Helicobacter pylori is a prevalent bacteria that is estimated to be residing in 50% of the human population and up to 85% of adults in developing countries making it one of the most widespread gut bugs (1). It has been implicated in peptic ulcers, gastritis (inflammation of the stomach lining) and gastric cancer (2, 3). Read on to learn more about what helicobacter pylori is, symptoms and implications in disease.
What is Helicobacter pylori
Bacterium come can come as gram-positive and gram-negative. Unfortunately for those infected with Helicobacter pylori it is a gram-negative bacterium. According to A Concise Manual of Pathogenic Microbiology gram-negative bacteria are among the most prevalent in nature. Many gram negative bacteria are harmless to humans but a few, including helicobacter pylori, are considered pathogenic. Pathogenic gram negative bacteria present more of an issue than their gram-positive relatives as they have two cell walls making them much harder to treat.
Helicobacter pylori was originally cultured by two Australian scientists Robin Warren and Barry Marshall in 1982. In the early 80’s scientists and researchers were starting to associate gastritis (inflammation or irritation of the stomach lining) and hypochlorhydria (very low stomach acid production.) Simply culturing the bacteria helicobacter pylori wasn’t enough to suggest that it had anything to do with gastritis. To prove that helicobacter pylori could infect the human stomach Marshall ingested the bacteria. The next two weeks he experienced symptoms including vomiting, headaches, irritability and halitosis (bad breath.) The infection was confirmed endoscopically. Morris, another Australian researcher, followed suit by ingesting helicobacter pylori and confirmed infection of the bacteria and stomach acid production. The poor guy struggled to rid the pathogenic bacteria for 5 years! (5)
It is interesting to note that Helicobacter pylori grows best between a PH of 6 and 8. The fact that it can take up residence in the human stomach is interesting. A healthy human stomach has the PH of between 1-3 (6) with an average of 1.4. The discrepancy between the bacteria’s preffered PH and the human stomach means that helicobacter pylori must have developed some adaptive features that allow it to make such an acidic environment home (7).
The answer to the question of how it can survive in such a low PH involves urease. Apparently “h. Pylori expresses the highest level of urease seen in bacteria.” The basic biochemistry goes something like this. Helicobacter produces urease that hydrolyzes urea from the host’s bloodstream to produce ammonia and bicarbonate (very basic substances that counteract the stomach’s naturally low PH) The knock-on effect from that cascade of events raises the environment’s PH (the stomach) making it more hospitable to helicobacter pylori among others (5).
Within the cell wall of Helicobacter pylori resides lipopolysaccharide (aka LPS.) LPS could possibly be the main mechanism responsible for the inflammation piece of the story. It’s presence triggers an immune response and promotes inflammatory cytokines a healthy response that becomes a serious issue under chronic conditions (8). Even with a natural and impressive immune response helicobacter pylori is very rarely eradicated without an antimicrobial protocol on place. Though it has been shown that helicobacter pylori can survive the low PH of the stomach it does take energy and makes it more difficult for the bacterium to originally colonise. This is a major headline for anyone on acid suppressing drugs (PPI’s etc) and is another point in favour of the case for stomach acid. Helicobacter pylori: host genetics and disease outcomes (9).
Side note: It is very common for people to be prescribed stomach acid neutralising agents, mainly as a poor attempt to treat heartburn and GERD. Limiting one’s stomach acid (thus raising the stomach from a healthy 1-3 PH) is a surefire way to increase the incidence of bacterial and fungal infections. The extremely low PH of a healthy stomach is there to neutralise possible infections. It is also paramount to healthy and effective digestion, absorption and assimilation of nutrients!
What to look for if suspecting Helicobacter pylori infection
There are many symptoms associated with helicobacter pylori. Generally they are very similar to many other GI infections so a high quality functional pathology test is essential to determine infections. Please do not simply go off this list and assume you have helicobacter pylori. Don’t guess, TEST!
- Vertical ridges on fingernails
- Loose stools
- Stomach pain
Again please be sure to test to be 100% sure.
There are a few things that are helpful when struggling with a combination of the symptoms listed above. I have found this helpful while waiting to hear back from the pathology labs. The following points focus on palliative care and can help to reduce symptoms. Remember the golden rule of Functional Medicine “The greatest good is treating the root cause.” Treat your infection when you do get your lab results back. Until then you can
- Eliminate many refined foods (mostly the junk foods). Dairy and gluten may need to be removed as well but this depends on each individual.
- DO NOT TAKE ANY HCL supplements! This is very important as Helicobacter pylori can cause stomach ulcers. HCL can seriously damage and present or forming stomach ulcers.
- Some people find that supplementing with a high quality digestive enzyme to be helpful as well.
Possible consequences of helicobacter pylori infections
Many papers have been written on the subject of helicobacter pylori in association with human illness and disease. As Chris Kresser is fond of saying “correlation is not causation.” There may be factors not accounted for and a few researchers are even suggesting that helicobacter pylori could have a protective effect that we will be outlining below.
