Episode 304: H. Pylori - What You Need to Know
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Erin was inspired to create this episode after sharing her recent stool test with clinically high levels of H. Pylori. She dives into the hotly debated topic within the industry: is H. Pylori an integral part of our health or is it something that needs to be completely eradicated? Learn the nuances behind how to test for H. Pylori, when we should treat it, and when it may be best left alone.
Are you a practitioner who is interested in learning the nitty-gritty of H. Pylori, stool tests & gut health? Apply to the Funk’tional Nutrition Academy. Applications for the spring cohort are now open!
In this episode:
What H. Pylori is and how it suppresses stomach acid [7:39]
The role H. Pylori plays in gastritis and ulcers [13:00]
Classic symptoms of stomach ulcers [16:01]
The connection between H. Pylori and other health issues [18:54]
Ways to test for H. Pylori [20:17]
Why treatment should never be solely based upon lab results [27:00]
Resources mentioned:
Funk’tional Nutrition Academy™
Qualia Mind (get $100 off and an extra 15% off your first purchase with code FUNK)
LMNT Electrolyte Replenishing powder (Use code FUNK get a free sample pack with any purchase!)
Ned Natural Remedies (get 15% off your order with code FUNK)
Organifi supplement powder (save 20% on your order with code FUNK)
Learn more about Gut Health & Functional Nutrition
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291: How to Support Your Gut While on Antibiotics
257: Leaky Gut, Microbiome, & Digestion | Legacy Series
255: Gallbladder, Bile, Gut Health, and Hormones | Legacy Series
88: All Things Gut: H. Pylori, GERD, SIBO, Candida, CBD & More
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Erin Holt [00:00:02]:
I'm Erin Holt, and this is the Funk'tional Nutrition Podcast, where we lean into intuitive, functional medicine. We look at how diet, our environment, our emotions, and our beliefs all affect our physical health. This podcast is your full bodied, well rounded resource. I've got over a decade of clinical experience, and because of that, I've got a major bone to pick with diet culture and the healthcare model. They're both failing so many of us. But functional medicine isn't the panacea that it's made out to be either. We've got some work to do, and that's why creating a new model is my life's work. I believe in the ripple effect.
Erin Holt [00:00:39]:
So I founded the Funk'tional Nutrition Academy, a school in mentorship for practitioners who want to do the same. This show is for you. If you're looking for new ways of thinking about your health and you're ready to be an active participant in your own healing, please keep in mind this podcast is created for educational purposes only and should never be used as a replacement for medical diagnosis or treatment. I would love for you to follow the show, rate, review and share because you never know whose life you might change. And of course, keep coming back for more. Hello, my friends. Today we're doing it. The H.
Erin Holt [00:01:16]:
Pylori episode. A few months back, sometime in the fall, I ran a GI Map stool test on myself. I typically do those about once a year just to keep eyes on my gut. And I had tested positive for H. Pylori and it was clinically relevant, so the levels were high and there was a virulence factor present. So I decided to treat, and I was sharing my GI Map results. After eight weeks of treatment, I retested and it was still present and the symptoms were still there. So I decided to retreat again.
Erin Holt [00:01:48]:
That's what I'm currently doing. So anyway, I was sharing these labs, and a lot of folks wanted to hear more about H. Pylori, so we're doing it. So perhaps you've had a GI map in the past and it has showed positive for H. Pylori. Let's talk through some of that. One thing that I want to note that feels relevant is that this is not the first time that I've seen H. Pylori on a stool test for myself.
Erin Holt [00:02:14]:
It's just that the levels have always been low, so I didn't want to act on it. There is a lot of debate over whether H. Pylori is more commensal, meaning it is a normal, natural part of our gut and we can expect to see it there or it's more pathogenic. And the reality is it's probably somewhere in between. But this is really widely debated. The biggest experts in the field don't even agree on this, and I'm going to put that forth. So you know that and you understand that because there's a lot of people that are going to tell you anytime you see H.
