If it’s an infection, the solution is simple, right? Antibiotics? Not so fast. We are aware now of the limitations of antibiotics for chronic bacteria and of course the fact that many chronic infections are viral and therefore would be made worse by antibiotics. Antibiotic resistant infections are on a dramatic rise, and it is clearly due to the irresponsible overuse of antibiotics in medicine and livestock. I don’t wish to discuss the limitations of antibiotics in this post, that is a topic all on its own.
Many of my patients present to me with their diagnosis already. It ranges from chronic fatigue syndrome, Fibromyalgia, Autoimmunity, Lyme, to Epstein Barr Virus. The problem with labels, which is what a diagnosis can be, is that it leads the doctor and patient to believe that the “label” is what needs to be treated. Allow me to explain.
These labels are often given when someone has had chronic symptoms that do not respond to medications and get worse over time. After repeated doctor visits and increased frustration, the doctor orders various blood tests that reveal the presence of antibodies to chronic viruses and/or bacterial infection. These include but are not limited to:
- Epstein Barr Virus (EBV)
- Herpes Simplex virus 1 & 2 (HSV)
- Human Herpes Virus 6 (HHV 6)
- Cytomegalovirus (CMV)
There are many instances where several of these infections come up positive at the same time. Could you be so unlucky to experience multiple infections at the same time? I don’t think so.
The infections I listed above are a collection of incredibly common viruses and bacteria. For example, it is estimated that 95% of the adult population of the world has exposure to the Epstein Barr Virus (EBV). Bad luck? I don’t think so.
But wait, just because it’s common does not mean it is normal.
When looking for evidence of exposure to the common infections, the blood tests ordered usually include a white blood cell count (to determine if you are experiencing an acute infection). There is also a IgM and IgG test for each of the infections your physician ordered.
Ig stands for Immunoglobulin. We test for the M form and the G form, IgM & IgG. An immunoglobulin is a flag that attaches to the virus telling your immune cells to gobble up the virus and get rid of it. The flags, or immunoglobulins, are made by your immune system.
IgM is a type of flag that is for a new or acute infection and IgG is a flag that is made for long term immunity after the acute phase is over. The IgG system is what tells your immune system, years later that you had seen this virus before and therefore won’t let it cause an acute problem again. Kind of like how we keep from getting the chickenpox again as an adult after you’ve had it as a child.
The overwhelming majority of the time, the IgM (acute test for recent infection) is negative on a blood test and the IgG (long term immunity) is positive for the tested infection. Well that is to be expected right? Most people have been exposed and therefore should have evidence in their blood of that old exposure. The problem is not that the test is positive; the problem is when the number is more than triple the accepted positive value.
For example, let’s assume that positive for EBV (or whatever is being tested) in one laboratory could be .69 where .69-.99 is considered a weak positive (equivocal) and above .99 is clearly positive. Perhaps your blood test says .80. That would be more than triple the accepted positive value of .99. In this situation, the immune system is making excessive antibodies to an infection experienced long ago. Why is it doing so?
The chickenpox virus (herpes zoster) is a great example, because after you’ve been exposed, your IgG system keeps it suppressed for the rest of your life. You see, you never get rid of the chickenpox virus, you merely keep it wrapped up, usually at the base of your spinal nerves. However, when your immune system is challenged or suppressed, the dormant chickenpox virus can see an opening to express itself and travel down the spinal nerve and cause a painful rash on your skin called shingles.
The issue with shingles is not that you had chickenpox as a child, the issue is your immune system being suppressed. The same holds true for the Epstein Barr Virus (EBV) in the example above. The problem is not that you were unlucky enough to kiss the wrong person or touch the wrong door knob to get infected in the first place. The issue is your immune system is suppressed, and the virus is allowed to express itself resulting in robust immune response.
In many cases, there will be several of the common infections that are more than triple positive at the same time, indicating the immune system is overwhelmed and fighting what seems like a losing battle.
So, Why Such Severe Fatigue?
This is a simple question to answer. If you’ve ever had the flu, you know that when the immune system is activated, your energy is zapped. You lay in bed until the “acute” infection is resolved in 5-7 days, and then you’re up and running again. Now, just imagine the flu never resolves, and your energy is being utilized by your immune system, with no end in sight.
We have to change the way we look at infections. We have to stop thinking that an infection is a bug that must be expelled from the body. We have to start looking at certain infections or exposures to microbes as common and unavoidable. They also may be very helpful, much like our recent acceptance of the importance of bacteria in the gut. We have to ask different questions.
The next post will dive deeper into what can be done to get the immune system to stop utilizing all of its energy.
Thanks for reading!