Acyclovir, Famciclovir & L-Lysine: Can Anti-Viral Medication for Herpes Help Control Meniere’s Disease?

As mentioned in my page Ménières & HERPES, there are many published medical studies suggesting a link between Meniere’s Disease and Herpes Viruses.

Acyclovir & Famciclovir

Acyclovir (also known as Aciclovir) helps to stop herpes viruses from spreading to other cells. It is used to treat chickenpox, shingles, and genital herpes. Acyclovir is available as tablets, capsules, an ointment, a suspension or as an injection. Acyclovir can be used to treat recurrent outbreaks.

Like acyclovir, Famciclovir can help prevent herpes viruses from spreading to other cells. It is available as a tablet for the treatment of cold sores (herpes simplex 1) and genital herpes (herpes simplex 2). It also has a longer therapeutic effect than Acyclovir so it doesn’t need to be taken as frequently throughout the day.

You may wish to discuss with your GP or specialist the possibility of incorporating anti-viral medication into your Meniere’s management plan.

Be aware that these anti-viral medications are quite expensive and can cost anywhere from AUD$120 to $420 depending on the strength of the tablet and the quantity required. So if your GP or specialist were to let you try Acyclovir at say 2,000mg/day for a period of two weeks, you would need 140x 200mg tablets, so two packs of 90 tablets, which according to the Australian PBS would cost AUD$232.24 (the full dispensed price because this medication is not listed for Meniere’s Disease). Famciclovir is also listed on the Australian PBS for similar prices. Discuss with your GP or specialist which one will be best for you to try.

My GP, who is quite holistic, let me try Aciclovir 200mg tablets (2 to 4 tablets) taken three times a day. I found that I struggled to take the tablets, because their shape was a bit jagged to swallow & there were so many tablets* 6 to 12 (1,200mg to 2,400mg daily), so I ended up taking about 1,400mg to 1,600mg which probably wasn’t enough for me to get a good result. If my GP is in agreement, I will definitely try another round of anti-viral medication in the near future. *(in addition to my other medication.)

If you would like to incorporate anti-viral medication into your Meniere’s management plan, then discuss this with your medical practitioner. You may also wish to print the abstracts for these two studies below and show them to your GP or specialist.

“Randomized double-blinded, placebo-controlled clinical trial of famciclovir for reduction of Ménière's disease symptoms.”
“Effectiveness of Acyclovir on Meniere's Syndrome. III. Observation of Clinical Symptoms in 301 Cases.”

This is also an interesting read but if you are considering an intratympanic injection my suggestion would be to try Dexamethasone instead of Ganciclovir (see my posts on Dexamethasone): 

“Intratympanic application of an antiviral agent for the treatment of Ménière's disease”

This medical article testing Valacyclovir & Methylprednisolone for the treatment of Vestibular Neuritis (the second most common cause of peripheral vestibular vertigo) was also interesting:

“Methylprednisolone, valacyclovir, or the combination for vestibular neuritis.”

L-Lysine

Before trying either Acyclovir & Famciclovir, I suggest you consider taking the essential amino acid L-Lysine. It is not a prescription medication and can be bought over the counter from most chemists and health food stores.

I can recommend Nature’s Own L-Lysine 500mg (200 tablets) as it is readily available in Australia, however you could order The Vitamin Shoppe L-Lysine (300 capsules) which I found much easier to swallow than the Nature’s Own tablets. Also, the Vitamin Shoppe L-Lysine capsules come in bulk which is very cost effective and worth the cost of shipping to Australia (particularly with the current strong Australian dollar).

Nature’s Own L-Lysine 500mg Tablets
The Vitamin Shoppe L-Lysine 500 Capsules

My GP recommended I try a high dose of up to 4,500mg daily, however “The John of Ohio Meniere’s Regimen” suggests up to 3,000mgs daily. I suggest you start with the recommended amount on the bottle then consult your GP before increasing to a higher amount.

The John Of Ohio Regimen - Jan 2010 UPDATE

Also you could try incorporating more dietary sources of L-Lysine into your diet, such as:

Pulses/Legumes: Soybeans, Lentils, Azuki Beans, Kidney Beans, Chickpeas and Navy Beans.

Fruits/Vegetables: Peas.

Grains: Amaranth.

Meats: Beef, Catfish, Chicken or even Eggs.

Dairy: Milk & Parmesan Cheese (although it is high in Sodium which is a bit of a Meniere’s no-no but a little would be fine).

HAVE YOU TRIED ANTI-VIRAL MEDICATION OR L-LYSINE TO MANAGE YOUR MENIERE’S? If so, please share your story in the comment section below.

Ménière’s Disease: Is Psychoneuroimmunology (PNI) & Herpes the Cause?

