How to prevent recurrent shingles and cold sores

If you want to know how to prevent recurrent shingles and cold sores, the answer is even more important than you might think. This is because the mechanisms responsible can be involved in other processes very relevant to your overall health – not just for the prevention of the said outbreaks. So, it might be good to know about them and make sure everything is optimised in how your body functions.

What causes shingles and cold sores?

First of all, you might have noticed that the shingles and cold sore breakouts look similar. They present as vesicular rash, although you can have shingles and just feel the pain. This is because the viruses causing the outbreaks are related. They are all Herpesviridae – or herpesviruses. This large family includes nine viruses that can affect humans:

Alpha Herpesviruses:
- Herpes Simplex Virus Type 1 (HSV-1) – primarily causing cold sores (oral herpes)
- Herpes Simplex Virus Type 2 (HSV-2) – primarily causing genital herpes
- Varicella-Zoster Virus (VZV, a.k.a. Human Herpesvirus 3 – HHV-3) – causing chickenpox (varicella), and later in life shingles (a.k.a. herpes zoster – this is always the manifestation of virus reactivation, never a first infection)
Beta Herpesviruses
- Cytomegalovirus (CMV, a.k.a. Human Herpesvirus 5 – HHV-5) – often asymptomatic but can cause severe disease in certain conditions
- Human Herpesviruses 6A, 6B and 7 (HHV-6A, HHV-6B, HHV-7)
Gamma Herpesviruses
- Epstein-Barr Virus (EBV, a.k.a. Human Herpesvirus 4 – HHV-4) – causes infectious mononucleosis (glandular fever) and is associated with several cancers; there is evidence linking this infection with the development of autoimmunity
- Kaposi’s Sarcoma-Associated Herpesvirus (KSHV, or Human Herpesvirus 8 – HHV-8)

Do I really catch the viruses so easily?

The characteristic linking all these viruses is their capacity to establish lifelong infections in humans. So, no, you don’t have to catch them every time they cause problems. The viruses had been there all along, but something changed and allowed them to multiply again.

Much can be said about every one of the herpesviruses. For now, we’ll focus on the Alpha Herpesviruses. They can all ‘hide’ in nerve cells after the clinical signs of the first infection are resolved. We’ll then look at how to prevent recurrent shingles and cold sores, because these viruses can reactivate after the initial infection has been resolved.

HSV infection

The first infection with HSV occurs via direct contact with infected saliva or lesions. The virus then enters local neurons (nerve cells) where it becomes latent. This means it is not active, but ‘alive’ and ready to replicate again when the right conditions arise. When reactivated, the painful, fluid-filled blisters appear in the same region as the initial infection, although more severe forms can occur in certain conditions. The virus can spread from a reactivated lesion just like from the first infection.

Reactivation triggers:

Stress (physical or emotional) or fatigue
Illness or fever
Ultraviolet exposure (sunburn – especially for HSV-1)
Hormonal changes (e.g., menstruation)
Immunosuppression (HIV, chemotherapy, corticosteroids)
Trauma to the area (e.g., dental procedures for HSV-1, sexual activity for HSV-2)

VZV infection

The primary infection with VZV is always chickenpox. It is one of the most contagious infectious diseases. It can spread via airborne transmission (virus particles can become aerosolised from an infected person’s coughing, sneezing, or even skin lesions, and travel through the air), or direct contact (the fluid inside chickenpox blisters contains infectious virus particles).

After the acute infection resolves, the virus enters latency in nerve cells. Their location will determine how the reactivations will manifest. It usually means a painful rash along a single nerve region (a belt-like distribution along nerve pathways, hence the name ‘zoster’ from Greek). In the head region, herpes zoster can lead to facial paralysis or even vision loss and hearing loss. Shingles is always a reactivation of the virus in a previously infected individual. It is also contagious, but the susceptible individuals (contacts that are not immune to the virus) will develop chickenpox, not shingles (not yet, anyway).

Reactivation Triggers

Aging (generally the risk starts to increase >50 years)
Immunosuppression (HIV, cancer, chemotherapy, organ transplant)
Stress or trauma
Chronic conditions (diabetes, autoimmune diseases, etc.)

What can you do about these viruses? How can you prevent recurrent shingles and cold sores?

Prevention is the best treatment, as always. If you can achieve prevention of the primary infection, that would be ideal, because there is no cure yet. However, there are things that can help even if the virus is already in the body. Antiviral medication can be used in all clinical scenarios, but this is usually reserved to severe cases or can be used in topical applications.

In order to understand how to prevent recurrent shingles and cold sores, we need to look at reactivation triggers.

