AYURVEDA PERSPECTIVE ON H PYLORI INFECTION

Do You Have the #1 Gut Infection in the World?

Flip a coin and that's the likelihood you are infected right now. Over 50% of the world's population battles this gutsy bug^[1] , making it one of the most widespread infections in existence. If you have this bug, you may notice your intestines are occasionally tender and inflamed. This highly contagious bug is called Helicobacter pylori. It is a gram negative bacteria discovered by two Australian doctors in 1982, Barry Marshall and Robin Warren. They not only discovered H pylori, but also proved that Hp infections cause 80% of stomach ulcers. Their discovery revolutionized treatment of ulcers - a common, incurable, and sometimes fatal condition at the time. Their groundbreaking research earned them a Nobel Peace prize in 2005.

H pylori not only causes ulcers, but affects your health in many ways. It irritates the lining of the stomach, causing inflammation. Chronic H pylori causes permanent damage to the stomach (atrophic gastritis), causing loss of stomach function and poor secretion of stomach acids. When infected, your ability to digest food diminishes over time, meaning you get less and less nourishment from your food. Eradicating H pylori can be an important way to both improve your digestion and maintain your health and vitality as you age. H pylori ability to cause stomach cancer earned it a notorious distinction as the only bacterium recognised as a Grade 1 carcinogen by the World Health Organisation.

Many Hp infected individuals have little or no symptoms, despite the presence of inflammation. Others will experience a chronic ache or burning pain in the abdomen that does not wax or wane with eating. Sometimes the pain masquerades as mild nausea. You can check for pain by pressing your fingers against your stomach, as in the diagram at right. And, by pressing into your upper GI, directly above the belly button.

Despite feeling hungry, poor acid production in indivduals infected by H pylori reduces appetite. Your stomach may feel bloated and heavy after only a small portion. Appetite is also reduced in Hp (H pylori) infected individuals due to lower ghrelin levels. Ghrelin is known as the hunger hormone. The mechanism of ghrelin suppression is not known however the suppression of ghrelin may not be unique to H pylori. Infection and inflammation of the stomach generally reduces appetite. I.e. you lose your appetite when sick. Leptin, the satiation hormone, is also lower in Hp infected individuals. Thus, while appetite is decreased, so are feeling of fullness after a meal. After eradication of H pylori, ghrelin levels return to normal. ^[8]

Your esophagus may feel hot & sour even in the absence of acid reflux or heartburn. If you have H pylori, you may have frequent burping and bloating as activity of the bacteria releases carbon dioxide.

Although believed to be transmitted through saliva, vomit or fecal matter (oral-oral and fecal-oral routes), the method of transmission of H pylori is still poorly understood. Sharing drinks, kissing or living with someone who has H pylori may be common ways of catching this disease. Once established, H pylori is hardy and resilient. The infection is generally believed to persist for life unless it is treated.^[2] H pylori may spontaneously disappear in the elderly as the stomach's mucosa becomes thinner and inhospitable.^[3]

The number of those infected varies by country. Countries with good sanitation have lower rates of infection. Those traveling to developing nations face greater risk of infection. Prevalence also varies by race, age, and socio economic status. In the United States, H pylori affects 60% of Hispanics, 54% of African Americans, and 20% to 29% of Anglo Americans. Kids are also more likely to contract the disease. There are many ways to test for H pylori infection. A blood test for antibodies is a common inexpensive method. However, it shows a positive result for past infections as well as current infections. Stool and breath tests are more reliable for a current infection.

Development of H pylori

H pylori is unique because of its ability to survive in the harsh environment of the stomach. It protects itself from stomach acids by releasing urease into its outer membrane.^[4] Urease is an enzyme that breaks down urea, naturally found in gastric juices, into ammonia and carbon dioxide. The ammonia, which is basic, neutralizes any acids that have penetrated the outer membrane, allowing the bacteria to survive.

