150: Understanding Epstein-Barr Virus + Skin Rashes w/ Dr. Kasey Holland

Epstein-Barr Virus (EBV) is commonly known as mono or the kissing disease. EBV can cause a host of problems in the body, including the skin. Today's guest is here to explain all about EBV.

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My guest today, Dr. Kasey Holland, is a licensed Naturopathic doctor.

She earned her Doctorate in Naturopathic medicine at Bastyr University in Seattle, WA through a four-year CNME accredited program. While there she completed specialty rotations in environmental medicine, immune wellness, oncology, IV therapy, Parkinson’s disease, emergency medicine and mind body medicine.

After this, she worked in an Integrative health clinic that incorporated functional medicine during her residency. This has provided her with exposure to a wide variety of pathologies and patient care in order to serve you better.

She has always been passionate about helping people overcome mystery and chronic illnesses. This was further solidified after her own health obstacles.

Dr. Kasey's specialties include the toxic trio: chronic EBV, Lyme disease, mold exposure.

Join us as we talk about EBV: What it is, what causes it to reactivate, and how to get tested.

Have you experienced reactivating Epstein-Barr Virus (EBV)? Let me know in the comments!

In this episode:

  • What is Epstein-Barr Virus?
  • How and why does Epstein-Barr reactivate?
  • Classic, and unusual, symptoms of EBV
  • How to get tested for EBV
  • Relationship between EBV and candida
  • How does EBV affect the skin?
  • Is there a link between reactivated EBV and shingles?


“Epstein-Barr virus is commonly known as mono and the kissing disease. That's what we always think of it as. So, usually, you get it when you're a child, sometimes it's later in high school or college. You might not ever know that you've had it because it can be extremely mild and self-limiting.” [2:34]

“When EBV is reactivated, it definitely does cause problems. No doubt about it. It has pathways that it turns on that are extremely inflammatory, that are linked to autoimmune conditions, cancers, all sorts of scary things. But hardly ever would I say that it's just Epstein-Barr virus reactivating that's leading to people with symptoms.” [5:58]


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150: Understanding Epstein-Barr Virus + Skin Rashes w/ Dr. Kasey Holland FULL TRANSCRIPT

Jennifer: Hello, everyone. Thank you so much for you guys always tuning in and joining us for all these interesting conversations.

Jennifer: My guest today is Dr. Kasey Holland. She's a licensed naturopathic doctor and she earned her doctorate in naturopathic medicine at Bastyr University in Seattle, Washington through a four-year CNME accredited program. While there, she completed specialty rotations in environmental medicine, immune wellness, oncology, IV therapy, Parkinson's disease, emergency medicine, and mind/body medicine. After this, she worked at an integrative health clinic that incorporated functional medicine during her residency, and this provided her the exposure to a wide variety of pathologies and patient care in order to serve you guys better. She has always been passionate about helping people overcome mystery and chronic illnesses, and this was further solidified after her own health obstacles. Her specialties include the toxic trio, chronic Epstein-Barr virus, Lyme disease, and mold exposure. And today, we are going to talk about chronic Epstein-Barr.

Jennifer: Thank you so much, Dr. Kasey, for joining us.

Dr. Holland: Thank you for having me, Jen. I'm really looking forward to this episode.

Jennifer: So I consider you to be the who's who of Epstein-Barr. I really enjoyed learning from you, especially on Instagram. You've got a great account there and I know you're very active on that. And a lot of people have this concern that Epstein-Barr virus is the reason behind all of their health problems. And so a lot of people with skin issues, they will, at a certain point, they'll start becoming incredibly fatigued, they'll just feel really unwell and have this constellation of symptoms that doesn't make any sense. A simple Google online will somehow get you someplace that will probably say all of your symptoms are the result of Epstein-Barr. So, what I'd like to do is start off by asking the question, what exactly is Epstein-Barr virus, for those who don't know what it is?

