H. pylori - what’s the story? {Part 2} - Electric Vitality

Innocent bystander or to be eradicated at all costs?

Welcome back to Part 2 of this article series all about H. pylori.

In Part 1 of the H. pylori series, we looked at:

some context in regards to this unique but misunderstood bacteria in terms of how it is viewed by the medical community and by people seeking to improve their digestive health
how the medical research community - and some progressive healthcare practitioners - are pushing for a long overdue re-evaluation in regards to the relationship between H. pylori and human health
numerous amazing facts about this bacteria which really help to set the scene to help us re-evaluate our relationship with it
the problems caused by inappropriately targeting H. pylori as the culprit in someone's health challenges

In Part 2 below, we will look at:

typical symptoms that DO or DO NOT warrant H. pylori treatment
why some people report feeling better after treatment
common myths about H. pylori such as H. pylori reducing stomach acid in all cases
the relationship between H. pylori and B12
virulence factors - what they are and why they matter

Medical Disclaimer: The information included in this article is for entertainment purposes only. It is not intended or implied to be a substitute for professional medical advice. Reading the information in this article - and the website in general - does not constitute a physician-patient relationship. Discuss any health concerns with your medical provider before starting or changing treatment for any health condition.

H. pylori: what's the story? Innocent bystander or to be eradicated at all costs?

Typical H. pylori symptoms that warrant investigation and possible treatment

There is no evidence that H. pylori infection causes IBS/SIBO, GERD, LPR or reflux-type symptoms.

The symptoms that DO warrant H. pylori investigation typically include pain patterns found in those with gastritis and ulcers - that is, pain in the upper abdomen either while eating or within 2-3 hours after eating; vomiting, nausea, excessive belching/burping and/or unexplained weight loss.

Note also that some of these symptoms can also be caused by other conditions not related to
H. pylori - eg. gastroparesis, SIBO for example, IBD. So it’s essential for anyone experiencing any of these symptoms to have a thorough medical workup with further investigations as needed. The presence of these symptoms doesn’t necessarily mean that H. pylori is the cause even if it’s detected on pathology testing - this will be covered in more detail below.

Why do some people report feeling better after H. pylori treatment?

Typical medical treatment of H. pylori is either “triple therapy” or even “quad therapy” - usually, a combination of antibiotics and PPIs (proton pump inhibitors which block stomach acid).

Aside from the small subset of people that genuinely need to eradicate H. pylori, the antibiotics for H. pylori will also reduce levels of bacteria typically found in SIBO and gastroenteritis - a risk factor for dyspepsia - and PPIs themselves are also antimicrobial. So, do they feel better because they eradicated H. pylori or because levels of other bacteria were reduced? We should also not discount the power of placebo.

As a reminder, I have many clients who pinpoint a worsening in their health to their triple or quad therapy for H. pylori, so I urge you to think very carefully about trying to eradicate it if you don’t fit into the category of people for whom it does need to be eradicated. We know that the microbiome has a difficult time re-establishing itself after even one round of antibiotics, so triple- and quad-therapy is a big hit to the microbiome and your health.

Does H. pylori lower stomach acid?

This line gets repeated a lot on the Facebook groups when someone - often me 😉 - questions the validity and relevance of a finding of H. pylori on an individual’s stool test. Invariably, the line that “but H. pylori reduces stomach acid so therefore it must be eradicated” gets used again and again.

There are two mechanisms by which H. pylori lowers or neutralises stomach acid, however it’s critical to understand that this isn’t happening in everyone that has H. pylori. It’s occurring only in the context where H. pylori’s sophisticated pathogenic properties have been activated. One mechanism is a gene to gene interaction between H. pylori and host cells - your cells - and the other is the production of ammonia via the urease enzyme - this creates a cloud of ammonia around the bacteria to buffer against the highly acidic environment.

The urease enzyme is highly nickel-dependent. One active urease molecule requires 24 nickel ions for full enzymatic action. If there is not enough nickel available, the enzyme cannot be activated. Could this be one of the environmental reasons why in some cases, H. pylori causes disease whereas in most people it doesn’t? This means one can have H. pylori present in their gut, but it’s not doing anything harmful because there’s not enough nickel available for urease activity.

From a rational perspective, if it were true that H. pylori always lowers stomach acid - which is what some are arguing in Facebook groups when someone shares a positive GI Map H. pylori result - then most people on the planet would have low stomach acid by default, since the majority of the population across the globe still carries H. pylori. It makes no sense from a physiological perspective for most of the world’s population to have low stomach acid.

There are many fundamental aspects of health that can cause suboptimal stomach acid levels such as low zinc, low chloride, low potassium, chronic stress, poor vagal tone and hypothyroidism to name just a few. It’s concerning that these barely get a mention with all the focus on H. pylori. If you aren’t assessing and treating those first, why not? Is it easier to believe digestive issues are caused by a “nasty” pathogen?

H. pylori and B12

In genetically susceptible individuals, H. pylori may trigger an antibody response against intrinsic factor, potentially leading to pernicious anemia and B12 deficiency. It is difficult to determine if a B12 deficiency is definitively caused by H. pylori since there are so many potential causes of B12 deficiency. Meaning that if you have a B12 deficiency and test positive for H. pylori, the deficiency may not be caused by the bacteria’s presence. Testing for both
H. pylori and intrinsic factor antibodies is essential if someone has low B12 even when their diet has plenty of B12 sources. However, a B12 deficiency may also be caused by low stomach acid and/or bacterial overgrowth such as SIBO.

Virulence Factors

Various secreted virulence factors have been identified for H. pylori which may influence the development of disease. These factors can be identified in some testing, such as the GI Map stool test. The research into the risks of the various virulence factors is still ongoing and there is no consensus as yet. This research will ideally eventually help clinicians make more informed decisions about the need for treatment, in the context of other factors present in the individual.

There is a complex interplay of virulence factors with each other and also with other factors such as geographical region, the individual’s health and environmental factors. This means that the presence of particular virulence factors does not solely determine the clinical outcome in an individual.

As of writing, cagA and some variants of vacA have been most consistently associated with severe gastroduodenal disease in both children and adults, whereas the role of outer membrane proteins, such as babA2, sabA, homB and oipA, is currently unclear.

Some research has even suggested that some of the virulence factors may in fact be protective of disease, either alone or in combination with other factors. More research is needed to clarify this point.

What this means is if you see positive virulence factors on a GI Map test is “we don’t know yet how this will influence your health”. In other words, positive virulence factors on a GI Map test are not automatically a cause for concern as with a positive H. pylori result.

What's next?

In the next part of the series, we will get to the really juicy stuff - the protective role that
H. pylori plays in human health. Far from being a villain, H. pylori is actually associated with health benefits - truly! I hope you stick around for that installment.

Do you need help figuring out your digestive health problems?

If you're ready to get answers and make meaningful progress with your health so you can get back to doing what you love, find out how to work with me. I am a Clinical Nutritionist and Naturopath based in Sydney, Australia. I work with clients worldwide.

I also offer a stool test interpretation service.