Epstein-Barr Virus or EBV is a herpes virus (Herpes 4) that is significantly connected to Hashimoto’s disease and many other autoimmune diseases. It is the most common infection I see in my patients with Hashimoto’s thyroiditis. Testing for Epstein-barr virus is fairly straightforward but treatment can take a long time.
How do you get infected?
Epstein-Barr Virus is transmitted by saliva resulting in mononucleosis (“mono”) also known as “the kissing disease.” EBV can also be transmitted via semen during sexual intercourse, by blood or blood transfusion. Most people get infected when they are young after their first kiss or if they exposed to another infected person’s saliva on a shared drinking glass.
What are the symptoms of mono due to acute Epstein-Barr Virus infection?
Swollen lymph nodes in the neck
Enlarged liver and spleen
The above symptoms are the usual result of the initial infection which lasts about 2-4 weeks but sometimes they can go on for months. Once your immune system fights off the virus, it becomes inactive for life. Epstein-Barr Virus however can reactivate later in life resulting in autoimmune disease such as Hashimoto’s thyroiditis, fatigue and many more illnesses. This is similar to the Chicken Pox virus that stays in your body for life but it can reactivate resulting in painful shingles.
Key point: Just because you never had mono, this doesn’t mean you can’t have the virus. Some people get infected with EBV and never develop symptoms.
You can infect another person no matter how old you are if the virus is reactivated in your body.
***Some people will have a “mono-like” illness and EBV antibodies are negative. This is due to another active infection including cytomegalovirus, toxoplasmosis, herpes 6, herpes 7, HIV or hepatitis B.
What health problems can Epstein-Barr Virus cause?
Many autoimmune diseases such as Hashimoto’s disease, Lupus, Rheumatoid arthritis etc.
Weakened immune system making it more difficult to fight other infections
Facial nerve palsy (Bell’s palsy)
Chronic fatigue syndrome
Paralysis on one side of the body
Pancreatitis (swelling of the pancreas)
Myocarditis (swelling of the heart)
Epstein-Barr Virus is also associated with a number of cancers including Hodgkin’s lymphoma, Non-Hodgkin’s lymphoma, nasopharyngeal carcinoma, and Burkitt’s lymphoma.
What is the best test for Epstein-Barr Virus?
Blood testing through all commercial labs such as Labcorp are readily available for testing.
Let’s break down each test component:
EBV Viral Capsid Antigen (VCA) IgM: Indicates an active infection and stays positive for 4-6 weeks.
***VCA IgM antibodies can cross-react with cytomegalovirus, toxoplasmosis, herpes simplex or rheumatoid factors. This must be taken into account due the potential of a false positive.
***VCA IgM antibodies have been shown to rise in those over 60 years of age.
EBV Viral Capsid Antigen (VCA) IgG: Positive in the early stages of infection peaking at 2-4 weeks, then it begins to drop and stays positive for life.
EBV Nuclear Antigen (EBNA) IgG: Not positive in the acute phase but starts to elevate 2-4 months after infection. IgG stays positive for life.
EBV Early Antigen (EA) IgG: Positive in the acute phase of infection and then begins to drop for 3-6 months after infection. A positive test indicates active infection.
The early antigen is usually left out of many EBV tests I review which unfortunately means we can’t make an accurate diagnosis of reactivation without it. Since the VCA and EBNA IgG tests are positive for life, it is best to use the Early Antigen IgG to monitor successful treatment of the infection. The VCA IgM is beneficial to have only if you want to see if it is an acute infection or a recent reactivation. The panel I order through Labcorp contains all of the above markers and then I will just use the Early Antigen IgG in most cases to monitor progress.
The Monospot test is not a very accurate test because it is negative many times in children with mono. It also has shown to have too many false positive and false negative tests.
It is important to note that in very rare cases, you can have active EBV infection but none of the antibodies are present on your blood tests.
If you are hypersensitive to mosquito bites then you may have an active infection.
How does Epstein-Barr Virus cause Hashimoto’s Disease?
Dr. Michael Pender does an excellent job in this paper explaining how EBV can cause autoimmune diseases including Hashimoto’s thyroiditis. I will try and simplify the paper for you below.
Due to specific genetic reasons, people with autoimmune disease tend to have fewer immune cells that can fight the Epstein-Barr Virus so it can more easily reactivate and stay active. Biopsies of the thyroid glands of patients with Hashimoto’s disease and Epstein-Barr Virus show massive amounts of the virus inside the thyroid gland. This results in an immune attack on the virus and the thyroid gland.
A number of things can prevent your ability to fight off EBV including:
Too much estrogen in your body
Vitamin D deficiency
Low Ferritin levels
Chronic stress (adrenal and autonomic nervous system imbalances)
Gut dysbiosis and/or gut infection
Insufficient protein intake known as “Protein Energy Malnutrition”
Other stealth infections that are stressing your immune system
What are the best treatment options for Epstein-Barr Virus?
There are a number of compounds that are effective for EBV including:
I want to make it very clear that simply taking any of these will most likely not result in successful treatment. Why is that? Simply attacking the virus does nothing to solve the underlying reasons why your immune system can’t control this virus. A successful treatment plan is a comprehensive approach including all the things we do in functional medicine such as gut health, stress physiology, macro/micronutrient balance, hormone balancing, reducing inflammation etc.
Many people make the mistake of taking compounds for EBV which suppresses the viruses activity, but then it just reactivates when they stop supplementing. This is because the reasons why it reactivated have not been addressed.
There are cases where I don’t even target the virus and it deactivates because we work on the underlying causes of the infection. It is however extremely beneficial in many cases to target the virus as well as everything else that needs fixing for a quicker and more successful outcome.
Epstein-Barr Virus and Hashimoto’s Disease Summary
The first thing to do is work with a functional medicine practitioner who will properly test you for EBV reactivation. The second thing to do is work with your functional medicine practitioner to balance all of your body systems and address all the potential causes of EBV reactivation noted above. This way you can have lasting control of the virus so it doesn’t reactivate again.
As long as the Epstein-Barr Virus is active, your immune system will continue to be under stress and out of balance. Since Hashimoto’s disease is an autoimmune disease, all potential stressors on the immune system must be eliminated in order to be successful and heal properly.
I get great results with patients who have Hashimoto’s disease with associated Epstein-Barr Virus reactivation. This is one infection you don’t want to overlook so get tested soon and you’ll be on your way to eliminating one more piece of the Hashimoto’s puzzle.