Did you know, you probably have virus lurking in the shadows? It’s called the Epstein-Barr virus (EBV) and an estimated 90 percent of us have it. Fortunately, for most of us it lies dormant, like a sleeping giant. Only when something triggers a reactivation of EBV does this virus rear its ugly head.
Epstein-Barr virus is part of the herpes family and also known as human herpesvirus 4. Usually passed through saliva, EBV is the cause of infectious mononucleosis – also known as “mono” or “kissing disease.” Typically, teenagers come down with this condition and first notice there’s a problem when they experience extreme fatigue. Interestingly, extreme fatigue can also cause a reactivation of Epstein-Barr virus.
Though there are many conditions where EBV is the cause or a trigger, extreme fatigue is a unifying symptom that occurs in most cases. Symptoms of an active Epstein-Barr virus, include:
- Extreme fatigue
- Fever
- Sore throat
- Swollen lymph nodes
- Enlarged spleen
- Swollen liver
- Rash
- Emotional disturbances and stressors
- Autoimmune diseases, like Hashimoto’s thyroiditis
How Epstein-Barr Virus Causes Autoimmune Disease
Autoimmune conditions are caused when an overactive immune system begins attacking healthy tissue. We are learning more and more, what often sets off the immune system response in the first place can be a variety of infections, including EBV.
CD8+T cells are types of white blood cells your body uses to keep the EBV virus in check. When there’s an impairment or a deficiency of these cells, the EBV virus is free to run rampant. The amount of CD8+T cells you have can be negatively impacted by age, estrogen levels, and vitamin D deficiency, certain medications and treatments, and poor immune system function. This is important because autoimmunity is on the rise and we need a better understanding of its underlying causes.
If you want to know more about What to Do if You Have an Autoimmune Disease, check out my free guide.
So, what can be done to treat Epstein-Barr? If it’s so common, surely there’s a simple explanation or cure? Actually, the best way to tackle Epstein-Barr is similar to how we deal with an imbalance of gut microbes – manipulate the environment so balance is restored. The most important thing I find is to support the natural immunity and decrease exposures to environmental toxins and other infections. Let’s take a closer look.
Treating the Epstein Barr Virus
There is no known cure for the Epstein-Barr virus, and therefore treatments should focus on returning the creature back to it’s sleeping or dormant state. So, in order to treat EBV the approach needs to focus on getting the virus back in check, not killing it. This means manipulating the condition of your body – the environment where the Epstein-Barr virus lives.
When I discover a patient of mine has Epstein-Barr virus, here are the things I consider:
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- Clean diet and proper nutrition – This reduces inflammation and immune system burden. We eliminate gluten, dairy, allergens, and start a plant-based Paleo diet. Sugar is one of the most powerful immunosuppressives so that must be eliminated at all costs.
- Heal the gut – Healing the gut is a priority for anyone dealing with EBV. Toxins can leak through damaged gastrointestinal lining and cause the immune system to overreact. This process is also known as endotoxemia, driven by LPS.
- Eliminate any infections – Check for any coexisting infections and work to treat these. I often think of it as “infectious burden” and work to decrease the load on the immune system.
- Reduce toxic burden – We are bombarded by tens of thousands of chemicals everyday, find out how to Reduce Your Daily Toxin Exposure. It is critical also to decrease total toxic load by eliminating any toxic exposures.
- Optimize detox pathways – This includes supporting the liver, kidneys, and colon and may be supported by various nutritional supplements and other homeopathic drainage remedies.
- Improving sleep habits – This is essential because so many repairing and detoxification processes occur during the deepest stages of sleep. I advise no less than 8 hours per night or as much sleep as required to wake up refreshed without an alarm clock.
- Reduce stress – Stress is a major cause of immune system dysfunction, it could even be what awakened your EBV in the first place. You must work to reduce stress – your health depends on it. Try prayer, meditation or spending time in nature. Self care must be a priority.
- Herbal supplements – Herbs such as Ashwagandha, licorice, St. John’s wort, lemon balm, ginseng, and holy basil may be used for immune system support and for their antiviral and adaptogenic properties.
- Supplements – I use these for suppressing EBV reactivation
- Monolauren: 1800 mg twice daily
- Olive Leaf: 1000-1500 mg twice daily
- L-Lysine: 1000-1500 mg twice daily
- Cat’s Claw tincture: 30-60 drops twice daily
When viruses diminish due to these treatments it isn’t because any of these things attack the virus, but instead they help put your body in a state that isn’t ideal for the virus to reproduce. Hopefully, this strengthens your immune system and returns this typically harmless virus back to it’s benign state.
