By Dr. Shawna Darou, ND
Today’s article will talk about the link between Epstein Barr Virus and autoimmune thyroid disorders. This can be an essential piece of the autoimmunity puzzle, and one that can allow antibodies to reverse and thyroid function to return to normal if it is addressed thoroughly. As you may already know, when we treat autoimmune disorders from a naturopathic and functional medicine perspective, we are looking for underlying causes and triggering factors. These can include food sensitivities, intestinal permeability, gut dysbiosis, heavy metals, and infections.
What is Epstein Barr Virus?
Epstein Barr Virus (EBV) is a very common viral infection, causing mononucleosis as an acute illness. Most of you are familiar with this illness causing fatigue, swollen lymph nodes, sore throat, fever and sometimes and enlarged liver and spleen. Interestingly, many people have been exposed to the Epstein Barr Virus and never had symptoms, especially if they had it before the age of 10.
What many people do not know is that once you have had EBV, it stays in your body forever, and for most people in a dormant state. It can however reactivate, even many years after the original infection, causing extreme fatigue and other symptoms (see below). The reactivated virus also has the potential to trigger or exacerbate autoimmune diseases, especially autoimmune thyroid disorders like Hashimoto’s Thyroiditis.
What causes reactivated EBV?
The most common cause of reactivated EBV is chronic high stress. I see this most often in women in their 40’s, juggling life between children, career and aging parents, but truly it can happen at any time.
Other causes of reactivated Epstein Barr Virus can include:
- Chronic stress
- Low vitamin D
- Other infections – gut dysbiosis, Lyme, HSV1/2, Parvovirus, HHV6, and more
Symptoms or reactivated EBV:
Reactivated EBV typically looks like a prolonged flu without a fever, with symptoms such as:
- intense fatigue
- swollen lymph nodes
- muscle and joint pain
- depression or low mood
- possibly chronic sore throat
- lab testing may find abnormal liver function tests
It is usually possible to accurately diagnose reactivated EBV with the correct lab testing. In Ontario, these tests are done through Public Health, so they need to be requested by a family doctor or nurse practitioner (not a Naturopathic Doctor), although in many other jurisdictions they can be ordered directly.
- Epstein Barr Virus (EBV) – EBV VCA IgG/EA/EBNA
- Epstein Barr Virus (EBV) – EBV VCA IgM
(Note: the “Monospot” test is not reliable for reactivated Epstein Barr Virus.)
How to interpret results:
- EBV VCA IgM (Viral Capsid Antigen) – Positive = positive in acute infection and recent reactivation
- EBV VCA IgG (Viral Capsid Antigen) – Positive = had or currently have EBV infection (stays positive for life after infection)
- EBV EBNA (Nuclear Antibody) – Positive = past infection (stays positive for life)
- EBV EA IgG (Early Antigen) – Positive = active or reactivated EBV infection. Most helpful to measure progress of treatment.
To summarize, the typical result of reactivated EBV are:
- VCA IgM positive; and
- EA (early antigen) positive
The Autoimmune Connection:
There are several possible mechanisms that link the EBV and autoimmunity. These range from molecular mimicry (where the immune system mistakes similar body proteins and attacks the thyroid and the virus); CD8+ T-cell deficiency leading to poor control of EBV infection, and an to an overactive immune response to the organ where EBV has infected; a higher viral load of EBV in those with autoimmunity compared to those without; and ‘bystander activation’ of the immune system in response to an ongoing infection, among others.
It is also important to note that if the body is in a state of chronic stress or poor nutrition, the immune system as a whole is not functioning optimally, meaning it will be much more difficult to manage a chronic infection such as reactivated EBV.
In the case of Hashimoto’s thyroiditis, we often see that thyroid antibody levels can dramatically reduce when the Epstein Barr virus is treated. If this is found early in the diagnosis, especially when your thyroid hormone levels are normal or ‘subclinical’, we may even reverse the course of hypothyroidism completely.
Addressing Reactivated Epstein Barr Virus:
1. Rest and reduce stress
This is the most important step in the treatment of reactivated EBV. Chronic high stress and lack of sleep have a profound effect on the immune system, and in this case symptoms of EBV can arise.
2. Optimize nutrition
Optimal nutrition when fighting a virus includes sufficient protein, high-antioxidant foods (think colourful vegetables and fruits), foods rich in beta carotene (orange vegetables especially). Minimal grains and sugars can also be helpful to reduce immune system stress and improve nutrient density.
3. Natural anti-virals
Please note that anti-viral supplements or medications alone will rarely correct this issue 100%. It is essential to rest and address stress especially.
Natural anti-virals can include supplements such as Lauricidin, St. John’s wort, Olive leaf extract, Lemon balm, L-Lysine, Echinacea and Licorice root at top on the list. Treatment is chosen based on other factors present (ex. sore throat, yeast issues, fatigue, etc.) to select the best 2 or 3 from this list.
4. Immune support
Immune support from nutrition (above) and also through supplements such as Vitamins C and D, Zinc, mushroom extracts and echinacea can improve the immune response to the virus.
5. Adaptogens herbs (for stress)
Along with taking a serious look at your current life stresses, herbs such as Ashwagandha, Reishi mushroom, Holy basil and Licorice root can be helpful to modulate the stress hormone response and speed up recovery.
Other areas that may need to be addressed:
Naturopathic and functional medicine approach is to address the whole person, not just the virus. This means looking at why it reactivated, a very close look at stress levels and stress management, and underlying imbalance in other systems that can be contributed to overall load on the body: hormone balance, gut health, toxic load, inflammation and more.
If you would like to explore the possibility of Epstein Barr virus as part of the trigger for your Hashimoto’s, or suspect that reactivated EBV may be causing your fatigue, please book in for an appointment. The starting point is to get the correct lab testing done, and then we can move forward with treatment. This is actually a fairly common issue – so many of us have been exposed to Epstein Barr virus in our past, even without clear knowledge of having mononucleosis.
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