The 'H' of H. pylori is short for Helicobacter. Helico means spiral. H. pylori's spiral shape helps it burrow into the mucus layer coating the stomach, where it is protected from immune cells and lethal stomach acids. There, H. pylori uses its threadlike tendrils to attach itself close to the stomach lining, where it enjoys a relatively neutral pH environment. Adherence to the stomach wall also protects the bacteria from being flushed away by peristalsis or mucus turnover.^[5] In people producing large amounts of acids, H pylori avoids the acid-producing parietal cells of the upper stomach and instead colonizes the pyloric antrum (exit of the stomach). In those with less acid, H. pylori colonizes the entire stomach.^[6] Occasionally, H. pylori burrows inside the cells of the lining itself, where it is impervious to antimicrobials.^[7]

To borrow into the mucosa, it also releases chemicals that degrade the mucus gel structure, effectively liquefying the protective mucus layer of the stomach. The degradation of mucus exposes gastric tissue to caustic acids. These acids, ammonia, as well as other oxidising waste products produced by H pylori cause inflammation of gastric tissue (gastritis), erosion (ulcers) and damage to DNA, leading to increased risk of stomach cancer. Inflammation is present in all individuals with H. pylori infections, even patients without symptoms. Chronic gastritis may result in loss of acid-producing cells and reduced stomach function (atrophic gastritis).

Potential Benefits of H pylori Infection

Is H pylori a good bacteria or a bad one? The answer is controversial. Given that H pylori has been present in human remains dating at least 50,000 years and possible longer. Given the tens of thousands of years of colonization, it is likely that mutual adaption of both organism have led to symbiosis.

Many doctors believe that testing and treatment of H pylori is not necessary unless symptoms are present. This is because Hp infected individuals have lower rates of asthma, food allergies and IBD. This is due to the fact that H pylori colonizes the stomach mucosa, not the stomach itself. Since the immune system recognizes that H pylori is not an invader, the immune system 'backs off' so to speak. The voluntary retreat of the immune system is adaptive, otherwise everyone would have some form of inflammatory bowel disease simply due to the large number of bacteria present in the intestines. Instead, the body simply suppresses this response to bacteria that colonize the GI.

Specifically, H pylori has been shown to protect against inflammation from Shigella and Salmonella attacks as well as inflammatory bowel diseases in general.^[9] Salmonella is a potentially fatal disease that was responsible for the fall of Athens and the rise of Sparta. Thus, having a H pylori infection may be a selective advantage. Other organisms in the gut were found to dampen inflammation caused by H pylori. The presence of C difficile, for example, was shown to reduce H pylori related inflammation in mice.

Treatment of H pylori

Standard western medical treatment includes antibiotics. However, H pylori is increasingly resistant to common antibiotics.For this reason, doctors often recommend two antibiotics are used at the same time. Use of antibiotics may have side effects, including proliferation of Clostridium difficile, a bacteria that causes diarrhea.

Doctors may recommend bismuth salts (such as Pepto Bismol ?), yogurt or probiotics containing lactobacillus, and herbs to enhance the effect of the antibiotics and aid in eradication.^[10] Bismuth salts have been used for over three centuries to cure various forms of dyspepsia due to their antimicrobial action and ability to soothe & coat the stomach. Although bismuth salts may suppress an active H pylori infection, cure rates are low.

The presence of infection in the gut causes buildup of free radicals released by the immune system to combat the bacteria. Antioxidant supplements are thus supportive for individuals with H pylori infection. One such antioxidant is vitamin C, naturally found in many berries as well as the ayurvedic herb amalaki. Vitamin C levels were found to be significantly lower in individuals with H pylori infection. Improving vitamin C levels led to eradication of H pylori in 30% of cases^[11] ,^[12] .

Antimicrobials such as ginger, cinnamon, garlic, oregano & turmeric can inhibit H pylori growth. Antimicrobial herbs are especially useful if they are anti-inflammatories as well, such as barberry, turmeric, fresh ginger, and cinnamon. Cinnamon extract also interferes with H pylori's ability to use urea for protection against stomach acids. Fresh ginger also promotes regeneration of the protective mucus layer^[13] . Licorice root may be soothing and cooling. Green tea has been shown to block adhesion of H pylori to the stomach lining.

A Japanese study suggests that broccoli sprouts can reduce the presence of H pylori antigenin stool tests by 40%, indicating reduced presence of infection. The use of broccoli sprouts over mature heads is preferred because sprouts are higher in sulfurophane, an anti-bacterial compound believed to be behind the results. However, stool antigen returned to pre-treatments levels within 8 weeks.^[14]

From bismuth salts, to broccoli, most supplements reduce H pylori infection, inflammation, and ulcers only, but have not been proven in scientific studies as a reliable method for eradication. I.e. the infection returns after the supplement is stopped. Furthermore, many alternative therapies showed promising results in vitro (meaning in a test tube) but these results did not transfer over to in vivo (meaning in a live person) studies.^[15] Numerous website make wild claims about the effectiveness of alternative therapies based up these in vitro studies. Given the increasing resistance of H pylori to antibiotics, these alternative therapies may be helpful to quell infection long enough for an ulcer to heal. Additionally, these therapies may possibly be used in conjunction with antibiotics to improve eradication rates.

