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Herpes and Shingles

Vitamins C and E

Vitamin C (ascorbic acid) is important in maintaining immune status. Vitamin C can strengthen white blood cell function and boost interferon levels. It is a free radical scavenger (Li W et al 2001) and protects tissues from oxidative stress and enhances the actions of vitamin E (De Souza MC et al 2000).

In one clinical trial, a water-soluble bioflavonoid/ascorbic acid complex (600 to 1000 milligrams [mg] of bioflavonoids and 600 to 1000 mg of ascorbic acid taken three to five times daily) was shown to be effective in the reduction of recurrent HSV1, reducing blisters and preventing disruption of vesicular membranes. Remission of symptoms was observed in 4 days (Terezhalmy GT et al 1978).

In another randomized, double-blind, placebo-controlled study on the topical treatment of recurrent mucocutaneous herpes, a pharmaceutical ascorbic acid formulation with antimicrobial properties (Ascoxal®) demonstrated the antiviral effects of vitamin C. A cotton pad soaked in the Ascoxal® solution was firmly pressed on the lesion for 2 minutes three times (with 30-minute intervals in between) for one day only. The treatment resulted in markedly reduced symptoms and fewer days of scab formation (Hovi T et al 1995).

High levels of vitamin C can protect levels of vitamin E in tissue and may contribute to the immune-enhancement of vitamin E (Chan AC 1993).

Vitamin E is a powerful antioxidant and free radical scavenger. A highly publicized study of vitamin E to boost immune function appeared in 1997 (Meydani M et al 1997). The double-blind, placebo-controlled study looked at healthy humans older than 65 years. Supplementation with vitamin E for 4 months improved clinically relevant indices of cell-mediated immunity.

Zinc and selenium

Zinc plays many roles in basic cellular function, including DNA replication, RNA transcription, cell division, and cell activation. Zinc is a specific activator of T-cells, T-cell division, and other immune cells. Zinc also functions as an antioxidant and stabilizes membranes against the oxidative effect of other minerals, such as iron and copper, by increasing the levels of catalase, superoxide dismutase, and glutathione-S-transferase. Zinc-deficient patients display reduced resistance to infection (Cuevas LE et al. 2005).

In a double-blind, placebo-controlled, randomized clinical trial that evaluated the effect of a zinc oxide/glycine cream on facial herpes in 46 patients, treatment reduced or shortened the duration of cold sore lesions (5 days) compared to placebo (6.5 days) when applied within 24 hours of onset of symptoms. The cream also reduced the severity of symptoms, particularly blistering, soreness, itching, and tingling (Godfrey HR et al 2001).

Selenium (an antioxidant with immune system–boosting properties) may help suppress the reactivation of herpesviruses by increasing immunity. A number of studies have shown that the combination of zinc and selenium enhances immunity in the elderly. A pioneering study published in Lancet (Chandra RK 1992) found that seniors taking modest doses of a multivitamin/multimineral supplement containing zinc and selenium showed a general reduction in infection and required antibiotics for significantly fewer days annually.

A more recent study brings the effect of zinc and selenium into sharper focus. This well-designed, randomized, placebo-controlled, double-blind study found that seniors taking these two minerals had significantly fewer infections over a 2-year period, but that vitamin supplementation alone did not have a major effect (Girodon F et al 1997). The zinc and selenium supplement cut the number of infections by nearly two-thirds, compared to placebo.

Cimetidine: A Novel Approach

Cimetidine (Tagamet®), an over-the-counter drug, helps reduce the severity of herpes outbreaks (especially in patients with shingles), as well as reduces the amount of time of active infection. It works by temporarily inhibiting T-suppressor cells. T-suppressor cells down-regulate the immune system after the pathogen has been destroyed. Because of the inhibitory effect on T-suppressor function, cimetidine therapy is contraindicated in patients who have had organ transplants or who have autoimmune disorders (Kumar A 1990).