HSV infection prevention

Avoid direct contact with active lesions
Do not share objects that may be contaminated (cutlery, utensils, cups, lip balm, lipstick, toothbrush, towels etc.)
Hand hygiene after touching active lesions
Prevent HSV-2 transmission from pregnant women to newborns with antiviral therapy during the third trimester

HSV reactivation prevention

Use lip sunscreen
Avoid local trauma
Immune function optimisation (that includes stress management, healthy diet and lifestyle, management of chronic or acute disease which is associated with inflammation [a.k.a. immune activation], and generally ensuring a balanced and adequate immune function – more on this over the next paragraphs)

VZV infection prevention

Avoid contact with people with chickenpox or shingles – not always easy because chickenpox is contagious 1-2 days before rash onset (1)
Vaccinate individuals who have not been previously exposed to the virus and do not have contraindications

VZV reactivation prevention

Zoster vaccine administration (not during active infection) in adults, indicated based on immune competency (sometimes suggested by age)
Immune function optimisation (as above)

Immune function optimisation to prevent recurrent shingles and cold sores

If you are wondering how to prevent recurrent shingles and cold sores, first you need to know how infectious diseases work.

The two fundamental factors that determine susceptibility, severity and recovery in infectious diseases are the pathogen (the viruses in our context and they are already in the body) and the terrain. The terrain refers to the host’s internal environment, and the essential aspect is immune function. Ultimately, all other factors such as nutritional status, stress or nervous system balance, microbiome, toxin exposure and elimination, cellular energy, age etc. – will influence infectious disease outcome via the immune function. Reactivation triggers will elicit some sort of immune imbalance which will then allow the virus to multiply again. For latent infections with frequent reactivations, immune optimisation is the key intervention for preventing outbreaks. It sounds like one task, but there are many influences on the immune function to consider.

How to prevent recurrent shingles and cold sores using a Functional Medicine approach

A Functional Medicine approach aims to address the root causes of cold sores and shingles recurrence. We do this by optimising immune function, reducing viral reactivation triggers, and generally supporting cellular health through nutrition, lifestyle, and targeted supplementation.

Please bear in mind that the best approach is a personalised one, especially for supplements which may not work for everyone, or may even have deleterious effects in some cases.

Also, it is likely that more than one factor will need optimisation, so a thorough and comprehensive assessment will identify all areas that require intervention. Think about it this way: the vast majority of the adult population are people carrying at least one type of latent herpesvirus. Nevertheless, just some people will experience the frequent virus reactivations at any age, be that over 50, over 70, or whenever. So, whilst there are immune changes associated with more advanced age, the number of years will not carry the same importance as lifestyle and diet for example. That is good news, since we know how to celebrate and honour the passage of time, but not (yet) reverse it. At any age, you can strive to optimise immune function, and you know you’ve achieved that when all modifiable factors have been addressed.

1. Diet

A nutrient dense diet, providing adequate quantities of vitamins, minerals, essential fatty acids, amino-acids and phytonutrients, is the ideal choice for good health in general, and also for herpesviruses reactivation prevention. Good nutrition will support metabolic pathways and immune processes. The immune system is very complex and very demanding in terms of the substances it needs to perform its functions optimally. A nutrient deficiency could easily lead to immune imbalance. This goes beyond the classic nutrients influencing the immune function, like vitamin C, vitamin D or zinc.

Also, bear in mind that our needs are individual, and that the recommended daily allowances are averages for healthy individuals (2) and are set based on avoiding risks like rickets (3) or scurvy (4) – obsolete, not reflecting our current understanding of nutrients’ roles in the body, and not even close to levels needed for optimal body functions. The peace of mind of getting a multivitamin and mineral with a compelling label, on top of a reasonably good diet, may be just an illusion. Ideally, you would use tests to understand what your body needs.

As a general guidance, avoid (excess) refined carbohydrates due to their complex influence on immune function (i.e., via microbiota-dysbiosis (5), excess reactive oxygen species (6) and advanced glycation end-products (7) acting as inflammation triggers, and via inflammatory mediators produced by excess adipose tissue (8)).

There is evidence supporting some plants as having antiviral properties. However, a diverse and balanced diet should be ideal, unless you are ready to take the next step: personalisation. Working directly with a functional medicine doctor will allow you to identify your specific needs and support your body towards optimal health in a more targeted way. Keep in mind that even some foods generally considered as healthy or immune-system-beneficial, may create inflammation in some individuals.

Of the non-pharmacological remedies, so far propolis stands out as a very promising alternative. So promising that it was shown to be more effective than the antiviral acyclovir (9), the current gold standard in anti-herpetic treatment. Whilst we are waiting for the relevant clinical trials, it is probably safe to assume that, where not contraindicated, propolis might substitute acyclovir in long-term herpetic recurrence prevention.