Other more extreme therapies have have been tried in a few cases, with some success and include:
- Antiviral medication, Acyclovir or valcyclovir
- Immune cell therapy when used in a person after a transplant.
- Bone marrow transplant is an extreme therapy that has been documented in two life threatening cases.
- Cord blood stem cell transplants. This is a new but emerging treatment that may be very successful in tough cases.
Ineffective Epstein-Barr Treatments
Though I prefer to offer solutions to health conditions, I want to briefly touch on some treatments of EBV are not effective because there’s a lot of misunderstanding surrounding this virus. In general, the follow treatments only temporarily stop symptoms and only in some people:
- Antiviral therapy such as ganciclovir and vidarabine.
- Immunosuppressive agents such as cyclosporine and corticosteroids.
- Immunomodulatory therapy such as interferon alpha and interferon gamma.
- Cytotoxic chemotherapy such as anthracyclines, etoposide, cyclophosphamide, vincristine, and prednisone.
- Infusions of cytotoxic T and lymphokine-activated lymphocytes.
This isn’t to suggest that your doctor shouldn’t temporarily recommend some of these, however, none of these are by any means a cure for Epstein-Barr virus and you should proceed with extreme caution.
Find a Functional Medicine Doctor with Experience in Epstein-Barr Treatments
The science surrounding the Epstein-Barr virus is developing daily. If you think you might have a condition due to EBV, it’s important to find a doctor who’s experienced in conditions related to the reactivation of this virus. If you need help finding a functional medicine doctor, I’ve made a helpful guide to get you started – How to Choose a Good Integrative and Functional Medicine Doctor.
The Epstein-Barr virus is a significant condition I wish more people knew about – Share this article to spread awareness of this sleeping giant.
Resources:
https://www.cdc.gov/epstein-barr/about-mono.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3250620/
https://www.cdc.gov/epstein-barr/about-ebv.html
https://www.ncbi.nlm.nih.gov/pubmed/2169064
https://www.ncbi.nlm.nih.gov/pubmed/15906243
https://www.hindawi.com/journals/ad/2012/189096/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2776035/
https://www.ncbi.nlm.nih.gov/pubmed/18266798
https://www.ncbi.nlm.nih.gov/pubmed/11960276
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2776035/
Thank you! This is such helpful information. Bloodwork confirmed that I had somehow reactivated EBV almost 2 years ago and because of some very bad medical advice, I fell into a dark hole of paralyzing ill-health. Through discovering functional medicine (working with Sarah Zielsdorf here in IL) and a lot of research and self-care, I had practiced most of the action points you have mentioned, and have recovered very well with some remaining sleep issues. THANKFUL! I have recently been using Monolaurin (flu season) and have noticed that there are pretty heavy energy dips at the end of the day when I use it, which is otherwise very uncharacteristic of me. Can monolaurin bring about a Herx reaction of fatigue – even this far out from reactivated EBV?
Thanks for reading – and for all of your great posts! Bless you
Monolauren doesn’t usually cause herx with anti-viral effect but the anti-fungal effect may be more potent and cause die-off type reactions
This is interesting and I’m grateful to find this one question and comments. I have two autoimmune conditions and started doing an even stricter diet than I was on before….doing AIP now and I did find out from my ND that my EBV is reactivated. We’re treating with monolaurin for 6 weeks and buffered Vit C (I’m adjusting dosing daily b/c of its affects on other things). Interesting, I have a terrible rash on my torso that has developed and I wondered if it’s some kind of healing crisis. My Naturopath thought that or allergic reaction to something. Admittedly, the holidays brought a bit of cheating with small amount of maple syrup and coconut sugar and perhaps it’s that. Anyway, makes sense about die-off symptoms even with some of those natural sugars and yeast. I know you can’t give advice but could the rash be related to the monolaurin? I have 10 more days of my 6 weeks taking it.
Monolauren will also treat fungal dysbiosis and the fact that sugars trigged rash makes it likely related to die off of yeast
I appreciate this information as I’ve been reading 2 books that emphasize EBV as a likely culprit in Fibromyalgia/CFS. You mention Acyclovir, which I take when I get a cold sore. Is there any information on the dosage of Acyclovir and the duration to help combat EBV? I feel like I’ve tried everything else and nothing is helping. With 5 kids and a job, I’m pretty desperate!