Additionally, avoid the following when you have an H pylori infection

Digestive Irritants	Avoid smoking, alcohol, caffeine and spicy foods because they are digestive irritants.
Stress	Avoid stress because it increases acid levels in the stomach.
Aromatic	Aromatic herbs are herbs that emit a strong aroma, such as mint. Aromatics destroy the stomach mucus lining - potentially exposing the stomach to further irritation.
NSAIDS	Use acetominophens instead as NSAIDS may increase risk of ulcers.
Sugary foods / fructose	Even though sweet taste is soothing to the stomach, sweet taste also feeds bacteria.

When attempting to eradicate or minimize presence of H pylori, the following may be useful. Consult your doctor to find out which therapies are best for you.

Anti-inflammatories	There are a number of anti-inflammatory herbs that also have one of more of the below properties.
Antimicrobial	Yes, antimicrobial herbs can help, especially those that can survive the low pH of the stomach.
Astringents	Yes, helps reduce inflammation.
Easy to Digest	Yes - especially when atrophic gastritis present
Antioxidants	Yes - helps reduce inflammation. Research shows vitamin C supplements are helpful.
Probiotics	Probiotics can compete with H pylori. Bifidobacteria is especially useful against gastritis.
Demulcent	Demulcents include slimy foods like oatmeal and okra. These can soothes the stomach and rebuild the mucosa. The additional mucus may allow h pylori to survive more easily. Suggestion: Mix demulcents with antimicrobials such as coconut oil & turmeric when taking.

An Ayurvedic diet consistent with the constitution of the client reduces stress on the digestive system and may improve the efficiency of herbs used, as well as efficacy of antibiotics. The client should follow all of the rules of maintain optimum digestive during the treatment.

Specific foods not mentioned with beneficial properties include:

Pomegranate Juice	Astringent, anti-inflammatory, improves digestion
Coconut Oil	Antimicrobial, soothes inflammation
Blueberry, strawberry, etc.	High antioxidant
Other cruciferous vegetables	Like broccoli, these contain sulfurophane.
Hibiscus	Astringent, anti-inflammatory
Cilantro	A cooling digestive useful for GI inflammation
Kale, Endive	A bitter vegetable which may cool inflammation
Aloe vera gel	Anti-inflammatory, anti-microbial
Honeydew, Cabbage Juice, Pear Juice	Cooling, soothing anti-inflammatories

Herb Formula for H Pylori

Note amalaki as the primary herb for anti-oxidant and anti-inflammatory effect. The dosage of antimicrobials in the formula should be sufficient to kill H pylori. We used several anti-microbials for broad spectrum action. Finally, we included herbs for soothing the stomach. No clinical trials have been done with this formula. For best results, please modify this formula according to the constitution of the client.

5	Amalaki	Anti-oxidant, anti-inflammatory
1	Shatavari	Anti-inflammatory, antimicrobial
1	Neem	Anti-inflammatory, antimicrobial
1	Vidanga	antimicrobial
1	Cinnamon	Anti-inflammatory, antimicrobial, digestive
1	Green Tea	Reduces adherence
1	Licorice Root	Soothes stomach
1	Avipattikar Churna	Digestive

Alternative Herbs:
To licorice root: Marshmallow Root 1 - Soothes stomach
To neem: Barberry 1 - Anti-inflammatory, antimicrobial

Take 1 tsp in warm water, aloe vera, and wedge of lime 3x/day. If Aloe vera irritates take with pomegranate juice & lime only.

Recipe for H Pylori

1lb	Broccoli
1 clove	Garlic
? tsp	Cinnamon
? tsp	Turmeric
1 Tbsp	Coconut Oil

Cover broccoli with water and bring to a boil. Reduce heat to a simmer and cover. Meanwhile, mix turmeric and cinnamon with several drops of water to form a paste. Sautee chopped garlic in coconut oil. Add spice paste and continue frying for 10 seconds. Deglaze pan with a cup of water from broccoli and pour into pot. Continue simmering until broccoli is soft. Serve with rice and a protein source.

