Mini Mikkipedia - Why did I get that cold sore?

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Host

Mikki Williden

What is Mikkipedia?

Mikkipedia is an exploration in all things health, well being, fitness, food and nutrition. I sit down with scientists, doctors, professors, practitioners and people who have a wealth of experience and have a conversation that takes a deep dive into their area of expertise. I love translating science into a language that people understand, so while some of the conversations will be pretty in-depth, you will come away with some practical tips that can be instigated into your everyday life. I hope you enjoy the show!

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Bye!

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Hey everyone, it's Mikki here. You're listening to Mini Mikkipedia on a Monday and today I want to chat about the Herpes simplex virus. HSV, I know, not a particularly pleasant thing to chat about, but it's super common for people to have the virus, to experience flares or outbreaks and then to manage these in the context of

00:36
and otherwise busy life, et cetera. And of course, I am definitely one of those people who have the virus and over the last couple of months, and this is unusual for me actually, once was coming back from the UK and I was just super run down and I got like a cold sore, that's what it's otherwise known as, above my lip. And then the second time is actually just last week after being out in the sun a lot. And both of those

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situations if you have the virus already can place you at risk of a flare. And what is also known is that if the virus which typically lies dormant is flared up, then the likelihood of another flare occurring is also greater. So herpes simplex virus is a common viral infection that belongs to the herpes virus family, HSV, and it's known for causing infections primarily in the

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the genitals, though it can also affect other areas of the body. And you might know people or yourself get cold sores, cold sore-like lesions, etc. around your nose and things like that, which is another quite common trigger or flare point. There are different types of HSV. HSV1, type 1, is commonly associated with oral herpes causing cold sores or fever blisters around the

02:02
It can also though cause genital herpes through oral genital contact. This type is highly prevalent and around 50 to 70% of the global population carries the HSV1 virus and is often acquired during childhood or adolescence. And it is super interesting, right? It's one of those almost stigmatizing, or it feels when you have a cold sore, that it's a super stigmatizing infection. Yet...

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you know, most of us actually have had the virus at one point or another. HSV2, so type 2, is primarily causes genital herpes, leading to sores or blisters around the genital and anal regions. And it's typically spread through sexual contact, and it is less common than HSV1. However, people with HSV2 infections may experience more recurrent symptoms than those with HSV1.

02:56
So HSV is transmitted through direct contact with an infected person's skin, mucous, membranes, or body fluids. And it can happen through kissing or oral contact, that's HSV type 1, oral-genital contact, which is both of them, 1 and 2, and sexual contact including vaginal, anal, oral sex, primarily HSV 2, but also HSV 1 in some cases.

03:23
Also, sharing personal items like razors, lip balm, or eating utensils, though it is less common, you can still transmit the virus through this way. So after the initial infection, HSV trails to nerve cells near the infection site and establishes latency. So latency just means that the virus sort of hides in the nerve cells, remains dormant for periods of time, hopefully extended periods of time.

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And for what it's worth, before I got the cold sore that I had in September, I don't think I'd had one for several years actually. And during this phase, it doesn't cause any symptoms, but it can reactivate, leading to recurrent symptoms or shedding of the virus, even without visible symptoms, which is otherwise known as asymptomatic shedding. And reactivations can be triggered by various factors, and these include stress,

04:18
Illness or a weakened immune system. Hormonal changes, so they may be more common in women who are at the menstruation phase of their cycle. Skin trauma or sun exposure. And also certain foods, and particularly those foods that are high in arginine. And I will get to arginine in a minute. So this is what I find really interesting.

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post coming back from the UK and having jet lag, maybe picking something up on the flight with regards to a cold. And then I developed the cold sore just above my lip. And I definitely felt run down at that time, just with launching my program, coming back after quite a lot of emotional stress, and just trying to sort of settle things here before having to travel again. And that's when I first noticed. And sleep, obviously, with jet lag wasn't ideal.

05:16
I'm the one that I have just had was a bit of a surprise really because we were over in Scottsdale for my business coach Jill's meeting. And there's and I were doing a ton of like hiking and running. I say a ton like not a ton according to you endurance athletes, you know, very, you know, ultra running types. But you know, my training load for that week, although not a lot in terms of kilometers run because it was a lot of hiking as well.

