~Herpes and Shingles, Part 2 - Nutritional Approaches

What You Have Learned So Far...

  • The herpes family includes several related viruses, including HSV1, HSV2, and varicella-zoster virus. These viruses are extremely common, with the majority of the US population showing antibodies to viruses in the herpes family.

  • The herpes viruses are distinguished by their ability to go into clinical dormancy, or a period in which they hide in the body before becoming reactivated. Herpes outbreaks are often characterized by skin lesions and fever, along with other symptoms.

  • The varicella-zoster virus is responsible for chickenpox in children. After the initial outbreak, the virus can enter a long period of latency and reappear in the sixth decade of life as shingles.

  • Both HSV1 and HSV2 can cause oral or facial lesions or genital disease. The herpes viruses can also infect the central nervous system, internal organs, and eyes. Neonatal herpes is usually passed from infected mothers to children during birth.

  • Contrary to popular belief, genital herpes can be transmitted even when active lesions are not visible and symptoms are not present. People with the disease can shed the virus or may have lesions that are not readily visible.

  • Conventional treatment for herpes relies on antiviral drugs that have powerful side effects. These drugs can help lessen the severity of outbreaks.

  • Reactivation is associated with a weakened immune system, so patients with herpes might consider an immune-boosting nutritional program to strengthen their immune systems. Many supplements have been proven to fight herpes by boosting the immune system or by interfering with the virus’s ability to penetrate cell walls.

Antioxidant Defenses

Although there is no cure for herpes viruses infection, various supplements have shown the ability to reduce the severity and even the frequency of outbreaks. This might be due to their ability to support a healthy immune system (a weakened immune system has been associated with herpes reactivation).

Antioxidants are particularly important immune-boosting supplements. Multiple clinical studies support the theory that antioxidants are of benefit in the management of herpes viruses (Bhaskaram P 2001; Elmadfa I et al 1994; Grimble RF 1997; Sheridan J et al 1997).

Vitamin A and beta-carotene

Vitamin A plays a role in protecting the skin and mucous membranes from invasion of microorganisms. In 178 HIV-positive women with genital herpes, who were neither pregnant nor taking oral contraceptives, vitamin A levels were closely associated with cervical HSV shedding. Increased shedding was associated with decreased vitamin A (Mostad SB et al 2000).

Experimental studies have documented vitamin A’s effectiveness against other herpes viruses. The strong antiproliferative activity exerted by retinoids (vitamin A derivatives) indicates these compounds may be useful tools in the management of EBV–related disorders in immunosuppressed patients (Pomponi F et al 1996).

Beta-carotene is the major precursor of vitamin A (Meisenberg G et al 1998). Studies show that long-term beta-carotene supplementation may be beneficial for immune, viral, and tumoral surveillance in aging individuals. In a controlled, double-blind study, the effects of 10 to 12 years of beta-carotene supplementation on natural killer (NK) cell activity were evaluated. Although no significant difference was seen in NK cell activity in the middle-aged groups, elderly men who took supplements of beta-carotene had significantly greater NK cell activity than the control group receiving placebo (Santos MS et al 1996).

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 herpes viruses 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, 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 herpes viruses 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).


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 (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).

Continued . . .

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