Dr. Holland: Yeah. So, Epstein-Barr virus comes from the herpes virus family, and we have several different ones in there. So, you think of HSV-1, which is what causes canker sores, the chicken pox, it's all the same family there. And the interesting thing about that family is that virus stays in your body, but it can reactivate.

Dr. Holland: So, Epstein-Barr virus is commonly known as mono and the kissing disease. That's what we always think of it as. So, usually, you get it when you're a child, sometimes it's later in high school or college. You might not ever know that you've had it because it can be extremely mild and self-limiting. But usually, it's a sore throat, low grade fever, a headache, really a lot of fatigue. That's what we know and what it's kind of famous for, is the fatigue. And doctors say that it should last two weeks and then you get better and you shouldn't have to deal with it again because your immune system should kick in and keep it in a latent state where it's asleep, but now we see that that isn't always the case, that it turns back on.

Dr. Holland: And so we see that it turns back on in a lot of people. Over 90% of people are exposed to this virus. It's really common. It's in our saliva glands and mucus membrane, so it's really common to be a carrier of it and you don't know. So then we have this debate of, well, do we have it, and everybody has it, or do some people have it and it's contributing to their symptoms? So, that's kind of the basics of, I think, why there's so much question around Epstein-Barr virus.

Jennifer: Okay. And so I think the one point that is worth being made and I think made early, that do you feel, as someone who addresses Epstein-Barr, that if you do have Epstein-Barr virus or it's reactivated, do you think that that is always the only problem that most people… if it is an issue that that's the only thing that they would have going on?

Dr. Holland: So, there are different strands of Epstein-Barr virus, so there are some that infect different immune cells that are more aggressive. And in those cases, it's a lot more rare, but in some instances that really can be the biggest thing going on and it can be a lot more aggressive. But in vast majority of cases where usually it's infecting the B cells and whatnot, we see that Epstein-Barr virus really is classified as an opportunistic infection. So, it's not going to cause problems unless there's other things going on. So, more likely, we see that it's a kind of a whistleblower for, “Hey, your gastrointestinal health is off, or you are just under a lot of stress, or you've been exposed to toxins.” It actually has a protein on it that's really smart, and it senses.

Dr. Holland: There's all these tests and studies saying like, “Okay, what causes it to reactivate?” And what we see that all the things that they look at have in common is that they all cause oxidative stress in the body. So, lots of things can cause oxidative stress, anything from emotional stress, to a car accident, to other viruses, to toxins, molds, you name it, and those are the things that it's changing the dynamic in your body and that virus knows, “Hey, it's a good time to come out and party and cause problems.”

Dr. Holland: So, when EBV is reactivated, it definitely does cause problems. No doubt about it. It has pathways that it turns on that are extremely inflammatory, that are linked to autoimmune conditions, cancers, all sorts of scary things. But hardly ever would I say that it's just Epstein-Barr virus reactivating that's leading to people with symptoms.

Jennifer: So, if someone was like, “Oh no, no, no. I really truly believe that it's just Epstein-Barr. That's my whole kitten caboodle here that I got to worry about.” If you think that, would you agree that it's probably likely you're missing the bigger picture, there's other pieces that need to be addressed, that if you just fixate on Epstein-Barr, you're probably going to miss?

Dr. Holland: Definitely. I've seen people taking all the natural antiviral supplements you can imagine and just focusing on ways to kill the virus and they don't feel any better. They're still exhausted or dealing with a multitude of chronic symptoms.

Jennifer: And speaking of those symptoms, what are some of the symptoms that you feel are classic, and then maybe if there's any weird odd ball symptoms that you might see that if a patient was to come to you, you'd be like, “You know what? We should probably get you tested for Epstein-Barr”?

