As a doctor trained in the functional medicine approach to healthcare, I spend much of my time discovering and treating chronic illnesses, including those encompassing chronic inflammation, which can often be traced to immune system dysfunction. The COVID-19 pandemic demonstrates daily how an infection can trigger a powerful immune response resulting in inflammation.

With COVID-19, the inflammation primarily impacts the lungs, but it can affect other organs and tissues, as well. Deaths from COVID-19 are typically a result of excessive inflammation caused by the body’s over-the-top immune response.

Inflammation isn’t all bad. In fact, it’s part of the mechanism responsible for enabling the body to fight disease, recover from injury, and repair damaged tissue. Any trauma to the body’s cells triggers an inflammatory response. The immune system releases inflammatory chemicals, which expand blood vessels and cause them to leak, thereby delivering healing cells and substances to the site that’s injured or under attack. The expansion and leaking of blood vessels are what cause the inflammation.

Unfortunately, the immune system can become the body’s own worst enemy, identifying healthy cells as threats and attacking those cells — a condition referred to as autoimmunity. Various autoimmune diseases can develop as a result, depending on the cause and the organs or tissues being damaged. With type 1 diabetes, the immune system attacks pancreatic cells, impairing the body’s ability to produce insulin; with Hashimoto’s thyroiditis, the immune system attacks the thyroid; with rheumatoid arthritis, it primarily attacks the joints; with multiple sclerosis (MS) and Guillain-Barré syndrome, it attacks nerve cells; with myocarditis, it attacks the heart; and so on.

The exact mechanism that gives rise to an autoimmune disease remains a mystery. However, evidence suggests that the cause may be traced to a genetic susceptibility triggered by one or more environmental factors, which may include chronic stress, poor diet, gut dysbiosis (an imbalance of microorganisms in the intestines), infections, environmental toxins, as well as other stressors.

Recent research points to viral and bacterial infections as being major triggers for several autoimmune diseases, including the following:

Autoimmune Disease	Infectious Agent
Guillain-Barré syndrome	Epstein-Barr virus, cytomegalovirus, Campylobacter (bacteria)
Hashimoto’s thyroiditis (hypothyroidism)	Epstein-Barr virus
Lupus	Epstein-Barr virus
Lyme disease	Borrelia burgdorferi (bacteria) and Borrelia mayonii (bacteria)
Multiple sclerosis (MS)	Epstein-Barr virus and measles virus
Myasthenia gravis	Hepatitis C virus, herpes simplex virus
Myocarditis	Coxsackievirus B3, cytomegalovirus, chlamydia (bacteria), Epstein-Barr virus
Rheumatoid arthritis (RA)	Epstein-Barr virus, hepatitis C virus, Escherichia coli (bacteria), mycobacteria
Type 1 diabetes	Coxsackievirus B4, cytomegalovirus, mumps virus, and rubella virus

Medical researchers and clinical practitioners have different theories on how infections contribute to the onset of autoimmune diseases. Some suggest that the antibodies produced in response to certain infections attack healthy cells in the body that resemble, in some way, the bacteria or virus that caused the infection. Others note that many viruses infect the immune cells in order to reproduce, and that this infection alters the immune response. A third possibility is that the infection flips a switch in the host’s genes that negatively impacts immune function.

Focusing on the Epstein-Barr Virus

As you skim through the table above, you may notice that one virus in particular — the Epstein-Barr virus (EBV) — is implicated in a number of autoimmune diseases. EBV may play a role in many autoimmune diseases for the following reasons:

• EBV is associated with lymphomas — cancer that begins in the infection-fighting cells of the immune system, called lymphocytes.
• EBV remains in the body throughout one’s life, remaining dormant for long periods of time with the possibility of reactivating later. This follows the course of autoimmune diseases that exhibit a worsening of symptoms later in life.
• EBV alters the host’s genes in a way that may negatively impact immune function. In 2018, scientists at the Center for Autoimmune Genomics and Etiology (CAGE) at Cincinnati Children’s Hospital Medical Center published a study showing that “a protein produced by the Epstein-Barr virus, called EBNA2, binds to multiple locations along the human genome” associated seven autoimmune diseases: multiple sclerosis (MS), rheumatoid arthritis (RA), inflammatory bowel disease (IBD), celiac disease, juvenile idiopathic arthritis (JIA), systemic lupus erythematosus (SLE), and Type 1 diabetes.
• EBV may infect healthy organs, triggering an immune response that damages healthy cells as the immune system tries to eradicate the virus. Biopsies of the thyroid glands of patients with Hashimoto’s disease and EBV show massive amounts of the virus inside the thyroid gland.

