Is Epstein-Barr Virus really Treatable and Reversible?
It’s a such a polarizing question, and so much avoided, actually, due to common misconceptions about EBV….so I can’t wait to say it once and for all, both to the clinicians and to those suffering from EBV… and to the doctors and other practitioners, many of whom I have met, who themselves struggle with EBV: EBV may actually be treatable and reversible in some cases.
(A full disclose: as a doctor of clinical nutrition I do not diagnose or treat any disease. I work with a whole person using nutritional and life style modifications to promote their wellness and optimal health- this is also my approach to chronic EBV).
The Current Status of EBV in Traditional Medical Practice
There are several misconceptions in medical community about EBV. While experienced and forward-looking medical doctors and functional doctors are doing formidable work for their patients with EBV, they are a minority and are in high demand. In the ideal world, any family physician could diagnose chronic EBV and provide the effective support for that population. But we have a long way to go.
Here are some of the most frequent misconceptions, inconsistent with medical literature.
The common belief in medical community is that you can only have mono, infectious mononucleosis, once and it goes away on its own, despite medical term “chronic mononucleosis syndrome” (Dubois et al., 1984) and common reinfections of the virus.
It is believed that you cannot have a recurring or chronic EBV if you did not have mononucleosis in the past. This is not what I hear from the EBV community: while many indeed have a history of mono, a substantial percentage does not remember ever having it. This is consistent with research indicating that EBV infections in infancy or early childhood can be so mild that they can be easily missed or undetected. However, the virus remains in the host for the rest of their lives.
There is also a belief that since at least 90% of global population has the virus, the presence of antibodies only means past infection, even though research is clear that VCA IgM antibody indicates current infection (especially the initial one), while IgG EA is a marker of current EBV reactivation (De Paschale, 2012). According to research, there are several complications in interpreting EBV lab results. I wrote an entire chapter on this issue in my book and a synopsis of the most common lab scenarios here.
Finally, those in the middle of a mono flareup are still told that there is nothing to do and you just need to rest. While rest is paramount, the longer the mono continues, the more cellular damage, immortalization of the infected B-cells (which will lyse with each reactivation, spilling new virions), and the more long term risk of autoimmune disorders or even possibly cancer. EBV lives latent (dormant) much of its life in the host, but “the virus can persist throughout life with low or intermittent levels of virion production” (De Paschale, 2012). The infected immortalized cells cannot be destroyed by the immune system and become factories of new virions.
And while for large percentage of people with mono, recovery is smooth and they go back to a normal life, for some, that is not the case. Since we have about 3mln recorded cases of mononucleosis annually in the US alone (possibly many more that are unrecorded), even a small percentage of that population may mean epidemic proportions of people suffering from chronic complications of EBV.
I want to share a case report that exemplifies a smart protocol that rapidly stalled the acute EBV infection. This case report is just a story of a medical doctor applying a therapy to a group of patients. Even though it is just a single report, it deserves a closer look. Historically, some intelligent case reports have changed the course of medicine. It is important, therefore, that we give this study the attention and credit it deserves as it has a potential for inspiring more clinical studies with patients with EBV. We certainly need more. Let’s discuss!
A Case of Acute EBV Reversal within 24-48 Hours
Here is a study by Dr. Dana Flavin (Flavin, 2006). Dr. Flavin is a very seasoned functional medical doctor (who could already retire) that single-handedly reversed an acute form of EBV infection presenting as splenomegaly within 24-48 hours in a group of 50 children and young adults.
Her EBV protocol led to “the dramatic improvement and successful reversal of all symptoms in this disease for a rapid return 24-48 hours to optimal health.” She was able to “reduce the viral infection load including reversing splenomegaly within hours with (our) treatment from research on the disease’s pathology”.
“Mononucleosis, an Epstein Barr Viral EBV infection, is treatable and rapidly reversible. By understanding the basic pathology and molecular biology of viral diseases we are now able to inhibit the toxicity of the disease while simultaneously increasing the immune defense to stop the viral replication.” (Flavin, 2006)
Let me present the case and expand on it.
A Spleen Primer
The case report Dr. Flavin recorded reports on splenomegaly, which can be caused by mononucleosis, the acute form of EBV infection. Enlarged spleen can cause complications if left untreated, including spleen rapturing and internal bleeding, and can be life threatening, and in some cases it has to be surgically removed. Most spleen raptures occur within 30 days of initial symptoms, and similarly, it takes about 30 days for splenomegaly to self-resolve (Foreman et al, 2005). This is of particular importance to consider since the protocol applied by Dr. Flavin resolved splenomegaly within 24-48 hours.
