H. pylori - what’s the story? {Part 4}

Welcome to Part 4 of the H. pylori series. 

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, we covered:

• 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

In Part 3 of the H. pylori series, we reviewed:

• The benefits H. pylori confers on our health (really!) particularly for eczema, asthma, GERD and even peptic ulcer disease
• The best testing options for H. pylori

In Part 4 below, we examine:

• when it is appropriate to test for H. pylori
• the risks of inappropriate treatment
• what to do if you do have a positive result for H. pylori and it is appropriate to treat
• what to do if you have GERD and/or LPR (silent reflux)

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.

When to test for H. pylori

So, now that we have established that H. pylori is actually protective for many conditions and is a commensal, friendly, species in most cases, we should only go looking for H. pylori in a very specific set of circumstances. It also means that any treatment of H. pylori needs to be strategic and not the equivalent of a sledgehammer.

Unfortunately, a lot of healthcare practitioners will link H. pylori to various conditions in order to drum up business and this is a key reason I wrote this series. There is already enough misinformation and anxiety out there in the “wellness” space. It really needs to be reined in and corrected.

Below are the symptoms or conditions where assessing for the presence of H. pylori is warranted:

• Suspicion or high risk of gastritis, peptic ulcer or gastric cancers.
• There is some evidence that some H. pylori virulence factors are associated with Hashimoto’s thyroiditis, so it may be worth checking in that case; however the evidence as it stands is not definitive 

Risks of inapproropriate diagnosis and treatment

Inappropriate diagnosis in any situation can lead to psychological stress, wasted money and time before the genuine factors affecting an individual’s health are correctly identified. This is why I don’t recommend stool tests like GI Map that report on H. pylori because I’ve seen first hand the unnecessary stress - and distraction - it causes people.

As already discussed, H. pylori treatment - especially triple- or quad-therapy - has very real risks:

• Long-term harm to your gut environment and microbiome
• Contribution to the significant community problem of antibiotic resistance* - we know that the antibiotic portion of triple therapy has now increased from 7 days to 14 due to antibiotic resistance
• Contributing to the continuing eradication of H. pylori in the community - meaning that all the benefits H. pylori confers on human health may be lost 
• The PPI component of treatment can affect nutrient absorption and increase the risk of contracting gastroenteritis (ideally, PPIs should only be used for a short time)
• Research has actually shown that eradication of H. pylori has worsened clinical outcomes in chronic GERD

*Antibiotic resistance means that many commonly used antibiotics and even lesser used ones become less effective over time due to overuse. This means we as a community are at higher risk of contracting infections that cannot be effectively treated with antibiotics.

What to do if you have H. pylori on your test results

If you see a H. pylori positive result on a validated test, consider your symptoms, family history and other pathology findings. Assess your personal situation - what are your risks? Do you have gastritis or an ulcer? Do you have a familial risk of gastric cancer?

An upper endoscopy - along with a colonoscopy if one hasn’t been done recently - is always a good idea for anyone with chronic gut issues.

Treat yourself - your symptoms and risks - and not just your test result. Trying to eradicate
H. pylori can end up with you chasing your tail indefinitely and distract from the true cause/s of your health challenges. The medical treatment of H. pylori involves strong antibiotics and a PPI which also has antibiotic properties. The collateral damage on the gut microbiome is real and we know that in some cases, H. pylori is not successfully eradicated or the bacteria returns after a period where it isn’t detected.

If the goal is purely eradication, the outcome is mostly likely not going to be successful because the factors that drove the H. pylori to become pathogenic with subsequent problems have not been addressed. Also, many people go through H. pylori treatment only for the bacteria to remain present on a re-test.

If it is appropriate to treat H. pylori, consider a naturopathic approach alongside medical treatment. Work on restoring the innate protective features in your digestive tract including the mucosa, reduce your psychological stress, oxidative stress and other factors influencing the situation. There are also many nutritional strategies to disrupt urease enzyme activity.

Esteemed Australian Naturopath and Nutritionist Rachel Arthur - a go-to source of quality scientifically-based information - recommends an approach called “rehabilitate not eradicate”. Her recommendations - which I use in clinic - are to support the gastric mucosa, support immunity, limit urease secretion, reduce or manage psychosocial stress, use plant compounds and targeted nutrients.

Always work with your treating medical practitioner regardless of what you choose to do with treatment, because ongoing monitoring is important.

If you have GERD/reflux or LPR (silent reflux)

If you suffer from these conditions, it’s imperative to investigate further to determine what’s driving your symptoms. As covered in Part 3 of the series, H. pylori is actually considered a protective factor in GERD outcomes. Poor esophegeal tone, low stomach acid levels, low zinc levels, hiatal hernia and SIBO are the main factors I look for with clients who have reflux, GERD or LPR (silent reflux). Interestingly, some of the same naturopathic treatment that can help with H. pylori-associated gastritis and ulcers will also benefit reflux, GERD and LPR.

Please always consult your doctor about medical diagnosis and treatment - don’t solely rely on any information you read on the internet or social media when making medical decisions. That includes this article!

Conclusion

H. pylori is a misunderstood and unfairly maligned bacteria - in most cases, it’s an innocent bystander or a red herring. Many people try to eradicate it at all costs - often, this just worsens pre-existing gut dysbiosis and causes gut environment dysfunction.

H. pylori has been demonstrated in many research studies to play a protective role in different conditions - eradicating it often worsens the outcome for the individual.

We co-evolved with bacteria in a symbiotic relationship - we are the host they live in and they provide us with many benefits. Of course, some bacteria can play a pathogenic role, however that is only in particular circumstances. Examining the context in which this bacteria is found - the individual and their overall health - is key to successfully helping someone to improve their health without causing harm.

Treating the individual and not the test result is a cornerstone of the naturopathic ethos “first do no harm”. Assessing the individual’s health from a holistic viewpoint prevents unnecessary and potentially harmful treatment.

References

References and additional resources are listed in Part 1 of the series.

Do you need help figuring out your digestive health problems?

If you're ready to get answers and make meaningful progress with your gut 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.