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Reactivated Epstein-Barr Virus & Long Haul COVID

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As our knowledge of COVID-19 expands, researchers have documented a significant incidence of Reactivated Epstein-Barr Virus (EBV) in patients with long haul COVID. Studies show acute COVID can cause a near-immediate triggering of reactivated EBV, while other cases show EBV reactivation several months after COVID.

EBV is the virus that causes mono, and its symptoms can complicate any already challenging recovery from COVID. Read on to discover the symptoms of Reactivated EBV, why we believe there is a connection with long haul COVID, and what to do if you suspect you're suffering from Reactivated EBV or long COVID.

Reactivated Epstein-Barr Virus & Long Haul COVID

For many, the effects of COVID are lingering. While social isolation has eased, some are still learning how to handle personal illness, economic impacts, or the sickness and passing of friends and family members. This is especially true for those suffering from what the CDC has labeled "long COVID."

Sometimes called post-COVID or long haul COVID, these persistent COVID symptoms can last for weeks or months after infection, or they can remain latent and surface down the road. Though the effects of COVID are difficult enough, the symptoms associated with long COVID can also cause the recurrence of chronic health issues.

Recent research has explored a connection between long COVID and reactivated Epstein-Barr Virus (EBV). EBV is one of the most common diseases worldwide, and people often contract the virus when they're young. Though it's possible to reactivate EBV, most people only have a serious bout with the virus once in their lifetime. However, the symptoms of long COVID are increasingly suspected to be a trigger for reactivated EBV. We have now seen this pattern with dozens of patients at The Center for Fully Functional Health.

The implications of this connection are serious and far-reaching due to the volume of EBV infections globally. Individually, patients are justified in concerns about how to protect their health. Societally, the connection between long COVID and chronic health conditions is important for estimating healthcare capacity, conducting research, and offering treatment guidance.

As public interest in the effects of post-COVID symptoms continues to grow, so do worries about the connection to long-term health issues. In this article, we'll review what EBV is, the connections between long COVID and reactivated EBV, and the hope offered to patients through holistic treatment options that treat the root causes of viral illness.

What Is Epstein-Barr Virus?

EBV is a variant of the herpes virus (human herpesvirus 4) and it's a common infection. (1) In fact, it's estimated that 95% of the population has had EBV. EBV's ubiquity is due mostly to its very easy transmission. It can be contracted through routine personal interactions like sharing a drinking glass, sexual interactions, blood transfusions, or contact with bodily fluids. EBV has the highest incidence rate in younger patients aged 15-24. (2)

EBV Symptoms

Similar to COVID, EBV symptoms are often quite general. Thankfully, the symptoms are often not severe. In most cases, EBV is treated with over-the-counter fever reducers and antiviral or anti-inflammatory supplements. Rest is essential during recovery, and physical activities are usually discouraged to prevent a ruptured spleen (swollen spleens are a core symptom). Other common symptoms include:

  • Persistent, unexplained fatigue
  • Weakness after activity
  • Sore throat
  • Swollen throat and neck lymph nodes
  • Inflammation
  • Aches and chills
  • Headaches
  • Lightheadedness

Reactivation of EBV and Its Causes

Unfortunately, EBV is a bit like a bad houseguest - it just won't leave. EBV stays dormant for a lifetime, and it can flare up periodically depending on personal health and habits. Some patients (particularly young ones) can also experience an occurrence of infectious mononucleosis after having EBV.

Though EBV typically remains latent with no further severe issues, it can be reactivated again for a few reasons. These reasons include:

  • High stress levels
  • Insufficient immune system
  • Chronic infections
  • Antibiotic treatments
  • Significant hormonal changes
  • Inflammatory conditions or toxin/mold exposure

Reactivated EBV Symptoms

Reactivated EBV can produce a variety of challenging symptoms that endure for weeks or months if not treated appropriately. Reactivated EBV also commonly brings an increased risk of additional co-infections. The Reactivated EBV symptoms our physicians see most often are:

  • Fatigue, typically chronic and often debilitating
  • Severe achiness
  • Headaches
  • Sore throat
  • Rash
  • Swollen lymph nodes
  • Swollen spleen
  • Swollen liver and/or liver dysfunction
  • Abnormally low platelet levels
woman laying on a couch with her eyes closed blowing her nose

What Is Long Haul COVID?

Long COVID, sometimes called "long haul COVID," is simply a description of persistent symptoms and an inability to fully recover from the initial infection. (3)

Initial research suggests that variants of the COVID-19 virus (e.g., Omicron, Delta, etc.) are less likely to cause long-haul cases, with some studies claiming a reduction of about 50%. (4) It's important to keep in mind that there are many factors that determine whether someone gets COVID or long COVID, including vaccination status, immune susceptibility, pre-existing medical conditions, and many others.

The research on long COVID is still developing, and it's clear that the myriad symptoms associated with COVID recovery make it hard to offer a definitive diagnosis for some patients. Also, long COVID symptoms mimic those of many other chronic health conditions. Persistent fatigue, shortness of breath, and other general health issues could be symptoms of anything from a poor lifestyle to much more acute problems.

According to the CDC, there isn't currently a test specifically for detecting long COVID (LC), but the symptoms listed below are the ones most commonly associated with LC. (5)

General Long COVID Symptoms

  • Exhaustion or fatigue that interferes with daily life
  • Symptoms that get worse after physical or mental effort (also known as post-exertional malaise)
  • Fever

Respiratory and Heart Long COVID Symptoms

  • Difficulty breathing or shortness of breath
  • Cough
  • Chest pain
  • Fast-beating or pounding heart (also known as heart palpitations)

Neurological Long COVID Symptoms

  • Difficulty thinking or concentrating (sometimes referred to as brain fog)
  • Headache
  • Sleep problems
  • Dizziness on standing up (lightheadedness)
  • Pins-and-needles feelings
  • Changes in smell or taste
  • Depression or anxiety

Digestive Long COVID Symptoms

  • Diarrhea
  • Stomach pain

Other Long COVID Symptoms

  • Joint or muscle pain
  • Rash
  • Changes in menstrual cycles

You may notice many of these symptoms are also present with Reactivated EBV, making them exceptionally severe and potentially debilitating. The crossover in symptoms can also complicate diagnosis.