As general principles supported by evidence, with the specific purpose of minimising herpetic outbreaks (10):

Avoid excess arginine (during periods of high risk such as increased stress but also during outbreaks to minimise virus replication). High-arginine foods are: white meats (chicken, pork, turkey), legumes, nuts, seeds, whole grains. Cocoa (hence chocolate) is on this list too, unfortunately. So, no chocolate eating when stressed (definitely not one with nuts) if prone to herpetic reactivation. By ‘prone to herpetic reactivation’ you should probably understand: you have the latent virus in the body + you have other factors that influence the immune system in an unwanted way. Balance is key, because high arginine foods have their own health benefits.
Ensure adequate amounts of lysine in the diet. High-lysine foods are dairy, meat and fish, so achieving adequate amounts is more difficult in vegetarian and especially vegan diets. If you may need a supplement, you should work with a healthcare practitioner.

2. Stress management

Stress chemistry promotes inflammation (11) and immune balance shifts that can trigger virus reactivation. Inadequate sleep is a recognised stress to the organism with deleterious immune consequences (12). Therefore, sleep hygiene is part of stress management.

Simple measures that we can apply to improve prognosis for people at risk of herpetic reactivations are:

Enough good quality sleep
Mindfulness, meditation, breathwork
Moderate exercise
Adaptogenic herbs if recommended by a trained healthcare professional

Even in this area of stress management, personalisation will optimise outcomes. Some people will set aside those hours for sleep, will make sure the environment is just right (dark, quiet, optimal temperature), and will still have trouble falling asleep or staying asleep or waking up refreshed. In those cases, targeted nutritional interventions or supplemental support may be needed, based on the individual’s genetic makeup, to allow a favourable balance of neurotransmitters and hormones involved in stress reactions – always on top of the general measures mentioned above.

3. Gut health optimisation

The digestive system is one of the main barriers between our internal environment and the external factors. So, no wonder it is home to most of the immune system (our defence). Dietary changes lead to major and rapid shifts in the microbiota composition (bacteria that live in the gut) (13) and that exerts one of the most important influences on immune function. Stress will do the same (14).

Thus, diet and lifestyle factors such as sleep and stress levels influence gut health and immune balance. Beyond that, specific investigations may reveal problems that need further interventions, i.e., supporting microbiota diversity, treating any pathogenic colonisation, ensuring normal gut permeability.

4. Addressing other root causes of virus reactivation

Sometimes, there are hidden triggers of immune imbalance which will culminate in herpesviruses reactivation. To be able to design interventions to mitigate risk, a thorough Functional Medicine assessment may identify:

Chronic infections that can be viral, bacterial or fungal
Hormonal imbalances
Various types of toxin exposure, sometimes coupled with genetic variants that lead to suboptimal detoxification

Chronic diseases are generally closely associated with inflammation. This doesn’t only mean conditions like autoimmune disease, where we know that immune dysfunction is the main thing causing problems, and we frequently use immune-targeted medication (15), but also asthma (16), cardiovascular disease and diabetes (17), etc. Optimal management of these conditions should include a comprehensive assessment and interventions like diet and lifestyle, alongside any necessary medication, to manage the low-grade, chronic inflammation, or sometimes the major immunological dysfunction that can contribute to herpesviruses reactivation.

5. Special immunology considerations on how to prevent recurrent shingles and cold sores

The immune system is not one thing. It is a miraculously complex network of intricately complex components that continuously interact among them and with the external factors to create either a perfect symphony called health, or a more or less disastrous dissonance leading to different diseases of various severity levels.

The good news is that a holistic approach to health focusing on healthy diet and lifestyle should be sufficient to ensure good immune function in most cases. Even when things have started to go wrong, it is still worth going back to those basic interventions. And no – whilst they may be lifesaving in certain circumstances, medications like corticosteroids or monoclonal antibodies will not ‘fix’ your immune system. You may think that such powerful medications are root-cause approaches, but they really are not.

Still, as already suggested, sometimes our needs are too specific to be fulfilled by generic approaches. This is when in-depth assessments and targeted interventions may be required to maintain or to restore harmony in the body.

When frequent herpesviruses reactivations become a problem, it may be worth performing specific immune system assessments to understand if the balance between its components may have shifted and is allowing those recurrent outbreaks (18). In a very simplistic summary, sometimes the antiviral defence is not adequate, sometimes it is overwhelmed by other immune components.

All the factors already discussed – diet, lifestyle etc. – can and do play a role in the immune system balance. However, once an imbalance occurs, the right strategy to reverse it becomes essential, because the wrong order of interventions might aggravate problems.

Get the support you need

This is what we do at The Allergy-Immunology Doctor. We assess your individual circumstances, and we create a plan to optimise your immune function. If you would like to discuss how we may be able to help, you can book a free discovery call.

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