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The Pesky, Problematic Viral Infection Known as Epstein-Barr

"This infectious and potentially harmful viral infection known as the Epstein-Barr virus is something we're still studying and learning about."

If you went to a public middle or high school, you probably remember the dreaded condition called Mono which could linger for weeks. It’s sometimes referred to as the “kissing disease” because that’s one of the ways this extremely infectious condition could spread. What many of us don’t know is that the virus that causes this condition — the Epstein-Barr virus — is extremely common and the vast majority of us will be exposed to it at some point. Today, Dr. Keller Wortham, MD, will shed some light on this pernicious virus, some of the issues it can cause, and steps we can take to minimize its harmful effects.

Video Highlights 

  • 01:03: Mononucleosis
  • 02:02: What is the Epstein-Barr Virus?
  • 04:38: When Epstein-Barr is More Serious
  • 06:03: Recognizing Epstein-Barr
  • 08:18: The Role of Epstein-Barr in Other Conditions
  • 11:08: What Can We Do?
  • 13:59: Wrap-Up


If you or someone you knew developed the dreaded kissing disease in middle or high school, you may remember some of the symptoms: it could cause intense fatigue, leaving you tired for weeks. It could even result in spleen issues that prevented some students from participating in sports for more than a month.

This condition was known as “mono”, an abbreviated version of “Infectious Mononucleosis,” so named because of what happens to certain white blood cells during the course of the infection. Mono is caused by a particular virus known as the Epstein-Barr virus, or EBV for short. 

What is the Epstein-Barr Virus?

EBV is one of the most ubiquitous viruses on the planet. It's estimated that 85 to 90% of all humans will come down with or be exposed to Epstein-Barr. Part of this is because this virus tends to cause infections very easily, and is transmitted from one person to another easily. Exchanging bodily fluids like saliva is one of the ways this occurs, hence the name, “the kissing disease” although it can also be transmitted by sharing food and drinks, or even just by close proximity with someone. 

So, this pesky virus is transferred very easily through saliva and other things like that, and it can cause a latent infection. When you have a latent infection, you might not have symptoms of for months — so you go around feeling fine, and transferring it to other people. Eventually, maybe a month later, you may start to come down with symptoms. Because it’s spread in such a sneaky way, it can easily be transmitted across a large population. 

The good news is that unlike some of the very dangerous viruses out there like HIV or hepatitis, Epstein-Barr virus typically doesn’t have severe consequences. We can think of it like some of the herpes viruses — the ones that give you herpes labialis, which is the typical kind of oral herpes. In fact, Epstein-Barr virus is related to the herpes virus — it's not exactly the same, but it's in the same category of viruses. It's actually known as herpes virus number four. 

So even though this virus is transmitted very readily and widely across the population, it usually doesn't cause a devastating consequences. You might not even know you had the Epstein-Barr virus, and it doesn’t always cause mono. You might just experience some vague symptoms such as feeling a littletired, or worn out, a sore throat, swollen glands, or a swollen spleen, which is why (as we mentioned previously) you shouldn’t participate in contact sports if you're afraid that you have an Epstein-Barr virus infection. But in general if you have it, you’ll feel sick for a little while, recover, and then move on. 

When Epstein-Barr is More Serious

That being said, there are some people who get Epstein-Barr virus infections that are much more robust. It’s believed that the older you are when you get your exposure, the worse it can be for you and your body. In this way it’s a bit like with chickenpox; if you get chickenpox when you're really young, it might cause a very mild infection. But if you don't have and you get it much older, chickenpox can cause a pretty serious infection on people. 

Those who get a serious Epstein-Barr viral infection can experience more serious issues, like inflammation of theliver or hepatitis. They may have things likeanemia, low blood cell counts, or thrombocytopenia, which is low platelets. They may get meningitis, or myocarditis, which is inflammation in the tissues of the brain and heart respectively. So, these are a lot of things that can be quite serious and really put you down for the count. 

So the symptoms can range from super mild to extreme,long-lasting fatigue. It’s not entirely clear why this happens — it might be related to how old you are at the age of transmission, and part of it might have to do with your own immune system, genetics, and the genetics of the particular EBV strain you contracted. 

Recognizing Epstein-Barr

So, how do you know if maybe you've come down with Epstein-Barr virus or mono, and need to be screened for some of these potentially more serious things? 

Fortunately, your doctor can easily detect it on a blood test. The blood test looks at antibodies, which are are your immune responses, to different elements of the virus. Examining the antibodies to different elements of the virus can help us map out whether you have the infection, how long ago you got it, and whether it’s in a chronic active state, or more of a dormant state. 

There are three particular antibodies that we look for. 

