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Epstein-Barr Virus (EBV): The Top Symptoms Of This Insidious Autoimmune Infection + What You Can Do

Epstein-Barr Virus is one of the most prevalent, insidious health problems we face as a society. In fact, according to the CDC 9 out of every 10 adults (1) have antibodies indicating a past or current EBV infection. As a functional medicine expert, I have seen EBV as the driving force behind many of my patients chronic health problems with researchers continuing to find links between EBV and the development of many of our modern day chronic health problems. 

So, even though we don’t fully understand the mechanisms behind EBV one thing is for certain: we can’t ignore its obvious impact on our overall health. I may even go as far as to say if we don’t give EBV the weight it deserves in our medical system, we are in for an epidemic of chronic illness even more so than we already face. But what exactly is EBV and how do you know if you have it? Let’s find out.

What is Epstein-Barr Virus (EBV)?

Epstein-Barr Virus (EBV) is a pervasive and persistent virus that affects a significant portion of the global population. As a member of the herpesvirus family, EBV establishes lifelong infection in the human body that can lead to a range of health problems years after the initial infection. EBV spreads primarily through saliva and infects epithelial cells and B lymphocytes upon entering the body. Most initial infections occur during childhood or adolescence and often go unnoticed or present as mild cold-like symptoms. 

Epstein-Barr Symptoms

Epstein-Barr Virus infection can manifest in various ways, ranging from mild or asymptomatic to more severe symptoms, depending on your individual immune response and the stage of infection.

1. Mononucleosis (Mono)

This is the most commonly recognized manifestation of EBV infection as it is the only manifestation to include obvious symptoms with initial infection. These symptoms often appear 4 to 6 weeks after exposure to the virus and typically include:

  • Fatigue and weakness that can persist for weeks or months

  • Sore throat

  • Swollen lymph nodes in the neck and armpits

  • Fever

  • Headaches

  • Enlarged spleen or liver (that may also cause abdominal pain)

  • Loss of appetite

  • Rash

2. Asymptomatic or Mild Infection

Most individuals infected with EBV don't experience any symptoms at all or only mild symptoms that resemble a common cold or flu. Since they may not be aware that they have been infected with the virus, it can make a diagnosis of a dormant infection becoming active later down the line more difficult.

3. Chronic Epstein-Barr 

For some people, an initial EBV infection can turn into a rare, progressive condition known as Chronic Epstein-Barr Virus Infection Syndrome (2) that can last for 6 months or more, sometimes indefinitely. When this happens, it prompts your body to produce an excessive amount of lymphocytes - a type of white blood cell crucial for healthy immune function - that can lead to symptoms like fever, swollen lymph nodes, anemia, low platelet numbers, liver dysfunction, enlarged spleen, and an increased risk of other infections.

The problem with EBV

What distinguishes EBV from other viruses is its ability to persist in the body for life. After the initial infection, the virus remains dormant within B cells, capable of reactivation under certain circumstances. When this happens, it can result in a variety of chronic health conditions including autoimmune diseases and an increased risk of developing certain cancers.

Because of its dormant nature, EBV can be difficult to diagnose. Unless you have a doctor that is familiar with EBV and understands how it works (unfortunately, this is an area where most mainstream medical doctors lack) you can go years without getting to the real cause behind your health problems.

Health problems associated with EBV

Researchers have found EBV to be a trigger for the development of multiple health problems. While this is not an all-encompassing list, these are a few of the most clinically-studied health problems associated with EBV infection.

1. Multiple sclerosis

Multiple clinical studies (3) have shown a clear connection between EBV and the development of multiple sclerosis. One study in particular published in the journal Science, (4) found that the risk of developing MS increased 32-fold after EBV infection. What’s even more shocking? Multiple sclerosis risk was not increased if people were infected by other viruses. 