Conclusion

In conclusion, H pylori is a common infection in humans that leads to ulcers, gastritis, and loss of stomach function. It has some possible benefits as well. Testing and treatment is generally not recommended unless symptoms are present. Treatment with antibiotics remains the most reliable method of H pylori eradication. However, due to increasing resistance, alternative therapies, proper diet, and lifestyle techniques can aid the eradication of this pathogen from the body. Take special care, before recommending any herb, that in vivo studies have confirmed effectiveness, rather than relying on in vitro studies only. Clients should consult their medical doctor before making any changes to their diet and lifestyle.

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[1] Pounder RE, Ng D (1995). "The prevalence of Helicobacter pylori infection in different countries". Aliment. Pharmacol. Ther. 9 (Suppl 2): 33 - 9. PMID 8547526

[2] Brown LM (2000). "Helicobacter pylori: epidemiology and routes of transmission" (PDF). Epidemiol Rev 22 (2): 283 - 97. doi:10.1093/oxfordjournals.epirev.a018040. PMID 11218379.

[3] Goodman KJ, O'rourke K, Day RS, Wang C, Nurgalieva Z, Phillips CV, Aragaki C, Campos A, de la Rosa JM (December 2005). "Dynamics of Helicobacter pylori infection in a US-Mexico cohort during the first two years of life". Int J Epidemiol 34 (6): 1348 - 55. doi:10.1093/ije/dyi152. PMID 16076858.

[4] Scientists discover how helicobacter survives gastric acid. Abi Berger (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1117475)

[5] The Role of Helicobacter pylori Outer Membrane Proteins in Adherence and Pathogenesis - Monica Oleastro 1 and Armelle M?nard 2,3,* -https://www.mdpi.com/2079-7737/2/3/1110

[6] Kusters JG, van Vliet AH, Kuipers EJ (July 2006). "Pathogenesis of Helicobacter pylori Infection". Clin Microbiol Rev 19 (3): 449 - 90. doi:10.1128/CMR.00054-05. PMC 1539101. PMID 16847081.

[7] "Helicobacter pylori: an invading microorganism? A review". FEMS Immunol. Med. Microbiol. 36 (3): 117 - 26. doi:10.1016/S0928-8244(03)00020-8. PMID 12738380.

[8] Leptin and Ghrelin in Relation to Helicobacter pylori Status in Adult Males. Jatin Roper, Fritz Francois, Peter L. Shue, Michelle S. Mourad, Zhiheng Pei, Asalia Z. Olivares de Perez, Guillermo I. Perez-Perez, Chi-Hong Tseng, and Martin J. Blaser. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2435636)

[9] Prior Helicobacter pylori infection ameliorates Salmonella typhimurium-induced colitis: mucosal crosstalk between stomach and distal intestine. Higgins PD1, Johnson LA, Luther J, Zhang M, Sauder KL, Blanco LP, Kao JY. (https://www.ncbi.nlm.nih.gov/pubmed/21560200)

[10] Wang KY, Li SN, Liu CS, Perng DS, Su YC, Wu DC, Jan CM, Lai CH, Wang TN, Wang WM (September 2004). "Effects of ingesting Lactobacillus- and Bifidobacterium-containing yogurt in subjects with colonized Helicobacter pylori" (PDF). The American Journal of Clinical Nutrition 80 (3): 737 - 41. PMID 15321816.

[11] Effects of high dose vitamin C treatment on Helicobacter pylori infection and total vitamin C concentration in gastric juice. Jarosz M1, Dzieniszewski J, Dabrowska-Ufniarz E, Wartanowicz M, Ziemlanski S, Reed PI. (https://www.ncbi.nlm.nih.gov/pubmed/9926292 )

[12] Nontraditional therapies to treat Helicobacter pylori infection. Morris O Makobongo, Jeremy J. Gilbreath, D. Scott Merrell (https://www.researchgate.net/publication/261221943_Nontraditional_therapies_to_treat_Helicobacter_pylori_infection )

[13] Mahady et al., 2005; Nanjundaiah et al., 2011; Haniadka et al., 2013

[14] Gutsy Germs Succumb to Baby Broccoli (https://www.hopkinsmedicine.org/news/media/releases/Gutsy_Germs_Succumb_to_Baby_Broccoli)

[15] Exploring alternative treatments for Helicobacter pylori infection. Guadalupe Ayala, Wendy Itzel Escobedo-Hinojosa, Carlos Felipe de la Cruz-Herrera, and Irma Romero (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3925854)