Like most health conditions, Hashimoto’s has no single cause.
It is the result of the perfect storm of factors that include a genetic predisposition, exposure to some pathogen (often a herpes virus), the breakdown of the gut and barrier systems (without or without the help of gluten), exposure to gluten, environmental toxins like radiation, mercury and other toxic chemicals and often, some particularly stressful event.
In this post we explore one of those causes, the herpes virus.
As many of you know, I have Hashimoto’s and have made it my life’s work to understand everything I can about the causes, treatment and management of this disease.
I also have herpes simplex 1 (along with 90% of the population). While this is not a life threatening disease it can be the cause of shame and embarrassment, especially when I get a more serious outbreak on my face or lips.
As a health care practitioner, there are times when having an outbreak of herpes has made me feel like I’m not very good at my job because it can look much worse than it is.
But the reality is that there are few other biological entities as resilient and unstoppable as the herpes virus. All the technology at our disposal is pretty useless when it comes to trying to eradicate this infection.
And I suppose one blessing of having it is that I can not venture too far from the things I know I need to do to stay healthy. The virus will rear it’s ugly head and remind me to get back in line.
In addition, one thing I have observed in my own life is that an outbreak of herpes can also affect my Hashimoto’s, resulting in a debilitating double whammy that can affect me emotionally, physically and psychologically.
So I thought I would explore this in more depth, and look at the relationship between herpes and Hashimoto’s. You may be surprised by the information and the impact that these various herpes diseases can have.
There are 8 different herpes viruses known to infect human beings. These include herpes simplex 1 & 2, varicella zoster (which causes chicken pox) also known as herpes 3, Epstein Barr virus (herpes 4), Cytomegalovirus (herpes 5), Human Herpes Virus 6 & 7 and Human Herpes Virus 8 found in people with complications due to HIV.
While the whole herpes family is believed to be linked to autoimmune disease, there is more research into the link between herpes simplex 1 & 2, Epstein Barr, and Cytomegalovirus and autoimmune thyroid disorders like Hashimoto’s.
The common factors that unite them is that all of them remain in the body forever, they can remain dormant for years and then get reawakened (often by stress or stressful events) and they all have the potential to do harm to the brain because the herpes virus has an affinity to nerve tissue.
Herpes simplex virus (HSV) infections are very common worldwide. HSV-1 is the main cause of herpes infections on the mouth and lips, including cold sores and fever blisters. It is transmitted orally (through kissing or sharing drinking glasses and utensils). HSV-1 can also cause genital herpes, although HSV-2 is the main cause of genital herpes.
HSV-2 is spread through sexual contact. You may be infected with HSV-1 or HSV-2 but not show any symptoms. Often symptoms are triggered by exposure to the sun, fever, menstruation, emotional stress, a weakened immune system, or an illness (like Hashimoto’s).
While most herpes infections do not cause serious complications, infections in infants and in people with weakened immune systems, or herpes infections that affect the eyes, can be life threatening. In addition, herpes virus attack nerves so they can do damage to the brain by attacking the ganglia.
In fact, Herpes simplex encephalitis (HSE) is an acute or subacute illness that causes both general and focal signs of cerebral dysfunction. Brain infection is thought to occur by means of direct neuronal transmission of the virus from a peripheral site to the brain via the trigeminal or olfactory nerve. The exact pathway is unclear, and factors that precipitate HSE are unknown.
Epstein-Barr is the virus that causes mononucleosis and is part of the herpes family. Even if you didn’t come down with it in high school or college, you were very likely infected with it, an estimated 95% of US adults have been infected with this virus.
It can present without any symptoms and has been linked to both Hashimoto’s and Graves’ disease. In my own patient population about 80% of the people I have worked have been diagnosed with EBV.
I surveyed our Facebook group and asked how many also had the Epstein Barr virus. Of the 131 (and counting) people with Hashimoto’s who responded 85% were aware that they had been exposed to the Epstein Barr virus.
This is obviously not a rigorous study, but it does show you just how prevalent this infection is in this patient population.
It has also been linked to other autoimmune diseases, such as Multiple Sclerosis, Lupus, and Sjogren’s syndrome. In addition, both fibromyalgia and chronic fatigue syndrome are also linked to EBV.
Epstein Barr can also lead to inflammation of the brain (viral encephalitis). This is a serious concern with Hashimoto’s because it can also have a profound impact on the brain and this inflammation has the potential to lead to neurodegeneration and cognitive decline.
