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A sample entry from our student Q&A Treasure Chest that features hundreds of similar topics, available as an ongoing resource for our students…
A question from a Practitioner:
I have several questions about shingles. I have a patient who is relatively young (early 40’s) and in general good health. She does have some food sensitivities, which she excludes from her diet and eats relatively “clean.” She is very concerned, however, as she is currently experiencing her second bout of shingles within two years. The shingles are on her back, her face, near her cheek, and reportedly affect her eye. She is taking antivirals prescribed by her PCP, which she said he strongly suggested due to the involvement of her eye, and she doesn’t want to get the vaccine.
She has asked me for support in helping her find ways to prevent a third occurrence, since it is both painful and scarring to her skin. She has tried low arginine foods, taking l-lysine, essential oils, but has been inconsistent with using them. I’m wondering what I might best recommend for this type of patient?
SAFM Response:
Shingles is a skin dis-ease that manifests as a result of an active viral infection, which is generally believed to be varicella zoster virus (there is disagreement in the medical literature as to whether other viral co-infections might be involved in some cases as well). A typical outbreak occurs in adulthood and tends to cause rash-like skin eruptions that we call Shingles (which can be painless or, more typically, can be itchy, throbbing, and/or quite painful).
In most individuals, a viral infection remains relatively dormant for the remainder of life after an initial infection (which often occurs in childhood). A strong, balanced immune system keeps the virus at bay. However, periods of stress, inflammation, and/or suppressed immunity can allow subsequent outbreaks of latent viral disease. In the spirit of helping patients and clients to become truly more resilient (and thus less vulnerable to infectious challenges of all types!), our clinical goal is ideally to get at the root of and resolve the various dynamics that predispose a unique person to this recurrent viral disease (vs. just treating it suppressively).
You will often find that Shingles usually occurs as a perfect storm of multiple factors, most commonly including a combination of the following:
- Mental-emotional stress that suppresses immune function e.g. divorce, work crisis, suppressed anger. This may sound like such a commonplace, ho-hum factor, but it is often the key factor that is overlooked. There is perhaps nothing so important in avoiding reactivating viral disease than shifting our reaction to life circumstances such that we can reduce our physiological stress response. The old adage is true: “Life is much less about what happens to you and much more about how we choose to respond.” Said in a more empowered way, the part of our “environment” that we experience most often is our thoughts, and we can choose to shift those away from anxiety/despair/worst-case-outcomes to empowered/optimism/glass-half-full perspectives.
- Physiologic stress and inflammation e.g. undiagnosed/ignored food sensitivities, enhanced intestinal permeability with systemic circulation of LPS, oxalate overload, histamine overload, other infections such as covid or opportunistic overgrowths in the gut e.g. Candida, toxicity e.g. heavy metals, mRNA SARS-CoV2 vaccines.
- Antibiotics or immunosuppressive drugs that can cause other downstream immune function imbalance.
- Lack of consistent, sufficient, and deep sleep (this is another commonly under-emphasized factor given the socio-cultural norm of being relatively sleep deprived). The typical “6-7 hours of pretty good sleep” is simply Not sufficient to create optimal health for the vast majority of people.
- Insufficient levels of key immune nutrients e.g. Vitamin D, Vitamin A, and/or Zinc (or perhaps copper e.g. from excessive intake of zinc)
- Low White Blood Cell (WBC) count overall (perhaps as a result of ongoing behind-the-scenes battle to keep this virus under control, already being stretched thin combating a chronic, simmering microbial imbalance in the gut, and/or perhaps suboptimal due to insufficient levels of B12, Folate, Zinc, & Copper needed for synthesis)
- Common dietary factors which can suppress immunity are over-consumption of refined carbohydrates, known food sensitivities/allergies, or excessive alcohol intake (for a unique person’s body, this may be much less than they believe).
- Dry skin (e.g. hypothyroid, dehydration, inadequate dietary fat, low estrogen) is also often more susceptible to infectious dynamics
In individuals with recurrent Shingles, consider the following to reduce the risk of future outbreaks:
- Assess the above-mentioned nutrient needs and ensure all are optimal via labwork (specifically, in the upper half of the typical reference range)
- If no zinc data is available, perhaps supplement with 10-15mg zinc, 2-3x/day with food (key to avoid nausea!) in a bioavailable form e.g. citrate, amino acid chelate. If using for longer than a month, be sure that zinc and copper intake are balanced.