Hi Jill,
I cannot give medical advice on the blog – perhaps you can check with your doctor.
warmly
Dr Jill
I took 3grams valcyclovair a day for almost 2 years. Otherwise I ran fever, swollen glands, extreme debilitating fatigue. I’m a 120 lb female.
How long do you recommend doing this protocol for reactivated EBV? Will there be die off symptoms?
Hi Regina
I generally treat EBV for 6-12 months
warmly
Dr Jill
Thank you so much for the article, Dr. Jill – your work is greatly appreciated! As one part of a EBV treatment plan, you mentioned optimizing the detox pathways. I was particularly interested in knowing if you would have any recommendations re: brands of homeopathic drainage remedies.
Blessings,
Teresa
Hi Dr. Carnahan,
thank youfor this very interesting article!
What is your opinion in regards to the effectiveness of treating EBV, as well as other viruses and UV Blood Therapy (I am not sure about the official name for this treatment, when same amounts of blood is withdrawn, which is than exposed to UV light, and re-injected). Thank you very much!
Best, Claudia
Have you ever dealt with someone who has positive ebv positive cmv and swollen lymph nodes for two years. Cervical chain that hangs around 5 cm! Been to numerous specialist and get blown off!
Yes, you may try infectious disease or functional medicine doctors.
I’d be interested to see your opinion on the new MS treatment Ocrevus and it’s killing off of certain B cells and it’s effect on EBV.
HI – I’m interested in the herxing process – During treatment of EBV, I’ve been told I will go thru this – can you elaborate on this – what is actually going on during this time and how long does it last – does it have a stop & go pattern or is it just one big party – Thank you
I also have ebv, as well as positive rheumatoid factor. Is it possible that the positive rheumatoid factor, which I have read is an antibody, to the fc portion of an antibody, could be related to ebv? Any idea if stem cell injections could help rid ebv or cause harm? Also read EBV worsens copd. I am also a help b vacine non responder. Any recommendations?
if I had mono in high school….now 60…with high EPV levels…are those levels from high school or new in reinfection?
When you say “Sugar is one of the most powerful immunosuppressives so that must be eliminated at all costs”, do you mean all sugar including fruit or low glycemic like coconut sugar or just white, can sugar? Thanks!
Processed sugar is the biggest culprit, real sugars from fruit and other natural sources in moderation are fine.
I’ve been struggling with EBV and reactivation over a few years. I’d been feeling well recently until a tooth fractured and I had to have it extracted. I feel like the dental work has reactivated my EBV to some degree. I’m wondering if you’d seen this before and any suggestions. Thanks!
I would treat the same way
Do you suggest taking all four of the supplements listed in the article at the same time or only one of the four?
You will need to individualize treatment with your physician
Hello! As for kids treatment. What doses of supplements can you advice for them?
Hi Alie
Unfortunately I cannot give medical advice online
warmly
Dr Jill
Dr. Carnahan- I was a patient of yours in Peoria. I’ve had recurring EBV infections. Just as an FYI, I’ve had some good treatment with Dr. Shawn Schmidt at Natural Health Omaha. They use BioMeridian testing with a functional medicine focus. Found out I had a weird parasite and lots of Candida that no other tests picked up, plus the EBV. I was taking your protocol and had a super clean diet, but those things in my gut weren’t allowing the protocol to do it’s job right. Herbal and homeopathic tinctures have killed that stuff and a lot of the EBV, now maybe if I go back on the protocol, it will keep killing the virus. I wish all the good EBV docs could all share their info together so more patients could benefit from all the knowledge! Thanks!!
Hello,
Do you think Ozone Therapy (blood–systemic) is a good method of treating EBV virus. Also, do you think the homeopathic desbio is a good protocol to use to treat EBV.
Do you feel the Homeopathic Desbio for REBV is a good protocol to use?
I am not familiar with it but I do like homeopathic
Have you seen instances of reactivated EBV causing severe muscle weakness and shaking? Almost like a tremor? I have recently been having some health issues. Severe bouts of vertigo, swollen lymph nodes, sore throat. Thought it was a chest cold and took antibiotics. Two days after finishing, I started experiencing severe muscle fatigue/shakiness and just overall muscle weakness. It has been over 3 weeks and still no better. PCP ran blood work that showed elevated levels of all markers except my IgM.
