Herpes simplex virus is one of the most prevalent infectious organisms known; 60 percent to 90 percent of American adults carry oral herpes, and 30 percent to 35 percent have genital herpes, although only 25 percent of them are aware of having either.1
Various drugs are available to manage the disease, but your customers may be looking for alternatives. You can recommend several natural suppressive and topical treatments for herpes, including lysine, wakame, red sea algae, zinc, lemon balm, tea tree oil and vitamin C. Each holds promise for combating this prevalent virus, but the treatments have varying degrees of scientific substantiation.
A vexing virus
The two main forms of herpes simplex virus are type 1 and type 2. Type 1 causes oral herpes, also known as cold sores. Type 2 causes genital herpes. Occasionally, HSV1 can cause mild genital herpes and HSV2 can cause severe oral herpes. Oral herpes lesions are 2 to 4 millimeters in size. They occur mainly on or near the lips, but can also be inside the mouth. Genital herpes lesions are the same size, and cluster on the genitals, buttocks or both. Either type causes an average of four or five yearly outbreaks lasting seven to 10 days.2
Oral herpes can be transmitted by kissing or sharing utensils. Although nearly all adults have been exposed, for unknown reasons not everyone will develop cold sores. Genital herpes is transmitted by genital contact. A physician can usually diagnose either by visual exam, although special cultures may be used for genital herpes. Blood tests are available for both, but are not always accurate because they evaluate antibody levels that can vary and may not necessarily occur in conjunction with an outbreak.3
The conventional approach
The conventional medical approach is to use antiviral medicines, including acyclovir, valacyclovir and famcyclovir, to manage the disease. These medicines effectively reduce the frequency of oral and genital herpes recurrences by 70 percent to 80 percent. However, they are less helpful at treating existing lesions. On average they reduce duration by one day, from eight days untreated to seven days with treatment. Pain reduction of existing lesions is also moderate, averaging 35 percent reduction in perceived pain.
The antivirals are expensive to use for long-term suppression, ranging from $90 to $210 per month. They also interact with cardiovascular medicines and oral hypoglycemic agents. Although severe side effects are rare, about one-third of those who use them will experience gastrointestinal side effects.4
Given these shortcomings and the high prevalence of this disease, many consumers are seeking alternative treatments. Natural medicines have the advantages of being more cost-effective and possibly safer. Alternatively, they are less effective at preventing recurrences and are not as well studied.
Alternative virus control
Many natural products are marketed for both oral and genital herpes. They generally fall into one of two categories: suppressive treatments and topical treatments. Suppressive treatments are taken orally and are aimed at reducing the frequency of lesions, while topical treatments are applied locally to ease the pain and duration of existing lesions. Because these diseases are intermittent by nature, anecdotal reports may not accurately portray a treatment?s effects. If a consumer has a variable number of yearly outbreaks, some of which last longer than others, the consumer may have a hard time objectively evaluating a product?s benefits. The following treatments have shown benefit in clinical outcome trials.
Lysine, an amino acid, is the only natural substance with results from multiple clinical trials indicating a reduced number of herpes occurrences compared with placebo. For years, lysine was believed to suppress herpes outbreaks, yet clinical data were mixed. In 1981, researchers demonstrated that herpes viruses grown in tissue cultures were unable to replicate in a lysine-rich, arginine-poor environment.5 They hypothesized that by manipulating blood levels of arginine and lysine, one could affect herpes replication. This suggested that prior conflicting studies could yield better results if dietary arginine were controlled. Subsequent studies taking this variable into account bore out this expectation. One showed that low blood levels of lysine caused those with oral herpes to have more frequent outbreaks.6
Average diets do vary in lysine-to-arginine ratios. Most people get more lysine than arginine, but this isn?t always the case.7 In general, animal foods, including dairy, meat, poultry and fish, have more lysine than arginine. Chocolate, nuts and grains contain more arginine than lysine and therefore may provoke lesions.
In one study, researchers gave 52 patients with frequent oral herpes outbreaks either 1 g of lysine three times daily or placebo. Both groups were instructed to avoid nuts, chocolate and gelatin. During the six-month trial, those given lysine had an average of 3.1 oral herpes breakouts compared with 4.2 outbreaks experienced by those in the placebo group. Lysine at this dose poses no known risks of drug interactions.8
Tinkering with diet to avoid arginine-rich foods helps, but it appears lysine also needs to be taken in substantial doses to effectively manage the disease. Doses between 624 and 1,200 mg do not seem to work as well as 3 g per day in divided doses.9
Although there are some promising results, outcomes vary greatly from one participant to the next. When the data are reviewed closely, not all participants get the average 20 percent to 30 percent reduction per time period; many experience no reduction and roughly one-third have dramatic reductions—up to 90 percent or more. For unknown reasons, lysine seems to work well for some and not at all for others.