Dr. Holland: Yeah. So, in the acute phase, where it's the first time you get it, we kind of went over that where it's kind of a low grade flu-like. In the more chronic, we can see those symptoms come back and sometimes they will be cyclical. So, you'll get those symptoms and then they'll go away and they'll come back. We also see more… We can see kind of autoimmune disease type sometimes where you're getting joint pain and your skin is breaking out or something like that. We can also see brain fog. We can see anxiety, we can see insomnia. I mean, the list kind of goes on from there, but those are the main things. I would say that anxiety is the piece that really, I was like, “Oh,” I started to see that in a lot of people and realized like, “Oh, that's due to the Epstein-Barr virus or other things because of how much cytokine activity you have going on in your brain.”

Dr. Holland: Another thing that I commonly see with women is during menstruation or before menstruation, I actually was looking at the research on this, and there's a lot of different reasons for why it happens, but it's listed with Epstein-Barr virus and it being more active with menstruation. And so we'll see flare ups right before their menses or during, and then sometimes afterwards, it takes longer for them to feel energized, and then, of course, the chronic fatigue. That's the biggest thing where people get used to feeling so tired and they just think it's them or they're lacking motivation. It's really just this constant fatigue. And then, of course, the brain fog plays into that too.

Jennifer: Okay. And as far as getting somebody tested, what are some of the labs that… is it just a panel that someone could go and ask their doctor for, that's like, “Oh, I want the Epstein-Barr virus panel,” or are there certain labs that you run that a lot of times a conventional doctor that might not be used to digging so much, they might not realize they should be looking under some other rocks?

Dr. Holland: Yeah. So, you can go to your doctor and have them run a panel. The problem is that a lot of doctors will just run part of the panel. So, with Epstein-Barr virus, remember we have that initial reaction and then we have a reactivation. So, the initial reaction is measured with IgM antibodies, and that's your body's first response to an infection. And that's what's usually positive with the monospots. The monospot they do, and it can just be a finger prick, but if we're looking for chronic EBV, we want to do the IgM still, see if it happens to be the first time, or we actually see in some people when they reactivate, that their IgM is active again, which was really interesting, and there's a lot of reasons that that can happen. But then we also want to look at the IgGs.

Dr. Holland: Now, there's different pieces of the virus. So, there's the capsid area that contains the virus, and then there's the inside where the nucleus material is. So, we want to look at the viral capsid antigen IgG, and the nuclear antigen IgG. And then we have an early antigen IgG that's usually positive between three to six months when it reactivates, can sometimes be longer depending on our immune system. Our immune systems are so complex and I think we really underestimate that. But that early antigen can be a really sure sign of reactivation. So, we want all of those titers when we're looking at it, and your doctor can order that. So, your primary care physician can do a blood draw for that. That's the panel that I like to see.

Dr. Holland: Now, some labs will just look if it's positive or negative and some will actually give you the number of your titers. It's good to see the number on the titers so that we can actually see how high they are, because sometimes you might have everything negative but just one IgG, which at first could seem like just a past infection that you've had, but what you start to see is that number a hundred times the upper normal limit, sometimes above 600, and when that's happening and those symptoms, that's when the light bulb goes off and it's like, “Hey, this is not just a past infection even though we're not seeing that active early antigen right here.”

Dr. Holland: There are some functional labs, like the GI-MAP, that will look for EBV. That's helpful, but it's not going to give you the whole panel.

Dr. Holland: So, thankfully, though, the whole panel really is a simple blood draw that your doctor can order.

Jennifer: That's awesome. That is really, really great to hear, especially because some of this stuff can be very cost prohibitive for people, and if they're able to go get a panel like that, especially through their insurance, that can be a huge, huge help.

Jennifer: And so I wanted to ask you just how or is it possible for there to be a connection between Epstein-Barr and candida? Because a lot of people ask me about candida and you had mentioned that, and I wanted to ask about that.