While anyone can develop splenomegaly, children and young adults with mononucleosis are at particularly high risk. According to the Journal of Family Practice, “all patients with infectious mononucleosis should be considered at risk for splenic rupture since clinical severity, laboratory results, and physical exam are not reliable predictors of rupture” (Foreman et al., 2005).
The Most Important Practical Clinical Study on EBV you Have not Heard about… until now
I stumbled upon Dr. Flavin’s work while doing research for my book and I literally almost fell off my chair when I read it. My practice is almost all Epstein-Barr Virus related, so I have worked in this area extensively and I have honed in on the most effective therapeutic approaches for EBV.
However, I cannot personally claim that any disease is reversible as I am a doctor of clinical nutrition and not a medical doctor. Needless to say, I was beyond thrilled to see a physician use a very focused, simple, and accessible protocol and show what it can do to stall the virus.
I had an opportunity to talk to Dr. Flavin about this case report. Yes, as you can well imagine, I absolutely had to find her – I finally tracked her down all the way in Germany. I had great honor to chat with her.
She said she was simply trying to help save those 50 children and young adults. They all had enlarged spleens (splenomegaly), which is a form of an acute EBV infection, and which can lead to the spleen rapturing and result in internal bleeding, which in turn can lead to death. She sat down and dove deeply into medical research, physiology, and pathology in order to understand what drives the virus and then found simple well-researched tools to arrest the virus and its ability to damage the cells. In the process, she most likely saved 50 lives.
I am grateful for Doctor Dana Flavin for trying to save those young people. I am also deeply grateful that she decided to also record this case and publish it in a medical journal, so we all can benefit from what she did. Dr. Flavin’s brilliant approach to functional medicine reaches far beyond EBV and into cancer, but just this one study is ground breaking, and I hope it will help change the medical paradigm in clinical care of people with EBV.
What is most interesting to me is that this is a study from 2006 and I found it while I was writing my book ten years later, just as I was about to publish. How is it that in all the knowledge and research we know about EBV, this study is not at the forefront? Every clinician should know about this study. Every person with EBV should as well. Share it with your doctor and your family. Here is the link again.
The EBV virus is predictable but it does do a lot of damage. My biggest shock was to find that Dr. Flavin and I were using almost the same protocol even though I was a decade late and did not know about her work. Because the protocol is evidence-based, it does work. Acute EBV can be reversed and treated, just as Dr. Flavin proved. Do not let any physician tell you otherwise.
How is that different in chronic EBV? It still works. It just takes a more expansive protocol, a more multidisciplinary approach, with higher potencies of some of the supplements, and it takes weeks (perhaps months) rather than days. Extensive details are all available in my book. If these tools do not work, you have to look for toxic mold, EMF, heavy metals, pathogenic co-infections, or other complications, or… it is simply not EBV.
So let’s take a closer look at Dr. Flavin’s case report.
Let’s Talk about the Study: The Ways in which EBV Damages your Cells, and in which You Can Protect them
Lymph Nodes and Lymphocytes
EBV infection can cause enlarged lymph nodes. Lymph nodes are located in several places in your body, but the enlarged lymph nodes that many people with EBV experienced are located on both sides of your neck. This is most likely due to the fact that the viral entry is frequently oral. Lymph nodes are important as they filter out foreign particles and cancer cells.
Lymphocytes are one type of your white blood cells, your immune cells, that live in the lymph nodes and are designed to protect you from pathogens and invaders. Keep in mind that lymphocytes are supposed to protect you from cancer as well and that EBV is oncogenic, which means that it can cause cancer. 200,000 cases of cancer caused by EBV are reported a year globally and in one year alone, in 2010, 143,000 died of cancer caused by this virus. Damage to lymphocytes means damage to this protection as well.
Free Radical Damage from EBV
There are particularly nasty free radicals and reactive oxidative species (ROS) that EBV manufactures to affect your cells. Free radical damage and oxidative stress have been shown in research to cause chronic illness, chronic inflammation, premature aging and more. I will share another best-kept secret here with you before we go on: we have the tools that help us minimize oxidative stress and free radical damage and keep us healthy and young. We have evolved with them: they are called…antioxidants. We will talk about these shortly. Suffice to say that antioxidants are paramount in your recovery from EBV.
