Addressing Hidden Viral Infections in CFS/FMS Can Sometimes Be Helpful
Used with permission from the book: "From Fatigued to Fantastic!" 3rd edition (Penguin/Avery October 2007)
People with CFS/FMS are at high risk of having multiple viral and antibiotic sensitive infections because of their immune system dysfunction. That people usually have not just one, but several, infections simultaneously is significant. It suggests that although these infections may be a trigger for the illness in some cases, most of the infections occur because of the illness, setting you up for multiple and sometimes unusual infections that persist. These infections may then drag you down, further suppressing your immune system.
Fortunately, most people improve (and often get very healthy) by simply addressing sleep, hormonal, nutritional, and yeast problems. Once these areas are addressed, your body can often eliminate many persistent infections by itself. Some people, though, have infections that need therapy with antivirals and/or antibiotics, and almost all folks with CFS/FMS need anti-fungals (candida) therapy.
How can you tell if you need such therapies?
I would consider antiviral (and/or antibiotic) therapies if the following symptoms persist:
- Predominantly flu-like symptoms, with debilitating fatigue and little or no pain or fever. People with these symptoms are more likely to have an underlying persistent viral infection, such as HHV-6, CMV, or EBV.
- A fever over 98.6°F (even 99°F) and/or lung congestion, sinusitis, a history of bad reactions to several different antibiotics (people misinterpret this "die-off" reaction as being an allergic reaction), scabbing scalp sores or other chronic bacterial infections. People with these symptoms seem to be more likely to have bacterial, mycoplasma, or chlamydia infections that respond to special antibiotics.
Let's look at chronic viral infections and how to approach them.
Human herpes virus type 6 (HHV-6) is a virus that is related to the Epstein-Barr virus (EBV), cytomegalovirus (CMV), and also to the herpes viruses that cause cold sores and genital herpes. All of these are in the Human Herpes Virus family and stay in the body (usually in an inactive latent form for EBV, CMV, and HHV-6) for the rest of your life. Usually HHV-6 is transmitted like the common cold, and most adults have had HHV-6, as well as EBV and the cold sore virus, by the time they are twenty years old.
The problem with lab testing for infections in CFS
Unfortunately, there is no test that clearly distinguishes old dormant infections from viral reactivation. When you first have an infection, antibodies in the IgM family ("M" antibodies are like your bodies storm troopers) are elevated for 6-12 weeks, which indicates to doctors that you have an active new infection. After that time, the IgM test will be negative. The IgG antibody levels then stay elevated ("G" antibodies are like regular troops, suppressing the latent infection) for the rest of our lives. Because of this, when you check the standard IgG antibody testing almost everybody (including healthy people) tests positive for EBV and HHV-6 and many will test positive for CMV. That the IgG test is elevated, however, does not tell you if you have an active infection because of viral reactivation or simply an inactive, dormant infection. Other tests available to your doctor, such as PCR testing, are also still unreliable for a number of reasons and the IgM test will not be positive in the vast majority of those with reactivated viral infections.
Nonetheless, these infections are common in CFS, and the available IgG test may still offer useful information. Unfortunately, despite all of the data to the contrary, most doctors are not familiar with the research and still mistakenly think a negative IgM antibody test confirms that there is no active infection. Because most physicians are not aware of this research, and it may be important for your doctor to know about, I invite the more scientifically oriented reader to read Sidebar 1: "Research on Viral and Antibiotic Sensitive Infections in CFS/FMS."