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was probably, I think, maybe about 12 or 14 hours in across five days. So that's quite a lot for me. We are training for the Southern Lakes Ultra right now. So it's sort of one of those things where yes, that kind of event is not going to run itself, right? However, we were getting a ton of sleep. We were having breakfast before going out. We were fueling work required on the run. Like if it's a run hike and you're out there for say two hours

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Even two and a half hours, you don't really need any fuel. You just need to make sure you're hydrated well. However, if you were going out pre-breakfast, and we didn't actually do that because we were traveling to where we wanted to run, so we just had breakfast first, but you would initiate fueling in that run a little bit earlier. But what we were experiencing was a really dry heat, and it was sunny as well. We were pretty lucky actually because it was a bit of a cold snap.

06:43
And so the temperature was much more sort of mid 20s Celsius rather than the mid 30s that it had been the week before. But the sun was still really bright. And in fact, when I started feeling that it wasn't even a tingling on my lip, it was more just that sensation. I'm like, I think I'm getting a cold sore. And that occurred on Monday, New Zealand time. And I'm doing this podcast on Thursday. And it is actually almost healed up now. So it was not.

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at all to the same severity as the previous one that I had had in September. But skin trauma or sun exposure is a big one and I think it was just that I had some sunscreen on but it only had SPF 15 through Blistex on my lips and I think that was where the issue was because my lips got quite dry. So yeah that sun exposure or skin trauma can definitely trigger up in HSV type 1 and that is what I had experienced. And

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Also, I will add because I had had that previous flare very recently, I was going to be more at risk of having another one. So some of the symptoms, so HSV 1, as I mentioned, the cold sore or fever blisters around the lips or inside the mouth, and maybe on the nose as well, tingling, itching or burning sensations before the sores appear, which is what I experienced on Monday.

08:05
swollen gums, sore throat or flu-like symptoms in the initial infections. And then with genital herpes, which again could be HSV1 or HSV2, the painful blisters or sores on or around the genitals or anus, which sounds really uncomfortable, itching or tingling sensations before the outbreak, pain during urination in some cases, but also flu-like symptoms such as fever, swollen lymph nodes or muscle aches, especially in the initial outbreak.

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Other possible sites, which I mentioned also a little bit but Herpetic Whitlow, which is sores on the fingers or around nails, often in healthcare workers or children who suck their thumbs. Herpes gladiatorum, which sounds a little bit warrior-like, but it's skin infections caused by HSV-1 among athletes in close contact sports. There you go, gladiator.

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and ocular herpes, so HSV infection of the eye, leading to eye pain, discharge, or blurred vision, and it can cause more serious complications of untreated. So these are just other possible sites for the HSV-1 to sort of take hold. As I mentioned, after the first or primary infection, it can cause recurrent outbreaks, though the frequency and severity does vary among individuals.

09:24
Over time, the outbreaks tend to become less frequent and less severe due to the immune system adaptation. And potentially this is what I'm experiencing now with this relatively minor cold sore I had on my lip. But as I mentioned, stress or emotional strain, this is a really big one for cold sores or HSV1. Obviously, illness with a fever, physical trauma to the infected area, which is I think where the herpes gladiatorum.

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comes from with that close contact sports, sun exposure, and hormonal fluctuations. So despite advances in medical technology, there is no cure for HSV. Antiviral medications can help manage the symptoms, reduce outbreak frequency, and lower the risk of transmission. And common antiviral treatments include Zivirax. I have Zivirax when I get a cold sore. Also acyclovore. I think that's what it is.