Here Are Some Examples of Oxidation and Free Radical Damage
Imagine a bike left outside for a year- it will start rusting. Or imagine leaving an apple cut in half on the table for a few hours- it will begin to brown (unless it is genetically modified to not brown…but that is a different story). Now imagine a marathon runner dropping dead with a heart attack at the end of the race (it happens unfortunately).
Oxidation is the rusting of the bike and the browning of the apple. Why did the runner die? Because exercise creates oxidation. As long as you resupply antioxidants afterwards, you are fine. However, prolonged and intensive exercise like marathon running creates extremely high levels of oxidation and free radicals. Unfortunately, during the race, runners do not consume equally high amounts of antioxidants to protect them. Their arteries can be too damaged by the end of the race.
Exercise and EBV?
On that note, one of the most common complaints among people with chronic EBV is intolerance to exercise and very long recovery after one. In fact, your ability to feel well after you exercise can reflect your EBV status. Do you feel good-tired after you exercise, or do you feel like a truck ran you over again?
During reactivation and in chronic EBV, you have to be very careful and minimize exercise only to gentle stretches and perhaps walking, if that is even tolerated. As your EBV status improves, you will be able to incorporate more physical activity and enjoy it. Otherwise, you know you will be in pain or disabled in bed for another day or two, or even longer. If you look at it from the perspective of oxidative stress, it makes a lot of sense. When you have reactivation of EBV, your body is experiencing a flood of oxidative stress, free radical damage, and the accompanying inflammatory cytokines (we discuss those in more detail a little later). Adding more oxidation from rigorous exercise can tip the scale over. You can now see why you have to be gentle with physical exertion during a flareup.
Free radicals and oxidation are mechanisms that EBV uses intelligently. Since we have evolved with readily available antioxidants such as fruits, vegetables, beans, spices, herbs, and culinary herbs, and more…we have all we need to combat EBV. However, just like in marathon running, extreme oxidation requires extreme measures- when we are dealing with an aggressive and intelligent EBV that creates a free radical and inflammatory chaos, just antioxidants from food alone may no longer be a enough to move the needle. We need a more serious intervention: this is where high dosages of antioxidants in supplements come in.
Dr. Flavin presents a very complex scenario of how EBV triggers various pathways of oxidation and how they affect you, the host, on a cellular level. Here are just a few examples she discusses. For those interested in more detail, there is a link to her study at the bottom of this page.
Xanthine Oxide (XO)
XO is an example of a free radical created by EBV. It has been seen elevated 200 times above normal in patients with EBV and hepatitis B. According to Dr. Flavin, it is normally stored in liver and intestines but inflammation releases it- and it then “sticks” to the surface of the EBV-infected cells.
Endothelial Nitric Oxide
This free radical gas is slow-released and longer active. According to Dr. Flavin, it slows down the movement and activity of lymphocytes. These are the same lymphocytes that are abundant in your lymph nodes and are supposed to protect you from invaders such as EBV and also cancer cells. EBV basically stalls them.
As a result of high oxidative stress and free radicals, the EBV-infected cells produce more inflammatory cytokines like Prostaglandin E2, Tumor Necrotic Factor, bradykinins, and a cytokine-like substance BCRF1, which specifically suppresses your lymphocytes’ ability to clear viruses and cancer cells (here we go again- your lymphocytes are such prime target for EBV!). BCRF1 also suppresses interferon gamma, one of the best anti-EBV defense systems available.
NFkB is a protein complex, a nuclear factor kappa-light-chain-enhancer of activated B cells (B cells are the most commonly EBV-infected cells). It controls transcription of DNA, cytokine production and cell survival. NFkB is used by EBV to replicate – EBV incorporates some of NFkB’s own signaling into its life cycle and can induce more of NF-kB activation! (Hiscott, J., et al, 2006). In other words, the more NFkB, the more EBV can drive more of NFkB to replicate more.
Excess NFkB in general causes inflammation and unfortunately is common in Standard American Diet. Just one meal including an egg and sausage muffin sandwich and two hash browns has been shown to increase NFkB by 150% (from about 190 to about 510 AUC) for approximately two hours, causing an increase in oxidative stress and in C-reactive protein, another inflammatory marker (Aljada, A., et al., 2004).You can find a whole chapter on NFkB in my book (here).