Most people infected with CMV do not have any symptoms. Acute CMV infection can cause mono-like symptoms such as fever, enlarged lymph nodes, sore throat, muscle aches, loss of appetite and fatigue.
In people with compromised immune function, CMV infections can attack different organs and systems in the body and can lead to blurred vision and even blindness (CMV retinitis), lung infection, diarrhea, inflammation of the liver, inflammation of the brain (encephalitis). In more severe cases it can lead to behavioral changes, seizures and coma (again highlighting the impact of the virus on the brain).
It is not believed that the herpes viruses directly cause autoimmune disease. But they do play a part in it’s initial onset and progression and they can certainly make symptoms more intense and be a barrier to healing and feeling better.
There are many reasons for this and I will discuss them in a moment, but first let’s take a look at antigens and antibodies so that you can understand how these viruses cause problems in the body.
Antigens Trigger an Immune Response, Antibodies Bind to Antigens
An antigen is a substance that produces an immune response. So for example, foreign substances such as chemicals, bacteria, or viruses are all considered antigens. Foods can also be seen as antigens by the immune system.
However, an antigen can also be produced inside of the body, and even the tissue cells can be considered to be an antigen at times, which is what happens with autoimmune conditions such as Graves’ Disease and Hashimoto’s.
An antibody is a protein which is produced by the immune system, and this antibody binds to a specific antigen. Once the antibody binds to the antigen other immune system cells (i.e. macrophages) attempt to engulf and destroy the antigen.
There are number of theories about the different mechanisms that can lead viruses to trigger autoimmune disease. A couple examples are: direct bystander activation, and molecular mimicry.
Direct bystander activation: This describes an indirect or non-specific activation of autoimmune cells caused by the inflammatory environment present during infection. Think of this as being in the wrong place at the wrong time, just like being caught in a drive by shooting.
In this case, one part of the immune system becomes activated and this turns on other parts which can kill both viral-infected cells, and healthy cells as well.
So, for example, virus-specific T cells might migrate to the areas of a viral infection, and when these T cells encounter virus infected cells they sound the alarm and release immune proteins (called cytokines), which not only kill the infected cells, but also leads to “bystander killing” of other healthy cells nearby.
Molecular mimicry: This is a process where a foreign antigen shares an amino acid sequence or has a similar structure to self-antigens. So for example, a certain virus can have an amino acid sequence that is very similar to the amino acid sequence of human cells.
This can result not only in the production of antibodies against the virus, but can also lead to auto-antibodies against the human cells due to the similarities in the proteins.
Something else that can occur is that viral fragments can attach to human tissue and result in a hybrid that is part virus and part human and this can also be attacked by the immune system.
The mechanisms mentioned above really the end of a series of potential steps that lead to autoimmunity. There are some interesting theories about how this happens. This matters because if we can figure out how it is happening, it can help us figure out what how to treat it.
And what’s also interesting is that this same process takes place with all herpes viruses, it’s not unique to the ones that we’re looking at as examples.
It Starts with CD8+ T-cells
CD8+ T-cells are a kind of cell which inhibits viruses. Basically, once activated they kill bad cells.
Cells which viruses have infected are one example. These cells will be used by the virus to make more virus, so they must be killed by the immune system.
Having a deficiency of them is a common characteristic of virtually every chronic autoimmune disease (including: multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, Sjögren’s syndrome, systemic sclerosis, dermatomyositis, primary biliary cirrhosis, primary sclerosing cholangitis, ulcerative colitis, Crohn’s disease, psoriasis, vitiligo, bullous pemphigoid, alopecia areata, idiopathic dilated cardiomyopathy, type 1 diabetes mellitus, Graves’ disease, Hashimoto’s thyroiditis, myasthenia gravis, IgA nephropathy, membranous nephropathy, and pernicious anaemia).
Some scientists believe that this CD8+ T-cell deficiency may be partially responsible for the formation of these chronic autoimmune diseases, as well. And one reason is that they aren’t able to control the Epstein-Barr virus (EBV) or other herpes infection.
If EBV isn’t controlled, it can cause all kinds of problems in the body. When EBV infects B cells it can make them “auto-reactive”, which means its products (antibodies) target our own tissues.