  • The first is known as theviral capsid antibody. There are two kinds of this antibody: IgM, which come on right at the beginning, and then taper off, and then IgG antibodies which are your long-term coverage for years to come. So if we look at the test and there is IgM present, it means that you probably just got the infection. But if they've gone away and you've got IgG, it means you've been exposed in the past, but you're probably not in danger anymore. 
  • The second antibody we can look at is called theearly antigen. The early antigen is something that your antibodies do that spikes very early in the disease, and then slowly tapers off. So, again, we can use that to see whether you are still in a very early stage of the infection, or are you further past it. 
  • The third thing we can look at is something called thenuclear antigen. The nuclear antigen doesn't come on right away, but slowly escalates as time goes by. 

So, looking at the combination of those antibodies to those different proteins that are part of the virus, we can kind answer a few questions: Did this person just get this infection? Are we worried about it being active now? Have they had it in the past and therefore, have some immunity towards a new infection? And then if they have had this infection in the past, does it look like it's still activating or reactivating, or does it look like it's still dormant? 

The Role of Epstein-Barr in Other Conditions

The Epstein-Barr virus is a pesky one like some of the other herpes viruses, in that it can lay dormant in your body for many years and it can come up to get you in the future. Unfortunately when Epstein-Barr virus reactivates or when it causes changes to the cells, it can lead to some pretty serious consequences. And, honestly, we're still learning about how Epstein-Barr plays into different diseases. 

It is thought that Epstein-Barr plays a role in many nasopharyngeal cancers — cancers of the nose and throat. It may also play a role in some lymphomas (blood cell cancers), which makes sense because EBV attacks the white blood cells. It can also be involved in some gastric cancers. These can occur years after exposure to the virus, so you could be experiencing cancers when you’re an adult that are the result of viral infections you may have had as a teenager. 

In addition to cancers, Epstein-Barr has been implicated in autoimmune disorders. What sometimes happens is that you get a virus, and your immune system does what it's supposed to, and tries to fight off the virus. But sometimes the activity of your immune system can cross-react and start attacking parts of your body. That's why we call it autoimmune — it's your immune system attacking itself. It’s believed that Epstein Barr might be related or be one of the causes of things likelupus (an autoimmune disorder), rheumatoid arthritis, multiple sclerosis (a neurological disorder), inflammatory bowel disease, type 1diabetes, andthyroid disorders like Hashimoto's. 

So there’s a whole array of autoimmune disorders that can be related to this one viral infection, even though at first it may not have any symptoms at all. 

There’s also a situation in which the virus can wake up from its dorman state, and cause a long-term chronic infection. This is rare, but it does happen. Once again, blood tests can help confirm if you have a reactivated Epstein-Barr infection that is actively causing chronic issues and inflammation. If that's the case and it's confirmed by blood tests, you can try certain antiviral medications to help suppress the virus. But it's not known if those same antiviral medications can help with some of the other autoimmune disorders or cancer disorders once they've actually started. 

What Can We Do?

All of this sounds pretty scary, we know... what seems at first like a pretty benign infection you may have had when you were much younger resulting in these serious conditions. So, the question is, what can be done about a virus that is everywhere, and is so easily transmissible? The unfortunate news is, there’s not a lot that youcan do. You could avoid kissing anyone or ever sharing food or drinks with people. But if 90% of the population has it, that's going to be pretty difficult. 

Probably the best thing you can do is help your immune system be as robust as possible, and take steps to reduce inflammation in your body that might lead to some of these inflammatory conditions, make autoimmune diseases worse, or promote cancers. 

  • Reduce Stress in Your Environment — this is really important for reducinginflammation and boosting your immune system. 
  • Get Quality Sleep — Sleep is a major component inboosting immunity, so make sure you are gettingquality sleep for eight hours every night to protect your immunity and reduce inflammation. A lot of the biological processes that happen within our body when we're sleeping are very protective. They can help reduce cancers and autoimmune disorders. 
  • Exercise — In addition to getting adequate sleep, get adequateexercise as well. It’s super important for improving immunity. 
  • Diet— last but certainly not least thing is make sure you're eating a healthy diet — especially one that's rich invitamins andminerals, and that typically means aplant-based diet. We get a lot of our vitamins and minerals from vegetables, fruits, seeds, and nuts. Incorporate foods like spinach, prunes, blueberries, cocoa powder, bananas, carrots, and pears into your diet. These are all things that are very rich in vitamins and minerals. 

If you don't think you're getting enough vitamins and minerals in your actual diet, you can also take a multivitamin.Smarter Nutrition's Multivitamin includes vitamins and minerals derived from a lot of the foods we just listed. They are derived from organic food sources, which means they absorb better and are better for your body than synthetic vitamins and minerals found in many traditional multi tablets. This multi is also formulated based on research to help you ensure you get the right amount of nutrients in your diet — not overdoses or underdoses.


This infectious and potentially harmful viral infection known as the Epstein-Barr virus is something we're still studying and learning about. It's everywhere, and there's not much you can do to avoid it. But if you want to reduce your risk of developing some of the dangerous things that could come with it, like cancers, autoimmune disorders, and chronic infection, then make sure you increase your odds by making healthy lifestyle choices: getting adequate sleep, adequate exercise, and a diet rich in vitamins and minerals supplemented by a multivitamin.

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