Dr. Holland: Yeah. So, the more I started seeing people with EBV and the more candida I started seeing, and I was like, “This cannot just be a coincidence.” So, there's a study where they looked at herpes family viruses that were in candida biofilms. So, fungus can build biofilms too, which is basically kind of like an extension of itself to protect itself from the immune system, and bacteria will do that too. So, what they did was they tried different pharmaceutical antivirals against the herpes virus and it wasn't effective when the candida was there. So, it wasn't specific to Epstein-Barr virus, but Epstein-Barr virus is from that family. So, most likely there's a connection there. So, if you have candida in your gastrointestinal tract, not only is it going to burden your immune system and your ability to overcome a viral infection or, I mean, it's also causing a lot of other problems, but it looks like it can actually play into helping Epstein-Barr virus evade your immune system in your gastrointestinal tract.

Jennifer: Okay. So, let's say we've got Epstein-Barr that's hiding. It's hanging out, it's behind the scenes, behind almost our like little force fields that the candida create. And then we're like nuts. We got to figure out how to deal with these biofilms. But there are other factors to this too that can cause a reactivation, right? And this is where this comes into. We don't want to get… What is it? You missing the forest amongst the trees. We want to make sure that we're looking at this bigger picture, and there are so many other exterior pieces, mold, stress, and I'm certainly sure there's others. But can you talk a little bit about that, about how all of these different pieces can play together to allow Epstein-Barr to reactivate.

Dr. Holland: Definitely. Well, I mean, we can't not talk about mold, because mold, not only does it extreme stress in the body where it's hitting that signal of, “Hey, it's a good time for EBV to come and play,” but it actually causes B cells to forget what they've seen before. So, remember when I said the IgM, that sometimes it's positive again? Well, if you're exposed to mold, your body doesn't have the same memory of what your body's already fought, so that virus just keeps going and you don't fight it right. So, mold is a really, really big thing that we see associated with it.

Dr. Holland: Now, also just stress. So, if your body's in a sympathetic fight or flight state, which means you're prepared to run from a grizzly bear, the stress from our day to day activities, if you get a stressful work email, or text, or whatever is going on in your personal life, that stress response is the same as if you're running from a grizzly bear. So, when that happens, you're not really activating your immune system because you're getting away from the grizzly bear. So, we see a lot of people that it could be a chronic thing where they've just worked really hard their whole life, and they're stressed all the time, or maybe there was an acute thing where there was a big life event, or there was a car accident, something like that, but your adrenals and your thyroid and all of that play in to how you can fight Epstein virus, and if you're constantly stressed, then your immune system never really has a full, optimal chance to work. So, that's a really big piece.

Dr. Holland: And then we talked about candida, which usually goes back to gastrointestinal health, but then there's other things about gastrointestinal health. If you have intestinal permeability, or you have bacteria there that's not supposed to be there, or not enough of the good bacteria, all of those things can play into what's going on with Epstein-Barr virus. And if all you do is take some glycerides or Melissa, which are natural antivirals, you might knock it a little bit if you're lucky, but it's not going to get to the root of the problem and get to where you're actually having energy again.

Jennifer: So, if you are chronically fatigued with Epstein… Say Epstein-Barr reactivates and you are exhausted, physically exhausted, mentally exhausted, can that level of exhaustion show up in other ways? Could it show up in skin that becomes really dried out and rashy? Can you see hair thinning and other things that we kind of think of when we look at someone and you see that picture of just a person that's really almost like depleted?

Dr. Holland: Yeah, definitely. When there's candida, that's a lot of times when we see a lot of skin disruptions, which I know you are an expert in. So, when there's that picture, there's definitely something going on. And when we're tired, yeah, we start to see dryer skin almost like it's just not getting the nutrients that it needs. We can see hair thinning. Now, if there's mold involved, then all of that is really, really, really big. And then with the thyroid… So, Epstein-Barr Virus burdens of thyroid, but also if you had a low thyroid before, then that also plays in. And then it comes to where are you getting the nutrients that you needed, because low thyroid also can contribute to our hair thinning, things like that. So, those can all definitely be a part of the picture.

