Why am I tired? (Part 2)

Part II: Epstein Barr Virus (EBV)

In Part 1 of this series we discussed the foundational lifestyle factors that contribute to fatigue. Regardless of other causes, these lifestyle factors must always be addressed to recover from fatigue.

In the following parts of this series “Why am I tired?” we will discuss other variables that can contribute to fatigue.

One that gets a lot of attention is Epstein Barr virus (EBV), the virus that causes infectious mononucleosis (or “mono” aka, “the kissing disease”).

Is EBV really the demon virus it is sometimes made out to be? And how do you figure out if it could be contributing to your fatigue? Let’s review the facts, shed some light on the gray areas and figure out how to apply them in the clinic. 

Acute EBV

EBV is a member of the herpes family of viruses. About 95% of all of us will be infected by EBV in our lifetime and almost all will completely recover. 

Classic symptoms of acute EBV (meaning you have recently been infected) include: 

  • Fatigue (can be extreme)

  • Swollen lymph nodes

  • Sore throat

  • Fever

  • Headaches

  • Body aches

  • Swollen spleen and/or liver 

Many other infections and conditions can cause similar symptoms, so if you are dealing with these symptoms, make sure to get diagnostic testing before assuming it is EBV. Acute EBV (“mono”) is diagnosed with either the mono-spot test or elevated EBV IgM. Both of these tests look for your immune system’s acute response to a recent EBV infection. 

Traditional treatment is rest and hydration. You may benefit from a more proactive approach including personalized herbal antivirals, nutrients and treatments like acupuncture, but most people will recover completely on their own in about a month.

EBV lives on in the body.

Like some other common viruses, such as varicella zoster (chicken pox and shingles), herpes Type I and 2 (oral and genital herpes) and of course HIV, EBV can hide in our body and evade eradication by the immune system (this is also true of some bacteria, but that is a whole other topic for another time…). 

As many people experience, these viruses can reactivate and make us sick again. Often being run-down allows these viruses to reactivate when our immune system is compromised. 

EBV may be like these other viruses that can lay dormant, and then reactivate under the right (or wrong!) circumstances. 

Conventional medical practice only believes EBV can reactivate in a rare form of chronic EBV (CAEBV), while many Functional medicine, naturopathic and other non-conventional practitioners work under varying understandings of chronic EBV reactivation in other ways.

CAEBV

In conventional medical practice, Chronic, active EBV (CAEBV) is identified as a very rare disorder with debilitating life long and perhaps even fatal outcomes. It is characterized by continued severe EBV symptoms and other severe systemic health issues (pneumonia, rashes, anemia, nerve damage, liver failure). 

CAEBV is only diagnosed when a person has these specific symptoms and when testing finds DNA of EBV in your blood. Finding DNA of a specific organism in your body means it is alive and replicating and is the gold-standard for diagnosing an infection.

Other than CAEBV, conventional medical opinion is that EBV only makes us sick once in our lifetime and that EBV reactivation is otherwise asymptomatic. In response to EBV reactivation, the body simply upregulates EBV-specific memory immunoglobulins (EBV IgG’s) to bring it back under control.

What about the “other” “chronic EBV?” 

Among the top things patients ask me to investigate as a cause of their fatigue is EBV (also: hypothyroidism, check out these blogs to learn more about it). In my experience, if EBV is contributing to your fatigue, it is only part of the problem. And whether it is a primary cause, or secondarily reactivated due to other health issues is important to determine if you are to recover fully. 

Many non-conventional health practitioners and naturopaths diagnose chronic EBV (not the conventional CAEBV) based on varying levels of scientific validity and understanding of diagnostic testing. 

On one extreme, some purport EBV to be a widespread and primary cause of most peoples’ fatigue and well-meaning, if miseducated, integrative medicine practitioners mis-diagnose any elevated EBV IgG as a case of chronic, reactivated EBV. Having elevated EBV specific EBV IgG’s does not diagnose you with reactivated EBV most of the time. You must have a range of different measures of EBV IgG’s elevated and relevant health issues to consider this as an issue.

Neither conventional medical opinion that denies anything other than the extreme, rare cases of CAEBV, or the alternative and integrative medical practitioners that over- and mis-diagnose are getting it right. 

Here is a better understanding of how to determine if EBV is recurring and if it is part of your health issues. Scientific understanding is always advancing and this understanding may evolve with it, but this approach allows us to accurately combine known science with your personal health history to understand how to prioritize focusing on EBV (or not) in resolving your health issues.

Currently in my clinic, we will treat EBV as a contributing part of your health picture if:

  • You have symptoms of fatigue, swollen lymph nodes and other difficult to understand infections, autoimmunity and dysregulated health.

And:

  • You have elevated levels of all 3 EBV IgG’s 

    • viral capsid antigen (VCA)

    • nuclear antigen (NA)

    • early antigen (EA)

If you have all 3 EBV IgG’s (VCA, NA, EA) elevated but don’t have any systems, you do not need to worry about treating chronic EBV. This simply means your immune system is mounting a proper response to contain it.

If you do not have all 3 EBV IgG’s (VCA, NA, EA) elevated, look for other causes of your fatigue and infection symptoms. 

If you are diagnosed with chronic EBV, we also need to consider if it is the primary cause, or secondary to other things compromising your immune system. Often, it is the latter and to control EBV reactivation is as much about addressing other causes of health dysregulation such as the gut, diet, stress, sleep, nutrients, toxins and other infections, as it is about directly treating the EBV.

What can you do right now if you are fatigued and suspect EBV? 

First, go check out this post about The Foundations and address the fundamental drivers of health dysregulations and fatigue. Work on eating an unprocessed, nutrient dense, no flour, sugar or junk diet. Get at least 8 hours of quality sleep a night. Do moderate movement or exercise, as reasonably tolerated (consider Tai ji, Qi gong or gentle yoga if it is not). Address significant causes of stress in your life and develop stress resilience through mindfulness and meditation practices

Need more help figuring out your health issues and what to do?

We are always here for you to listen and personalize healing health journeys for you, based on science and compassion.

Tressa Breindel