You have a client with terrible digestive issues who doesn’t tolerate even the tiniest bit of hydrochloric acid (HCl), even after changing their diet and soothing their upper gastrointestinal tract with healing nutrients. Then there’s the client who’s been on proton pump inhibitors for years, but is still just as symptomatic as when their doctor first prescribed them. Or the client whose upper gastric symptoms are intractable, no matter how many upper GI healing agents you try.
With any of these scenarios, there’s a common bacteria in the stomach that may be to blame: Helicobacter Pylori, or H. Pylori for short. H. Pylori is a bacterium that lives in everyone’s stomach. While it’s a normal and natural part of the stomach environment, when it proliferates it can cause a whole host of symptoms and further problems: from something as mild as low-grade heartburn or nausea to much more serious issues such as gastric ulcers and even cancer.
H. Pylori thrives in an alkaline environment and damages the acid-producing parietal cells that line the stomach, essentially creating a cozy little home for itself. When the cells that secrete hydrochloric acid aren’t able to produce the required acid, the Is pH in the stomach increases and H. Pylori can proliferate further.
Pylori can be very challenging to deal with as a clinician for several reasons:
- Approximately 85% of H. Pylori infections are silent and asymptomatic. As such they can be easily missed and cause significant downstream issues due to low stomach acid, such as increased susceptibility to food sensitivities, dysbiosis, SIBO, parasitic infections, challenges with digesting and absorbing protein, B vitamins and all minerals, and an overall reduction of digestive function overall.
- H. Pylori is notoriously difficult to accurately test for and many tests yield false negatives. In our experience, the most accurate and most sensitive test for H. Pylori is qPCR testing (quantitative real-time polymerase chain reaction) which is a form of DNA analysis considered one of the most powerful and sensitive gene analysis techniques available.
- H. Pylori has very high recurrence rates, regardless of whether it is treated medically or addressed using natural, herbal eradication agents.
- The medical model for addressing H. Pylori is to eradicate the bacteria with an antibiotic while easing symptoms by using a proton-pump inhibitor or acid-blocking medication. The challenge with this approach is that because H. Pylori thrives in a low-acid environment, the PPI or acid-blocking medication may soothe symptoms but is only creating an environment even more conducive for the H. Pylori to proliferate once again
How do you know if your client has H. Pylori as part of their clinical picture? The types of symptoms associated with an H. Pylori overgrowth are similar to those associated with acute gastritis such as stomach pain, acid reflux, nausea, belching, and sometimes throat pain. But we can’t rely on symptoms alone since so many H. Pylori infections are asymptomatic.
If you’ve struggled to support your clients with H. Pylori and are looking to identify and resolve this issue once and for all, here are the essential factors to consider as a nutrition professional:
- Test, don’t guess, using an assessment with high sensitivity for detecting H. Pylori. You simply can’t rely on symptom presentation alone when it comes to identifying an H. Pylori infection.
- Address the terrain in addition to the pathogen. This is the piece so many clinicians – both medical and holistic – don’t address. Remember how overgrowth occurs in the first place: H. Pylori is a normal and natural part of the stomach environment. What creates the opportunity for it to proliferate in the first place? Low stomach acidity. This needs to be addressed both during the protocol and maintained afterward in order to prevent recurrence.
- Address the downstream impacts. Because of H. Pylori’s impact on the stomach’s ability to secrete HCl, we need to consider, assess, and then address any downstream impacts of hypochlorhydria beyond simply re-establishing the stomach’s ability to secrete sufficient HCl. What impact has this had on other aspects of digestive function such as enzyme production and bile flow? What impacts has this had on the balance of the microbiome overall? Have any food sensitivities been created as a downstream result? Have any pathogens, such as parasites, taken up residence in the gut as a result and need to be eradicated as well? It’s not enough to eradicate H. Pylori and assume the problem has been dealt with. We need to assess the whole picture and address any digestive imbalances that have arisen as a result.
One of the reasons why the clinical approach we teach at the Institute of Restorative Health is so effective is that we are very thorough and comprehensive with our healing protocols. We are always guided by a combination of client symptom presentation, objective test results, and highly customized protocols that are comprehensive enough to achieve real and lasting healing.
If you’d like to learn how to use these powerful tools in your practice, we will soon be accepting applications for our upcoming Level 1 program, Mastering the Art and Science of Gastrointestinal Healing, which starts in April 2021. Curious how IRH could work for you? Schedule a free call with our Admissions counselor here.