Sidebar 1 - Research on Viral and Antibiotic Sensitive Infections in CFS/FMS
• A study by Dylewski et al in the New England Journal of Medicine demonstrates that in immune compromised patients, as occurs in CFS/FMS, active infections correlate with elevations in IgG antibodies without elevations of IgM antibody and that a lack of elevation of IgM is not useful in these patients as a way to rule-out active infection. A high clinical suspicion must be maintained and implementation of anti-infective therapy should be based on elevated IgG levels.22
• In addition to mycoplasma, numerous studies have also demonstrated other bacterial and viral infections such as EBV, CMV, HHV-6, and enterovirus in CFS and FM patients that cause or contribute to the symptoms. The research also demonstrates that these infections are present and that an active infection correlates with an elevated IgG antibody, despite the lack of IgM antibodies.22-33 As with mycoplasma infections(see below), because these infections are generally not acute but rather reactivation of an old infection, an elevation of IgM antibodies is typically NOT seen with active infections of EBV, CMV, HHV-6, Borrelia (Lyme) and enterovirus.23-33 Because of the immune dysfunction seen in CFS, there may even be a lack of IgG antibodies present despite the presence of an active infection.30,34,35
• Immune suppressed patients have also been shown to be helped by anti-viral therapy in a number of studies.36-40
• It is clear that multiple infections are present in CFS/FMS patients. For example, one study found that 52% of CFS patients had active mycoplasma infection, 30.5% had active HHV-6 infection, and 7.5% had Chlamydia pneumonia infections vs. only 6%, 9% and 1% of healthy people, respectively. They conclude, "The results indicate that a large subset of CFS patients show evidence of bacterial and/or viral infection(s), and these infections may contribute to the severity of signs and symptoms found in these patients."41
Unfortunately, despite all of the data to the contrary, most doctors are not familiar with the research and still mistakenly think a negative IgM antibody test confirms that there is no active infection. Getting past the misconception that these infections are not active if the IgM test is negative is important, as we finally have therapies that are effective against many of these infections. Let's look at some of the more important ones.
A reactivated HHV-6 viral infection is present in many patients with CFS. A study in the Annals of Internal Medicine found 70 percent of patients with CFS had active HHV-6 infection.42 In another study of HHV-6 in CFS patients, 89 percent with very high HHV-6 IgG antibody levels of 1:320 and above were found to have active infections by cell culture. To compare, most healthy adults with an old, inactive infection have levels of 1:40 to 1:160. Though not all of the studies were able to document the infections, as CFS expert and Harvard Professor Anthony Komaroff notes in his recent review "the great majority of studies have found evidence of active replication of HHV-6 more often in patients with CFS than in healthy control subjects."43
When HHV-6 is present, it seems to affect the immune system's natural killer cells that are critical in fighting infections and are also often malfunctioning in CFS. Natural killer cell function is described in what is called lytic units, which means the ability of cells to lyse, or break down, foreign invaders. An average person has a lytic unit level of 20 to 250, with over 80 percent of healthy people having more than 40 units. However, in people with CFIDS, the mean natural killer lytic unit level is just 12 units. With your immune system so low, the reactivated HHV-6 can then also cause reactivation of the Epstein Barr virus. In addition, both HHV-6 and EBV can suppress immune function, and HHV-6 can suppress your body's ability to fight fungal/yeast infections as well.
Natural Immune Boosters and Antivirals
Thymic protein A is an excellent natural immune stimulant. Although not a hormone, thymic protein A mimics the natural hormone produced by the thymus, the gland that stimulates the immune system. I find it to be extraordinarily effective in fighting common acute infections of any kind that seem to pop up and recommend it be in everyone's medicine cabinet. In fact, whenever my kids get a cold, the first thing they say is "Dad, where's the white powder?" (the thymic protein)!
Although taking it for 1 to 3 days will quickly eliminate most acute infections, for the chronic infections of CFIDS, 1 packet three times a day for 3 months is needed. In one study, this dropped EBV IgG levels by 70 percent after 3 months in CFS patients.
Some other excellent immune boosters include:
- Leuko-Stim. This mix mostly stimulates immune function, but the olive leaf may also have anti-viral properties. It contains Olive Leaf Extract, Beta 1,3, Glucan, Maitake Mushroom Extract and Arabinogalactan (Larch).
- Maitake D Fraction 30. Contains 330 mg of maitake mushroom and extract (an immune stimulant).
- Anti-Viral. This natural combination contains a mix of Milk Thistle Extract (80 percent Silymarin), Phylanthus amarius, Phylanthus uraria, Monoammonium glycyrrhizinate, L-Lysine, N-Acetyl L-Cysteine, Astragalus Herb Powder, Lactoferin, Olive Leaf Extract, Dionea (Venous Fly Trap extract), and Selenium (Selenomethionine).