This is unusual and I do not think its related to EBV
I saw that you recommend treatment for 6-12 months. I’m wondering how long it takes to start seeing positive effects, plus will the ebv reactivate in the future?
usually some improvement in 1-2 months. If immune system is ever weakened it may reactivate
This does not sound typical for EBV
did you use cipro ? that can cause many nasty stuff
I read on Dr. Weil’s blog that the amino acid L-arginine can trigger the EBV. He advised to lower intake of foods high in this amino acid. Chocolate, peas, nuts and seeds all have this amino acid. Do you support this? I thought a healthy diet would include nuts, seeds and veggies. Chocolate as Cacao also has health benefits.
l-lysine inhibits viral replication and high intake of l-arginine may lower lysine levels
So are you saying that if I had mono in college that i probably still have EBV to this day? I often wondered if this was the case because ever since then, my lymph nodes swell every time I get a cold. Do you think this could be related?
EBV should remain dormant in a strong immune system but if stress or other factors weaken immunity it may reactivate
Dear Dr Carnahan, Thanks for this info. I’m a Functional Medicine doc. Recently have a patient who has been getting care with another doctor who straddles the line of conventional and functional medicine. He has been following my patient with Quantitative EBV viral loads: https://testdirectory.questdiagnostics.com/test/test-detail/10186/epstein-barr-virus-dna-quantitative-real-time-pcr?p=r&q=ebv%20dna&cc=MET. I had not used this test prior, nor seen it done previously. I am curious as to your comments on this test. I get your emails to practitioners, and in one sent earlier this week, you said, “If you are like me, you are frustrated by the lack of simple testing for viral load and specific viruses, particularly Epstein Barr”. Do you think this viral load test is not clinically useful? What is its place in following complicated EBV patients? Thanks so much for any light you can shed on this.
Yes, it may be useful but I think you can still have false negatives when virus is reactivated but not detected in blood
Read several articles not to eat eggs,dairy,gluten and pork when fighting ebv. And some that say eggs are fine to eat. What is your opinion?
I generally recommend no eggs or dairy with viral issues
I’m not sure I understand the difference between reactivated, and chronic active EBV. My fill-in practitioner said I have CAEBV, but has offered no advice until I see my primary in two weeks. I was just told no lifting, stay away from high risk groups (elderly, infants, immunosuppressed folk) and to treat myself as if I’m immunosuppressed. I know I had a reactivation 5 years ago, at which point I was diagnosed with CFS/ME. Does it reactivating again constitute CAEBV?
Thank you
Most of the population has had EBV at one time or another and will test positive for VCA IgG but that does not mean the virus is active. Reactivation means the patient has symptoms of EBV, such as fatigue or malaise and positive EBEA and EBNA titers.
Awesome blog. It sound’s quite interesting to read this post.
Thanks a lot for sharing this wonderful post.
I’m wondering what you mean by “plant based paleo” – is it okay to have lean sources of protein like chicken, turkey, and fish while healing EBV?
of course! but you would still consume primary plants… this is how I eat! 😊
Great! For some reason, I thought I needed to eat an entirely vegan diet to heal EBV. This is helpful!
Dear Dr. Jill,
Thank you very much for this article and the care you put around this subject.
I’m a 34yo man and I suffered from a quite severe (15-20 days of fever) Epstein-Barr AND Cytomegalovirus (the latter was the apparent main player) infection 14 months ago, precisely after a period of time where I had to go through very intensive work shifts and sleep deprivation that were leaving me extremely exhausted.
I recovered pretty well at that time, but then I went through a massive life-style change (moved back to Italy from London) to eliminate that work load that was affecting me so bad, that as a side effect caused me a lot of stress (which I’m working on, with good results).
All the above is then to say that after three more months, I started experiencing extreme fatigue again, even without doing very much during my days. I have been trying to take more and more better care of myself but improvements seem to be very slow. Do you believe this process is “normal”? I have been checked in many ways: blood work, heart functioning, thyroid and all seems to be fine. What I experience is un-proportioned fatigue and sometimes a sense of being “ill”, without any actual symptoms nor fever.
Anyways, I will implement the suggestions you give in your article (which I’m already partially doing), but I was also wondering if a short period of water fasting (like one day to start with) could be beneficial.
Many thanks again for your attention, Dr. Jill.
Bless,
Enrico
short fasting can be extremely beneficial