Sock Doc 17: Epstein-Barr Virus and More – Managing Chronic Viruses in Athletes and Living Your Best Life

April 22, 2022


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Dr. Steve Gangemi, The Sock Doc, is a natural health care doctor who founded and practices at Systems Health Care, an integrative wellness center in Chapel Hill, NC. Steve is also a longtime endurance athlete and is a wealth of knowledge for athletes looking to optimize wellness.

On this episode:

Introducing Epstein-Barr Virus (EBV) and other chronic viruses

  • There are thousands of types of herpes viruses, about eight affect us as humans.
  • With EBV, which causes mononucleosis, up to 90-95% of the adult population has this and not everyone will have even known they got it?
  • Mono is not just caught from kissing, they can be caught more easily just with interacting with someone infected, and we may not even realize it.
  • Also often a lot of misdiagnoses where mono is missed and treated as something else.
  • Either way, the virus doesn’t leave our body after the initial infection.
  • Why are some people horribly affected by EBV and having many flares, where others don’t even have any issues with it?
  • Acute symptom would be: sore throat, fever, fatigue, swollen lymph nodes, etc.
  • Chronic cases: chronic fatigue type syndrome, sore joints, feeling feverish and run down; it can vary person to person but for each person their pattern tends to repeat and be consistent.
  • The thing we want to know is what provoked it to flare? And what can we do to get it to calm down quickly?
  • What things provoke it? It varies… Epigenetics, lifestyle, diet, general health, immune function, overtraining.
  • A lot of people simply aren’t giving their body what it needs to improve and that is when epigenetic comes into play more. The thing to note is we CAN have a huge impact on these viruses and stop the vicious cycle of flares and feeling the persistence fatigue.
  • But for many athletes, we’re constantly pushing ourselves and more worn down.
  • Steve says during his time in school + training for Ironman World Championships he was more prone to cold sores than he is now with a more balanced, healthy lifestyle, diet and approach.
  • Viruses are much more opportunistic than many bacterial infections. But there’s not always a direct treatment for viruses as compared to certain bacterial infections.
  • It has to due with state of immune system, antioxidant issues and are you over-oxidized, inflammation and overall state of health all can affect the outcomes of a certain intervention treatment.
  • So it’s more about getting health in order so body can more effectively deal with certain viruses.
  • What can be confusing is that you can have high antibodies and high titers for EBV yet EBV may not be the cause or reason why you are feeling horribly. There’s no direct relationship 100% of the time. Partly because there’s no definitive to the bloodwork and a yes/no point; questionable cutoffs.
  • You could also have hormonal imbalances, gut issues, another virus or infection and that can cause the EBV to flare up more–so it’s about finding what else might be going on.
  • A lot of conditions, autoimmune and Lyme included, there’s no clearcut test, it requires some deeper analysis.
  • Usually these viruses or things like Lyme only are flaring up a lot when there’s other notable health conditions going on, or trauma, and so on. Usually never just one thing–so ask, what else was going on in the years leading up?
  • It’s interesting to dive more into the mindset of being sick with a condition and how the ego plays the role, and the importance of putting the ego aside to get real with what is going on/what was going on.


  • Seems like testing is difficult to achieve, and often it takes a long time to get it narrowed down to EBV.
  • You can go test crazy, but is that necessary?
  • With EBV, distinguish is it active or reactivation? Antibodies can stay high and even stay chronically elevated long past the infection or flare. You may feel better and have definite improvements in symptoms but antibodies may stay high.
  • So labs are only part of the picture; build a whole profile of the patient.
  • Some docs say, if your antibodies are 5-10x higher than normal range that could be a reactivation of a certain virus, but that doesn’t mean you are having a flare or reoccurrence.
  • Current or older infection data and how antibodies fall into place.
  • E.g., they will say if the IgG (longer term antibodies for someone who had the infection a long time ago) is greater than 10x the upper limit, that’s a positive result, ie reactivation. But the question to ask is, are there symptoms, how is the person feeling?
  • Anti-VCA IgM appears early in EBV infection and usually disappears within the early weeks. In testing for VCA, if it’s 5-10x higher that’s more of an active infection now.