Wakame and red marine algae, two sea vegetables, also may help reduce the frequency of outbreaks but have not been studied in controlled clinical trials. In addition to being a nutritious human food used for eons, sea vegetables contain sulfated polysaccharides, which have known antiviral properties. In an uncontrolled clinical-outcome study, a proprietary product named GFS, a specific extract of wakame, reduced the frequency of oral and genital herpes outbreaks. Six patients with histories of herpes were given 560 mg of GFS two to four times daily for up to 24 months. All reported complete inhibition of outbreaks while they were taking GFS. It was unclear whether or not a statistically significant reduction in duration was achieved since the frequency of participants? lesions while untreated was not determined.10 A placebo-controlled follow-up study will be necessary to evaluate the efficacy of wakame.
GFS is produced in Tanzania, but the manufacturers hope to have U.S. distribution within the year. It is not known how readily available wakame compares with GFS.
In vitro studies have shown red marine algae extracts to be antiviral against HSV1 at low enough concentrations to give it plausible utility as a human antiviral treatment. These data have been confirmed in limited animal studies, but human toxicology, pharmacokinetic data and clinical trials are still lacking.
Results of one such in vivo study showed that an extract from the red microalga Porphyridium completely prevented HSV1 and HSV 2 viruses from damaging cells in cultures and in rat and rabbit hosts. This was achieved at concentrations as low as 100 mcg per mL. Animal toxicology tests were done up to 2 mg per mL with no apparent harm.11
There are also data showing several natural medicines that, when used topically, can shorten the severity and duration of existing oral herpes lesions. The benefits are greatest when therapy is initiated within the first 24 to 48 hours. The most-studied agents include zinc, lemon balm, tea tree oil and vitamin C.
Zinc has been shown in clinical studies to be a useful antiviral. Topical zinc oxide in a cream base was shown in a double-blind, placebo-controlled study to be helpful for oral and facial herpes. Zinc oxide, applied every two hours within the first 24 hours, reduced the duration of lesions from an average of six-and-a-half days to five days. Overall severity of subjective symptoms was also lower in the treated group. A small number did experience local dryness and irritation, all of which resolved within a few days of stopping treatment.12 Although not commonly available as a nonprescription lip cream, zinc has been used as an ingredient in many topical natural blends.
Lemon balm (Melissa officinalis) is a common garden plant with a long history of use in European folk herbalism. Because of its antiviral constituents, it has recently been studied for its potential as a topical treatment for cold sores.
In a double-blind, placebo-controlled, randomized trial, a 70:1 concentrated extract of lemon balm was applied to cold sores four times daily for five days. A composite score consisting of size, spread and subjective ratings of lesion pain was taken on day two, usually when symptoms are at their worst. The 34 participants using lemon balm improved their score by 19 percent compared with the 32 subjects given placebo. The results also showed a reduction in healing time from an average of five (4.94) to four (4.03) days.13
Lemon balm extracts at a 70:1 concentration prepared for topical use are readily available from several manufacturers. Lemon balm has no known side effects or contraindications.
Tea tree oil (Melaleuca alternifolia) has demonstrated usefulness against a variety of pathogens, including HSV1 and HSV2. In one study from the University of Heidelberg in Germany, tea tree oil inhibited 50 percent of viral replication in a culture with solutions containing as little as 0.0008 percent tea tree oil.14
In an Australian study, 20 patients with histories of oral herpes applied either a 6 percent tea tree oil gel or a placebo five times daily to existing oral herpes lesions. The reduction of the lesions? duration compared favorably to topical acyclovir. Although both tea tree oil and acyclovir are well tolerated, tea tree oil is significantly less expensive.15
Undiluted tea tree oil can irritate skin. For treating herpes, it is available in lip balms and in blended products.
Vitamin C may have promise as a topical antiherpetic agent, especially if used within the first day of symptoms. In a randomized double-blind, placebo-controlled trial, a water-soluble vitamin C solution was applied for two minutes three times daily for the first day only. The treatment reduced pain, duration of scabs and amount of viruses present in lesions. The most dramatic finding was a reduction of time with scabbed lesions from 5.9 days in the placebo group to 3.4 days in the treated group. No side effects were seen in the treatment group.16
Topical vitamin C is available for more general skin care purposes and in combination products for herpes. It does not have significant side effects. Oral vitamin C is often purported to have antiviral properties, yet this has not been proven with herpes virus.
For your customers troubled by frequent herpes outbreaks, oral lysine may reduce the outbreaks significantly and is safe and inexpensive. Sea vegetable extracts appear promising, but need further study. For those suffering from acute oral lesions, over-the-counter topical natural medicines, such as tea tree oil, lemon balm extracts, zinc oxide and vitamin C, can shorten the severity and duration of symptoms. Several products exist for topical use that combine lysine and wakame, for example, with others, including licorice, propolis and goldenseal, which have been shown to inhibit viruses in test tubes. To manage herpes infections, customers looking for natural options have several choices available and several more on the horizon.
Alan Christianson, N.M.D., is a naturopathic physician with a private practice in Scottsdale, Ariz. His focuses include natural family care and nutritional medicine.
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Natural Foods Merchandiser volume XXV/number 5/p. 42-43