While there is suggestion of possible positive impact on human health most papers suggest that helicobacter pylori is definitely pathogenic. One peer reviewed paper outlined the fact that even symptomless infections with helicobacter pylori are cause for concern. The same paper associated helicobacter pylori with gastritis (inflammation of the stomach) gastric atrophy that could lead to vitamin B12 deficiencies, peptic ulcer disease, gastric cancer and gastric lymphoma (10).
The link between low stomach acid and gastric cancer is something worth looking into but needs a basic primer in GI biochemistry.
In a healthy functioning digestive tract the PH is the real trigger. Resting PH of a healthy stomach is between 1-3 (very acidic!) Food, generally closer to a neutral PH of 7 enters the stomach thus raising the PH. This event triggers the G cells in the stomach to produce the hormone gastrin. Gastrin triggers the parietal cells to produce hydrochloric acid that then lowers the PH. When the PH is sufficiently lowered gastrin production by the G cells is turned off.
In a stomach with chronically elevated PH or poor acid secretion due to H. pylori (or acid suppressing drugs!) the G cells are constantly being triggered, stimulating the production of gastrin. Prolonged elevation of gastrin levels has been associated with gastric cancer. Not to scare anyone but gastric cancer is the fourth most common cancer with almost a million new cases each year. In terms of deaths gastric cancer is number two (6, 11).
So that’s the bad of helicobacter pylori, and it seems fairly bad but there is another side. It has also been proposed that H. pylori is an opportunistic organism. One paper in an attempt to review and outline the possible benefits of helicobacter pylori made a number of interesting points
- Only 15% of people infected with helicobacter pylori display symptoms
- Less than 1% of those 15% symptomatic people go on to develop gastric cancer
- Helicobacter pylori has a negative correlation with asthma, GERD (makes no sense to me as it decreases stomach acid production)
The paper goes on to note the possibility of certain beneficial strains of helicobacter pylori. A direct quote sums up their position “If we look at Helicobacter pylori as a good bacterium with bad side effects…perhaps we can gain something from this bug” (12).
Don’t Guess, TEST
You will get used to reading that line. It is a principal tenement of Functional Medicine. As I review the different GI infections I’ve noticed that many of the symptoms are very similar. As many of the infections share very similar symptoms it is very important to know exactly what you are living with.
Helicobacter pylori can be assessed in a number of different ways (5).
- Stool antigen test. This test can be performed by your family doctor and is a good approach to screening for H. pylori. – Recommended
- Blood test – H. pylori can be detected via antibodies, specifically IgG, IgA and IgM) Apparently there are limitations with this test as it is impossible to test the treatment efficacy (the antibodies will still be present) – Not recommended. Antibodies can remain detectable even after you have cleared the infection. As such it is not a reliable way to track treatment progress.
- Urea breath test – It is possible to determine infection by analysing the breath for urea – Currently I am unfamiliar with this test and can’t recommend it.
Routes of infection
The big question is how do you contract helicobacter pylori. The two well researched methods of infection are oral-oral or fecal-oral. It seems obvious but if one member of a family has contracted helicobacter pylori other members are at high risk of infection. It is proposed that contaminated food and water are possible routes of infection. Anyone on tank water take note! (11)
Eradicate the bugs!
The conventional approach to treating helicobacter pylori involves a few different pharmaceuticals in tandem. Antibiotics alone are not sufficient due to the low PH of the stomach (they are much less effective at lower PH) so an acid suppressing drug was needed. Currently the first line therapy from conventional medicine involves two antibiotics, clarithromycin and metronidazole, and a PPI (proton pump inhibitors reduce stomach acid secretion to near zero for a period of time)
- Mastic gum
- Cranberry juice – helps prevent the bacteria from adhering to the stomach lining
- Garlic oil
- Licorice extracts
- Green Tea
- Honey and Propolis
I have come across dozens of cases of bacterial & parasitic infections here in Byron Bay, NSW. Living in the subtropics and relying on tank water for drinking, showering and cleaning can be problematic.
Learn more here.
References and Resources
- Novel Helicobacter pylori therapeutic targets: the unusual suspects
- Management of Helicobacter pylori infections
- Management of Helicobacter pylori infections 2
- A Concise Manual of Pathogenic Microbiology
- Helicobacter pylori : detection methods, diseases and health implications
- Why Stomach Acid Is Good For You
- Acid Related Disease: Biology and Treatment
- A Concise Manual of Pathogenic Microbiology
- Helicobacter pylori: host genetics and disease outcomes
- Helicobacter pylori infection: diagnosis and treatment
- Helicobacter pylori in the 21st Century
- Helicobacter pylori: beneficial for most
- Exploring alternative treatments for Helicobacter pylori infection
- Helicobacter pylori infection: a review of current scientific research on the efficacy or potential of herbal medicine for the treatment of H. pylori infection of the gastric mucosa