The following studies appear to demonstrate the effectiveness of cimetidine against herpes:

  • A combined in vitro/in vivo study evaluated the effect of cimetidine on herpes zoster. Treatment with cimetidine shortened the median time to initial pain reduction and to complete resolution of pain. It also promoted more rapid healing of skin lesions than did symptomatic treatment (Miller A et al 1989).
  • In 221 patients with shingles who were given 200 mg of cimetidine three times during the day and 400 mg at night, disease duration was reduced. It was suggested that use of cimetidine should begin even during the prodromal period, the time when the appearance of early symptoms may mark the onset of the condition (Kapinska-Mrowiecka M et al 1996).
  • Patients with herpes labialis (oral lesions) and herpes keratitis (a herpes infection of the eye) showed a shortened duration and frequency of infection after treatment with cimetidine (van der Spuy S et al 1980).
  • A case report in Canada appeared to show that cimetidine therapy reduced the expected length of the active phase of herpes zoster from 35 days to just 10 days (Hayne ST et al 1983).
  • A paper presented at Michigan State University concluded that patients with herpes zoster who were given cimetidine exhibited enhanced immunity (Kumar A 1990).

Cimetidine is sold over the counter. Refer to the package insert for possible drug interactions.

L-lysine: Active against Herpes

L-lysine, an essential amino acid, has been studied for its ability to reduce the reactivation rate of herpes (Flodin NW 1997; Marcason W 2003). It works by inhibiting the action of L-arginine during viral replication. Proteins within herpes are rich in L-arginine. An altered ratio of L-lysine to L-arginine, in favor of L-lysine, has been studied for its ability to inhibit the virus. While the results of some studies have been mixed, the following studies have shown L-lysine’s ability to inhibit herpes:

  • In a double-blind, multi-centered, placebo-controlled study evaluating L-lysine for the prevention and treatment of recurrent herpes infection, one group received 1000 mg of L-lysine three times daily for 6 months. This group had significantly fewer outbreaks, less severe symptoms, and more rapid healing. The researchers said that L-lysine was an effective agent for reducing the occurrence, severity, and symptoms of herpes (Griffith RS et al 1987).
  • In a second prospective, randomized, double-blind, placebo-controlled, cross-over study, oral intake of L-lysine (1248 mg daily) decreased the recurrence of herpes simplex in people with healthy immunity. A dose of 624 mg per day was not effective. L-lysine may also decrease the severity of symptoms associated with recurrences. Neither dosage shortened healing time (McCune MA et al 1984).
  • In a double-blind clinical study examining the long-term prophylactic efficacy of L-lysine supplementation for herpes labialis, volunteers who had a history of frequent outbreaks were recruited. The treatment group received daily oral supplements of 1000 mg of L-lysine. The L-lysine treatment group had significantly fewer outbreaks than the control group. Volunteers who were taken off L-lysine generally showed a significant increase in the recurrence of lesions. Data revealed fewer lesions when a person's serum L-lysine concentration exceeded 165 nanomoles per milliliter (nmol/mL) and increased significantly as concentration levels fell below 165 nmol/mL. These results suggest that prophylactic L-lysine may be useful in managing selected cases of recurrent herpes labialis (Thein DJ et al 1984).

Foods rich in L-lysine include legumes, eggs, yogurt, fish, and chicken (Balch PA et al 2000; Jamison JR 2004). Taking L-lysine with vitamin C and bioflavonoids together has been shown to reduce the risk of herpetic outbreaks (Balch PA et al 2000).

Propolis

Propolis, a natural product from bees, is comprised of a complex of antiviral chemicals (especially flavonoids).

In one study, extract of propolis was tested against the herpesvirus both in vitro and in experimental animals. In the in vitro study, propolis caused a 50 percent reduction in herpes infection. Administration of propolis before or at the time of infection yielded the most significant results. However, even when the propolis was added 2 hours after infection, it still yielded 80 percent to 85 percent protection. In the animal portion of the study, a weak propolis solution prevented the appearance of herpes symptoms in rats and corneal herpes in rabbits (Huleihel M et al 2002).

In a multi-centered randomized study, 90 men and women with recurrent genital HSV2 were divided into two groups to compare the healing ability of propolis ointment with natural flavonoids versus acyclovir ointment and placebo. Ointments were applied four times a day for 10 days. At day 10, 80 percent of patients in the propolis group had healed. Forty-seven percent had healed in the acyclovir group, and 40 percent had healed in the placebo group. Investigators concluded that an ointment containing flavonoids was more effective in healing genital herpetic lesions and in reducing local symptoms than ointments containing either acyclovir or placebo (Vynograd N et al 2000).

Thymus Extract

Extracts of thymus have immune system–enhancing and restorative properties (Corey L 2000). In a randomized, placebo-controlled study, immunodeficient patients with recurrent HSV1 cold sores who were given bovine thymus extract (Thymostimulin) for 6 months had only 17 recurrences versus 62 in the control group. A significant increase in total white blood cells, lymphocyte count, and T-cell numbers was detected. Thymus extract may be useful in reducing the risk of viral reactivation in people who have weakened immune systems (Aiuti F et al 1984).

