At 24 Sara Had Extreme Fatigue and Overall Low Quality of Life. How One Functional Medicine Doctor Helped Her Get Her Life Back

Epstein Barr Virus (EBV) is a common viral infection, with studies showing that an estimated 90% of adults have been exposed to EBV at some point in their lives. EBV is known to remain in the body, staying dormant in certain cells and tissues. This dormant virus can become active again, which may contribute to symptoms and has been associated with various conditions.

[signup]

CC: Epstein Barr Virus, Extreme Fatigue, Hypothyroidism, Hashimoto's Thyroiditis, Abdominal Bloating, and Constipation

Sara was a 24-year-old female who experienced extreme fatigue, digestive issues, brain fog, and a low quality of life. She rated her energy as a 2/10 on average. She needed 1-2 naps daily and avoided driving due to concerns about falling asleep. A year before our first visit, she was diagnosed with Hashimoto's thyroiditis and hypothyroidism, but treatment had not improved her energy or other symptoms.

She has had digestive issues since childhood and often experiences abdominal pain due to infrequent bowel movements.

Additional History

Three years ago, Sara moved to Los Angeles, California, for a high-stress job with long hours. A few months into her job, she noticed increased fatigue and digestive symptoms, along with sleep disturbances.

A year ago, she was diagnosed with Hashimoto's and started a gluten-free diet, which helped reduce her TPO antibodies.

Her diet was rich in whole foods with limited dairy, processed foods, and refined sugar. She had been on oral birth control since age 15 and had not had a period in over five years.

Lab Work

Comprehensive Stool Test Results

• Fecal Secretory IgA: mild elevation
• Short Chain Fatty Acids (SCFA) (Total): Low
• N-butyrate Concentration: Low
• Beta-glucuronidase: High
• Low beneficial bacteria: Akkermansia muciniphila: below detectable level

Nutrient Evaluation

• Normal Range: Riboflavin, Molybdenum
• Moderate Deficiency: Vitamin A, Vitamin C, Vitamin E, Glutathione, Thiamin, Niacin, Cobalamin, Magnesium, Manganese, Omega 3 Fatty Acids
• Severe Deficiency: Alpha lipoic acid, Pyridoxine, Biotin, Folate
• High Toxic elements Elevated: Mercury  

Lab Analysis

Epstein Barr Virus

Sara's lab work suggests a reactivation of her dormant EBV infection, as indicated by the positive EBV Early Antigen IgG. The additional positive EBV Viral Capsid and Nuclear AG IGG values suggest a past infection. At the same time, EBV Viral Capsid IgM was negative, indicating no recent initial infection.

The connection between heavy metal exposure and EBV was noted with elevated mercury levels and low antioxidants, B vitamins, minerals, and glutathione, suggesting oxidative stress.

TSH

Other factors contributing to her fatigue include her low TSH. A full thyroid panel was not performed as one was done a month before our visit, showing normal free T3/free T4 levels.

Gut Health

The stool analysis indicates low inflammation but a high toxic load with increased beta-glucuronidase. With the patient on birth control, her estrogen is managed through synthetic hormones, so another toxin exposure is possible. A comprehensive approach to support her body's detoxification is suggested, especially considering her high mercury level. Mercury is a known neurotoxin that may be linked to various health concerns.

A gradual approach to detox is suggested to avoid stressing her system, and establishing regular bowel movements is important for eliminating mercury.

Nutrients

Sara's labs also show borderline low iron and ferritin levels. Focusing on gut health and iron absorption may help support an increase in these levels.

Cortisol Support

Sara's DHEA-s levels were low, suggesting her adrenals may be under stress. Her cortisol output was mostly normal, except for a low morning level, indicating a delayed cortisol awakening response. Lifestyle changes and nutrient support may help with this.

Interventions

Epstein Barr Virus Support

• Consider reducing foods that may promote viral activity: red meat, egg yolks, and sugar.
• A list of foods that may support immune health was provided.
• Zinc Sulfate 15 mg 2x daily: high zinc foods also reviewed.
• Liquid Liposomal Vitamin C 1,000 mg 3x daily.
• Lysine capsules 500 mg 3x daily.

Digestive Support

• L Glutamine (Klaire Labs): 5 grams nightly to support gut health.
• Butyrate Complex to support low butyrate/SCFA levels and gut health.
• Calcium D glucarate 500 mg 2x daily to help manage beta-glucuronidase levels.
• Microbiome support: pomegranate/cranberry juice, matcha green tea powder, collagen powder, acacia powder.

Nutrient Restoration and Mitochondria Support

• Mitocore by Ortho Molecular was suggested with a gradual increase to 4 pills daily.
• High omega-3 fatty acid foods were also reviewed.

Mercury Detox

• Cilantro tincture 2x daily before food for one week, then two weeks off, then resume.
• Activated Charcoal capsules were taken mid-day between the first and second dose of cilantro tincture. Charcoal may help bind to certain substances.
• Sources of mercury in food, cosmetics, and the environment were reviewed.
• Infrared sauna 2x weekly for general wellness support.

Cortisol Support

• Lifestyle factors reviewed: regular sleep/wake times, outdoor walk within 45 minutes of waking for sunlight exposure, avoiding intense workouts after 2 pm, morning meditation starting with 5 minutes.
• Consider reducing toxin exposure: Berkey water filter, organic produce, organic & free-range meat, wild-caught fish, clean body care, and household products.

Follow Up Labs 3 Months Later

3 Months Follow Up Visit

At the follow-up visit, Sara reported feeling better. Her energy improved to a 5-8/10, and she was starting a new, less stressful job three days a week.

She was taking 1-2 naps a week but didn't feel the overwhelming need to nap as long as she maintained a regular sleep schedule with 9 hours nightly.

1.5 months into the protocol, she was able to begin exercising again without feeling fatigued.

Initially, she experienced diarrhea with the gastrointestinal support, but adjusting the dosage of the butyrate complex and taking it with meals helped her have regular bowel movements, and her bloating resolved.

She also noticed improvements in her skin and hair health, reduced brain fog, and memory issues, and she lost 6 pounds of excess weight.  

Summary

This case highlights the complexity of chronic infections and their potential effects on health.

Factors like heavy metal exposure and nutrient deficiencies may contribute to a weakened immune system, allowing latent infections like Epstein Barr to become active.

Checking for reactivated viral infections in adults with fatigue can be important for long-term health. As Sara continues to follow the protocol and allows her body time to recover, it is hoped that she will regain her energy levels. However, the potential for reactivation due to stress or lifestyle factors remains a consideration.

Patients with chronic fatigue or past viral infections such as EBV should consider working with a healthcare provider to monitor their health and develop a personalized care plan.