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VALICYCLAVOR, which is VALTRAX, these are these antiviral medications, and they can be taken during outbreaks to shorten their duration, or as a suppressive therapy to reduce frequency and severity of outbreaks and limit viral shedding. I'm not sure that I would recommend anyone take anything like this as a preventative measure, particularly because there are other lifestyle and diet things which can help with HSV management. And one of the first ones, which I do, and if I feel run down,

10:50
I can start to do it more as well. And that is actually take lysine. And most of you are really familiar probably with lysine. It is an amino acid that humans cannot synthesize but must acquire through food intake. And we get it particularly through dairy and meat. And for vegetarian and vegans, they're going to need supplements. The lysine is well-known for relieving the symptoms of HSV and decades of research support that high intracellular levels of lysine

11:20
does have an inhibitory effect on HSV multiplication in cell cultures, but there are also randomized controlled trials to show that anywhere between 1,000 mg and 3,000 mg per day reduces the severity and duration of outbreaks. For example, a six-month-long double-blind multicenter experiment using oral L-lysine supplementation showed that the lysine treatment group averaged 2.4 times fewer outbreaks.

11:49
with significantly diminished symptoms and shorter healing times than the placebo group. And also a similar study examining the prophylactic usage, so using in a preventative way to suppress HSV concluded that a significantly higher number of patients were recurrence-free on lysine versus placebo. So whilst we get it in the diet, there is a requirement over and above dietary intake that can help suppress the virus.

12:19
reduce severity and reduce the duration of the outbreak. And interestingly, the exact mechanism of action of lysine isn't fully known, but we do know that it acts as an anti-metabolite that suppresses the HSV viral growth promoting actions of its analogue arginine. And this is where I mentioned arginine before, and avoiding foods high in arginine can be quite helpful.

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Now arginine is another amino acid found in high protein white meats such as chicken, pork and turkey and legumes. Arginine exhibits the opposite effect on HSV so it promotes viral growth, acts as a medium for growth of HSV that is essential for the replication. Specifically, it's been found that arginine deficient cells are incapable of replicating. So they require arginine to replicate.

13:14
So what we, what practitioners often recommend is just to ensure you've got a good balance of lysine to arginine in your diet. And this really comes down to, I suppose, a diversity of foods, but probably importantly, and it was mentioned with vegetarian and vegans, is maybe supplementing with lysine if you are more prone to cold sores isn't a bad idea. And then potentially doubling that. So you could take a thousand milligrams.

13:44
prophylactically or preventative. And then if you do experience an outbreak, taking maybe three times that amount, 3000 milligrams, maybe take two 800 milligram in the morning, two 800 milligram at night, or something like that of supplement. It's certainly going to do you no harm and it may well be helpful for you. And just so you know, high arginine foods include nuts and seeds.

14:08
almonds, peanuts, walnuts, cashews, hazelnuts, sunflower seeds, sesame seeds, flaxseeds, chia seeds, grains like oats, wheat, barley, buckwheat, rice, particularly brown rice and quinoa, legumes such as lentils, chickpeas, soybeans, black beans, kidney beans and split peas. Both dark and milk chocolate contain high levels of arginine relative to lysine. Coffee though is pretty low in arginine just so you know. Shellfish is particularly high

14:38
Meat and poultry have higher levels of arginine but usually are balanced by moderate lysine levels. And cottage cheese and yogurt are higher in arginine compared to other dairy, but they do have lysine as well. So importantly with things like dairy is to monitor your response. Certain vegetables like Brussels sprouts, corn, spinach and onions are high in arginine, as is gelatin. So essentially then from a diet perspective, I think your priority needs to be

15:08
ensuring you've got that balance of lysine to arginine and probably taking a lysine supplement, particularly doubling that and then think about your arginine when you're in an outbreak. So think about your intake of nuts and seeds and grains and legumes during an outbreak. I think those are more important things. There are a couple of other compounds that may be helpful according to a narrative review of alternative symptomatic treatments for

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HSV, and this is in a journal called Viruses, and it was released in 2023. Propolis, which is a resin-like material synthesized by bees to coat small openings in their hives, and it's a natural product used widely in home remedies. And it's got a lot of proposed pharmacological properties, including antiviral properties and anti-inflammatory, etc. The most important complex chemical compound that renders propolis in an antiviral

16:05
agent is the phenolic acid, and it's thought that propolis may negatively affect the HSV1 and 2 viral replication in host cells. And these are in preclinical studies that look at cell cultures, not necessarily human trials. Although upon saying that, there have been some randomized double-blind placebo-controlled trials conducted to assess the efficacy.