Lactoferrin

Numerous studies have shown that lactoferrin, a whey protein found in human milk, and an antimicrobial, has powerful antiherpetic properties. Lactoferrin works by reducing the ability of HSV1 and HSV2 to penetrate cell walls (Andersen JH et al 2004). Studies have shown that:

  • Lactoferrin reduced the appearance of skin lesions in mice infected with herpes (Wakabayashi H et al 2004).
  • Lactoferrin works synergistically with acyclovir (Andersen JH et al 2003).
  • Lactoferrin was able to lower the risk of infection in the eye among mice infected with herpes (Fujihara T et al 1995).

Dehydroepiandrosterone (DHEA)

Reactivation of herpes and shingles has been associated with a weakened immune system. Among older people, who are more likely to get shingles, a reduced immune response might be caused by age-related changes in steroid hormones (Valenti G 2004a,b).

DHEA, a steroid hormone, is known to decline as people age. In a 1997 study (Khorram O et al 1997), scientists proposed that the oral administration of DHEA among elderly men would result in activation of their immune systems. Nine healthy men with an average age of 63 years were treated with a placebo for 2 weeks, followed by 20 weeks of DHEA (50 mg a day). After 2 weeks on oral DHEA, serum DHEA levels increased 3- to 4-fold. These levels were sustained throughout the study. Compared to placebo, DHEA administration resulted in:

  • An increase of 20 percent in insulin-like growth factor (IGF)-I. IGF-I is thought to be responsible for some of the anti-aging, anabolic effects that DHEA has produced in previous human studies.
  • An increase of 35 percent in the number of monocyte immune cells.
  • An increase of 29 percent in the number of B-cells and a 62 percent increase in B-cell activity.
  • A 40 percent increase in T-cell activity even though the total numbers of T-cells was not affected.
  • An increase of 50 percent in interleukin-2 (IL-2).
  • An increase of 22 percent to 37 percent in the number of NK cells and an increase of 45 percent in NK cell activity.
  • No adverse effects were noted with DHEA administration (however, this was a short study with few subjects).

DHEA has been shown in numerous human and animal studies to boost immune function via several different mechanisms (Danenberg HD et al 1995; Loria RM et al 1996; Solerte SB et al 1999). A study in the Proceedings of the Society for Experimental Biology and Medicine demonstrated that, when older female mice were treated with DHEA, several markers of immune function improved (Inserra P et al 1998).

Garlic

Garlic (Allium sativum) has substantial antiviral activity. Fresh garlic extract, in which thiosulfinates are the active components, was virucidal against every virus tested, including HSV1 and HSV2. The predominant thiosulfinate in fresh garlic extract is allicin (Weber ND et al 1992).

Life Extension Foundation Recommendations

Once herpes is contracted (the primary infection), the infected person (host) will carry the virus for life. The goal of herpes management is to support a healthy immune system with nutrients that have been shown to reduce the severity and possibly even frequency of reactivation episodes. In addition, patients with herpes should avoid excessive consumption of foods that are rich in L-arginine, such as chocolate and nuts. This will enhance the effectiveness of L-lysine by altering the balance in favor of L-lysine.

The Life Extension Foundation offers specially compounded nutrient mixes, such as Life Extension Mix, which supply everything you need to support healthy immune function. Alternatively, you may choose to take individual supplements to help treat herpes and improve immune function. As always, it’s best to launch a program of dietary supplementation under the supervision of a qualified physician. The Life Extension Foundation suggests:

  • Life Extension Mix—Follow label directions.
  • Cimetidine (Tagamet®)—200 mg three times daily and 400 mg at bedtime (800 mg at bedtime if you cannot take cimetidine throughout the day)
  • Vitamin A—20,000 international units (IU) daily during outbreaks; 2500 to 5000 IU for maintenance
  • Beta-carotene—25,000 IU daily for 7 to 10 days during outbreaks
  • Vitamin C (ascorbic acid)—5 to 10 grams (g) of esterified or buffered vitamin C during outbreaks
  • Vitamin E—400 IU of alpha-tocopherol or 359 mg of mixed tocopherols including gamma, delta, alpha, and beta tocopherols
  • Zinc—30 mg daily
  • Lactoferrin—300 to 900 mg daily during an outbreak; 300 mg daily for maintenance
  • Selenium—200 micrograms (mcg) daily
  • L-lysine—700 to 1400 mg daily to suppress outbreaks
  • Propolis—500 to 2000 mg daily during outbreaks
  • Thymus extract—2 capsules daily of Thymic Immune Factors
  • Garlic extract—1200 mg of Kyolic garlic twice daily during outbreaks; 1000 mg for maintenance
  • DHEA—100 to 200 mg daily if an outbreak appears imminent and during outbreaks until lesions disappear (blood testing is recommended after DHEA therapy to ensure adequate levels)