Erin Holt [00:02:53]:
Pylori, you need to treat it. And I want to tell you that I saw H. Pylori on myself and I decided not to treat it for kind of a while. I didn't see it as an urgent matter. It didn't really seem to be causing any overt problems. And it wasn't until I saw the clinically significant levels alongside the virulence factors, alongside more robust symptoms that I thought, okay, I'm going to do something about it now. I was watching Dr. Maya Shetreat's stories on Instagram the other day.
Erin Holt [00:03:23]:
She's been on the show before. I love her. And she said, we know some things and we don't know a lot. Now, mind you, she is MD. She's a medical doctor. She's a brilliant mind. And she said, we know some things and we don't know a lot. And this is, I'm going to do a little riff on this because it's something that I've been noticing how many people out there are calling themselves experts.
Erin Holt [00:03:46]:
I'm a hormone expert. I'm a gut expert. But the amount of research and experience and time, like years and years and years and years that it takes to build expert status is, I just think we're misusing that term. I've never really considered myself an expert in anything. And yet we have brand new practitioners who probably did, like, really good marketing courses or something that are coming out of the gate hot, being like, I'm an expert. And the more I think about this, I think what really makes somebody an expert is the ability to see all sides of something and almost to admit, like, there's so much I don't know. And in the world of gut health and really specifically the microbiome, there is so much we don't know. This field is in its infancy, and like I said, h.
Erin Holt [00:04:39]:
Pylori is hotly debated. And we just have to understand that we probably don't have all of the answers right now. So we just need to use clinical discernment and do our best. So this is something that we unpack more in depth in the Funk'tional Nutrition Academy. This podcast is really the intention behind this podcast is to create information and education for those who are looking to better their health. Now, of course, I have a lot of practitioners that listen to the show, and I'm so honored and grateful to have you here, but there's only so much that I can get into on the podcast. I can't teach you how to treat your clients and your patients through the podcast, and it's more of a responsibility thing than anything else because I want to make sure that I'm delivering information in a responsible way so people don't hear me. So today, for example, we'll talk about H.
Erin Holt [00:05:28]:
Pylori symptoms. What I don't want to happen is somebody listens to this, they self diagnose themselves with H. Pylori, they go out, they get a bunch of antimicrobials for H. Pylori, and they're taking oregano oil unnecessarily. There's, of course, so much context and nuance involved when we are thinking about how to address bacterial overgrowths in somebody. And it's my opinion that with a potential pathogen, we should be probably maybe working with a practitioner who understands all of the nuance and is able to look at your context. So, of course, that is more detail than I can provide in a 45 minutes, 60 minutes show. But when I have 14 months with you as a practitioner, we can really get into the nitty gritty of all of that, and so you can hone your clinical decision making.
Erin Holt [00:06:17]:
Today I will kind of talk about things to some considerations for, like, should we treat? Should we not treat? But again, this is more for the layperson who is perhaps working with a practitioner, saw their stool test say that they have H. Pylori, and then to kind of figure out, is this something that I should treat or not? But for practitioners, if you are using the GI map or you plan to use the GI map stool test in practice, you will see a lot of h. Pylori. Get ready for it. You're going to see a lot. It's very common, number one. But number two, the technology that the Gi Map stool test uses is going to pick up on a lot of H. Pylori, and then you have to decide, is this clinically relevant? Does this make sense for us to treat, given what we're seeing on the stool test, given the client's symptoms? I know, and I'm sensitive to the fact that our clients will often come to us looking for the one wrong thing to fix.
Erin Holt [00:07:14]:
And so it can feel really exciting to see H Pylori pop up because we're like, aha, here's the thing. Here's the one thing to fix, and maybe sometimes it works out that way. Treating H. Pylori can get people feeling really better. I mean, I've seen it countless, countless times. So I don't want to say we should never treat, but I also don't want to say we should always treat. So anyway, let's talk about H. Pylori, because this little bugger can absolutely cause a ruckus.