If a chronic viral or bacterial infection is suspected, consider addressing it with three months of Anti-viral regimen, Leuko-Stim or Maitake, plus thymic protein. Adding the silver solution may also help. These natural supplements can be taken on their own or with antibiotics and antivirals. Though these are more expensive than many other natural supplements, they can be very helpful in fighting these infections and are well tolerated. You'll see effects from therapy in about three months.
- Lysine is an amino acid (one of the building blocks of protein) that inhibits oral and genital herpes viruses by depleting arginine, another amino acid that the virus needs to grow. It is not known whether Lysine also inhibits EBV, HHV-6, or CMV, but these viruses are all members of the herpes family. Lysine is safe and inexpensive. The recommended dosage is 1,000 milligrams three times a day. Arginine is used by the body to make both nitric oxide and growth hormone. Decreasing arginine may therefore also decrease excessive nitric oxide activity in CFS. The down side is that it may also decrease Growth Hormone—which is too low in CFS. Because of this, it may be reasonable to take Lysine for 6 months, but I would not use it long term in CFS.
- Another therapy that may be helpful is vitamin C. High doses of 15 to 50 grams of vitamin C, administered intravenously, are often dramatically helpful for CFS when given in the intravenous nutritional therapy your doctor may administer called Myers Cocktails or Standard IVs (available at many Holistic physicians' offices).
- In addition, your clotting system may be activated by several infections, making it difficult to eliminate the viruses. Using the anti-clotting therapy can also make it easier for your body to eradicate infections.
Sidebar 3 - Natural Antiviral Therapies Available by Prescription
There are two therapies that deserve special mention. The first is a natural anti-viral derived from animal livers. Called Nexavir (formerly sold as Kutapressin), it is given by daily injection, either subcutaneously or intramuscularly. In my practice, I have seen dramatic improvement with regular use of the Nexavir. However, daily injections are a must, and the few patients who only used it three times a week did not get much, if any, benefit. The downside is that it costs $19 a day, and the symptoms may return when the injections are discontinued.
The second natural prescription therapy is gamma globulin. These are the actual antibody infection fighters derived from the serum of numerous blood donors. The serum is first altered to kill off any infections the donors may have had and then the antibodies are harvested. Although these antibodies can be helpful against both bacterial and viral infections, in patients with latter we have seen a die off reaction (initial flaring of symptoms) with each injection of gamma globulin. I am now advising patients to start with the Nexavir first and add the gamma globulin 1-3 weeks later. I recommend 2 cc be given intramuscularly weekly or 4 cc IM every other week for 6 doses, and then as needed. Although it can also be given through an IV, this delivery method is very expensive and does not seem to bring any additional benefit.
Antibiotic Sensitive Infections Such as Mycoplasma, Chlamydia, and Lyme Disease
Though beyond the scope of this article, this issue is discussed at length in my books. Research by Dr. Garth Nicolson and his wife, Nancy L. Nicolson, has shown that a number of antibiotic sensitive infections, including Mycoplasma and Chlamydia, can be important in CFIDS. These microorganisms can cause persistent infections and have similar characteristics. Mycoplasma are a type of ancient bacteria that lack cell walls and are capable of invading a number of types of human cells. They can cause a wide variety of human diseases. These organisms can cause the types of symptoms seen in people with CFIDS and, according to Dr. Nicolson, tend to be immune-suppressing. Unfortunately, they cannot be readily cultured on a culture dish. They are sensitive to antibiotics though.
Jacob Teitelbaum, M.D. is one of the world's leading integrative medical authorities on fibromyalgia and chronic fatigue. He is the lead author of eight research studies on their effective treatments, and has published numerous health & wellness books, including the bestseller on fibromyalgia From Fatigued to Fantastic! and The Fatigue and Fibromyalgia Solution. Dr. Teitelbaum is one of the most frequently quoted fibromyalgia experts in the world and appears often as a guest on news and talk shows nationwide including Good Morning America, The Dr. Oz Show, Oprah & Friends, CNN, and Fox News Health.