Herpes and Shingles Safety Caveats

An aggressive program of dietary supplementation should not be launched without the supervision of a qualified physician. Several of the nutrients suggested in this protocol may have adverse effects. These include:

Beta-Carotene

  • Do not take beta-carotene if you smoke. Daily intake of 20 milligrams or more has been associated with a higher incidence of lung cancer in smokers.
  • Taking 30 milligrams or more daily for prolonged periods can cause carotenoderma, a yellowish skin discoloration (carotenoderma can be distinguished from jaundice because the whites of the eyes are not discolored in carotenoderma).

DHEA

  • Do not take DHEA if you could be pregnant, are breastfeeding, or could have prostate, breast, uterine, or ovarian cancer.
  • DHEA can cause androgenic effects in woman such as acne, deepening of the voice, facial hair growth and hair loss.

Garlic

  • Garlic has blood-thinning, anticlotting properties.
  • Discontinue using garlic before any surgical procedure.
  • Garlic can cause headache, muscle pain, fatigue, vertigo, watery eyes, asthma, and gastrointestinal symptoms such as nausea and diarrhea.
  • Ingesting large amounts of garlic can cause bad breath and body odor.

L-Lysine

  • Do not take L-lysine if you have hyperlysinuria or the rare genetic disorder hyperlysinemia.
  • Consult your doctor before taking L-lysine if you have kidney failure or liver failure.

Selenium

  • High doses of selenium (1000 micrograms or more daily) for prolonged periods may cause adverse reactions.
  • High doses of selenium taken for prolonged periods may cause chronic selenium poisoning. Symptoms include loss of hair and nails or brittle hair and nails.
  • Selenium can cause rash, breath that smells like garlic, fatigue, irritability, and nausea and vomiting.

Vitamin A

  • Do not take vitamin A if you have hypervitaminosis A.
  • Do not take vitamin A if you take retinoids or retinoid analogues (such as acitretin, all-trans-retinoic acid, bexarotene, etretinate, and isotretinoin). Vitamin A can add to the toxicity of these drugs.
  • Do not take large amounts of vitamin A. Taking large amounts of vitamin A may cause acute or chronic toxicity. Early signs and symptoms of chronic toxicity include dry, rough skin; cracked lips; sparse, coarse hair; and loss of hair from the eyebrows. Later signs and symptoms of toxicity include irritability, headache, pseudotumor cerebri (benign intracranial hypertension), elevated serum liver enzymes, reversible noncirrhotic portal high blood pressure, fibrosis and cirrhosis of the liver, and death from liver failure.

Vitamin C

  • Do not take vitamin C if you have a history of kidney stones or of kidney insufficiency (defined as having a serum creatine level greater than 2 milligrams per deciliter and/or a creatinine clearance less than 30 milliliters per minute.
  • Consult your doctor before taking large amounts of vitamin C if you have hemochromatosis, thalassemia, sideroblastic anemia, sickle cell anemia, or erythrocyte glucose-6-phosphate dehydrogenase (G6PD) deficiency. You can experience iron overload if you have one of these conditions and use large amounts of vitamin C.

Vitamin E

  • Consult your doctor before taking vitamin E if you take warfarin (Coumadin).
  • Consult your doctor before taking high doses of vitamin E if you have a vitamin K deficiency or a history of liver failure.
  • Consult your doctor before taking vitamin E if you have a history of any bleeding disorder such as peptic ulcers, hemorrhagic stroke, or hemophilia.
  • Discontinue using vitamin E 1 month before any surgical procedure.

Zinc

  • High doses of zinc (above 30 milligrams daily) can cause adverse reactions.
  • Zinc can cause a metallic taste, headache, drowsiness, and gastrointestinal symptoms such as nausea and diarrhea.
  • High doses of zinc can lead to copper deficiency and hypochromic microcytic anemia secondary to zinc-induced copper deficiency.
  • High doses of zinc may suppress the immune system.

For more information see the Safety Appendix

 


 

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