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L-Lysine : An effective adjunct treatment for Herpes Simplex Virus outbreaks

In humans, the herpes simplex virus (HSV) can cause the common cold sore, herpes simplex keratitis and genital herpes. How does L-Lysine work? L-lysine is simply an essential amino acid (i.e. not produced by the body) that is commonly found in foods, and all of us likely have some every day. It just so happens that the herpes viruses as a group have their replication inhibited in an environment where there is a larger concentration of l-lysine, compared to another amino acid "arginine" (which is produced by the body)[1]. Thus, we can take advantage of this situation by saturating the virus with lysine and thus suppressing the virus ability to replicate. Lysine is readily available in most health food stores (e.g. Holland and Barrett) and many chemists, as a tablet or capsule. It is also relatively cheap (e.g. 120x1000mg tablets 7). Recommended as an adjunct treatment If you have a patient who suffers from recurrent HSK, recommend L-Lysine at the dosage below, at first symptoms of outbreak, and to seek medical advice as per normal. This should help reduce the severity and duration of the outbreak. (Personally, I also recommend it when they have an ordinary cold/flu, to reduce the chances of an outbreak developing.) Dosage: 1000mg x2 (1 tbl in morning and 1 tbl in evening, with water), each day for duration of outbreak or until symptoms stop. No longer than 7 days would generally be required. The above 2000mg l-lysine dosage is well within maximum recommended therapeutic dosage levels according to the FDA (100mg/kg/day, e.g. 3 times below for a 60kg person). A supplement dose of 3000mg per day has been found to be safe for short-term use[2]. I have a handful of recurrent HSV keratitis sufferers and I have been advising this supplement with good results. It is important to limit such outbreaks as each recurrent attack induces greater damage to the corneal nerves leading to reduced corneal sensitivity, corneal scarring and possible complications can include uveitis. From "There are about 500,000 people in the U.S. with a history of herpes simplex eye disease. Approximately 20,000 new cases of ocular herpes occur in the U.S. annually, and more than 28,000 reactivations occur in the U.S. annually. It usually affects only one eye and is one of the most frequent causes of blindness in one eye in the U.S." This can be a sight-threatening condition, thus if we know of a potentially effective and safe adjunct treatment option - why not try it? In the journal evidence below, please note that it is only the low dosage studies that were ineffective. Listed in chronological order: A multicentered study of lysine therapy in Herpes simplex infection.

Griffith RS, Norins AL, Kagan C. - Dermatologica. 1978;156(5):257-67. 312-1200mg (single or multiple doses) beneficial effect in accelerating recovery Lysine prophylaxis in recurrent herpes simplex labialis: a double-blind, controlled crossover study. Milman N, Scheibel J, Jessen O. - Acta Derm Venereol. 1980;60(1):85-7 1000mg longer recurrence-free rate Subjective response to lysine in the therapy of herpes simplex David E. Walsh*, Richard S. Griffith and Ali Behforooz - Oxford Journals Medicine Journal of Antimicrobial Chemotherapy Volume 12, Issue 5, p. 489-496 (1983) 936mg 88% considered supplemental lysine effective Failure of lysine in frequency in frequently recurrent HS infection. Treatment and prophylaxis Arch Dermatol. 1984 Jan;120(1):48-51. - DiGiovanna JJ, Blank H. 400mg tds = total 1200mg = fail (note the low dose separated throughout the day) Treatment of recurrent herpes simplex infections with L-lysine monohydrochloride. McCune MA, Perry HO, Muller SA, O'Fallon WM. - Cutis. 1984 Oct;34(4):366-73 1248mg effective at decreasing recurrence rate, 624mg not effective Lysine as a prophylactic agent in the treatment of recurrent herpes simplex labialis. Thein DJ, Hurt WC. - Oral Surg Oral Med Oral Pathol. 1984 Dec;58(6):659-66. 1000mg useful in reducing recurrence rate Success of L-lysine therapy in frequently recurrent herpes simplex infection. Treatment and prophylaxis. Griffith RS, Walsh DE, Myrmel KH, Thompson RW, Behforooz A. - Dermatologica. 1987;175(4):183-90. 1000mg tds = total 3000mg = success in all areas: lower recurrence, significantly reduced symptoms and healing time Clinical effectiveness of lysine in treating recurrent aphthous ulcers and herpes labialis. Wright EF. - Gen Dent. 1994 Jan-Feb;42(1):40-2; quiz 51-2. Helps reduce recurrence rate Lysine for management of herpes labialis. Tomblin FA Jr, Lucas KH - Am J Health Syst Pharm. 2001;58(4):298-300, 304. Tomblin and Lucas report in detail on the results of half a dozen studies of varying size, design and duration. According to Tomblin and Lucas, the studies showed lysine tended to be more effective as a preventative for HSV than as a treatment for an outbreak, and that results were dose-dependent. They noted that most of the more rigorous studies --- doubleblind, placebo controlled and providing statistical analysis --- were small, and suggested larger, well-designed studies could provide a more definitive answer. [2] Will taking the amino acid supplement lysine prevent or treat the herpes simplex

virus? Marcason W. - J Am Diet Assoc. 2003 Mar;103(3):351. A commentary only. Supplement daily dose of 3000mg shown to be safe for short-term use. Safety and effectiveness of an L-lysine, zinc, and herbal-based product on the treatment of facial and circumoral herpes. Singh BB, Udani J, Vinjamury SP, Der-Martirosian C, Gandhi S, Khorsan R, Nanjegowda D, Singh V. - Altern Med Rev. 2005 Jun;10(2):123-7. significant improvement - but involves other ingredients

In Vitro - beneficial/positive results [1] Relation of Arginine-Lysine Antagonism to Herpes simplex Growth in Tissue Culture Griffith RS, DeLong DC, Nelson JD - Chemotherapy 1981;27:209213 Feline studies - beneficial/positive results Effects of L-lysine and L-arginine on in vitro replication of feline herpesvirus type-1 David J. Maggs, Keith Collins et al. - American Journal of Veterinary Research December 2000, Vol. 61, No. 12, Pages 1474-1478 Efficacy of oral supplementation with L-lysine in cats latently infected with feline herpesvirus David J. Maggs et al - American Journal of Veterinary Research - January 2003, Vol. 64, No. 1, Pages 37-42 Ocular Manifestations of Feline Herpesvirus SE Andrew - Journal of Feline Medicine and Surgery, March 2001 vol. 3 no. 1 9-16 Other evidence: 1) University of Maryland Medical Center USA, recommends: see link 1 and link 2 2) Multiple L-Lysine products on the market for cold-sores 3) Anecdotal: Hundreds (perhaps thousands) of positive comments on online forums and product reviews for using lysine against HSV outbreaks (I personally have not read negative comments, i.e. ineffective, but they may exist, but would be a minority) 4) Lysine commonly recommended by vets for feline HSK

Precautions: While lysine is generally considered safe when taken as directed, the University of Maryland notes some cautions. High doses of lysine have been implicated in the formation of gallstones. If you are pregnant, breastfeeding, high cholesterol, heart or kidney disease, take arginine (another amino acid) or have any health care questions or concerns, you should consult with a health-care professional before taking lysine.