EBV and Autoimmune Disease: Symptoms, Tests, and Treatments
There are many chronic infections that are linked to the development or worsening of autoimmune diseases. These infections include Lyme disease, fungal overgrowth in the sinuses, and cytomegalovirus (CMV). But one of the most common chronic infections I see in clinical practice is Epstein-Barr virus (EBV).
This is an especially timely topic as a recent article in the journal Science further confirmed the link between EBV and multiple sclerosis (MS). In MS, the immune system mistakenly attacks and damages cells of the brain and spinal cord, making it difficult to coordinate movements like walking, talking, or writing. If you have MS or another autoimmune disease and you’re feeling extremely fatigued, it’s possible EBV reactivation is the cause.
In this article, I’ll go into the reactivation of EBV and why it’s a problem, as well as why EBV reactivates in some people and not in others. I’ll also explain how to know if you’re suffering from EBV reactivation, the symptoms, and treatments to relieve your EBV-related exhaustion.
What Is Epstein-Barr?
EBV is a common human herpes virus that was discovered by Anthony Epstein and Yvonne Barr in 1964. The Epstein-Barr virus causes infectious mononucleosis, or “mono.” It has been estimated that nearly 95% of adults around the world have had EBV and have antibodies to it.
Symptoms of EBV are:
Soft, swollen spleen
Swollen lymph nodes
EBV is transmitted from person to person through saliva (hence the nickname “kissing” disease), as well as by sharing a drinking glass, utensil, or toothbrush used by an infected person. Teens and young adults may show all of the signs and symptoms. Young children usually have few symptoms and it goes unnoticed. Sexual contact or blood transfusions can also spread the virus.
Can Epstein-Barr Reactivate?
Even after your immune system handles the initial infection, the Epstein-Barr virus persists in B-cells. As time passes, certain lifestyle and environmental factors (more on these factors below) can cause EBV to reactivate in vulnerable people.
Once this happens, the cells start to produce autoantibodies, which are antibodies that mistakenly attack your own tissues because they think they’re foreign invaders. This can be the beginning of autoimmunity.
Reactivation of EBV Linked to Autoimmune Disease
The recent article published in the journal Science was really interesting because it confirmed the connection between Epstein-Barr and autoimmune disease as a whole. It also repeated past research linking an EBV infection with the development of MS. The Science article discussed the strong evidence pointing to the link between EBV infection and MS, including a study published in January 2022 of more than 10 million U.S. military personnel.
Researchers measured EBV antibodies in the serum of 801 of those participants who were diagnosed with MS over a 20-year period. Thirty-five of the MS cases were initially EBV-negative and 34 became infected with EBV before they developed MS. Only one of the 801 MS cases was EBV-negative at the time they developed MS. The researchers believe this is “compelling data” that EBV is the trigger for MS.
The participants who had been infected with EBV were 32 times more likely to develop MS. The study authors didn’t observe this association with any other viruses.
So why the connection between EBV and multiple sclerosis? Scientists believe one explanation has to do with a concept known as molecular mimicry, where the structure of amino acids in EBV are similar to those in myelin and other central nervous system components involved in MS. Myelin is the fatty lining that surrounds healthy nerve cells and it is under attack in MS autoimmunity. Under this hypothesis, the immune system mistakenly attacks myelin because it confuses it with the foreign invader, EBV.
In addition to MS, reactivation of EBV is linked to autoimmune diseases such as:
• Chronic fatigue syndrome
• Grave’s disease
• Systemic lupus erythematosus (SLE)
For example, one study investigating the EBV-thyroid connection showed that EBV reactivation can trigger the production of Grave’s autoantibodies in cells. Another study looking at the connection between Epstein-Barr and lupus found that the autoantibody target in patients with lupus is highly similar to a protein in EBV, which goes back to the whole concept of molecular mimicry.
Symptoms of EBV Reactivation
In my clinical practice, I have noticed that the biggest symptom of reactivated EBV is chronic fatigue. If a patient has no other root cause to explain chronic fatigue, then I suspect EBV. For instance, they may be sleeping fine, they have good blood sugar, their thyroid is normal, and their cortisol levels are balanced. If so, it’s a red flag that their exhaustion is related to EBV and at that point we order a test.
Often, patients will arrive at our practice aware of the issue of EBV reactivation and suggest that this is the cause of their problems. We’ll test them and they often turn out to be right.
Why Some People Are More Vulnerable
Not everyone exposed to EBV develops an autoimmune disease. When you have a healthy and balanced immune system it’s able to keep those viruses and pathogens well contained and managed so they do not become a problem. But if you have an immune system shift, due to a stressful event, it allows those infectious agents to resurface and be more active.
Stress has a lot to do with immune system shifts. When somebody experiences a lot of stress, either physical, mental, or emotional something changes and it triggers an immune system imbalance. Stress is the last straw that tips the scales in favor of reactivation of EBV. The body tries to compensate for the stress load but it isn’t able to suppress that infection anymore.
The key thing to counteract these infections or reactivating infections is a well balanced immune system. A healthy immune system can keep viruses and other pathogens like Lyme in check.
The reason why EBV doesn’t reactivate in some people is either because their immune systems are balanced and able to suppress the infection. They’re not experiencing excessive stress or if they are, they’re able to cope with the stressors.
How to Test for EBV Reactivation
Standard blood tests for EBV measure antibodies against the virus and include:
• Anti-Viral Capsid Antigen (VCA) IgM – This appears in early infection.
• Anti-VCA IgG – This appears when you first contract EBV and then peaks two to four weeks later. If you’ve contracted EBV this antibody will stick around for the rest of your life.
• EBV Early Antigen (EA) IgG Antibody – High levels can be a sign of current infection, but it’s also an indication the EBV virus has reactivated.
• EBV Nuclear Antigen (EBNA) – This isn’t present during the acute, initial phase of illness, but levels slowly rise two to four months after you become sick and remain for the rest of your life.
Most people will be positive for Anti-VCA IgG. Unless you’ve been recently exposed, IgM will be negative. As far as EBV reactivation, it’s the early antigen test that’s important.
Many patients first arrive at our clinic and they have all the symptoms of EBV reactivation, but when we look at what other doctors have tested, they’ve only tested for past exposure (anti-VCA IgG). Since they did not have an early antigen test, they don’t know if EBV has been reactivated. That’s when we run the additional tests needed to find out if they have EBV reactivation.
How to Treat EBV and Chronic Fatigue
In patients whose EBV infection has reactivated, I first work on their stress levels, just like I would with autoimmune disease. I figure out what’s causing stress on the body and what is causing an imbalance in the immune system. Looking at the root causes of stress is important and takes an individualized approach.
At the same time, I have patients use a combination of botanicals and other supplements that both kill off the virus and fight it. Monolaurin, olive leaf extract, and L-lysine are antivirals we use in these patients.
People may need to rotate on and off of those supplements. It can take a long time. It could be six months or even years on and off the supplements if the EBV flares up again.
Is Epstein-Barr Reactivation Causing Your Autoimmune Issues?
As I mentioned earlier, there are a lot of factors that could be to blame for your chronic fatigue. It’s best to work with a functional medicine provider to rule out those issues and to order the right tests for EBV so that you can get at the root cause of your problem. That’s why I invite you to get in touch with the Caplan Health Institute so that we can work together to boost your energy levels and bring you back to vibrant good health.