Last semester I researched and wrote a condition monograph on Epstein-Barr Virus (EBV) for one of my classes at American College of Healthcare Sciences. This monograph provides a brief description of the condition, a summary of how allopathic medicine would treat this condition and then ideas from an integrative medicine perspective. It is estimated that 90% of us have antibodies present for EBV. If you or someone you know has EBV and you would like to read some alternative medicine ideas for treatment of this disease skip to the Integrative Support Protocols section.

Name of Condition
Epstein-Barr virus (EBV)

Body System(s) Affected
Immune system, nervous system, and hematological system

Pathophysiology
EBV, also known has human herpesvirus 4 (HHV 4) is spread through saliva or sexual contact. EBV is usually contracted during childhood and can remain in a latent state for many years. As many as 90% of the adult human population has anti-bodies present for EBV (CDC, 2018).

EBV is usually found in B lymphocytes; however, when latent is can also be found in the lymph nodes, organs and blood marrow. When active infection resides in the oral epithelium, contagion to others can occur (Longnecker & Neipel, 2007). Transmission can occur during kissing or contact with other body fluids such as blood or semen, sharing food, drinks, toothbrushes, eating utensils or with contact to anything that has saliva on it (CDC, 2018). Once EBV infects a person, the virus remains in the body forever. An asymptomatic person carrying the EBV may carry the active virus and transmit it to others throughout their life.

Allopathic (Modern Medicine) Diagnosis and Treatment

Symptoms
General symptoms of EBV are similar to other illnesses and include fever, fatigue, swollen neck lymph nodes, sore throat, swollen liver, rash, and an enlarged spleen. Symptoms typically resolve in less than four weeks; however, in some cases, they may persist much longer.

Diagnosis
Because symptoms are similar to many other illnesses, laboratory tests are needed to confirm EBV. The following are antigens associated with EBV: Viral capsid antigen (VCA), Early antigen (EA), EBV nuclear antigen (EBNA), and the monospot test. Both VCA and EA antigens can be detected in the acute phase of EBV while EBNA will not be present in the acute phase but can present two to four months after symptoms and remain present throughout life. The monospot test can be used to look for mononucleosis, which may be caused by EBV (CDC, 2018).

EBV may be associated with other conditions and may also be a cause of more serious diseases. Some of these diseases are Burkitt lymphoma, infectious mononucleosis, some cancers, neurological conditions such as encephalitis and meningitis, lymphoproliferative syndrome, oral hairy leukoplakia, chronic fatigue syndrome, auto-immune disorders like: multiple sclerosis, Kawasaki disease, systemic lupus erythematosus, oral lichen planus, rheumatoid arthritis, autoimmune hepatitis, and Sjogren’s syndrome (Cunha & Balentine,2019).

Treatment
According to the CDC (2018), treatment for general EBV symptoms is rest, maintaining hydration, and over-the-counter pain and fever medications. Persons with enlarged spleens should avoid contact sports and activities to limit the risk of rupture (Valachis & Kofteridis, 2012). For patients with more severe respiratory symptoms, a course of corticosteroids or prednisone may be helpful (Lerner et al., 2010). Lerner et al. also recommend valacyclovir for patients with IM at risk for complications such as myocarditis, meningoencephalitis, hepatitis, thyroiditis, or peripheral neuritis (2010).

When to Refer
Refer to a primary care provider (PCP) immediately if the client has trouble breathing, signs of jaundice, severe headache or abdominal pain, and when fever is prolonged. When general symptoms persist for more than four weeks, a visit to the PCP may be advised. In some cases, the PCP may refer the client to a specialist such as a neurologist, oncologist, or infectious disease specialist (Cunha & Balentine,2019).

Integrative Perspective of Causes
Since most people will acquire EPV in their lifetime, it is important to understand what causes the virus to activate or reactivate after initial suppression. Additionally, the severity of the secondary conditions associated with EBV ranges from mild to fatal.
Multiple studies show that EBV may reactivate in persons under physical or psychological stress (Coskun et al., 2010; McClure et al., 2010). Results of at least one study demonstrated that environmental stress leading to psychological stress also increased the risk of recurrence of EBV (Peek, Cutchin, Freeman, Stowe, & Goodwin, 2009). In a study by Uchakin, Parish, Dane, Uchakina, Scheetz, Agarwal, and Smith (2011), medical residents under extreme fatigue had increased levels of EBV DNA and cortisol levels. Because stress increases EBV reactivation, stress hormones, and lowers immune system function, stress management is a vital component of any EBV protocol.

Specialized Integrative Analysis
Separate CAM testing for the EBV does not exist; however, CAM practitioners should have a thorough intake interview with the client to understand any underlying lifestyle causes that could have triggered a dormant EBV to reactivate. The CAM professional will evaluate the client’s nutrition, sleep, stress, nutrient deficiencies, toxic load, etc. in an attempt to uncover the reason for the poor immune function that allows EBV to thrive.

