Shingles

Chickenpox Revisited

Childhood chickenpox is usually no big deal. A rash of itchy blisters, a touch of fever, a couple of days in bed and a few bowls of ice cream, and you're better. You might not even remember having had it.

But the virus that causes chickenpox remains in your body in nerves at the base of your spine, and it may reactivate years later as a searing case of shingles, or herpes zoster, its medical name.

When the virus flares, it moves out along the pathway of whatever nerve is involved, usually on the trunk, neck or face. The nerve becomes inflamed and extremely sensitive to touch. The area where the nerve reaches the skin burns and stings, then erupts in a splay of painful blisters that may last for up to a week or longer.

Shingles isn't something that you can just shrug off. And you shouldn't ignore it, even if you could. Doctors consider it a "pain emergency" and can offer some relief. Some studies also suggest that post-herpetic neuralgia, the lingering pain that sometimes follows an attack of shingles, is less likely to occur if you are treated within 72 hours of the onset of blisters with high doses of drugs that stop the virus from multiplying.

People with infections such as HIV and those taking chemotherapy drugs for cancer or immunity-suppressing drugs to protect organ transplants are at highest risk for a shingles episode. And your risk goes up simply as you get older.

"Most doctors use drugs to treat shingles, and a few drugs now in the pipeline may provide more help than ever," says Stephen Tyring, M.D., Ph.D., professor of dermatology, of microbiology and immunology, and of internal medicine at the University of Texas Medical Branch at Galveston.

Still, some doctors add nutritional therapy to their treatments, hoping to reduce inflammation, protect nerves and restore strong immunity, says Richard Huemer, M.D., a doctor in private practice in Vancouver, Washington, with a special interest in nutrition. Here's what they recommend.

Vitamin B₁₂ May Aid Recovering Nerves

It's considered an old-fashioned remedy, and it apparently doesn't work for everyone. But some doctors give their patients with shingles injections of vitamin B₁₂.

"It's true that this treatment has been around for a while, and it's one of the things we do where we can be pretty sure that we are going to get beneficial results," Dr. Huemer says. "Usually, it helps relieve the pain, probably more than anything else we offer, and it seems to shorten the course of the illness."

A study by Indian researchers reported that 21 people with shingles showed "dramatic response," as judged by relief of pain and the speed with which blisters disappeared, starting the second or third day of treatment with vitamin B₁₂ injections. What's more, none developed the lingering pain of post-herpetic neuralgia.

Vitamin B₁₂ is known to play an important role in nerve function, Dr. Huemer says. "It's needed by nerves to maintain the protective myelin sheath, a thick layer of fatty membranes that wraps around nerves and insulates them," he explains.

Injections of vitamin B₁₂ are absorbed more efficiently by the body than supplements. If you're interested in B₁₂ injections, you'll need to enlist the aid of your doctor. Doses vary. Dr. Huemer gives up to 2,000 micrograms once or twice a week until symptoms improve, then tapers off the dose. Other doctors may give 500 micrograms daily for six days, then weekly for six weeks.

It's impossible to get this large amount of vitamin B₁₂ from foods. Supplements can be helpful at 1,000 to 2,000 micrograms a day, according to Dr. Huemer. Absorption from supplements isn't as beneficial as injections, he explains. This amount of B₁₂ is extremely high (the Daily Value is only 6 micrograms) and should be taken only under a doctor's supervision.

Along with vitamin B₁₂, some doctors give injections of folic acid and the rest of the B-complex: thiamin, riboflavin, niacin, vitamin B₆ and the like. "Many of these vitamins work together, and restoring all of them helps people get better faster," says Robert Cathcart, M.D., a doctor in private practice in Los Altos, California.

Vitamin C May Dry Up Blisters

It's not exactly what you would call recent research. But two studies, one from 1949 and another from 1950, suggest that people having shingles outbreaks get substantial relief from intravenous doses of large amounts of vitamin C.