- If no Vitamin A data, perhaps supplement with at least 5000 IU daily with food (e.g. liver is the richest source) or a fully-formed Vitamin A (e.g. retinol palmitate or retinoic acid, not exclusively beta carotene, as some people cannot well convert). Vitamins A and D must especially be balanced.
- If no Vitamin D data, perhaps take at least 2000 IU daily with food of Vitamin D3. Ensure adequate magnesium First, as this is needed multiple times in the metabolism of Vitamin D (regardless of original source form).
- Address persistent mental-emotional stress. In particular, address elevated cortisol to prevent immune suppression. Low cortisol may be involved in immune dysregulation.
- Take 1500-2000mg lysine twice daily on an empty stomach. For the foreseeable future. This level may be sufficient to prevent the need for micromanaging lysine vs. arginine in the diet, but this will, of course, vary by person. There is clinical evidence showing the efficacy of lysine at higher doses.
- If additional antiviral support is needed, consider the herb cat’s claw, 500mg twice daily (e.g. Pure Encapsulations)
- Honor food sensitivities 100%. Heal any enhanced intestinal permeability with l-glutamine and mucilaginous herb support (e.g. Metagenics Glutagenics, twice daily) and ensuring optimal Vitamin D status.
- Take daily targeted probiotics that help to prime greater TH1 oversight. For this particular purpose, certain soil-based organism probiotics (e.g. Megasporebiotic) have been studied clinically to boost cell-based immunity to combat viruses.
- Address any sleep issues to ensure consistent, sound, and lengthy sleep. This might be helpful.
Certainly there may be more esoteric drivers and triggers. Be sure, however, to focus first on the fundamentals above. So often we look first or primarily to the more complex or unusual drivers or more targeted interventions, and we often miss the powerful, foundational needs of the body to have strong, comprehensive immune function (e.g. nutrition, sleep, stress management).
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15 Questions for “Shingles and Viral Reactivation”
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8.1
BHT (butylated hydroxytoluene) is a synthetic food preservative that is widely used in the US to prevent rancidity in fat-containing foods, such as breakfast cereals, baked goods, potato chips, pork sausage, peanut butter, instant potatoes, and other commercially prepared foods. Thus, in principle, BHT is a toxin and its safety is still being studied:
https://www.ncbi.nlm.nih.gov/pubmed/12396675
There are research studies that imply BHT could be effective against lipid-enveloped viruses (Herpes is one of them), especially if used topically, but long-term trials that confirm this substance as a safe and effective solution are still lacking.
As discussed in the article, when we apply a functional medicine lens to shingles you would dive deeper and ask why the body is having a hard time controlling the virus that is so ubiquitous in our population and stays dormant for most of the time for the majority of people. Also, functional medicine looks not only at the interconnectedness of the dis-ease but also at the solution – is this the most effective and least toxic solution for a given individual?
A good analogy here is a strong antibiotic that is indeed very effective against bacterial infection, but it does so at a great cost to the person who needs to use them. There certainly are situations when such a solution is life-saving, but not everyone will benefit long-term from such a radical treatment approach.
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7
Thank you for this! Would Monolaurin & Cat’s claw be a good combo for an EBV flare (no shingles though & no recent EBV test) in an AI client?
I would appreciate your insight or any other suggestions for moving forward!-
7.1
Yes, both of these would be suitable for addressing an EBV flare. Since you are a student you will be able to access this post:
https://schoolafm.com/ws_qa/chronic-epstein-barr-challenges/
which goes in-depth into EBV challenges and how to approach them.
You may also appreciate these public posts on autoimmunity interconnectedness:
https://schoolafm.com/ws_clinical_know/psoriasis-and-general-autoimmune-considerations/
https://schoolafm.com/ws_clinical_know/intestinal-permeability-the-autoimmune-connection/
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Megan Copeland says:
In the past, I have recommended Monolaurin. What are your thoughts??