According to a paper called “CD8+ T-Cell Deficiency, Epstein-Barr Virus Infection, Vitamin D Deficiency, and Steps to Autoimmunity: A Unifying Hypothesis” by Michael P. Pender, one theory is that autoimmunity occurs in the following steps:
1. First you have CD8+ T-cell deficiency – this has a genetic component.
2. Then, EBV (or other herpes virus) infection and spread of EBV because of CD8+ T-cell deficiency (there aren’t enough of these cells to kill these virus infected cells).
3. Increased antibodies against EBV (kind of like a second line of defense), your body responds and tries to bring in more help.
4. EBV infects a specific organ – and, particularly, B Cells in that organ. This corrupts the B cells to attack our own tissue. (One theory is that since viruses and bacteria have proteins similar to our own proteins, we mistakenly attack our own proteins. This confusion by our immune system is the ‘molecular mimicry’ I described above.)
5. B Cells proliferate in the infected organ (your antibody numbers increase)
6. T cells are drawn into the organ and also attack our tissue. Antibodies signal the attackers.
7. Development of ‘structures’ in the target organ, which causes B cells to attack our tissues. (This is dependent on Th17 cells ) This process repeats and builds on itself.
Some common factors that push autoimmunity are:
Low Vitamin D
High Chronic Stress
Low Vitamin D
Vitamin D and sunlight are very important for CD8+ T cells production, which may explain why countries that get less sunlight have a higher occurrence of autoimmunity. People with Hashimoto’s commonly have low Vitamin D levels.
Estrogen also decreases CD8+ T cells, which may explain the higher incidence of autoimmunity in females. Women with estrogen dominance and/or impairment of detoxification pathways in the liver may have too much circulating estrogen and this can cause problems with the immune system.
High Chronic Stress: High Cortisol/Low Pregnanolone
Chronic stress can cause reactivation of EBV, probably by downgrading the TH1 immune response. (TH1 are T helper cells that sound the alarm and also induce destruction. They are like the elite soldiers of the immune system.)
When you have chronic stress, your body keeps pumping out cortisol. Cortisol is made from cholesterol and a hormone that helps make cortisol is known as pregnenolone.
Pregnenolone is a neurosteroid and is important in the creation of other hormones like cortisol.
When your body is under constant stress (which is the state of living with an autoimmune disease like Hashimoto’s) and needs to keep producing more and more cortisol something called the “pregnenolone steal” can happen.
This is where cortisol is ‘stealing’ or diverting pregnenolone for cortisol production and depleting it. When pregnenolone is depleted, there will, of course, be less of it to produce more cortisol in the future.
Viruses Hijack the Mevalonate Pathway
When a viral infection becomes active it takes control over what’s known as the “mevalonate pathway.” Viruses use this pathway to make their protective outer coats.
In answer to this, your body makes interferon, which shuts down the mevalonate pathway, which in turn suppresses the virus. However, inhibiting this pathway may also lead to a reduction in synthesis of pregnenolone and Co-enzyme Q10 (which also may be depleted in Hashimoto’s).
One of the most common viruses that causes this pathway to be inhibited is Epstein-Barr Virus (EBV).
There’s also another problem.
When you’re under high stress the body releases cortisol, which suppresses your immune system.
Specifically, the TH1 (or T Helper 1) part of the immune system is suppressed by chronic stress. This aspect of the immune system (Th1) protects us from viral reactivation. Cells and proteins in this family sound the alarm and kill viruses.
When this part of the immune system is suppressed, viral infections can then reactivate- including EBV, herpes and a host of other viruses.
What’s really interesting about this is that Hashimoto’s was originally thought to be a TH-1 dominant disease and some people with Hashimoto’s do have TH-1 dominance.
And here’s where it gets tricky. If you stimulate TH-1, then you may risk firing up the part of the immune system that is destroying your thyroid. So this requires some real skill in dealing with with both Hashimoto’s and EBV or other herpes viruses at the same time.
There are some other things that EBV can cause problems with and these are really significant because they are also common problems with Hashimoto’s.
EBV can cause problems with serotonin, methylation, and can compromise the blood brain barrier and, as we have already seen, lead to neurodegeneration.
This is really interesting because with Hashimoto’s and hypothyroidism, serotonin can also become depleted. This one of the reasons why some people with Hashimoto’s experience depression and a lack of motivation and enjoyment in things. So the combination of Hashimoto’s and EBV can lead to some serious emotional issues.