Integrative Support Protocols (THIS IS WHERE THE INTERESTING INFORMATION IS)
The focus on the support protocols are related to the symptoms of chronic fatigue syndrome (CFS) associated with EBV. Because CFS can be caused by several factors including EBV, it is sometimes difficult to determine whether EBV virus is the true root of CFS in a patient or if co-factors are involved. For this report, we will assume the following general protocol for persons who have both EBV anti-bodies and CFS symptoms.

Diet
The immune system is depressed in cases of EBV. A nutritious diet, such as the optimal food pyramid can help improve immune function. Diet should include 5-7 servings of vegetables, four servings of healthy fats, 2-3 servings of legumes, 3-5 servings of low glycemic whole grains, 2-3 servings of fruits and high-quality proteins, and 1-2 servings of low-fat dairy (Pizzorno, 2013). The client should be encouraged to eat a variety of vegetables and fruits as well as wild-caught or pasture raised protein.

Leaky-Gut
Extensive research in recent years has highlighted the relationship between leaky gut, immune health, neurological disorders, chronic inflammation, auto-immune disorders, and more. EBV in particular has infinity to the amino acid sequence found in glycine-rich protein. When these proteins permeate into the blood stream, they can initiate or enhance an immune response (Vojdani, Lambert, & Vojdani, 2016). By healing or preventing leaky-gut, we can decrease the risk for activation of EBV as well as lower the risk of many other diseases. To prevent leaky-gut, avoid foods that contribute to the cause such as sugar, processed foods, alcohol, inflammatory foods, and foods that trigger allergies or sensitivities (Campos, 2017). Examples of inflammatory foods to avoid are sugar, red meat, unhealthy fat, processed foods such as bread, pastries, cereals, and refined carbohydrates (Sparks, 2018). To help heal a leaky-gut take probiotics (Pizzorno, 2013) and follow the suggestions under diet above. See the section below on herbs to help with leaky-gut.

Lifestyle
One of the allopathic treatments for EBV is rest. While rest is important and necessary, it is also important for the patient to incorporate movement as soon as they are able. Low impact activity such as yoga, Tai-Chi, swimming, and slow walking should be incorporated as soon as the patient can do so (Shan, 2007).

Because people under physical or mental stress appear more susceptible to EBV recurrence, a stress management protocol is needed and should be maintained during asymptomatic times. Adherence to any stress management program will depend on the client finding the right options that suit their personality and lifestyle. If there are stressful situations that can be resolved, such as financial or relationship stresses, one should work on resolving those situations. Some options for stress management may include journaling, meditation, prayer, humor, yoga, massage therapy, art therapy, self-care opportunities, attending counseling or financial management workshops, exercise, use of essential oils and herbal teas, and forest bathing.

Adequate quality sleep is often difficult for persons with EBV. Lack of physical activity, as well as psychological issues like depression that often arise from prolonged bouts of illness, contribute to poor sleep. Encouraging physical movement, a healthy mental state, and encouraging a physical environment conducive to sleep may be needed. Patients may use herbal support to help promote healthy sleep (see herbal support) (Icenhour, and Calbert, 1989). Essential oils can also promote rest and encourage healthy sleep patterns. Try diffusing one or more of the following essential oils: lavender, rose, sandalwood, chamomile, or ylang ylang (Micozzi, 2019).

Herbal Support
Herbs are powerful medicines that can be used to strengthen and repair our immune

system, support sleep, and improve digestion. While many herbs have a specific affinity for a body system, the results all circle back to improving our immune health.

• Adaptogen Adrenal Gland Support – glycyrrhiza glabra (licorice), borago officinalis (borage), elutherococcus senticosis (Siberian ginseng) (Shan, 2007).

• Digestive Support – Hydrasis canadensis (goldenseal), berberis vulgaris (barberry), Taraxacum officinale (dandelion) (Shan, 2007).

• Fever Management – Instead of taking an over the counter fever reducer, try a hot infusion of the following: 1 part each: dried catnip, elderflower, peppermint, and ½ part dried wild lettuce. Use 1-2 tablespoons of mixed herbs with a pint of boiled water. Steep for 20 minutes before drinking (Swift & Midura, 2018).

• Immune System Support– Echinacea purpurea (echinacea), Baptisia, tinctorial (wild indigo), astragalus membranaceus (astragalus) (Shan, 2007). Carnahan recommends ashwagandha, licorice, St John’s wort, lemon balm ginseng, and holy basil (nd).

• Leaky Gut – Calendula, golden rod leaf, marshmallow, meadowsweet, plantain leaf, self-heal, yarrow leaf and flower. You can make an herbal infusion of any combination of these plants by combining two – three tablespoons with one quart of boiling water. Allow the infusion to steep for 20 minutes before drinking (Swift & Midura, 2018). Drink daily.

• Sleep/Nervine Support – Verbena officinalus (verbena), scutellaria laterifoloa (skullcap), passiflora incarnata (passion flower) (Shan, 2007).

Supplements
Many people who suffer from CFS are deficient in one or more nutrients. The chart below lists supplements recommended from Shan (2007):

If serum 25 hydroxyvitamin D levels are below 80 nmol/L, patients should supplement with Vitamin D to decrease the risk of EBV recurrence (Zwart et al., 2011).