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in patients with a history of the HSV1 virus, and patients treated with the ointment had a mean healing time of 6.24 days compared to 9.77 days in the placebo group, in addition to earlier pain relief. And from a self-report perspective, the participants found it to be very effective or somewhat effective. But it is underutilized and it is understudied as well. So

17:02
Some people have suggested that utilizing propolis in conjunction with Zivirax may help suppress HSV1 and 2 reoccurrence over just the use of Zivirax alone. One other one that's come through is lemon balm. It is a traditional herbal medicine accepted as a mild sedative and antibacterial agent. And in one study, there was a lemon balm leaf extract.

17:31
reduced HSV1 cytotoxicity by 60%. So this tells me it's a preclinical trial. And there's been similarly another extract found to be 96% inhibitory, another cell culture trial looking at HSV1 strains. There have been some human trials, so a double blind study of 66

17:58
found that lemon balm cream significantly reduced symptom scores after two days of treatment compared to a placebo cream. And there's been another one as well. So lemon balm extract may be another safe and natural alternative for people to explore when it comes to treating the outbreaks. Something else of note actually is zinc. So it's an essential trace element for humans, a co-factor for over 300 enzymes.

18:29
over 2 billion people worldwide are affected by zinc deficiency. It's been found that in preclinical trials, the virus of HSV1 and 2 can be inactivated by pre-treatment with a zinc lactate. So I think that's super interesting. And in a study of 20 recurrent herpes patients, systematically treated twice daily with

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22.5 milligrams of zinc, so that's 45 all up. For four months over a one year period, there was a significant reduction in lesion episodes from six to three. And similarly, there've been other studies looking at the efficacy of zinc, and it's found that there have been greater reductions in lesion frequency. So because zinc is so important in the immune system and particularly in the function of our antioxidant superoxide dismutase,

19:24
That's something else to be mindful of is of course your zinc intake and getting zinc from food such as well seafood and meat etc but also assessing your zinc status well firstly through your diet because it's very difficult to establish deficiency through looking at just serum or just a taste test or a hair test or anything like that you always want to sort of triangulate that data.

19:49
But also if you do have a sort of poorly functioning immune system, zinc can be super helpful. But work with a practitioner when you're looking at zinc because you do want to get that zinc copper balance and make sure that it's not out of balance. So other things that have been looked at is of course diet quality, refined carbohydrates. There's very little in-depth study looking at this, but sweets may exacerbate HSV outbreaks. So diet quality is a thing for sure.

20:19
And then just really diet quality, stress management, and recovery. I think these are the really big levers that you can pull when it comes to looking at your overall immune function, obviously. So that is a lot of the information on HSV1 or HSV2, which I came up with. So the key takeaways is really that the prevalence is really common and very high worldwide, particularly which...

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with HSV1 and that transmission does spread through direct contact and usually is very early in life. And so if you had cold sores as a child, that virus is likely dormant in you and can be flared through things like stress management, skin trauma, sun exposure, infection or illness. So

21:11
It's more about living with HSV and being aware of strategies to support you when you get those outbreaks, but also managing your immune system and optimizing your immune system strategies so you reduce the likelihood of an outbreak occurring. I think those are the important things there. All right, team, hopefully that was enlightening for you.

21:34
It certainly was for me with regards to the lemon balm and the propolis etc. It's good to know a couple of other things you can sort of add to your armor of treatment strategies. I would like to remind you that Monday's Matter Christmas edition is open. It is a four-week primer I suppose to my Monday's Matter program. This is a perfect opportunity for you guys to skip that holiday weight gain that always occurs at this time of year.

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and celebrate without compromise basically. So Monday's Matter has those strategies there in place to allow you to maintain your progress, maybe even lose a little bit of body fat and improve body composition, but ultimately enjoy the festive season without that fear and guilt and shame associated with this inability to control yourself around food. We talk about all of this and more in Monday's Matter. Registrations are open this week. We kick off on Monday the 25th of November.

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would love you to join us. So look in the show notes for a link to that. And otherwise, hit me up in the DMs on Instagram, threads or Twitter @Mikkiwilliden, Facebook @MikkiwillidenNutrition, head to my website, mikkiwilliden.com. All right team, have the best week. See you later.