Methylation issues are also quite common with Hashimoto’s and some people have MTHFR gene mutations which can exacerbate this problem. In addition, dominance of the TH1 part of the immune system can lead to methylation problems, as well.
And, finally leaky gut and intestinal permeability are the hallmark of virtually all autoimmune diseases and this is sometimes the sign of a larger systemic problem involving all the barrier systems of the body.
The gut and the brain are very closely related and the same proteins that protect the barrier of the intestines also line the blood brain barrier. When one area is compromised the other can be as well.
So, the combination of EBV and Hashimoto’s certainly has all the ingredients of a potent vicious cycle that can create a downward spiral of difficult to resolve physical and psychological health problems.
Treating both EBV (and other herpes viruses) and Hashimoto’s at the same time can be tricky because herbs and supplements that are known to prevent reactivation of the virus can also stimulate parts of the immune system.
And if these parts of the immune system are causing tissue destruction and flare ups of your symptoms, then you are simply trading problems. And this approach may actually make matters worse.
So, let’s take a look at some obvious and less obvious treatment strategies that can keep EBV or other viruses at bay and not stoke the fires of autoimmunity.
One of the most important treatments for EBV (and other herpes viruses) is having stress relieving hobbies. Many people are aware of the destructive power of stress, but it always amazes me how little they are willing to do about it.
If you have Hashimoto’s and EBV and you don’t do things to reduce stress daily, you are setting yourself up for failure. It’s like walking into oncoming traffic and expecting not to be hit by a car or truck. You are going to be in a world of hurt if you don’t have daily habits for reducing stress.
These include meditation, yoga, qi gong, music, art, relaxation, massage, acupuncture, spa days, mineral baths, etc. These are not luxuries, they are necessities for someone living with Hashimoto’s and EBV.
I’m giving you permission to indulge yourself. If you need a note from your doctor for this, email me and I’ll be happy to write one for you. 🙂
Another thing to be conscious of are foods and supplements that can feed and encourage the herpes virus. The most common are foods that are low in lysine and high in arginine.
• coconut (coconut oil is fine since it has no amino acids)
• seeds and nuts
• orange juice
• wheat products and products containing gluten
• protein supplements: casein, the protein found in milk may also increase arginine levels.
What’s interesting to note here is that some of these foods are foods we commonly avoid with Hashimoto’s while others are staples of the Paleo and Autoimmune Paleo diets. (This emphasizes the importance of being flexible and of the highly individualized nature of the problem.)
Highly acidic foods and those laden with chemicals can also exacerbate viral infections and lead to outbreaks.
• all junk food
• too much red meat
• processed/white flour products
• food additives
• artificial sweeteners.
These are all also foods that can exacerbate your Hashimoto’s. So there’s no love lost here. Caffeine can potentiate or increase the utilization of arginine so that should be done in moderation.
There are several different strategies for treating EBV and other herpes viruses. Novice herbalists will often throw lots of immune stimulating herbs at the problem like astragalus, ashwaganda and medicinal mushrooms like maitake and reishi.
These are great herbs, but can be a really bad idea for some people with autoimmune disease.
Instead a more targeted approach of attacking the virus and strengthening different parts of the immune system with a more nuanced approach is a much, much better idea. The Chinese Herbal Materia Medica is full of herbs that can accomplish these tasks beautifully.
Here are some herbs that specifically attack EBV and other herpes viruses:
Angelica sinensis, chrysanthemum, citrus, lithosperum, milletia, paedria, picrorhiza
Isatis root, baphicacanthes, cnidium, lithosperum, forsythia, gardenia, chrysanthemum, vitex, dandelion, epimedium, lonicera
Belamcanda, clove, crataegous, dandelion, epimedium, houttuynia, inula, lonicera, portulaca, prunella, rhubarb, salvia, scrophularia
It’s important to note that many of these herbs have multiple pharmacological properties and can therefore be used to accomplish more than one thing if combined properly.
It’s important to strengthen the immune system to treat these herpes viruses, as well, but it must be done carefully.
As we saw before, Vitamin D is important for strengthening CD8+ T cells, as is glutathione and superoxide dismutase, EPA and DHA.
Turmeric is helpful because of it’s anti-inflammatory properties.
Also, there are couple of essential oils that I have found are very effective for first attacking the virus and, then healing the sores.
Ravensara is an excellent anti-viral oil that may applied topically directly on the lesions. Heliochrysum is an oil that helps regenerate flesh and can help to heal the sores more quickly.