Dissecting this further

  • Study mention: Clinical investigation of athletes with persistent fatigue and/or recurrent infections
  • “Recent studies have indicated that reactivation of non-primary Epstein-Barr virus (EBV) is a common cause of oropharyngitis in young adults and may be associated with the symptoms of URTI in competitive athletes. New tests for EBV reactivation were therefore included in the clinical investigation.”
  • “Evidence of Epstein-Barr virus reactivation was detected in 22% of the athletes tested.”
  • But correlation does not always mean causation, so even with that study finding a correlation, it does not mean that the EBV is causing the increased likelihood of illness in these athletes. It very well can be but not always certain.
  • And, other studies have shown that athletes are no more susceptible than general population, perhaps? Study.
  • Analogy of back pain and how the symptoms and physical presentation don’t always add up.
  • Book mention: Healing Back Pain: The Mind-Body Connection, by Dr. John Sarno
  • Address these things as a whole-person concept, and goes back to lifestyle, diet, etc…

So if it is EBV or another virus, how to deal

  • If EBV or another virus is the issue and that’s what you’ve decided, you can address the virus specifically to help immune system; natural remedies include astragalus, etc.
  • Athletes all know the concept of injuries, think of these viruses are like a systemic injury. So if symptoms coming on, build your go-to treatment.
  • E.g., a lot of people take lysine for HSV cold sores. But you don’t want to over-use this and mess with amino acid pools. It’s ok to take for an acute onset of cold sore but not recommended to take ongoing/daily as a preventative.
  • Lysine starves off arginine, lysine creates an imbalance and starves the virus of consuming higher levels of arginine.
  • Viruses are opportunistic. Antioxidant status can have a significant effect.
  • Steve is more of a fan of natural forms of Vitamin C (e.g. camu camu, whole food sources) over ascorbic acid.

Natural treatment options

  • Astragalus overall great for improving immune system.
  • Echinacea more anti-viral.
  • Selenium inhibits viral replication.
  • Olive Leaf is usually effective for EBV.
  • Vitamin A too. (A traditionally used in high doses for measles treatment even in babies.)
  • Using Vitamin A and selenium gives a bigger bang for your buck, rather than herbs alone.
  • Whereas, conventional medicine uses prescription anti-virals.
  • With shingles, another herpes virus, it also responds well to herbs.
  • The amount of flare up someone gets correlates with oxidation in tissues, and that oxidation can prolong recovery.
  • What about natural/more alternative treatment options such as ultraviolet blood irradiation?

The autoimmune connection

  • Link between EBV and autoimmune – High percentage of people with MS, lupus, have EBV
  • Can/does EBV trigger AI?
  • Decreased antioxidant status, increased oxidative stress, immune activation – viral mutations occur more rapidly and that chronic immune response can then turn into an autoimmune condition. AI conditions often spur from infections, which varies greatly, provoking the immune system in some chronic way.

Further thoughts

  • Don’t chronically chase the virus and lower numbers. You can still be doing great even if labs don’t change, don’t let that deter you!
  • It’s hard because these viruses and chronically dealing with them can be traumatic, so how can we come to terms and be in harmony with our bodies?
  • Cultivate more trust in our bodies, often our bodies are so good at dealing these things.
  • Where do we draw the line on testing? It can be a tough call. If you do enough labs, you will always find something wrong. Sometimes it’s ok to not test more.
  • Identifying with your illness, and the dangers of that. You are not your illness.

One Comment

  • Henry Carlos says:

    Has anyone ever tried MULTIVITAMIN HERBAL CURE for herpes simplex? I have had cold sores since I was a child. I used to have them one after the other. One would heal and another would be right behind it. When I got married, I started using this herbal remedies and chanced on these two. It took a while but I persisted taking these natural herbs every day. The persistent sores gradually disappeared and never came back not until this date. My mother had them all her life. Now I am 60 years ,the people I have also recommended the herbal remedy to has a similar result to mine. Am recommending this herbal formula to anyone with HSV1/2 visit their website multivitamincare org

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