Epstein-Barr Virus is one of the most prevalent, insidious health problems we face as a society. In fact, according to the CDC 9 out of every 10 adults (1) have antibodies indicating a past or current EBV infection. As a functional medicine expert, I have seen EBV as the driving force behind many of my patients chronic health problems with researchers continuing to find links between EBV and the development of many of our modern day chronic health problems. 

So, even though we don’t fully understand the mechanisms behind EBV one thing is for certain: we can’t ignore its obvious impact on our overall health. I may even go as far as to say if we don’t give EBV the weight it deserves in our medical system, we are in for an epidemic of chronic illness even more so than we already face. But what exactly is EBV and how do you know if you have it? Let’s find out.

What is Epstein-Barr Virus (EBV)?

Epstein-Barr Virus (EBV) is a pervasive and persistent virus that affects a significant portion of the global population. As a member of the herpesvirus family, EBV establishes lifelong infection in the human body that can lead to a range of health problems years after the initial infection. EBV spreads primarily through saliva and infects epithelial cells and B lymphocytes upon entering the body. Most initial infections occur during childhood or adolescence and often go unnoticed or present as mild cold-like symptoms. 

Epstein-Barr Symptoms

Epstein-Barr Virus infection can manifest in various ways, ranging from mild or asymptomatic to more severe symptoms, depending on your individual immune response and the stage of infection.

1. Mononucleosis (Mono)

This is the most commonly recognized manifestation of EBV infection as it is the only manifestation to include obvious symptoms with initial infection. These symptoms often appear 4 to 6 weeks after exposure to the virus and typically include:

• Fatigue and weakness that can persist for weeks or months
• Sore throat
• Swollen lymph nodes in the neck and armpits
• Fever
• Headaches
• Enlarged spleen or liver (that may also cause abdominal pain)
• Loss of appetite
• Rash
  

2. Asymptomatic or Mild Infection

Most individuals infected with EBV don't experience any symptoms at all or only mild symptoms that resemble a common cold or flu. Since they may not be aware that they have been infected with the virus, it can make a diagnosis of a dormant infection becoming active later down the line more difficult.

3. Chronic Epstein-Barr 

For some people, an initial EBV infection can turn into a rare, progressive condition known as Chronic Epstein-Barr Virus Infection Syndrome (2) that can last for 6 months or more, sometimes indefinitely. When this happens, it prompts your body to produce an excessive amount of lymphocytes - a type of white blood cell crucial for healthy immune function - that can lead to symptoms like fever, swollen lymph nodes, anemia, low platelet numbers, liver dysfunction, enlarged spleen, and an increased risk of other infections.

The problem with EBV

What distinguishes EBV from other viruses is its ability to persist in the body for life. After the initial infection, the virus remains dormant within B cells, capable of reactivation under certain circumstances. When this happens, it can result in a variety of chronic health conditions including autoimmune diseases and an increased risk of developing certain cancers.

Because of its dormant nature, EBV can be difficult to diagnose. Unless you have a doctor that is familiar with EBV and understands how it works (unfortunately, this is an area where most mainstream medical doctors lack) you can go years without getting to the real cause behind your health problems.

Health problems associated with EBV

Researchers have found EBV to be a trigger for the development of multiple health problems. While this is not an all-encompassing list, these are a few of the most clinically-studied health problems associated with EBV infection.

1. Multiple sclerosis

Multiple clinical studies (3) have shown a clear connection between EBV and the development of multiple sclerosis. One study in particular published in the journal Science, (4) found that the risk of developing MS increased 32-fold after EBV infection. What’s even more shocking? Multiple sclerosis risk was not increased if people were infected by other viruses. 

2. Lupus

This chronic autoimmune condition can affect multiple areas of the body including joints, skin, kidneys, blood cells, lungs, brain, and more resulting in fatigue, joint pain, rash, and fever. Research has long shown that EBV infection almost always precedes (5) the onset of lupus, with studies finding that EBV can promote the survival of autoreactive B lymphocytes and the production of interferon-a - two mechanisms closely involved with the development of this autoimmune condition.

3. Rheumatoid arthritis

Rheumatoid arthritis is one of the most common autoimmune conditions and is heavily triggered by EBV infection, with research showing that those with RA consistently have higher EBV antibody levels (6) than those who don’t have this condition.

4. Chronic fatigue syndrome

Chronic fatigue syndrome is a persistent and debilitating condition that is widely misunderstood and is often accompanied by other symptoms like muscle pain, headaches, and memory problems. While the exact connection between EBV and CFS is still being studied, a recent study (7) found that 38-55% of patients with CFS also had the EBI2 gene which is induced by EBV infection and is connected to a variety of autoimmune diseases.

5. Hashimoto’s thyroiditis

A 2015 Polish study (8) looked at the ability of EBV to “hide” in the thyroid and, once reactivated, stimulate the immune system to attack the thyroid, triggering autoimmune thyroid problems or Hashimoto’s disease, which is another common cause of fatigue.

6. Cancer

Studies have found that EBV infection is associated with certain types of cancers, particularly rare ones involving the lymphatic system like Hodgkin’s lymphoma, Burkitt’s lymphoma, (9) and nasopharyngeal carcinoma. (10)