My partner, Olesia Farberov makes a fantastic herbal salve with some of Chinese herbs mentioned above and both these essential oils called The Healer.
This is an absolute must for your purse, pocket and medicine cabinet. I prescribe it to all of my patients with herpes and use it myself because it just plain works.
Vitamins, Minerals and Supplements:
Research has shown that a daily intake of at least 1250 mg of lysine supplements can help control herpes outbreaks.
Zinc, Vitamin C and B vitamins may also be helpful.
Other supplements that can help increase CB8+ cells include:
N-Acetyl-Cysteine (NAC), butyrate, andrographis, and gynostemma
One area where I actually advocate using Western pharmaceutical drugs is in the treatment of these viruses. Acyclovir is a potent anti-viral and for some people who have really stubborn hard to treat outbreaks, it can be an effective tool in your arsenal.
Another drug to consider is Low Dose Naltrexone (LDN). It has the ability to modulate immune function and calm physiological stress. It can also be effective in helping the body to deal with the herpes virus.
At the end of the day, the reality is that these viruses are here to stay. They are remarkably adaptable and persistent and they have there own insidious intelligence.
We can not hope to defeat them, we have to accept them, live with them and adapt our lives to them. And the good news is, the most effective treatments for them like stress relieving hobbies and a healthy diet are also important ingredients in our long term health, happiness and well being.
Notes from Studying with Dr. M.M. Van Benschoten, O.M.D.
http://www.ncbi.nlm.nih.gov/pubmed/24008857: herpes and Hashimoto’s 3 case studies
http://www.hindawi.com/journals/tswj/2013/867389/: Role of herpes 6 as a trigger for autoimmune thyroid disease
http://jidc.org/index.php/journal/article/viewFile/22169789/645: Role of viruses in Autoimmune disease
http://www.virologyj.com/content/6/1/5: Viruses and thyroiditis
http://www.dana.org/Media/GrantsDetails.aspx?id=38800: herpes and MS
https://umm.edu/health/medical/altmed/condition/herpes-simplex-virus: good general info on herpes
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2654877/ : Viruses and thyroiditis
http://www.cellandbioscience.com/content/1/1/24 Affects of thyroid hormone on HSV-1 gene regulation
http://dx.doi.org/10.4236/health.2013.58162 Large cohort on TH levels and HSV 1 activation
EBV and Hashimoto’s
http://www.ncbi.nlm.nih.gov/pubmed/8750577: Elevated Epstein Barr titers in AIT
http://www.ncbi.nlm.nih.gov/pubmed/20404456: Immune responses to EBV in AITD patients
http://www.bioline.org.br/request?mb10037: EBV activation in AID patients
http://www.hindawi.com/journals/ad/2012/189096/: Hypothesis of how this all happens
http://www.ncbi.nlm.nih.gov/pubmed/16055563 Serotonin and EBV
http://www.ncbi.nlm.nih.gov/pubmed/21289059 EBV and methylation
http://www.ncbi.nlm.nih.gov/pubmed/20826008 EBV and the blood brain barrier
Infections and Autoimmune disease:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2665673/ role of infections in AID
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360274/ Molecular mimicry
http://www.ncbi.nlm.nih.gov/pubmed/12699597 T3 autoantibodies can cause latent EBV activation!
Neurological impact of herpes:
http://www.nature.com/nrneurol/journal/v3/n2/full/ncpneuro0401.html Neurological impact of herpes
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437531/ Herpes infections in the CNS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4175921/ Anxiety and depression and viral disease
http://medind.nic.in/daa/t12/i1/daat12i1p188.pdf Viral infections and depression
http://www.naturalendocrinesolutions.com/articles/which-viruses-can-trigger-thyroid-autoimmunity/ Good descriptions and solutions
http://www.ncbi.nlm.nih.gov/pubmed/11572634 virus induced autoimmunity
http://www.ncbi.nlm.nih.gov/pubmed/22095454 molecular mimicry as autoimmune intitiation
http://www.ncbi.nlm.nih.gov/pubmed/25445494 B cell epitope spreading
http://www.ncbi.nlm.nih.gov/pubmed/11140461 Epitope spreading
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360274/ Bystander activation
So now, not only is it my profession, it’s my passion, and it’s personal. I’ve been joking with people lately saying it’s a blessing and a curse. A blessing because I really get it, and a curse because I really got it! ?