resiliance

Creating great stress management habits gives your immune system a break to reset.  Interrupt chronic stress with micro-sessions of deep relaxation which can shift your stress response into a less harmful cycle. Try meditation with apps like HeadSpace and Calm, practice deep breathing, yoga, Qi Gong, or increase your time in nature.10

Master Your Menu

Eating a diet based in whole and organic foods is a first step to regaining your health. Cutting sugar, refined and processed foods is a must! However, that may not be enough. Years of poor diet or excessive stress on the body might mean you need more.  

Cutting edge diagnostics that identify food intolerances and nutrient deficiencies, common in those that have EBV symptoms, may be necessary. It’s also critical to track underlying blood sugar imbalance because low or high blood sugar exacerbates immune dysfunction and inflammation. This is often overlooked in those that don’t have overt diabetes, but we’ve found it to be critical restoring immune balance.

Seal Your Leaky Gut

Once you’ve cleaned up your diet, it’s time to heal your gut and balance the microbes that regulate immune function.11. By eliminating refined grains and sugar which feed unhealthy microbes while increasing high-fiber and prebiotic foods, you’ll feed your healthy microbes and starve harmful bugs.  Try out super-fibers like chicory root, bananas, onions, raw garlic, raw leeks, and Jerusalem asparagus.

On top of eating prebiotic food, add probiotics into your routine. Probiotics don’t fuel healthy bacteria, they ARE healthy bacteria. By including probiotics in your diet, you’re sending support staff to the bugs that need it. High-quality probiotic supplements and probiotic foods like yogurt, sauerkraut, kefir, cultured vegetables, apples cider vinegar, tempeh, and brine-cured olives can all help support microbial balance.

Lastly, adding glutamine-rich foods like bone broth helps heal the intestinal tissues and repair integrity. Glutamine is an amino acid that is in much higher demand when you have gut damage or chronic infection like EBV.12 Glutamine is known to support the immune system and prevent metabolic stress that’s linked to autoimmunity.13 Glutamine is also a building block for glutathione, one of your body’s most powerful antioxidants.  The best sources of glutamine are eggs, beef, tofu and bone broth.

Double Down on Detox

Toxins trigger the immune system to attack healthy cells while interrupting the immune system’s ability to fight pathogens.  To reiterate, preventing exposure is the first step but there’s no way to avoid every toxin, so detox is essential as well.

There are a few easy and effective ways to move harmful toxins out of the body.  First, increasing exercise improves detoxification by improving circulation and secreting sweat, moving toxins out of the body. Regardless of fitness level, increasing physical activity provides a benefit. Another way to increase sweat is by sitting in a steam room or sauna which will help to flush toxins.14 Exercise and steam or sauna can boost weight loss and when fat is lost, toxins like PCB’s and pesticides that store in fats cells have an opportunity to leave the body as well.15

Increasing fiber by eating more vegetables, fruits, nuts, seeds, and other plant-foods is extremely effective for balancing the immune system and decreasing toxins. Fiber promotes health liver and kidney detox while binding toxins in the gut to pull them out of the body.

Surefire Supplements

Herbs

Herbs such as atractylon, Ashwagandha, licorice, St. John’s wort, ginseng, and holy basil can all provide benefits alone, or in conjunction for immune, antiviral and adaptogenic properties.16-17

Omega-3

Omega-3 and omega-6 fatty acids (FA) support this immune-balancing process. Omega-3 and some omega-6 FA are the precursors to anti-inflammatory molecules, while most omega-6 propels the development of inflammatory molecules. Amazingly, the average American has a ratio of 15–20 omega-6 to 1 omega-3, but a ratio closer to 4:1 is much healthier and linked to lower risk of inflammatory diseases.18 Increasing your omega-3 FA intake with flax and fish oil can balance the ratio, but should definitely be done alongside a reduction in processed foods which are high in Omega-6.

Curcumin

Curcumin is found naturally in turmeric and can be taken as a concentrated supplement. Curcumin inhibits pro-inflammatory pathways, reducing chronic inflammation and oxidative stress.19

Resveratrol

Resveratrol is found in the skins of red grapes (and therefore red wine) that can reduce inflammation. Resveratrol can also help to reduce high blood sugar, an added benefit for many people aiming to balance the immune system .23

Vitamin D

Vitamin D is a powerful regulator of the immune system. Many studies have focused on the effects of vitamin D supplementation for those suffering from autoimmune disorders, but low vitamin D is found in those with active Epstein Barr, indicating a relationship.24-25

Final Thoughts

Developments in the science surrounding Epstein-Barr virus is growing on an ongoing basis and it’s important that your provider is staying up to date. Every tip I’ve shared will get you one step closer to regaining your health, but individualized therapies targeting your unique situation can mean getting better faster.  If you’re concerned that you may be suffering from an underlying Epstein Barr infection, it’s crucial to find a functional medicine doctor with experience in treating Epstein-Barr virus.

Resources:

https://www.health.pa.gov/topics/Documents/Diseases%20and%20Conditions/Epstein-Barr%20Virus%20.pdf

https://www.cdc.gov/epstein-barr/about-ebv.html

Harley JB, et al.Transcription factors operate across disease loci, with EBNA2 implicated in autoimmunity. Nat Genet. 2018 May;50(5):699-707. doi: 10.1038/s41588-018-0102-3. Epub 2018 Apr 16.