In addition to the autoimmune diseases already mentioned, EBV may cause or contribute to the following illnesses:

• Facial nerve palsy (Bell’s palsy)
• Chronic fatigue syndrome (CFS)
• Encephalitis
• Optic neuritis
• Pancreatitis (inflammation of the pancreas)
• Hemiparesis (paralysis on one side of the body)
• Pneumonia
• Transverse myelitis (inflammation on both sides of a section of the spinal cord)
• Viral meningitis
• Cancers, including Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, nasopharyngeal carcinoma, and Burkitt’s lymphoma

What is the Epstein-Barr Virus?

The Epstein-Barr Virus (EBV) is a herpes virus (herpes 4) transmitted by saliva, which causes mononucleosis, often referred to as “mono” or “the kissing disease.” EBV can also be transmitted via semen during sexual intercourse, by blood, or by a blood transfusion. Most people get infected in their youth — after their first kiss or after drinking from a cup or glass that has the virus on it.

If you’ve ever had mono (and there’s a big chance you have — even if you were never diagnosed), you’re familiar with the symptoms:

• Headache
• Sore throat
• Swollen liver and spleen
• Fever
• Swollen lymph nodes in the neck and armpits
• Fatigue
• Rash

The initial infection lasts about two to four weeks but can linger for months. After the immune system fights off the virus, it goes dormant, usually for the rest of the person’s life. This period is often referred to as the latencyphase. However, EBV can be reactivated later in life and cause one or more of the illnesses mentioned earlier in this post. EBV’s ability to reactivate later in a person’s life is similar to that of the chicken pox virus, which, after the initial infection, remains dormant but can reactivate later causing painful shingles.

Note the following:

• You can be infected with EBV and not develop any symptoms.
• You can have symptoms without testing positive for EBV antibodies; similar symptoms are associated with other viral infections, including cytomegalovirus, toxoplasmosis, herpes 6, herpes 7, HIV, and hepatitis B.
• Regardless of how old you are, whenever the virus is reactivated, you can infect someone else.

Can I Be Tested for the Epstein-Barr Virus?

Yes, blood testing is available through a number of commercial labs. I use an EBV test from LabCorp that examines the following four components:

Component	Result
EBV Viral Capsid Antigen (VCA) IgM	Indicates active infection and stays positive for 4-6 weeks
EBV Viral Capsid Antigen (VCA) IgG	Positive in the early stages of infection, peaks at 2-4 weeks, then begins to drop and stays positive for life
EBV Nuclear Antigen (EBNA) IgG	Not positive in the acute phase but starts to elevate 2-4 months after infection and stays positive for life
EBV Early Antigen (EA) IgG	Positive in the acute phase, begins to drop for 3-6 months after infection, and becomes positive again during reactivation

If you’re testing or being tested for Epstein-Barr virus, be sure the test includes all four components. Many EBV tests omit the EBV Early Antigen (EA) IgG component, which is essential for a diagnosis of reactivation and for monitoring treatment effectiveness.

Very rarely, someone can have an active EBV infection, even though the test results show that no EBV antibodies are present in the blood.

Treating Autoimmune Conditions

Because EBV and other infectious agents are often at the root of autoimmune diseases, the treatment for these diseases must identify and address any underlying infections while restoring healthy immune function. This approach enables the immune system to control the infection more effectively while scaling back its attack on the body’s healthy cells. Successful treatment requires a holistic approach that begins with a thorough exam and testing.