Erin Holt [00:07:39]:
So let's talk about how it can create problems within the body. H. Pylori is a bacteria, and it infects the stomach for the most part. So it comes into the stomach and it releases urease, and it does this so that it can survive. How cool is that? What a brilliant little critter. So it releases urease, which neutralizes gastric acid. So last week we talked all about acid reflux, and I do feel like I probably should have led with this, but go back and listen to last week's podcast before you listen to this one, because it was kind of a primer for today's episode. But the stomach is acidified with stomach acid.
Erin Holt [00:08:18]:
And part of the role of stomach acid is to neutralize pathogens. So it's one of our very first lines of defense, where if we're consuming bacteria, other pathogenic critters, once it hits the acidity of the stomach, it gets killed off. So H. Pylori is so smart in that it releases something which neutralizes that gastric acid, and then it gets to survive, it gets to live. It escapes the highly acidic environment of the stomach by actually shutting down parietal cell activity. Parietal cells are cells that help to produce HCl, stomach acid. So when we inhibit parietal cell activity, that leads to hypochloridria or low stomach acid. So this alone, low stomach acid, can cause its own set of problems and downstream side effects.
Erin Holt [00:09:15]:
We talked about some of the specific symptoms that you can see with low stomach acid last week. But when we suppress parietal cells, when we have low stomach acid, hypochlorhydria, we can also see iron malabsorption, we can see B12 malabsorption, we can see anemia, we can see other malnutrition, calcium malabsorption, that's going to lead to osteoporosis and fracture risk. Without enough stomach acid, we're going to have a hard time breaking down and digesting our proteins, which actually makes us not crave protein as much. So we can eat less protein because it feels like it just sits like a brick. So we lose our appetite for protein. It leads to low pancreatic enzymes. So then, because we need proper acidification of the stomach to trigger the release of enzymes that help to break down our food. So we might see more food sensitivities or just bloating, belching, just not feeling good when we eat, we need a proper ph to contract the gallbladder.
Erin Holt [00:10:12]:
So if the gallbladder is not contracting enough, if we're not releasing enough bile, we can see fat malabsorption, absorption symptoms. So this might just be like, oh, I eat fat and I don't feel well. Or it could be all the way downstream to I have chronically low vitamin D. So just the act of H. Pylori suppressing stomach acid can have a lot of big time effects in the body.
Erin Holt [00:13:00]:
The bacteria itself has strong binding capacity, so it has adhesion proteins, and it basically, like furrows in and binds to the gastric epithelium. And then once it's there, it reproduces. And so when they reproduce and replicate, they can then repopulate the stomach. So kind of like hard to get rid of it once it starts replicating. The bacteria also produce exotoxins, and these exotoxins can damage the gastric mucosa. So all of this is creating a local inflammatory response right in the stomach. And that can lead to gastritis, that can lead to gastric ulcers, and it can also go beyond the stomach and create a systemic inflammatory response. So we talked about gastritis last week. H. Pylori is the most common cause of gastritis.
Erin Holt [00:13:54]:
Gastritis is basically just the term for inflammation of the lining of the stomach. The symptoms associated with gastritis are stomach pain, burning, aching, the constantly having to use antacids. And they do provide temporary relief, like you're popping tums and it makes you feel better short term. Feeling hungry an hour or two after eating, heartburn. All of those reflux symptoms that we talked about last week, constant sense of feeling full or nausea, or having bitter taste in the mouth, belching. Again, a lot of the symptoms that are consistent with acid reflux. So h. Pylori is the most common cause of gastritis.
Erin Holt [00:14:35]:
But we can't just blame H. Pylori. Alcohol abuse is a big one. Autoimmune gastritis, bile reflux, we talked about that last week, medications, NSAIDs and corticosteroids. So if you pop advils often, that can absolutely cause gastritis. Aspirin is another one. Doesn't mean you can never take these things, but they absolutely do impact the lining of the stomach. But truly, above and beyond all of those, H.