2. Lupus

This chronic autoimmune condition can affect multiple areas of the body including joints, skin, kidneys, blood cells, lungs, brain, and more resulting in fatigue, joint pain, rash, and fever. Research has long shown that EBV infection almost always precedes (5) the onset of lupus, with studies finding that EBV can promote the survival of autoreactive B lymphocytes and the production of interferon-a - two mechanisms closely involved with the development of this autoimmune condition.

3. Rheumatoid arthritis

Rheumatoid arthritis is one of the most common autoimmune conditions and is heavily triggered by EBV infection, with research showing that those with RA consistently have higher EBV antibody levels (6) than those who don’t have this condition.

4. Chronic fatigue syndrome

Chronic fatigue syndrome is a persistent and debilitating condition that is widely misunderstood and is often accompanied by other symptoms like muscle pain, headaches, and memory problems. While the exact connection between EBV and CFS is still being studied, a recent study (7) found that 38-55% of patients with CFS also had the EBI2 gene which is induced by EBV infection and is connected to a variety of autoimmune diseases.

5. Hashimoto’s thyroiditis

A 2015 Polish study (8) looked at the ability of EBV to “hide” in the thyroid and, once reactivated, stimulate the immune system to attack the thyroid, triggering autoimmune thyroid problems or Hashimoto’s disease, which is another common cause of fatigue.

6. Cancer

Studies have found that EBV infection is associated with certain types of cancers, particularly rare ones involving the lymphatic system like Hodgkin’s lymphoma, Burkitt’s lymphoma, (9) and nasopharyngeal carcinoma. (10)

What causes Epstein-Barr?

While anyone can become infected with Epstein-Barr, studies have found (11) that certain factors can increase your risk of coming in contact and becoming infected with this virus.

  • Age: EBV infections are more common among teenagers and young adults. 

  • Close contact: Direct contact with saliva, such as kissing or sharing utensils, drinks, or personal items, increases the likelihood of contracting EBV, since the virus spreads through saliva.

  • Weak immune system: Individuals with weakened immune systems due to conditions like HIV/AIDS, organ transplantation, certain medications (such as immunosuppressants), or other illnesses are more susceptible to EBV infection and potential complications.

  • Living conditions: People living in a crowded environment like a college dormitory or military barrack, can increase the risk of exposure and transmission of the virus.

  • Genetics: Some individuals may have a genetic predisposition that makes them more susceptible to developing complications from EBV infection.

  • Gender: Women are more likely to experience mono compared to men.

  • Sexual activity: People who are sexually active and have had multiple partners are more likely to experience EBV infection.

  • Geographical location: People who live in a tropical country are more likely to become infected since EBV can spread easier in these environments.

With all this being said, even if you do become infected that doesn’t mean you will experience any long-term complications or further health problems from EBV infection. Under normal conditions, your immune system is designed to keep the virus in its dormant state and prevent it from becoming an active infection. However, various factors can trigger the reactivation of EBV by weakening your immune system and causing the virus to become active again.

Some key factors that may contribute to EBV reactivation include:

  • Stress: Psychological stress has been shown (12) to impact immune function and contribute to EBV reactivation.

  • Infections: Concurrent infections or illnesses, particularly those that affect the immune system, can trigger EBV reactivation. One study found that COVID-19 infection could trigger (13) dormant EBV infections.

  • Hormone imbalances: Fluctuations in hormone levels, such as those occurring during puberty, pregnancy, or menstruation, can potentially influence (14) EBV reactivation.

  • Poor lifestyle habits: Inadequate sleep, poor nutrition, excessive alcohol consumption, and smoking can weaken the immune system, making individuals more susceptible to EBV reactivation.

  • Underlying health conditions: Certain gut health problems like ulcerative colitis (15) or other chronic health problems can compromise your immune system and make you more prone to EBV reactivation.

  • Toxin exposure: Exposure to environmental toxins, xenobiotics, (16) or pollutants may also contribute to immune system suppression, potentially allowing EBV to reactivate.