Jennifer: Yeah. It's not as simple. When you go online, a lot of people go, “It's this one thing.” And you're like, “No, you kind of have to rule some things out. You have to navigate this complex picture and narrow it down to what exactly is going on.” But if someone has a reactivation, would you really… and I don't know how to categorize this correctly. So, I mean, you described to us what this is like, but are you really getting rid of Epstein-Barr or are you just getting your immune system to a point where it can kind of beat Epstein-Barr back into submission and then it just like hangs out there? Because we're stuck with viruses for life, right?

Dr. Holland: Right. Yeah. So, there's the latent phase and the lytic phase of Epstein-Barr virus, and we never actually eradicate the virus. So, that's another thing to go like, “I'm taking this to kill the virus.” I'm like, “Yeah, but the virus is still there.” So, what we see with chronic illnesses and Epstein-Barr virus is there's the question of like, did this cause this or was that there because we were headed down that path already? So, for me, you're getting your immune system and your body to a place where it can keep the Epstein-Barr virus in latent state, where it's not turning on those proteins that are going to cause inflammation and set you up for other chronic illnesses. And it's always going to be there. So, there is no completely eradicating it out of the system. So, really, the best option is your own immune system, and it needs to be able to put it in the latent state. So, figuring out what is inhibiting your immune system to be able to fully do that is the plan to getting Epstein-Barr virus under control.

Jennifer: So, it is possible. It's not like you're going to end up with a lifelong battle, let us hope. It shouldn't be a lifelong battle to keep Epstein-Barr latent, quiet.

Dr. Holland: So, it's interesting on the titer tests, because very commonly we'll see the early antigen go back down. That's pretty standard, but sometimes that'll go back down even when we still have symptoms, and then we have the IgGs that show past infection are still high. Those can take a lot longer to come down. So, even when people start to not have symptoms, they'll stay high, and we really need to do some more research into that area and what's really going on, but when we're at that phase, it's really important to pay attention to the symptoms and how people are feeling. So, look at your quality of life. If you have energy again… One of the biggest signs that I see is people, when they're able to exercise again. So, a lot of times with Epstein-Barr virus, one symptom that can happen is if you work out or you exercise, you're not just tired, you're like out, and it's referred to as post-exertional fatigue or malaise, and there's actually a diagnostic code for that.

Dr. Holland: So, if we start to see, oh, you can exercise again and your body can recover, that's a really good sign. So, we have to pay attention to the body and what it's saying that it's able to do. But I have worked with people that have said, “I was getting checked for MS and having MRIs,” and then we got to their digestive problems or dealt with mold, and they're back to hiking. I had it myself personally with a mold exposure reactivate, and I went from not being able to do five minutes of yoga to I'm doing yoga and lifting weights. So, our body is made to heal and we can overcome it when we give it the things that it needs.

Jennifer: Yeah. And I want to ask you too. I've had a bunch of clients who've had issues with shingles and, I guess, other reactivation issues, and so they'll take lysine, the amino acid lysine. Do you feel like lysine is helpful with Epstein-Barr?

Dr. Holland: I have not seen lysine make a huge improvement with fatigue, but that doesn't mean that it's not helping get the virus under control, and I have seen it really help with herpes outbreaks. So, I think it can be helpful for reigning in the viral load, but I haven't seen it be like, if you just take lysine, that it helps with the fatigue.

Jennifer: Okay. And actually, just out of a kind of curiosity, is there any connection between somebody who has had or has the Epstein-Barr kind of hanging out, hiding under the surface, and maybe getting shingles, which is the reactivation of chickenpox, but early. Because a lot of times we think of that as a “old person's issue,” right? But I had it when I was 27. I know an increasing number of people who have had it and multiple times at very young ages. Do you notice, in your practice, at all, any connection between the two?

Dr. Holland: Yeah. So, I think it really just comes down to looking at the total load in your body. So, let's look at your total viral load. Well, all those viruses are from the same family. So, your body is trying to deal with them and it's putting out fires, but it can't keep up. And then we see those viruses have more opportunity to cause problems too, because those are kind of all opportunistic… it's an opportunistic family, really. And the same thing happens with, say ,candida. If you're exposed to mold, it's a different type of fungus, but then we see that you're more sensitive to the candida that you have in your gastrointestinal tract and your fungal load. So, we look at that whole viral load and it can definitely all contribute.