Erin Holt [00:15:00]:
Pylori is the primary driver of gastritis. And same for ulcers. Ulcers are similar, but not exactly the same. So again, gastritis is inflammation of the stomach lining, whereas ulcers are more like open sores in the lining of the stomach. So you think about what an ulcer is like on your skin. It's the same thing, but it's happening inside. So if you just think about it, it sounds pretty painful. You can see why it would cause some symptoms.
Erin Holt [00:15:27]:
It's like an abrasion of the GI mucosa. It's mucosal membrane that just won't heal. It's like an open sore, an open wound. They can get pretty deep and pretty wide through the mucosa, and there's different regions that they can happen. They can happen in the stomach lining that's often referred to as a gastric ulcer. It can happen in the duodenum, which is the first part of your small intestine. That's called a duodenal ulcer, but the kind of catch all term is peptic ulcer, which is what is most commonly used. And that basically refers to an ulcer anywhere in the stomach, the lower esophagus, or the small intestine.
Erin Holt [00:16:01]:
Now, symptoms of ulcers are, it's a little tricky because not everybody is symptomatic. So some people can have peptic ulcers and not have any symptoms, but here are the classic symptoms. And the symptoms can kind of differ depending on where the ulcer is. So gastric ulcers in the stomach, you are more likely to have pain when you eat. So the first couple of hours or right after eating, you might feel pressure, a gnawing kind of pain, or a severe sharp pain. Whereas with duodenal ulcers, the pain happens when the stomach is empty. So it's more like two to 4 hours after you eat. So you might wake up at night with stomach pain or upper gi pain.
Erin Holt [00:16:43]:
Again, it's that gnawing pressure, kind of burning, sharp pain, and it can oftentimes feel better when you're eating food. So again, not everybody with ulcers has these symptoms, but those are the more classic symptoms. And if you are experiencing any of those, getting checked for H. Pylori is a really smart move, because if H. Pylori is causing these things, you will have to treat the H. Pylori in order to heal it up. And that's why I started last week talking about all the other contributing factors to reflux, because some of these symptoms can overlap with reflux. And we want to make sure that we're not blaming a bacteria for what a bacteria isn't doing.
Erin Holt [00:17:25]:
But there are certain times where you absolutely want to make sure that H. Pylori isn't at play, because H. Pylori is found in 90% of duodenal ulcers and up to 80% of gastric ulcers. And kind of same deal as what I was talking about before. NSAID use can contribute to ulcers. Those NSAIDs irritate and they damage the lining of your stomach and your intestinal lining. So just kind of keep that in mind. But H.
Erin Holt [00:17:49]:
Pylori is the number one cause of ulcers. So those are some of the more obvious signs that H. Pylori is at play. But H. Pylori can also be asymptomatic in quite a lot of people. Only about 15% of those with H. Pylori infected with H. Pylori go on to have peptic ulcers and around one to 3% go on to develop gastric cancer.
Erin Holt [00:18:15]:
So this is why we want to take H. Pylori seriously, especially if there's any red flag presentation. It's a small percent of overall H. Pylori infections, but it's something to definitely be aware of. So red flags would be losing weight without trying, not feeling hungry, nausea and vomiting, anemia, black stool, feeling very tired, chronic coughing. Those are things that if you know you have H. Pylori and you have these symptoms, absolutely, that's something you need to go to your doctor about. And obviously, that is the worst case scenario.
Erin Holt [00:18:54]:
But even in non worst case scenarios, H. Pylori can wreak some havoc. It's associated with some non cancerous diseases like asthma, Parkinson's and diabetes. It just activates the immune system. It's a key factor in overall pathogen load, and so it can activate the immune system in a way that we don't want the immune system activated. And, of course, there's so much more that goes alongside of that, like, are you eating well? Are you sleeping well? Do you go outside? Do you move your body? Are you hydrated? All of these things influence our immune health, but if we are not really taking care of our body, plus we have a high pathogen load, that creates a recipe for disease, and that's just how our bodies work. Other things that H. Pylori can do, it can damage the vascular endothelium.