Natural tools to treat EBV

In conventional medicine, there is no single treatment for EBV. Patients are either told to wait it out or may be given medications to address their pain or other associated symptoms. Instead of just managing symptoms, functional medicine aims to strengthen your immune system to help put EBV into remission and your symptoms as a result. 

So whether you are struggling from symptoms of an acute EBV infection or an autoimmune condition as a result of EBV reactivation, these are some of the tools we utilize in my telehealth functional medicine clinic to address EBV.

1. Try natural medicines

A 2023 study published in the International Journal of Molecular Sciences (17) found that some dietary compounds have powerful antiviral activity against EBV. You can find these in certain foods and in supplement form. 

  • Curcumin 

  • Epigallocatechin gallate

  • Resveratrol

  • Moronic acid

  • Andrographolide

2. Take Vitamins C + D

An exciting study published in Medical Science Monitor found (18) that higher levels of vitamin C produced lower levels of EBV in people with mono and chronic fatigue syndrome with another study showing that Vitamin D was able to bring down (19) Epstein-Barr antibodies in patients with Multiple Sclerosis.

3. Manage stress levels

Since stress and chronically high cortisol levels are key triggers of EBV reactivation, it’s vital to alleviate stress as much as possible. Do this through stress management techniques like meditation and deep breathing techniques as well as cortisol-balancing supplements like ashwagandha.

4. Heal your gut

A Microbiology Spectrum (20) study found that EBV can increase the production of pro-inflammatory cytokines in your gut leading to bacterial dysbiosis and the development of autoimmune disease like rheumatoid arthritis. Since your gut is the foundation of your entire health and houses the majority of your immune system, keep EBV at bay by healing your gut with tools like daily probiotics and gut-healing superfoods like bone broth.

Seeking help from a functional medicine expert

If you think EBV could be a factor in your health case, I recommend seeking out help from a functional medicine practitioner who is familiar with addressing EBV. Not only can they run viral labs to assess an active or past infection, they can run additional labs to determine if there are any other underlying health problems contributing to your health problems such as gut dysfunctions, hormone imbalances, toxin load, and more. In my telehealth functional medicine clinic we take a comprehensive approach to your health to put together personalized action plans tailored to your specific needs.


Dr Will Cole


Expert For mindbodygreen + goopHelping Thousands Around The US + worldwideInternational Bestselling Author + Speaker


  1.  Centers for Disease Control and Prevention "About Epstein-Barr Virus (EBV)" Accessed December 2023.

  2. National Center for Advanced Translational Sciences Genetic and Rare Diseases Information Center "Chronic Epstein-Barr Virus Infection Syndrome" Accessed December 2023.

  3. Soldan, Samantha S, and Paul M Lieberman. “Epstein-Barr virus and multiple sclerosis.” Nature reviews. Microbiology vol. 21,1 (2023): 51-64. doi:10.1038/s41579-022-00770-5

  4. Bjornevik, Kjetil et al. “Longitudinal analysis reveals high prevalence of Epstein-Barr virus associated with multiple sclerosis.” Science (New York, N.Y.) vol. 375,6578 (2022): 296-301. doi:10.1126/science.abj8222

  5. Enfrein, A, and M Hamidou. “Epstein-Barr Virus et lupus systémique : quels liens ?” [Epstein-Barr Virus and systemic lupus: Which connections?]. La Revue de medecine interne vol. 43,8 (2022): 487-493. doi:10.1016/j.revmed.2022.03.341

  6. Toussirot, Eric, and Jean Roudier. “Pathophysiological links between rheumatoid arthritis and the Epstein-Barr virus: an update.” Joint bone spine vol. 74,5 (2007): 418-26. doi:10.1016/j.jbspin.2007.05.001

  7. Kerr, Jonathan R. “Epstein-Barr Virus Induced Gene-2 Upregulation Identifies a Particular Subtype of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis.” Frontiers in pediatrics vol. 7 59. 13 Mar. 2019, doi:10.3389/fped.2019.00059