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6.1
SAFM Team says:
Indeed, this can also be a potent antiviral, but I don’t typically recommending ever going with (any) one, single antiviral agent but rather a combination of 3 or more at once. Specific viruses are going to be more of less sensitive to various agents in a specific body in a way that cannot be measured; it’s best to go with a combination that is likely to ensure efficacy. Plus, microbes evolve and can develop resistance quickly! I typically recommend the same strategy in regard to antibacterial or antifungal or antiparasitic remedies as well.
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Wendy says:
Thank you for this helpful article! Student also asked “If supplementing with lysine, do foods higher in arginine need to be avoided completely or just kept in moderation (i.e. nuts/seeds)? ” If client is not sensitive to nuts/seeds, should they be avoided completely or kept in moderation? thank you!
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5.1
In my experience, an elimination is not typically necessary and simply a mindful, moderate consumption if lysine is being supplemented daily. But of course, each person is different. I would keep in mind the other more “root cause” related points in this article as perhaps higher priorities for focus.
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Claudia Seviciu says:
I have a question regarding Lysine which is recommended for the “Shingles ” or Herpes Zoster…. I am finding myself confusing it with N-Acetyl-L-Cystaine….as I am new to the process I would truly be great for clarification.Many thanks– Claudia
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4.1
Lysine and cysteine are two totally different amino acids. Lysine is an essential amino acid; cysteine is non-essential and made in the body from the essential amino acid methionine (assuming sufficient co-factor nutrients are available to allow this conversion to happen as needed; it requires ample, activated Vitamin B6 in particular). N-Acetyl-Cysteine (aka “NAC”) is a way to get additional cysteine into the body via supplementation.
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Toni Profera says:
Thank you for this, it is extremely valuable with all of its detailed recommendations and your thorough explanation of why. Can you speak a little more about the whys and why nots of the shingles vaccine? Can it trigger shingles or cause more underlying problems? Also if someone gets recurrent shingles outbreaks, even mild ones, should they take nuts out of the diet?
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3.1
My largest concern about the use of vaccines to counter viruses is two-fold. (1) There are MANY viruses, and we cannot logically intend to function optimally in light of their presence by developing a vaccine to counter every one. (2) Every vaccine brings additional adjuvants into the body. Beyond the innate toxicity of these substances (e.g. aluminum), we must remember that they are indiscriminately provoking the immune system into having a strong response (that’s what promotes the sustained level of antibodies that the antigen alone would never be able to do). I believe that adjuvants can potentially be a strong exacerbating factor for autoimmune activity in the body. The resulting skewing of immune function (overwrought about some threats and under-responsive to others) could also definitely render the body more vulnerable to future infections. If one is using supplemental lysine, as long as nuts are not a primary food (e.g. a cup a day), I don’t see the need to eliminate them. I believe our efforts are better placed at addressing some of the more foundational, insidious, truly root causes.
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Karen Rose Tank says:
Hi Tracy,
Thank you for this great thorough article about Shingles.
I turned 60 this year and I’ve been reading about the new, 2-part Shingles vaccine. While I know it dues not get to the root cause, many physicians are highly recommending it and say it is very effective for prevention.I’m on the fence. Thank you for your research based insight!
Karen
Integrative Nutrition Health Coach -
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Tracy, can you explain why you are not a proponent of using soil-based probiotics for extended use? Can they be harmful? Thank you.
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1.1
Simply because they are not endemic. Our goal should be to get to the root cause of gut imbalances, and once there is stability, I believe prebiotics and cultured foods are the most natural way to maintain that. If long-term probiotics are needed, I believe it is safest for these to be endemic species. While it is not even close to a majority response (and I disagree greatly with internet-promoted myths otherwise), I have had a few clients over the years develop gut imbalances due to ongoing use of SBO probiotics. If someone feels they “need” SBO probiotics long-term to maintain gut stability, it is likely evidence that the true root causes of gut imbalance have not been fully addressed, and there is important puzzle piecing work left to be done.
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Hello, what is your opinion of BHT for lessening the symptoms of shingles? Is it still effective in the latter stages of flare up? Does it help with postherpetic neuralgia?