Erin Holt [00:19:43]:
So this is why H. Pylori is associated with cardiovascular risk. It's involved in atherosclerosis development. Remember how I said the bacteria can furrow into the gastric lining? It can also do this with vascular endothelium, and it can damage it just the same way. That it can do it in the stomach, and that is what can create atherosclerosis and plaque. Okay, that was a whole mouthful to say. It can also be involved in autoimmunity with molecular mimicry at play. H.
Erin Holt [00:20:17]:
Pylori is associated with certain autoimmune diseases, including autoimmune liver disease, lupus, type one diabetes, rheumatoid arthritis, Sodrin's, hashis, psoriasis, Crohn's disease, colitis, and more. So if we're seeing H. Pylori in clinically relevant numbers and we know that there's history of autoimmunity, I would probably be more likely to treat in that scenario. But let's talk about how you can actually know if you've got H. Pylori. There are different ways to test conventionally, so if you went to your doctor or a GI specialist, this is what they would do. There's a urea breath test. So you drink a glucose solution, and it's very reliable for an active infection.
Erin Holt [00:21:03]:
It's non invasive. It's just you drink the glucose solution, and they measure urea in the breath. There's also a stool antigen, so a stool test that is also reliable for active infection. Now, I will say that if you're taking PPIs, if you're taking any type of bismuth, so that would be pepto Bismol or any other bismuth supplements. If you're taking antibiotics, you're more likely to have false positives if you take the test while taking these. So you can wait four weeks, get off of these things, wait four weeks before testing, you can still get a positive on those things, but that's just something to be mindful of. And then there's also an endoscopy, so they take a biopsy, which is obviously very invasive. It is more reliable if there's actually destruction of the mucosa with that active infection.
Erin Holt [00:22:01]:
And then there's an antibody blood test, which is very non invasive. It's just a quick blood test, but it doesn't indicate if the infection is active, because those antibodies can be present and positive for years after an active infection, and that is more from the conventional side of things. And then, as I noted, you can also get a comprehensive stool test, which is what we run in functional medicine. I will talk about the GI Map, since I already opened that loop at the start of the show. Gi Map uses quantitative PCR, which is totally different than the other ways of testing that I just described. Completely, completely different. And because it's PCR, it can pick up on very low levels of h pylori that are not clinically relevant. So this is where I want practitioners to tune in.
Erin Holt [00:22:49]:
If you are a practitioner running a GI Map and you are treating every single scrap of h pylori that you see, you might be overtreating. And then for my non practitioners who are listening, just understand that if you are working with a practitioner and you do run a GI Map and you see scraps of H pylori, that doesn't necessarily mean it's the one thing that's causing all of your problems and it absolutely should be eradicated. Maybe in some cases it should be. But just understand that GI Map is going to pick up on a lot of H pylori, and that's where the skill set of the provider comes into play. And this is why I always say it's not just about the test, it's about the interpretation of the test. I am not an advocate for people to just get stool tests by their onesies like you really need to know what data you're looking at and then what to do with that data. And that's where I think a skilled practitioner can come in really handy. By the way, I've got skilled practitioners.
Erin Holt [00:23:47]:
If you need this help, I offer this. This is something that we actually offer in our clinic, so reach out to us if you need help with this sort of thing. I like to consider ourselves pretty good at what we do, so that is on the table as an option for you.
Erin Holt [00:26:49]:
But in some situations we do treat, and then in some situations we leave it alone. Like I said, for myself, I left mine alone for a while. It just didn't make sense to treat it given the context.