  8. Janegova, Andrea et al. “The role of Epstein-Barr virus infection in the development of autoimmune thyroid diseases.” Endokrynologia Polska vol. 66,2 (2015): 132-6. doi:10.5603/EP.2015.0020

  9. Mundo, Lucia et al. “Frequent traces of EBV infection in Hodgkin and non-Hodgkin lymphomas classified as EBV-negative by routine methods: expanding the landscape of EBV-related lymphomas.” Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc vol. 33,12 (2020): 2407-2421. doi:10.1038/s41379-020-0575-3

  10. Su, Zhi Yi et al. “The role of Epstein-Barr virus in nasopharyngeal carcinoma.” Frontiers in microbiology vol. 14 1116143. 9 Feb. 2023, doi:10.3389/fmicb.2023.1116143

  11. Craig D. Higgins, Anthony J. Swerdlow, Karen F. Macsween, Nadine Harrison, Hilary Williams, Karen McAulay, Ranjit Thomas, Stuart Reid, Margaret Conacher, Kathryn Britton, Dorothy H. Crawford, A Study of Risk Factors for Acquisition of Epstein-Barr Virus and Its Subtypes, The Journal of Infectious Diseases, Volume 195, Issue 4, 15 February 2007, Pages 474–482,

  12. Kerr, Jonathan R. “Epstein-Barr virus (EBV) reactivation and therapeutic inhibitors.” Journal of clinical pathology vol. 72,10 (2019): 651-658. doi:10.1136/jclinpath-2019-205822

  13. Gold, Jeffrey E et al. “Investigation of Long COVID Prevalence and Its Relationship to Epstein-Barr Virus Reactivation.” Pathogens (Basel, Switzerland) vol. 10,6 763. 17 Jun. 2021, doi:10.3390/pathogens10060763

  14. Hara, Sayuri et al. “High Level Estradiol Induces EBV Reactivation and EBV gp350/220(+)CD138(+) Double-positive B Cell Population in Graves' Disease Patients and Healthy Controls.” Yonago acta medica vol. 62,2 240-243. 20 Jun. 2019, doi:10.33160/yam.2019.06.010

  15. Kato, Shu et al. “Substantial Epstein-Barr virus reactivation in a case of severe refractory ulcerative colitis: a possible role in exacerbation.” Clinical journal of gastroenterology vol. 14,2 (2021): 584-588. doi:10.1007/s12328-020-01319-w

  16. Stancek, D et al. “Links between prolonged exposure to xenobiotics, increased incidence of hepatopathies, immunological disturbances and exacerbation of latent Epstein-Barr virus infections.” International journal of immunopharmacology vol. 17,4 (1995): 321-8. doi:10.1016/0192-0561(95)00006-n

  17. Eladwy, Radwa A et al. “The Fight against the Carcinogenic Epstein-Barr Virus: Gut Microbiota, Natural Medicines, and Beyond.” International journal of molecular sciences vol. 24,2 1716. 15 Jan. 2023, doi:10.3390/ijms24021716

  18. Mikirova, Nina, and Ronald Hunninghake. “Effect of high dose vitamin C on Epstein-Barr viral infection.” Medical science monitor : international medical journal of experimental and clinical research vol. 20 725-32. 3 May. 2014, doi:10.12659/MSM.890423

  19. Røsjø, Egil et al. “Effect of high-dose vitamin D3 supplementation on antibody responses against Epstein-Barr virus in relapsing-remitting multiple sclerosis.” Multiple sclerosis (Houndmills, Basingstoke, England) vol. 23,3 (2017): 395-402. doi:10.1177/1352458516654310

  20. Fadlallah, Sukayna et al. “The interplay between Epstein-Barr virus DNA and gut microbiota in the development of arthritis in a mouse model.” Microbiology spectrum, vol. 11,5 e0204223. 24 Aug. 2023, doi:10.1128/spectrum.02042-23


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