DO NOT Underestimate Antioxidants when You Have EBV
If oxidation is how EBV drives its progress, antioxidants should logically be the best defense. And they are, and that is the direction Dr. Flavin took with her 50 young patients. That is also what I teach all my clients. It is 100% consistent with research.
Just to give you an example, studies show that vitamin D, curcumin, lipoic acid, and chrysanthemum can inhibit EBV by inhibiting NFkB. Antiviral NFkB inhibition has also been shown in basil, bee propolis, Boswelia serrata, Cat’s claw, cloves, Coq10, DHA, EPA, gamma linoleic acid, garlic, ginger, grape seed extract, green tea, glutamine, glutathione, licorice, milk thistle, N-Acetyl Cysteine (NAC), pomegranate, ret hot pepper, pycnogenol, resveratrol, rosemary, selenium and zinc, among others. I discuss each of these in much greater detail in the book, and I reference medical literature accordingly for every single item on the list above. The literature is clear.
Dr. Flavin’s Protocol
Dr Flavin was strategic. While diet high in antioxidants is extremely beneficial in Chronic Active EBV, she had 50 young patients in a hospital at risk of rapturing their spleens. She did not have time. Looking at research she picked the most practical, researched, and readily available supplements that the patients would be able to handle. She settled on 5 nutrient-based anti-EBV supplements and one herb. She presented them all in detail, including potencies, in her study, which you can access here. Her goals were to:
- Curb NFkB: Vitamin C, Vitamin E, mixed tocopherols, NAC, Selenium, zinc
- Increase interferon gamma: licorice root, zinc
- Decrease viral toxicity/free radical damage: licorice root, Selenium
- Decrease EBV’s viral replication: Selenium, Vitamin E
- “Unstick” the eNOS from lymphocytes so they can move and fight the virus again and to reverse splenomegaly: NAC
This was all Dr. Flavin needed to use to be able to reverse the enlarged spleens in the whole group within just 1-2 days. I wrote about literally every single item she used in my book in greater detail: the very same agents utilize many more physiological pathways to stall EBV. They truly are EBV superstars and that is why they have been a back bone of my EBV work in my own clinic as well.
EBV Bottom Line
You may not believe that these common and readily accessible supplements could be so effective against such formidable virus. But they are. As I deal mostly with more chronic aspect of EBV, I have the opportunity to expand on the protocol by adding more nutrients and more nutrient-based antivirals and strategically increasing dosages of the supplements, which I document in detail in my book as well.
If your child has an enlarged spleen, you have Dr. Flavin’s protocol readily available at your fingertip. Of course, consult with another practitioner to make sure all the supplements are appropriate and safe for this particular case.
If you or your patients struggle from chronic EBV, I hope my book will provide more support, with expanded protocols, detailed dosages and forms of each supplement, and with detailed foods, botanicals, herbs, culinary herbs, spices, and the necessary (and evidence-based) lifestyle and environmental modifications.
Future of EBV
Dr. Flavin’s study is hopefully the beginning of many more physicians to publish their case reports or more controlled studies on EBV. We need them to validate her case report and to pave the way for changes in the way EBV is approached now. One of my professional goals is to collaborate with other clinicians to indeed run some EBV studies and publish them. It is just a matter of finding time and resources. The clinical discussion on EBV is currently coming to forefront, so I know we will see more evidence in medical literature of practical applications for natural EBV solutions similar to Dr Flavin’s from other clinical practices. For any clinician reading this article, I ask that you consider publishing if you have experience and consistent results in the work you do for your EBV patients.
More work from Dr. Flavin
I am honored to call Dr. Flavin my friend. I hope we can have her back here in the US to teach the new generations of functional medicine physicians and other practitioners before she retires! Her brilliant clinical work for EBV as well as cancer leaves a true legacy for the way medicine could evolve moving forward.
Dr. Flavin’s Foundation (if you would like to support it and contribute)
Dr. Flavin talking about cancer
Here is my book, The Epstein-Barr Virus Solution
Aljada, A., et al., Increase in intranuclear nuclear factor kappaB and decrease in inhibitor kappaB in mononuclear cells after a mixed meal: evidence for a proinflammatory effect. Am J Clin Nutr, 2004. 79(4): p. 682-90.
The photo by Joshua Reddekopp, courtesy of Unsplash
Here is a link to the study discussed in the video.