How Are EBV and Long Haul COVID Connected?

Research studies on the relationship between long COVID (LC) and EBV have shown a connection between acute COVID symptoms and reactivated EBV (detected serologically). While some studies indicate that EBV reactivation can occur several months afterward, others have shown the co-presence of both viruses, which suggests a near-immediate triggering of EBV in acute COVID cases. (6, (7)

This research is still developing, and current studies are somewhat limited in scope. However, the research is strong enough that doctors now consider LC a known trigger of reactivated EBV. Clinical guidance must follow a clear understanding of the way(s) in which COVID triggers EBV, which simply hasn't been discerned.

There are a few missing links in the most recent research on LC and EBV. First, it's unclear if LC can definitively cause an occurrence of EBV viremia, meaning the presence of EBV in the bloodstream. This is a more severe form of infection.

Second, in cases where COVID and EBV are detected concurrently, it's unclear whether reactivated EBV is interpreted as symptoms of long COVID (or vice versa). (8) The degree to which EBV and LC simply exacerbate and conflate symptoms can be hard to say with certainty since the viruses operate in similar manners.

Because there is not yet a clear clinical protocol for LC and reactivated EBV, it is vital that you see an experienced Functional & Integrative Medicine physician who has treated both conditions and can formulate a treatment plan based on your personal symptoms, medical history, and laboratory test results.

functional medicine doctor consulting with a patient

When to Seek Treatment for Reactivated EBV

There isn't much clinical guidance on when patients should seek treatment for EBV after having COVID. The generality of symptoms can make this problem even more frustrating. Rather than waiting until things get serious, our guidance is a bit more proactive. Here are some simple, straightforward questions to ask yourself (or to help advise a family member or friend):

  • Did you test positive for COVID, and have you had lingering symptoms?
  • Do you know that you've previously tested positive for EBV or been diagnosed with mono?
  • Are your post-COVID symptoms causing significant reductions in your quality of life?
  • Do you wish you could regain your pre-COVID alertness and comfort levels?
  • Are you over 50? Older patients typically have a longer and more difficult recovery from COVID, and your age alone could be a good reason to seek testing and treatment.

Because most people are infected with EBV at some point during their lives (perhaps without knowing it), it's a good idea to seek testing if you suspect that it has been reactivated. This can help prevent worsening symptoms and potential complications down the road.

At-Home Treatments for Reactivated EBV You Can Start Today

There are simple and effective ways to fight EBV and LC symptoms at home before seeing a doctor or starting treatment with your medical care provider. The following list of simple home remedies can help you start feeling better and mitigate the effects of reactivated EBV or LC:

  • Take active steps to improve your sleep
  • Try breathing exercises to promote circulation, lung health, and alertness
  • Focus on healthier eating by removing common inflammatory foods (sugar, gluten, dairy) and adding in more organic, whole foods
  • Support your gut and immune system with probiotics
  • Take natural immune-boosting supplements like olive leaf extract, lysine, vitamin c, zinc, etc.

These measures are not meant to replace the care of a qualified clinician, but they can help speed recovery while you await appointments and testing.

What Testing and Treatment Recommendations Can You Expect for Reactivated EBV?

Your care provider should perform a deep dive through testing, medical history analysis, and observation to find the root cause(s) of your symptoms. This potentially includes EBV, along with other viruses like CMV or bacterial reactivation of infections like mycoplasma and chlamydia pneumoniae.

In addition to viral infections, your practitioner should also look at evidence of tick-borne illnesses, mold-related illness, hormone dysregulation/abnormalities, nutrient deficiencies, and gut health markers.

How Can Reactivated EBV Be Treated?

LC and EBV can both be combated effectively by promoting immune system vitality and addressing key factors in chronic health issues. EBV and COVID both affect mitochondrial functions, and they attack basic DNA-repairing mechanisms. Finding ways to support and boost those functions is a great first step down the treatment path - especially if they are easy, all-natural methods.

At CFFH, our approach focuses on building a foundation for long-term health. Though exact treatment methods for conditions like reactivated EBV and LC will vary based on your needs, we often follow the proven 5-step process outlined below:

  1. Identify whether EBV is reactivated through testing and look for other reasons symptoms may be occurring.
  2. Reduce stressors such as a lack of sleep with supplements and reduce reactivated infection with herbal tinctures. In certain cases, antiviral prescription medications may help, but only minimally.
  3. Optimize detoxification with the help of lifestyle changes to improve sleep and stress management, as well as detoxifying MedSpa therapies, including the Full Spectrum Sauna, Red Light Therapy, and lymphatic drainage.
  4. Support mitochondria, energy production, and hormone balance with supplementation, and provide structural support of muscles/bones/membranes with supplements, food, and movement.
  5. Personalize your treatment plan and ongoing care with a Functional Medicine practitioner.

If you're currently experiencing the symptoms described in this article, or if you're suffering from a chronic health issue, schedule your consultation with our team today to start the journey toward a holistically healthy and functional life. We'll help you understand the next steps and potential treatment options to recover a quality of life.

The Center for Fully Functional Health is located in Carmel, Indiana, and you can reach us by calling (317) 989-8463, Monday - Thursday 8AM to 5PM Eastern, or by filling out the contact form at the bottom of this page.



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