This is my personal theory. © Beatrice T, AUSTRALIA. 2010

SUMMARY

2011 marks the 150th year since the French physician, Prosper Ménière, first reported in 1861 that vertigo was caused by inner ear disorders. Since then the medical community has learnt little about the cause, treatment or potential cures for this disease. As a lay person impacted with Ménière’s Disease I have observed my own symptoms, triggers & treatments, and learnt as much as I can from public literature and the personal stories of others.

After a number of years of research I have come to the conclusion that the most likely cause of Ménière’s Disease is an inner ear herpes triggered through the Psychoneuroimmune (PNI) route. Simply put, long-term exposure to psychological stress negatively alters the immune system, triggering a latent herpes virus to attack the inner ear. This virus causes inflammation which reduces circulation of the inner ear fluids which in turn affect hearing & balance. Periods of remission are due to the herpes virus becoming dormant.

MY BACKGROUND

I was diagnosed with Ménière’s Disease in Nov 2007, but experienced unilateral hearing loss for three months in early 2004. After my MRI came back negative for an acoustic neuroma, I wondered whether the hearing loss had been caused by stress. I had heard about the motivational author Louise Hay who theorised that negative thoughts could negatively impact the body, causing or contributing to the manifestation of illness.

At the time I found myself hearing a lot of my friend’s troubles (their marital problems, dissatisfaction with their workplace, their health concerns, etc) which added to my own life stressors. So I politely informed my friends that, as much as I loved them, I didn’t want hear any more bad news or criticism of any kind. My friends complied and I made an effort not to worry or be critical, and within three weeks my hearing had completely recovered.

I didn’t have any further issues with my ear until Nov 2007, after a very stressful year (particularly in the last few months) due to business, relationship and family issues. Since being diagnosed with Ménière’s Disease I have followed the advice of my GP, ENT & that of the medical establishment, which has brought me some comfort but no real solution or Ménière management plan.

THE HERPES SIMPLEX VIRUS (HSV) CONNECTION

In 2009 I came across a posting by “John of Ohio” a biologist whose hypothesis is that Ménière’s Disease is caused by herpes of the inner ear. According to him, “European studies, and now American ones too, have shown an almost universal presence of various herpes viruses in post-mortem examinations of the inner ear of Ménière’s Disease sufferers.” John of Ohio Ménière’s Regimen (established in 2004) is based on a variety of vitamins & mineral supplements, as well as herbal & homeopathic medications. Learn more about this regimen on the below link.

John of Ohio's Meniere's Regimen

The link between Ménière’s Disease and herpes was tested in a number of studies including one that tested the antiviral Acyclovir (aka Zovirax) on Ménière patients. ("Effectiveness of Acyclovir on Meniere's Syndrome III Observation of Clinical Symptoms in 301 cases," Mitsuo Shichinohe, M.D., Ph.D., The Sapporo Medical Journal, Vol. 68, No. 4-6, December, 1999)

In this study, patients were each “treated with 2,000 mg/day of acyclovir for an average period of two weeks. There were 250 patients who were ultimately evaluated.  In 82.5% of cases diagnosed as Meniere's Disease, 85% of cases diagnosed as Meniere's Syndrome (symptoms of Meniere's Disease but other basic diseases could not be completely excluded), and 89.1% of cases diagnosed as vestibular dysfunction, vertigo disappeared, and tinnitus and hearing were improved.  No side effects were observed.”

It was concluded that, “while a viral etiology (cause) of Meniere's Disease has not been positively established, there are researchers who suspect, even in the absence of persuasive evidence, that a virus, and particularly the herpes simplex virus (HSV), *may* be a factor in *some* cases diagnosed as Meniere's Disease.”   More info: 
Meniere Treatment

THE PSYCHONEUROIMMUNE CONNECTION

PERSONALITY TYPES SUSEPTABLE TO STRESS

It is well documented that certain personality types are more prone to stress. One study looked at the stress of medical students. (“Personality traits and types predict medical school stress: a six-year longitudinal and nationwide study.” Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway.)   
Personality traits and types predict medical school stress

In this study, “the traits of neuroticism and conscientiousness were independent predictors of stress.” ‘Brooders’ (those with low extroversion, high neuroticism and high conscientiousness) were “at risk of experiencing more stress, whereas 'hedonists' (those with high extroversion, low neuroticism, low conscientiousness) were more protected against stress”. Furthermore those with “high neuroticism and high conscientiousness” were considered to be particularly high risk.

Other studies have established that there is also a cancer-prone personality, which is described by Robert M. Sapolsky as “one of repression – emotions held inside, particularly those of anger. This is a picture of an introverted, respectful individual with a strong desire to please – conforming and compliant.”