References
Campos, M. (2017, September 22). Leaky gut: what is it, and what does it mean for you. Retrieved from https://www.health.harvard.edu/blog/leaky-gut-what-is-it-and-what-does-it-mean-for-you-2017092212451

Carnahan, J. (nd). The sleeping giant – tips to treat reactivation of epstein-barr virus. Retrieved from https://www.jillcarnahan.com/2018/01/25/sleeping-giant-tips-treat-reactivation-epstein-barr-virus/

Centers for disease control and prevention. (2018, May 8). About epstein-barr virus. Retrieved from https://www.cdc.gov/epstein-barr/about-ebv.html

Centers for disease control and prevention. (2018, May, 8). Epstein-barr virus and infectious mononucleosis: for healthcare providers. Retrieved from https://www.cdc.gov/epstein-barr/hcp.html

Coskun, O., Sener, K., Kilic, S., Erdem, H., Yaman, H., Besirbellioglu, A. B., . . . Eyigun, C. P. (2010). Stress-related epstein-barr virus reactivation. Clinical and Experimental Medicine, 10(1), 15-20. doi:http://dx.doi.org/10.1007/s10238-009-0063-z

Cunha, J., and Balentine, J. (2019, January, 16). Epstein-Barr Virus. Retrieved from https://www.emedicinehealth.com/epstein-barr_virus_infection/article_em.htm#what_is_an_epstein-barr_virus_infection_ebv_infection

Lerner, A, M. L., Beqaj, S. H., Gill, K., Edington, J., Fitzgerald, J. T., & Deeter, R. G. (2010). An update on the management of glandular fever (infectious mononucleosis) and its sequelae caused by Epstein–Barr virus (HHV-4): New and emerging treatment strategies. Virus Adaptation and Treatment, 2, 135-145. doi:http://dx.doi.org/10.2147/VAAT.S6749

Longnecker R, Neipel F.(2007). Introduction to the human γ-herpesviruses. In: Arvin A, Campadelli-Fiume G, Mocarski E, et al., editors. Human Herpesviruses: Biology, Therapy, and Immunoprophylaxis. Cambridge: Cambridge University Press. Chapter 22. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK47397/

McClure, H. H., Martinez, C. R., Snodgrass, J. J., Eddy, J. M., Jimenez, R.,A., Isiordia, L. E., & McDade, T. W. (2010). Discrimination-related stress, blood pressure and epstein-barr virus antibodies among latin american immigrantsin oregon, US. Journal of Biosocial Science, 42(4), 433-61. doi:http://dx.doi.org/10.1017/S0021932010000039

Micozzi, M. (2019). Fundamentals of complimentary, alternative, and integrative medicine (6th ed.). St. Louis: Elsevier.

Peek, M. K., Cutchin, M. P., Freeman, D., Stowe, R. P., & Goodwin, J. S. (2009). Environmental hazards and stress: Evidence from the texas city stress and health study. Journal of Epidemiology and Community Health, 63(10), 792. doi:http://dx.doi.org/10.1136/jech.2008.079806

Pizzorno, J.E. & Murray, M.T. (2013). Text book of natural medicine (4th ed.). St. Louis: Elsevier.

Shan, Y. (2007). Chronic fatigue syndrome. Primary Health Care (through 2013), 17(1), 25-29. Retrieved from https://search.proquest.com/docview/217843770?accountid=158302

Sparks, D. ( 2018, May 25). Home remedies: how a healthy diet can manage paid. Retrieved from https://newsnetwork.mayoclinic.org/discussion/home-remedies-how-a-healthy-diet-can-help-manage-pain/

Swift, K. and Midura, R. (2018). Herbal medicine for beginners. Emeryville, CA: Althea Press

Uchakin, P. N., Parish, D. C., Dane, F. C., Uchakina, O. N., Scheetz, A. P., Agarwal, N. K., & Smith, B. E. (2011). Fatigue in medical residents leads to reactivation of herpes virus latency. Interdisciplinary perspectives on infectious diseases, 2011, 571340. doi:10.1155/2011/571340

Valachis, A., & Kofteridis, D. P. (2012). Mononucleosis and Epstein–Barr virus infection: Treatment and medication. Virus Adaptation and Treatment, 4, 23-28. doi:http://dx.doi.org/10.2147/VAAT.S17837

Vojdani, Aristo, PhD,M.Sc, C.L.S., Lambert, J., & Vojdani, E., M.D. (2016). The gut-brain axis: Autoimmune and neuroimmune disorders. Alternative Therapies in Health and Medicine, 22, 31-46. Retrieved from https://search.proquest.com/docview/1851070027?accountid=158302

Zwart, S. R., Mehta, S. K., Ploutz-Snyder, R., Bourbeau, Y., Locke, J.P., Pierson, D.L., Smith, S.M. (2011, April). Response to Vitamin D Supplementation during Antarctic Winter Is Related to BMI, and Supplementation Can Mitigate Epstein-Barr Virus Reactivation, The Journal of Nutrition, Volume 141, Issue 4, Pages 692–697, https://doi.org/10.3945/jn.110.134742 Retrieved from https://academic.oup.com/jn/article/141/4/692/4630635