In one of the studies, by researchers in North Carolina, seven of eight people with shingles reported relief from pain within two hours of the first dose, drying of blisters within one day and complete clearing in three days. In the other study, French researchers reported that they were able to cure all 327 people with shingles with three days of intravenous vitamin C.

Vitamin C may help bolster immunity in several different ways, explains Raxit Jariwalla, Ph.D., head of the virology and immunodeficiency programs at the Linus Pauling Institute of Science and Medicine in Palo Alto, California. Additionally, studies show that in large doses, vitamin C can inhibit replication of certain types of viruses, including those in the herpes family, Dr. Jariwalla says. It can also impair the ability of certain viruses to cause infection, he adds.

How vitamin C exerts its antiviral action isn't known, Dr. Jariwalla says. "It's probably by a multi-targeted effect rather than a single effect," he says.

By virtue of its antioxidant ability, vitamin C can also neutralize inflammation-causing biochemicals that are produced by immune cells as they do battle, Dr. Jariwalla says. That talent may help spare nearby cells that would otherwise be damaged by the battle between immune cells and viruses.

Many of the doctors who prescribe vitamin C for viral infections use it both intravenously, as neutralized sodium ascorbate, and in the largest oral dose that can be tolerated without causing diarrhea, Dr. Cathcart says. "We literally flood the body with vitamin C," he says. This large amount helps keep both blood levels and levels inside cells high enough to dampen inflammation, he explains. He usually gives daily intravenous doses for three to five days, by which time the blisters are gone. "I've never had a case that goes on to post-herpetic neuralgia or neuritis," he says. "This handles it very nicely."

Large amounts of vitamin C can cause diarrhea. For this reason, Dr. Cathcart explains, a doctor should determine how much vitamin C can be tolerated without diarrhea before a high dose is prescribed. In addition, notes Dr. Jariwalla, the amount of vitamin C that a person can tolerate before a laxative effect is experienced increases with the severity of illness or infection. If you'd like to try this therapy for shingles, you should discuss it with your doctor.

While it's impossible to get a high-enough dosage of vitamin C from foods, many doctors suggest that you'd still do well to include citrus fruits in your daily diet. That's because the white rinds and membranes of citrus fruits contain bioflavonoids, chemical compounds related to vitamin C that are also potential immunity boosters and inflammation fighters.

Vitamin E May Ease Long-Irritated Nerves

One of the worst potential consequences of a shingles attack is pain that just won't quit, caused by chronic nerve inflammation. Although it hasn't been studied recently, several older research reports suggest that high doses of vitamin E can help resolve this persistent pain.

One report, published in 1973 by Los Angeles dermatologists Samuel Ayres, M.D., and Richard Mihan, M.D., found "highly gratifying results" with vitamin E used orally and topically. Of 13 people treated, 9 experienced complete or almost complete relief from pain, 2 were moderately improved, and 2 were slightly improved. Two of those who experienced complete or almost complete relief from pain had had post-shingles pain the longest: one for 13 years, the other for 19 years.

Vitamin E is incorporated into the fatty membranes of all cells, including nerve cells, which are protected by the myelin sheath, the thick wrapping of fatty membranes mentioned earlier, explains Dr. Huemer. There, vitamin E helps shield cells from the damage that occurs during a viral attack. Vitamin E can neutralize harmful biochemicals that are produced by immune cells as they ward off viruses. It may help stop the damage that can lead to lingering inflammation, Dr. Huemer says.

Dr. Ayres and Dr. Mihan used high doses of vitamin E in their study: 1,200 to 1,600 international units daily. Dr. Huemer simply recommends 400 international units a day. Consider medical supervision for doses of more than 600 international units daily.

Order the Complete Package

Vitamin E, along with other nutrients, stimulates immunity in other ways that may be helpful to people with shingles, especially those who seem to have weakened immunity, says Dr. Cathcart. "Many of my patients with herpes zoster have low immunity, so I work with an array of nutrients to rebuild their systems," he explains. These nutrients include vitamin A, the B-complex vitamins, zinc, selenium and others. For the full story on boosting your immune system, see page 320.