THE PSYCHONEUROIMMUNE ROUTE

The Psychoneuroimmune Route is discussed in the book ‘Why Zebras Don’t Get Ulcers’ by Robert M. Sapolsky, a professor of biology and neurology at Stanford University and research associate with the Institute of Primate Research, National Museum of Kenya.

Why Zebras Don't Get Ulcers, Third Edition

In his book Robert states that, “evidence is pouring in from many quarters suggests that stress may indeed impair our immune systems and increase the risk of illness”. He outlines the Psychoneuroimmune Route as thus:

1. The individuals in question have been stressed

(Stress differs tremendously among people. What is stressful to one individual may not be to another. Significant universal stressors included: the death of a loved one, divorce, financially threatening unemployment. Engaging in battle or even a significant car accident would fit the bill.)

2. Stress causes the stress-response (the secretion of glucocorticoids, epinephrine, and so on)
3. The duration and magnitude of the stress-response in these individuals is big enough to suppress immune function
4. The suppressed immune function increases the odds of these individuals getting some infectious disease, and impairs their ability to defend themselves against that disease once they have it.

THE BUILDING BLOCKS OF PSYCHOLOGICAL STRESSORS

According to Robert M. Sapolsky’s book (chapter 13) the following are the building blocks of psychological stressors:

1.       Lack of Outlets for Frustration

2.       Lack of Social Support

3.       Lack of Predictability (there are some exceptions to this)

4.       Lack of Control (there are some exceptions to this)

5.       A Perception of Things Getting Worse

As anyone with Ménière’s Disease could attest, most of the above stressors provide momentum to the Ménière’s Disease pathology. The disease creates an environment where there is little control or predictability which impacts on social activities adding to the perception of things getting worse. Outlets for frustration also become fewer (i.e. alcohol avoidance or participating in activities).

THE LATENT HERPES VIRUSES

A latent virus is one that burrows into some cells and goes into hibernation for a while, lurking near the cellular DNA, but not yet replicating itself. Robert states, “At some later point, something triggers the dormant virus out of latency and it reactivates. After going through a couple of rounds of replication the by now larger number of viral particles burrow in and go latent again.” Herpes viruses are can go latent for years, even decades before flaring up again.

Herpes viruses can interact with the immune system in two very cunning ways.

1. Herpes viruses know when your immune system is low.

Herpes viruses measure your glucocorticoids levels. According to Robert, “Herpes DNA contains a stretch that is sensitive to elevated glucocorticoids signals, and when levels are up, that DNA sensor activates the genes involved in coming out of latency”.

The viruses wait until the immune is run down, then they quickly replicate a few times. Robert states, “It’s been endlessly documented that latent viruses like herpes flare up during times of physical or psychological stress.” This includes Epstein-Barr virus and varicella-zoster (which causes chicken pox and shingles).

2. Herpes viruses can artificially trigger the stress-response.

Herpes viruses cause your hypothalamus to release Corticotropin-Releasing Hormone (CRH) which releases Adrenocorticotropic Hormone (ACTH) which raises glucocorticoids levels. So a person doesn’t even need to be stressed because it artificially triggers the stress-response (step 2 of the Psychoneuroimmune Route). What’s more, elevated glucocorticoids levels (step 3) impair your immune defences against activated herpes, this leads to a flare up (step 4).

THE LIFESTYLE ROUTE
Robert also discusses the Lifestyle Route which involves things like carcinogenic substances (alcohol, smoking), epidemics, sneezing on others, diet (inc: skipping breakfast habitually), lack of sleep, hypertension, obesity, and lack of physical activity… among other things.

Lack of social support and social isolation are particularly damaging. According to Robert data shows that, “the fewer social relationships a person has, the shorter his or her life expectancy, and the worse the impact of various infectious diseases”. Positive social relationships include: marriage, contact with friends and extended family, church membership, or other group affiliations. Robert states that, “for the same illness, people with the fewest social connections have approximately two-and-a-half times as much chance of dying as those with the most connections” (after controlling for variables).

CONCLUSION

It is likely that the catalyst for Ménière’s Disease is chronic psychological stress (1) which causes the stress-response (2), suppressing immune function (3) that activates the latent herpes virus (4) which inflames the inner ear’s tissues (5) causing problems with fluid circulation and drainage (6).

Rupturing of the inner ear membrane can provoke an attack as can ongoing damage & displacement of the crystals in the fluid. Both affect the ability of the brain to accurately process information from the three sensors of balance (the vestibular, the eyes & the sense of proprioception). Conflicting information causes the brain to temporarily “crash” (much like a computer). Acute attacks can stimulate the autonomic nervous system leading to shortness of breath, and sudden changes in body temperature.

In my opinion, Ménière’s Disease management should address all of the above stages with an emphasis on reducing psychological stress, improving immune function and combating herpes viruses. This should encompass lifestyle changes as well as orthodox medicines & complementary therapies.