Cao Y. EBV based cancer prevention and therapy in nasopharyngeal carcinoma. NPJ Precision Oncology. 2017;1(1):10. doi:10.1038/s41698-017-0018-x.

Loebel M, Eckey M, Sotzny F, et al. Serological profiling of the EBV immune response in Chronic Fatigue Syndrome using a peptide microarray. Pagano JS, ed. PLoS ONE. 2017;12(6):e0179124. doi:10.1371/journal.pone.0179124.

Brook M, Christian L, Hade E, Ruffin M. The Effect of Perceived Stress on Epstein-Barr Virus Antibody Titers in Appalachian Ohio Women. Neuroimmunomodulation. 2017;24(2):67-73. doi: 10.1159/000478658. Epub 2017 Sep 22.

Olmo NRS, do Nascimento Saldiva PH, Braga ALF, Lin CA, de Paula Santos U, Pereira LAA. A review of low-level air pollution and adverse effects on human health: implications for epidemiological studies and public policy. Clinics. 2011;66(4):681-690. doi:10.1590/S1807-59322011000400025.

. Irwin MR, Olmstead R, Carroll JE. Sleep Disturbance, Sleep Duration, and Inflammation: A Systematic Review and Meta-Analysis of Cohort Studies and Experimental Sleep Deprivation. Biological psychiatry. 2016;80(1):40-52. doi:10.1016/j.biopsych.2015.05.014.

Massart R, Freyburger M, Suderman M, et al. The genome-wide landscape of DNA methylation and hydroxymethylation in response to sleep deprivation impacts on synaptic plasticity genes. Translational Psychiatry. 2014;4(1):e347-. doi:10.1038/tp.2013.120.

Hansen MM, Jones R, Tocchini K. Shinrin-Yoku (Forest Bathing) and Nature Therapy: A State-of-the-Art Review. Miyazaki Y, Kobayashi H, Park S-A, Song C, eds. International Journal of Environmental Research and Public Health. 2017;14(8):851. doi:10.3390/ijerph14080851.

. Pascal M, Perez-Gordo M, Caballero T, et al. Microbiome and Allergic Diseases. Frontiers in Immunology. 2018;9:1584. doi:10.3389/fimmu.2018.01584

Lacey JM, Wilmore DW.Is glutamine a conditionally essential amino acid? Nutr Rev. 1990 Aug;48(8):297-309.

Kim H. Glutamine as an Immunonutrient. Yonsei Medical Journal. 2011;52(6):892-897. doi:10.3349/ymj.2011.52.6.892.

Sears ME, Kerr KJ, Bray RI. Arsenic, Cadmium, Lead, and Mercury in Sweat: A Systematic Review. Journal of Environmental and Public Health. 2012;2012:184745. doi:10.1155/2012/184745.

Garth L. Nicolson, Nancy L. Nicolson, Paul Berns, Marwan Y. Nasralla, Jorg Haier, Meryl Nass. (2003) Gulf War IllnessesJournal Of Chronic Fatigue Syndrome 11:1, pages 135-154. 

Cheng Y, Mai J-Y, Hou T-L, Ping J, Chen J-J. Antiviral activities of atractylon from Atractylodis RhizomaMolecular Medicine Reports. 2016;14(4):3704-3710. doi:10.3892/mmr.2016.5713.

Wang L, Yang R, Yuan B, Liu Y, Liu C. The antiviral and antimicrobial activities of licorice, a widely-used Chinese herb. Acta Pharmaceutica Sinica B. 2015;5(4):310-315. doi:10.1016/j.apsb.2015.05.005.

Patterson W, Georgel PT. Breaking the cycle: the role of omega-3 polyunsaturated fatty acids in inflammation-driven cancers. Biochem Cell Biol. 2014;92:321-328.

He Y, Yue Y, Zheng X, Zhang K, Chen S, Du Z. Curcumin, inflammation, and chronic diseases: how are they linked. Molecules (Basel). 2015;20:9183-9213.

Carreras A, Zhang SX, Peris E, et al. Effect of resveratrol on visceral white adipose tissue inflammation and insulin sensitivity in a mouse model of sleep apnea. IJO. 2015;39:418-423.

Dankers W, Colin EM, Van Hamburg JP, Lubberts E. Vitamin D in autoimmunity: molecular mechanisms and therapeutic potential. Front Immunol. Jan 20, 2017; doc 3.

Dobson R, Giovannoni G, Ramagopalan S. The month of birth effect in multiple sclerosis: systematic review, meta-analysis and effect of latitude. Neurol Neurosurg Psychiatry. 2013;84:427-432.

Zipitis C, Akobeng A. Vitamin D supplementation in early childhood and risk of type 1 diabetes: a systematic review and meta-analysis. Arch Dis Child. 2008;93:512-517.

Bendsen NT, Stender S, Szecsi PB, et al. Effect of industrially produced trans fat on markers of systemic inflammation: evidence from a randomized trial in women. J Lipid Res. 2011;52:1821-1828.

Maghzi HAtaei BKhorvash FYaran MMaghzi A. Association Between Acute Infectious Mononucleosis and Vitamin D Deficiency. Viral Immunol. 2016 Sep;29(7):398-400. doi: 10.1089/vim.2016.0038. Epub 2016 Aug 9.