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FAQ
These frequently asked questions expand on the key clinical concepts in this article and provide additional context for practitioners supporting clients with suspected H. pylori overgrowth.
What is Helicobacter pylori (H. pylori) and why is it clinically important?
H. pylori is a bacterium that naturally exists in the stomach but can become problematic when it proliferates. According to this article, overgrowth may contribute to symptoms ranging from mild heartburn and nausea to gastric ulcers and even cancer, making it an important consideration in digestive health.
When should practitioners suspect H. pylori as part of a client’s clinical picture?
Practitioners should consider H. pylori when upper gastrointestinal symptoms persist despite appropriate interventions or when clients have a history suggesting impaired stomach acid production. The article highlights clients who cannot tolerate hydrochloric acid, remain symptomatic despite proton pump inhibitors, or fail to improve with upper GI healing protocols.
Can H. pylori be present without causing symptoms?
Yes. Approximately 85% of H. pylori infections are described as silent and asymptomatic in this article. Because symptoms are often absent, practitioners should avoid relying solely on symptom presentation when determining whether H. pylori may be involved.
What symptoms are commonly associated with H. pylori overgrowth?
Common symptoms resemble acute gastritis. These may include:
- Stomach pain
- Acid reflux
- Nausea
- Belching
- Throat pain
The article also emphasizes that these symptoms are not specific enough to confirm H. pylori because many infections are asymptomatic.
How does H. pylori affect stomach acid production?
According to the article, H. pylori damages the stomach’s acid-producing parietal cells. As hydrochloric acid production decreases, stomach pH rises, creating an environment that allows H. pylori to proliferate further.
Why can low stomach acid contribute to recurrent H. pylori overgrowth?
The article explains that H. pylori thrives in a low-acid, more alkaline stomach environment. If stomach acidity is not restored after eradication, the conditions that allowed the bacteria to overgrow may persist, increasing the likelihood of recurrence.
Why isn’t symptom presentation alone enough to diagnose H. pylori?
Symptoms alone are not sufficient because most H. pylori infections are asymptomatic. The article recommends testing rather than guessing to improve clinical accuracy.
What testing approach does the article recommend for detecting H. pylori?
The article recommends using a highly sensitive assessment and identifies qPCR (quantitative real-time polymerase chain reaction) testing as the most accurate and sensitive option based on the authors’ clinical experience. It also notes that many other testing methods may produce false-negative results.
What downstream digestive problems can result from H. pylori-associated low stomach acid?
The article describes multiple downstream consequences of hypochlorhydria that practitioners should evaluate, including:
- Food sensitivities
- Dysbiosis
- Small intestinal bacterial overgrowth (SIBO)
- Parasitic infections
- Reduced protein digestion
- Poor absorption of B vitamins and minerals
- Overall reduced digestive function
Why is addressing the digestive terrain important when supporting clients with H. pylori?
The article argues that treating the bacteria alone is often insufficient. Practitioners should also address the low-acid environment that allowed overgrowth to occur in the first place to help reduce the risk of recurrence.
What should practitioners evaluate after addressing H. pylori?
Practitioners should assess the broader effects of impaired stomach acid rather than assuming the problem has been resolved. The article recommends evaluating digestive enzyme production, bile flow, microbiome balance, food sensitivities, and the possible presence of additional pathogens that may require attention.
Why can H. pylori be difficult to manage successfully?
The article identifies several reasons H. pylori can be challenging to manage. These include its high rate of asymptomatic infection, the potential for false-negative test results, and its tendency to recur even after medical or herbal eradication strategies.
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ABOUT THE AUTHOR
Margaret Floyd Barry, FNTP MRHP is owner and Executive Director of the Institute of Restorative Health. She’s a functional nutritionist, author, speaker, educator, and real food advocate. Through years of experience working with the most complex client cases, including reversing her own autoimmune condition, Margaret uses a powerful system for restoring health by addressing the root cause of illness.
Today, Margaret teaches fellow practitioners the same proven system she uses to get her clients life-changing results through the Institute of Restorative Health – a two-year comprehensive functional nutrition certification program for qualified health professionals. Margaret also runs Restorative Corporate Wellness, a team of Restorative Health Practitioners facilitating health transformations with corporate clients. She is the author of Eat Naked and its follow-up cookbook The Naked Foods Cookbook. She’s also the host of the Clinician’s Corner podcast, where she interviews some of the world’s top experts in the fields of functional health and nutrition.