Jennifer: Cool. And just one last question. This is me being a little bit of a nerd. So, you mentioned on the GI-MAP… And for everybody listening, that's a stool test. It's a functional stool test. So, it's not the traditional thing you go to your gastroenterologist and they order at Quest or LabCorp. It's not that. It's a much more comprehensive stool test. But there is an Epstein-Barr marker on that test. So, if that test comes back positive for Epstein-Barr, what does that tell you? Would that be a signal to you like, “Ooh, we should probably dig a little deeper into this”? What would your opinion be on that marker showing up as positive?

Dr. Holland: Yeah. So, if it shows up as positive, then it's really hard to tell if it's active or not, so you can just do a blood panel to check. And also, if the patient is symptomatic… Usually if reactivated EBV is happening, there's the tick. So, if they have a lot of energy, which most people, if they feel great and have a lot of energy aren't running their GI-MAP, but again, I think it is good to get it checked because EBV is linked to autoimmune conditions, including irritable bowel disease and things like that. So, that can be early precursors where we're turning on inflammatory things in our gut that we don't want to be, and we want to make sure to take care of that to prevent further problems down the road too.

Jennifer: All right. So, I thought of one more question that I have to ask. So, do you feel like there's this idea that certain nutrients like copper, for example, can feed Epstein-Barr? And there are some theories out there that are like, “Oh, these specific things,” like copper jumps out in my mind, that we've got to get copper out of our systems. Have you found that that's the case? It sounds to me like it's more about looking at the system as a whole, but there's some people like, “I just got to get the copper out of my system. There's excess copper.” I find that most people are supplementing with so much zinc on their own, which is also equally concerning, because you can throw your zinc/copper ratio off, and I'm like, how many people are really that toxic with copper?

Dr. Holland: Yeah. I mean, you don't want to be toxic with copper, but I agree, usually, there's like Wilson's disease, which is a copper overload. So, usually, you're going to have other symptoms if you have a true copper overload. Now, there is the saying of heavy metals and things feeding Epstein -Barr virus. I haven't seen any research where it's actually like, “Hey, this virus eats this,” but all those things cause oxidative stress, and with oxidative stress, that's, remember, what's sending that signal to that virus like, “Hey, it's a good time to party,” and we do see that when we have heavy metals, Epstein-Barr virus is usually causing problems. So, I do think that that makes things worse, but I don't think that this idea that it's actually feeding the virus is quite right. Making it worse or making it able to be more active, that could definitely be more accurate.

Jennifer: Okay. Fair enough. Fair enough. Wow. You are a knowledgeable person, so I'm so glad that we had the opportunity to sit down and talk about it, especially, let's have a real conversation about it, right? Let's talk about what science tells us, what we're seeing in clinical practice. And I think it's really helpful too that the panel to check for this is accessible. Whether your doctor's willing to do it, that's another matter. But if you really feel so inclined, you can find other doctors to add to your team to help support you.

Jennifer: I want to make sure people can find you. You have a website, drkaseyholland.com, and your Instagram is fantastic. It's just @drkaseyholland. We'll make sure to put all of that in the show notes, that way it's super easy for everybody to find you. And I hope that at some point we'll be able to have you come back because it'd be great to talk more about this kind of stuff, and obviously, you mentioned mold, and mold is another big question that people oftentimes ask. But thank you so much for joining us, Dr. Kasey. I appreciate it.

Dr. Holland: Thank you so much for having me, Jen. It's been great.

“Epstein-Barr virus is commonly known as mono and the kissing disease. That's what we always think of it as. So, usually, you get it when you're a child, sometimes it's later in high school or college. You might not ever know that you've had it because it can be extremely mild and self-limiting.”