Erin Holt [00:27:00]:
But whoever you're working with, your practitioner should never be treating you based on the lab data only. You hear me? They should never be treating you based on the lab data only. They need to be treating you based on the context. How are you feeling? How are you presenting? What else is going on with the other lab markers? What's going on with the other data that we have? So when we're looking at a GI Map, some other things that we want to see. One are the virulence factors. Are there any virulence factors present? I usually take that pretty seriously, so I tend to want to go in with treatment if there are virulence factors present. The other one is what are the symptoms? If there's upper GI symptoms, symptoms of ulcer, symptoms of gastritis, those are things you would probably want to consider treating. Like I said earlier, history of autoimmunity, that's a situation where I would be more likely to treat.
Erin Holt [00:28:08]:
We're also looking at downstream effects. Is there low elastase on the GI map, is there symptoms of low stomach acid? Is there a lot of other overgrowths on the GI map? Iron malabsorption, remember, is a big one with low stomach acid. So they might be low in iron, they might be low in B twelve. They might have anemia, there might be malnutrition and associated symptoms with malnutrition, things like hair loss. So we're looking at the overall picture, and then if they have their own history of H. Pylori, if they're like, I've treated it, it comes back, I treat it, it comes back. That might be something to consider. Or recurrent peptic ulcers, especially duodenal ulcers.
Erin Holt [00:28:47]:
If they have a history of that, that's probably something to treat. If they have a high family risk of gastric adenocarcinoma, that would be a situation where you'd probably want to consider treating and in terms of treatment. So like I said earlier, I can't tell you exactly what to do. That would make me feel a bit irresponsible. However, I can share that it is relatively simple to eradicate with herbals. So the conventional approach is a triple antibiotic therapy. And that's like pretty severe. That is a pretty harsh thing.
Erin Holt [00:29:19]:
It will work. It's not that it doesn't work, but man, you're taking a lot of antibiotics. But the nice thing about H. Pylori is there are a lot of herbs that have anti H. Pylori activity, and it really does respond well to certain herbs. Barberry is one of them. Oregano is another goldenseal, Oregon grape, chinese gold thread, yerba mansa. All of those have anti H.
Erin Holt [00:29:45]:
Pylori activity and so they can be effective at clearing H. Pylori. But something you really, really want to understand if there is ulcers or gastritis present, sometimes just going in hardcore with antimicrobial herbs can cause a lot of pain and discomfort. So we don't necessarily want to just use the herbs right away. I think I talked about this last week, laying down the slippery, silky blanket that is the stomach lining. We want to help the gastric mucosa heal. So if it's inflamed, if there's an open wound in there, we want to really support that and make sure we're bringing down the inflammation before we start to kill off the H. Pylori.
Erin Holt [00:30:32]:
Sometimes we do it simultaneously. Again, this is more the skill set of the practitioner and kind of understanding how to do this dance of treatment. But one thing you can do is an apple cider vinegar challenge test. And so you can take two tablespoons of apple cider vinegar. And if you have burning with that, that can be a good indication that you want to spend time healing the gastric lining for a month or up to two months before you go in and treat H pylori. We eventually need to get you to a point where you can tolerate acidity because we need that acidic ph to avoid reinfection. Right. So we want to acidify the stomach, but that can be problematic if gastritis is present.
Erin Holt [00:31:22]:
So we have to kind of figure out which one comes first. And we might need to spend time healing the gastritis. There are certain things that are really helpful at healing the lining of the gut. DGL is a big one. Mastic gum, glutamine, bismuth. Cabbage juice can be really helpful. So if you have a juicer, you can actually juice cabbage, and that can be super helpful for the lining of the gut, the lining of the stomach more specifically, and healing ulcers. So those are all things that you can talk to your practitioner about.
Erin Holt [00:31:55]:
And like I said, if you need help with any of this, reach out to us. And for my practitioners listening, we are about to open up enrollment for FNA. So get your applications in. I would love to have you. All right, my friends, that's it for today. I will catch you next week. Thanks for joining me for this episode of the Funk'tional Nutrition podcast. If you got something from today's show, don't forget to subscribe, leave a review, share with a friend, and keep coming back for more.
Erin Holt [00:32:26]:
Take care of you.