For example, when treating an individual who has Hashimoto’s thyroiditis, I test first for EBV reactivation. If the test result for EBV reactivation is positive, I first look for reasons why the immune system is unable to control the virus, such as the following:

• Anemia
• Poor sleep
• Chronic stress, causing adrenal and autonomic nervous system imbalances
• Gut dysbiosis and/or infection
• Inflammation (yes, inflammation can also impact immune function)
• Nutrient deficiencies, including protein, vitamin D, and zinc
• Insulin resistance
• Low ferritin levels (ferritin is a blood protein that contains iron)
• Other undiagnosed infections
• Excess estrogen
• Toxic mold or other environmental toxins

Eliminating or significantly reducing all factors that may be stressing the immune system is often enough to deactivate the Epstein-Barr virus. However, targeting the virus — in addition to restoring healthy immune function — is often helpful for a quicker and more successful outcome. A number of compounds are helpful for treating an active EBV infection, including the following:

• Artemisinin
• Berberine
• Cordyceps
• Curcumin
• Epigallocatechin gallate (EGCG)
• Monolaurin
• Olive leaf extract
• Reishi mushrooms
• Vitamin C (high-dose, intravenous)

Note: By itself, attacking the virus with supplements isn’t enough for long-term success. You must address the underlying causes of immune system dysfunction, so the body can keep the virus in check. These supplements may help to control the virus temporarily, but without restoring healthy immune function, the virus will reactivate when you stop taking the supplement.

I take a similar, holistic approach to treating all autoimmune disorders. First, I test for underlying infections and look for other factors that may have triggered the illness. Then I examine the various systems of the body to identify any dysfunction that may be impairing the body’s ability to heal itself, such as immune system dysfunction or the body’s inability to detox itself. I then identify and address all causes of dysfunction and provide additional treatment, as necessary, to combat the infection or any other factors, such as toxic mold, that may have caused or contributed to the disease.

The patients I treat for autoimmunity generally fall into two categories — those who’ve been diagnosed with an autoimmune disease, such as Hashimoto’s thyroiditis, and patients who are experiencing poor health but haven’t received a clear diagnosis or effective treatment. Patients in the latter group may have a vague diagnosis of chronic fatigue syndrome or depression, which provides little or no insight into what’s causing them to feel miserable and often results in treatments that may offer some temporary relief at best.

Regardless of whether you have a clear diagnosis, if you’re experiencing symptoms like those describe in this post but your treatment isn’t nearly as thorough as what I provide my patients, I strongly encourage you to consult a functional medicine practitioner. A doctor trained in functional medicine can unravel the mystery behind your illness, identify the root causes, and provide your body with everything it needs to achieve and maintain optimal health and fitness.

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Disclaimer: The information in this blog post is provided for general informational purposes only and may not reflect current medical thinking or practices. No information contained in this post should be construed as medical advice from Dr. Matt Lewis, D.C., DACBN, CFMP®, nor is this post intended to be a substitute for medical counsel on any subject matter. No reader of this post should act or refrain from acting on the basis of any information included in, or accessible through, this post without seeking the appropriate medical advice on the particular facts and circumstances at issue from a licensed medical professional in the recipient’s state, country or other appropriate licensing jurisdiction.

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About the Author: Dr. Matt Lewis, D.C., DACBN, CFMP^® specializes in diagnosing and treating the underlying causes of the symptoms related to chronic and unexplained illness through nutrition, lifestyle, chiropractic, and other natural approaches to whole-health healing in Tampa, Florida. He earned his B.S. in Biology from Shenandoah University, his Doctorate in Chiropractic from Life University, his Diplomate status in Clinical Nutrition from the American Clinical Board of Nutrition, his CFMP^® from Functional Medicine University, and his certification as a Digestive Health Specialist (DHS) through the Food Enzyme Institute. Dr. Lewis’ passion for health and wellness stems from his own personal experience. With a family history of autoimmune conditions and diabetes, and his own lab tests showing his genetic susceptibility to Hashimoto’s thyroiditis (autoimmune thyroid), he has learned how to restore his own health and vigor to prevent the onset of these and other illnesses and live an incredibly active life. Through this process, he acquired a deeper understanding of health and wellness, which he now offers his patients in Tampa.